Asian health center tries unconventional approach to counseling

In her first months as a community health worker, Jee Hyo Kim helped survivors of violent crime access support services and resources. When a client with post-traumatic stress disorder sought a therapist, she matched him with a therapist who met his needs. She helped customers who were afraid to leave their homes get food delivery vouchers. As one client described her, Kim was a “connector.”

Then Kim learned to move on. Through a training program, she has acquired the knowledge and confidence to provide emotional support. She learned evidence-based mental health skills, such as asking open-ended questions. She also discovered that some of the things she was already doing, such as listening attentively and repeating what she hears, are at the heart of communicating empathy – an essential part of a successful relationship between a client and his or her mental health provider.

“It was really refreshing to see that it has a name and to realize that these are skills,” she said.

Asian Health Services, where Kim works, is part of a young movement trying to address a dire shortage of therapists by training community health workers and other unlicensed professionals who have a trusted relationship with their community to provide mental health services to their add tasks. This approach, which has already been implemented abroad and has been proven to help address some common mental health conditions, is called lay therapy.

The Oakland, California-based community health center primarily serves low-income Asian immigrants who speak limited English. As a community health worker, Kim now also practices lay therapy under the supervision of a licensed therapist. She is unlicensed, but as a Korean immigrant and strong-arm robbery survivor, she shares lived experiences with many of the people she serves, helping her build trust.

Research shows that Asian Americans see mental health providers at a lower rate than people of other races, and up to half of some subgroups report difficulty accessing mental health care. These types of numbers may be just the tip of the iceberg, as Asian Americans may even be reluctant to seek help.

Cultural stigma against mental illness and the feeling that your problems pale in comparison to the trauma faced by previous generations are among the reasons, says Connie Tan, senior research analyst at AAPI Data, a think tank.

Asian Health Services introduced lay counseling during the COVID-19 pandemic. Violence against Asian Americans increased and there was a shortage of therapists fluent in any of the fourteen languages ​​spoken by the communities served by the health center. Six percent of people in the US identify as Asian, Native Hawaiian or Pacific Islander, but these groups represent only 3% of psychologists.

Concerned that people would fall through the cracks, the health center launched an initiative in 2021 to support victims of violence. In addition to lay counseling and therapy from licensed providers, available in several languages, the program, known as the Community Healing Unit, offers services such as helping clients access funds for crime victims.

The program has sent 43 community health workers, case managers and other employees to a lay mentoring training program, said Ben Wang, director of special initiatives at the health center. Interns learn through formal instruction, observing teachers provide guidance and practicing guidance with each other, along with feedback from instructors.

Thu Nguyen, a survivor of domestic violence, struggled with fear and self-blame. “My inside talk is eating me up,” she explained. She worried that sharing with family members would be a burden on them and didn’t know where else to turn for support after meeting a therapist she didn’t click with. Through the program, Nguyen was assigned to Kim, who connected her to a compatible therapist.

Nguyen also leaned on Kim for emotional support. When she confessed to feeling guilty and inadequate as a single mother, Kim responded without judgment and affirmed Nguyen’s commitment.

“She confirms my feelings,” said Nguyen, a Vietnamese immigrant. “She would say, ‘I understand it’s hard. You’re doing your best.'”

Asian Americans may have difficulty finding therapists who understand their culture, speak their language, or come from similar communities. Licensed therapists typically must obtain an advanced degree, pass professional exams and work under supervision for at least two years. Requirements vary by state and by type of license. It has long been assumed that this process guarantees high-quality care.

Proponents of lay therapy argue that this path is costly and time-consuming, limiting diversity in the field and exacerbating the therapist shortage. They also point to favorable research. Lay counseling has been implemented in several countries, where mounting evidence has shown that it can improve symptoms of depression, anxiety and a few other mental health conditions.

‘The idea that someone without a permit wouldn’t be able to do that [communicate empathy] skilled is ridiculous,” says Elizabeth Morrison, a psychologist and co-founder of the Lay Counselor Academy, which has trained 420 people, including Kim, to add lay counseling to their roles since launching two years ago. Interns come from a variety of careers, including faith leaders and first responders.

The 65-hour, mostly virtual course teaches topics such as supporting people who have experienced trauma, counseling methods such as cognitive behavioral therapy and motivational interviewing, first-line strategies for treating depression and anxiety, and boundary setting. The course does not teach how to diagnose mental illness. Instead, students learn to emphasize their strengths, acknowledge feelings, avoid advice, and otherwise listen empathetically.

Asian Health Services staff members who provide lay counseling will receive ongoing support and guidance from a program manager and a licensed therapist after training, Wang said.

Raquel Halfond, a senior director at the American Psychological Association, said she believes it is important that lay counselors receive training and practice under the supervision of a licensed mental health professional, but the group has no formal model or standards for using laymen. advisors.

The course not only builds skills, but also recognizes what many students are already doing or have learned, which may not be recognized as counseling. “It’s like this invisible, unpaid work, and people take it as someone being nice,” Morrison said.

Lay advice is still in its infancy, and it often takes years for a new field to become established – and for insurers to join in. Morrison and Laura Bond, a researcher at Harvard Medical School’s Mental Health For All Lab, another lay counseling training initiative, said they are not aware of any organizations that can bill public or private insurers for lay counseling.

In an email, Leah Myers, a spokesperson for the California Department of Health Care Services, which oversees Medi-Cal, the state’s Medicaid program, acknowledged that there is no billing code for lay counsel or certification for lay counselors. She said Medi-Cal reimburses certain unlicensed providers for services that “may include activities that could be considered ‘lay counseling’ type activities,” but would require more detail to reach a determination.

The largest grant from the state of California’s Community Healing Unit to support hate crime victims expires in 2026. The program has helped more than 300 people and is developing a survey to gather feedback, Wang said.

Nguyen knew Kim wasn’t a licensed therapist, but she didn’t care, she said; she appreciated that Kim, a fellow Asian woman, made her feel safe to process her feelings. Kim was also easily accessible through bi-weekly check-ins and responded quickly when Nguyen called at other times.

Now, Nguyen said, it’s easier to tell himself, “You’re doing a good job.”

KFF Health News 2024. Distributed by Tribune Content Agency, LLC.