The publication of the University of Miami Department of Psychiatry and Behavioral Sciences
Special Issue:
Spring | Summer 2022
Diversity, Equity and Inclusion in Mental Health
Diversity, Inclusion, and Community Engagement The Miller School of Medicine is committed to fostering diversity. Diversity enriches the medical environment by building mutual respect and teamwork to prepare students, faculty members and staff for citizenship in an increasingly complex society. It strengthens the environment by providing opportunities for communication between people of varied backgrounds, promoting personal growth and a healthier community by encouraging critical thinking and challenging preconceptions. Furthermore, as a diverse community, the school is better prepared to face the challenges of the future, in advancing medical knowledge with research, and in dealing with the clinical needs of our society.
A Message from the Chair
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ear Friends, I am pleased to share with you this special edition of BrainStorms highlighting diversity, equity, and inclusion initiatives in the Department of Psychiatry and Behavioral Sciences and at the Miller School of Medicine. In conjunction with initiatives set forth by Dr. Henri Ford, Dean and Chief Academic Officer of the Miller School of Medicine, we have prioritized activities related to access and opportunity for underrepresented minorities, both within and outside the Department.
Historically, segments of this population have encountered barriers to both pursuing medical education and careers, and/or receiving quality health care. As leaders in the field, it is our responsibility to act, improve, and increase access for those who need it most, including: underrepresented minorities, members of the LGBTQ+ community, and gender non-conforming individuals. In 2020, the Miller School established a Task Force on Racial Justice in response to the political and racial climate that has permeated the country and our medical school. Following suit to narrow focus to the mental health field, we established the Diversity and Inclusion Committee, one of the first Departments to do so in the Medical School. Comprised of junior and senior faculty, residents, and staff, the Committee meets regularly to discuss current events; review works published on diversity in medicine and how it impacts mental health; and propose actions to improve equity and access for all to Department and University resources and opportunities. We are developing and supporting strategies to attract residents and medical students of varying backgrounds to the Department and MSOM by including more diverse membership on admissions committees, increasing diversity in our faculty, and collecting data to glean insight to the everyday experiences of our Department members to spark conversation on priority areas where we can improve. Additionally, we are focused on new measures to recruit, retain and support underrepresented faculty and ensure they are armed with tools to succeed. Several of our research projects involving underrepresented minorities are full steam ahead. Our investigators are taking a boots-on-the-ground approach to recruiting and educating members of the community to participate in clinical trials. Led by Dr. Girardin Jean-Louis, Director of the Center for Translational Sleep and Circadian Sciences, their grassroots activities include visiting neighborhoods in and around Miami, speaking with local small business owners, and disseminating information about the value of taking part in scientific research. Investing time and resources in these
communities is critical to our mission of building trust and long-lasting relationships, particularly with those who will be driving the field of mental health forward in the future (p.6). The Registry for Older African American Adults at Risk for Alzheimer's disease (ROAAR) study, led by
Dr. Elizabeth Crocco, Professor and Medical Director of the Memory Disorders Clinic, is well on its way to recruiting the 120 African American volunteers to build an advanced registry of those at risk for Alzheimer’s disease and related disorders using state-of-the-art and culturally relevant novel cognitive tests (p.5). The Media and Innovation Lab (MIL), directed by Dr. Azizi Seixas, recently announced the groundbreaking MILBox study. Supported by Amazon Web Services among other innovative health-technology companies, the study aims to bridge the digital health divide among underserved populations by applying powerful new technology in personalized and precision medicine (p.2). We are privileged to practice medicine and conduct research in one of the most culturally rich regions in the country. Creating a modern workforce reflective of the vibrant population here in Miami unites us and makes us better clinicians, researchers, physician-scientists, colleagues, and mentors. While there will always be areas we can improve, I am proud of our Department members for embracing these new initiatives and contributing time and ideas so we may all continue working toward our shared goal of equal and equitable health care for all. Regardless of what communities with whom you identify, we are one family. One U. Respectfully,
Barbara
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Digital Twins Groundbreaking study supported by Amazon Web Services and Open Health Network uses data from wearables and in-home sensors to create “digital twins.”
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niversity of Miami Miller School of Medicine researchers announced a research project designed to create an individual’s “digital twin” using health and environmental data collected from in-home and on-body sensors. Once created, healthcare practitioners could apply artificial intelligence (AI) to an individual’s digital twin to virtually test and evaluate various treatment options and potential outcomes before applying them in the physical world. Stemming from the Media and Innovation Lab (The MIL) recently launched at the Miller School, and in conjunction with Amazon Web Services (AWS) and Open Health Network, the MILBox project represents a major step toward a new paradigm in health and wellness to deliver precise, personalized medicine based on data collected directly from an individual and their local environment. Azizi Seixas, Ph.D.,Founding Director of the Media and Innovation Lab (The MIL), and Associate Director for the Center for Translational Sleep and Circadian Sciences at the Miller School of Medicine, and one of the nation’s leading experts on sleep health, is partnering with Girardin Jean-Louis, Ph.D., Director of the Center for Translational Sleep and Circadian Sciences and Professor of Psychiatry and Behavioral Sciences, on the project. Starting with Sleep The first phase of the project, based on Dr. Seixas’ earlier research funded by the National Institutes of Health (NIH), will study the link between poor sleep including conditions such as sleep apnea, and serious health disorders, including heart disease and dementia. The project will use patient-worn and home-based sensors and test kits to gather biological, clinical, behavioral and environmental data to assess sleep patterns, weight, air quality and stress levels. The MILBox contains a host of devices to capture and catalog these data, such as an ambulatory blood pressure monitor, an actigraph to measure sleep and wake cycles, a smart scale, an air
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quality device, and a mobile phone to securely transmit data to the cloud. “We want to demonstrate that this kind of individualized data capture can spur a new line of research and personalization in healthcare,” said Dr. Seixas. “With the capacity to discover everything we can about the individual, we can change the relationship between people and their health.” Data through the MILBox project will be securely managed and analyzed using cloud-based technology, such as machine learning (ML), powered by AWS. Subject matter experts at The MIL and AWS will develop a cloud-based platform for remote patient monitoring that includes a healthcare data lake integrated with an Electronic Health Records (EHR) system to power personalized care.
“We are excited to collaborate with The MIL and healthcare innovators at the University of Miami Miller School of Medicine to build a medical innovation ecosystem focusing on academic medicine, including medical education, clinical care, research, and community outreach,” said Andreia Pierce, Ph.D., M.B.A., head of AWS Research. “AWS will support the development of technology infrastructure, training workshops and other activities that can help improve health outcomes.” Participants in the research program will receive a single kit, the MILBox, containing all the necessary sensors and devices required to measure and transmit their health and environmental data, including a mobile phone that will serve to tether all the devices and transmit data to the cloud. The project, which enrolled its first participants late last year, is seeking to include a diverse group of 1,500 participants in its first phase, with an emphasis on traditionally underserved communities or communities of color in Florida and the New York tri-state area. Creating a Digital Twin The sensors will gather longitudinal data over seven consecutive days for each participant. The results of those measurements will then be combined to create a “biological health algorithm” unique to that individual. This algorithm will act as a “digital twin” of the individual, allowing researchers to employ AI and other techniques to determine the connection between poor sleep and other health conditions. Eventually, such “digital twins” could comprise sufficient detail about an individual so that a computer could test different treatment or wellness options against that model to predict which are most likely to produce the best outcomes for that person. Instead of prescribing treatments based on a statistical model of outcomes across a large population, this new approach would provide each patient with a personalized recommendation calculated to produce the best outcome.
The work of managing, processing, and protecting the privacy of so much data relies on the PatientSphere 2.0 technology platform from Open Health Network of Mountain View, California. PatientSphere 2.0 is a personalized, HIPAA-compliant, care coordination management system that integrates health and medical data from a wide range of sources and supports seamless communication between the patient and a broad-based care team. Using blockchain technology and big data techniques, the Open Health platform will support the MILBox app on the user’s smartphone, maintain the cloud-based data acquisition system, manage the data analysis and construct the “digital twin” algorithm. “The MILBox is going to revolutionize the digital health landscape, and to do that requires the kind of advanced, flexible and powerful technology that is at the heart of Open Health Network and PatientSphere 2.0,” said Tatyana Kanzaveli, founder and CEO of Open Health Network. “Our company will work with Dr. Seixas to create the advanced platforms and apps that enable this kind of innovation in health care while also protecting valuable and sensitive personal data.” While the initial MILBox contains an assortment of the best sensors available from known brands, the underlying technology is device agnostic, so that different and improved sensors can be substituted over time. The data gathered can also be expanded to include additional real-time biological, digital, behavioral, clinical, psychosocial and environmental data to expand the ability of the “digital twin” to model an individual’s overall health. “You will be able to add and subtract different devices based on the use case,” Seixas said. “We’ve designed this to be future-proof and support our larger mission of creating a new kind of personalized health care.”
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Director’s Update: CNSA Expands Work in 1Florida Alzheimer’s Disease Research Center to Reach Diverse Cultures ith the aging of the population and the vast diversity of ethnic and cultural groups in South Florida, it has become more important than ever to address early detection of cognitive impairment and identify mechanisms and treatments that will lead to optimal intervention and prevention strategies.The CNSA is one of 33 Alzheimer’s Disease Centers of Excellence and is home to the Florida statefunded Memory Disorders Clinic directed by renowned expert Dr. Elizabeth Crocco, Chief of Geriatric Psychiatry and Medical Director of the CNSA.
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Since receiving our NIA designation as a Center of Excellence in Alzheimer’s disease ($15 million NIH/NIA grant for the 1Florida Alzheimer’s Disease Research Center), the CNSA has been focusing on expanding outreach to Black and African American individuals, who are twice as likely as Whites to develop Alzheimer’s disease. A traditionally underserved and underrepresented population, when surveyed, only 48% of Blacks reported being confident they can access culturally competent care. We have also focused on the high number of comorbid diseases that disproportionately affect African American older adults including vascular risk factors, diabetes, renal disease, and allostatic load as well as social determinants of health. Dr. Rosie Curiel Cid is leading the ADRC Outreach, Recruitment, Retention and Community Engagement Core. The Core facilitates engagement between the ADRC and people with dementia, their caregivers, and both the
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professional and local lay communities to ensure information is communicated bi-directionally. Her team has set up various community stakeholder programs, established a Community Ambassadors Program, and is hosting regular community events to promote health literacy and foster an academic-community partnership. As the CNSA’s Director of Cross-Cultural Neuropsychology, her team has been extremely active in developing digitized culturally fair measures to assess older adults in their preferred language and in a manner that overcomes barriers to accurate and reliable assessment. Dr. Marcela Kitaigorodsky, head of day-to-day research operations at the CNSA, has ensured that the fidelity of our work, training the next generation of scientists and running several large concomitant projects, has gone smoothly. For those interested in pursuing a career in Alzheimer’s disease research or care, we provide a depth and breadth of education and experience you won’t find anywhere else—including our Alz Stars program, which offers an all-Alzheimer’s curriculum and an opportunity to do research. An added advantage: proximity to one of the most diverse regions in the nation. Millions of people from different backgrounds and cultures call South Florida home, and we’re fortunate to be working alongside these communities to not only educate them about brain health, but also better understand their concerns about aging. Early-career physician-scientists have a unique opportunity to work with these minoritized populations and contribute to the CNSA and ADRC’s research. (continued on page 16)
ROAAR Study: Our Experts Direct their Focus to Alzheimer’s Disease (AD) in an At-Risk African American Population t the Center for Cognitive Neuroscience and Aging (CNSA), Elizabeth Crocco, MD, Medical Director of the UM Memory Disorders Clinic, received $250,000 from the Florida Department of Health. This grant entitled, Building an advanced cognitive biomarker Registry for Older African American adults at Risk for Alzheimer’s disease, or the ROAAR study, is currently engaging the expertise of investigators and has been successful in recruiting African American individuals in their research and clinical care.
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A growing body of evidence suggests that the prevalence of AD may be two to three times higher among older African Americans as compared to non-Hispanic whites, yet they are significantly underrepresented in research. “Despite the challenges throughout this COVID-19 pandemic, we have been very successful in reaching minority communities and helping to break through barriers that have historically prohibited them from seeking and obtaining care and participating in
important clinical research.” Dr. Crocco said. The aim of the project is to recruit 120 African American volunteers to build an advanced registry at risk for Alzheimer's disease and related disorders using state-of-the-art and culturally relevant novel cognitive tests, as well as advanced neuroimaging of the brain and genetic analyses. This project fills a critical gap and is expected to become the foundation of current and future NIH-funded projects in Florida that include this underserved group of individuals. Dr. Crocco and the CNSA team are well underway to meeting these goals within the 2022 year.
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The Science of Sleep in Miami
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leep is increasingly recognized as a driving factor of good health and/or disease. Recently, the elite journal Science featured sleep research on its cover, underscoring how important the discipline has become. Girardin Jean-Louis, Ph.D., a sleep scientist at the University of Miami Health System, was one of several researchers featured in the issue. Dr. Jean-Louis recently moved to Miami to establish the Center for Translational Sleep and Circadian Sciences at the University of Miami Miller School of Medicine. The group will investigate the underlying mechanism of circadian rhythm (our internal 24-hour clocks) and the reasons why some communities face sleep and circadian disparities that can drive long-term health consequences. “Laboratory data has shown that Blacks do not receive adequate exposure to the light-dark cycle,” said Dr. Jean-Louis. “As a result, if you compare melatonin secretion, a marker of the endogenous circadian rhythms individuals of the white race/ethnicity approximate the expected 24-hour photoperiod, but it’s much shorter for those of the Black race/ethnicity.” Nobody understands the root causes of these disparities, but the consequences are pretty straightforward. Poor sleep, resulting from circadian misalignment, can increase the risk for obesity, diabetes, cardiovascular disease, depression, and dementia. Adequate sleep is so essential to overall health, the U.S. Department of Health and Human Services has included it in its Healthy People 2030 initiative. Dr. Jean-Louis and his TSCS research team will investigate sleep and circadian disparities in Miami’s Black and Hispanic communities to fully understand the circadian misalignment observed in those communities, their downstream cardiovascular and brain health consequences, and possible remedies.
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The New York experience Before coming to Miami, Dr. Jean-Louis spent eight years at the NYU Grossman School of Medicine. He developed a program to delineate the causes of sleep disparities and to implement precision behavioral medicine interventions to reduce those disparities. This has required the involvement of various community stakeholders and health champions, given individuals in minoritized communities tend to distrust the medical establishment. He and his team had to build relationships, an incremental but ultimately successful process. They recruited local influencers to join a Community Steering Committee and met people in their neighborhoods—churches, barbershops, beauty salons, and other gathering spots—to share their simple pitch: Sleep is one of the most important things you can do to improve your health.
Through this process, they debunked several myths, such as snoring is a sign of good sleep. “They think Uncle Bob is in a deep sleep, but they were surprised to learn that snoring is a symptom of sleep apnea," said Dr. Jean-Louis. “Unfortunately, Uncle Bob’s snoring is actually a risk that could lead to a heart attack or stroke because he's not breathing well.” Over time, the NYU Sleep Disparity Workgroup became a trusted partner in New York's vulnerable and disadvantaged communities, helping many people overcome their distrust of white coats and attending clinics for much-needed care. The next level Buoyed by the recent article in Science and other recognitions, Dr. Jean-Louis is replicating his NYU success in Miami. Fortunately, he does not have to start from scratch. A member of his NYU Community Steering Committee made a few local introductions, allowing the team to hit the ground running.
With this community buy-in, the Miller School of Medicine sleep and circadian researchers will begin the rigorous process of determining why the circadian clocks in Blacks, and possibly other minorities, may run slower than others. Dr. Jean-Louis has a long list of scientific questions he is investigating. How does a person’s environment influence their sleep—light, noise, temperature, air quality, green space (or the lack of it)? What are the genetic and epigenetic (molecular tags that govern gene expression) signals that influence sleep? Does systemic racism or discrimination play a role? The circadian lab will provide a highly controlled environment to help answer these and many other questions. “The circadian lab we’re now building will help us delineate these circadian disparities and better understand the physiological triggers that are causing them,” said Dr. Jean-Louis. Once we understand the biological underpinnings of these disparities, we will be in a better position to help the community implement programs to improve the health of their circadian clocks.”
Please spread the word! The PRIDE Summer Institute on Behavioral Medicine and Sleep Disorders Research is delighted to announce its upcoming program in June 2022. This program will provide intensive didactic and mentored research training to underrepresented minority faculty (URM as defined by the NIH), and those with disabilities, engaged in behavioral medicine and sleep disorders research. The goal of this multidisciplinary training and mentoring institute is to provide mentored learning opportunities to URM faculty in an environment of inclusive excellence, employing state-of-the-science methods and innovative techniques in their fields. This program is tailored to mentor URM post-doctoral scientists in establishing independent academic research careers. The PRIDE Institute is a research-career advancing opportunity at the University of Miami and is funded by the National Heart, Lung, and Blood Institute (NHLBI).
For more information about the program and eligibility requirements, please visit: pridecc.wustl.edu/apply. Or for further questions, please contact Ana Sanchez Alfonso at ags229@med.miami.edu.
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Roundtable: A Conversation About the State of Diversity in Psychiatry he challenges of the last few years have highlighted numerous issues in our country and around the world. Significantly, issues around racial and social justice, diversity, equity, and inclusion have garnered more attention than ever before. The troubling events we’ve witnessed have had cascading effects on individuals’ mental health and revealed most of these problems are systemic—entrenched in the blueprint of a different society from a different time. Five faculty members from our Department’s Diversity and Inclusion Committee voluntarily gathered for a conversation on how diversity—or lack thereof—has shaped their careers and approach to their work today. Moderated by Samantha Richter, Director of Communications, the roundtable generated discussion about the current state of diversity in psychiatry, what changes and improvements need to be made, and ideas for initiating action to spark those changes.
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Please note, some answers may have been edited for length and clarity. The responses from participants are their own personal opinions and experiences and do not necessarily reflect the positions of the Miller School of Medicine or UHealth System.
(SMB) Steve McLeod-
(JB) Judite Blanc, PhD
(VF) Vanessa Feliciano, PsyD
(DJ) Daniel Jimenez, PhD
(VP) Vanessa Padilla, MD
Bryant, MD
“My research is all about diversity because I’m interested in the impact of historical context on racial /ethnic health disparities.”
“I am highly passionate about community mental health and devoted to pursuing a career path that allows for the integration of clinical skills, culturally competent practice, and empirically informed intervention.”
“I have dedicated my career to identifying physical and mental health disparities affecting the nation’s racial /ethnic minority older adults and developing innovative strategies to reduce, and ultimately eliminate these disparities.”
“All of our patients deserve the best quality medical care, especially those afflicted by a mental health crisis which can make them vulnerable and put them at higher risk of stigmatization even within a variety of healthcare settings.”
“ I am honored to shepherd the ongoing discussion among the nearly two dozen members of the Diversity and Inclusion Committee. They have opened my eyes to the possibilities and opportunities for enriching the Department of Psychiatry and Behavioral Sciences and the communities we serve.”
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SR: The Oxford Languages Dictionary defines diversity as the practice or quality of including or involving people from a range of different social and ethnic backgrounds and of different genders, sexual orientations, etc. What does ‘diversity’ mean to you in the context of your job? VF: I provide direct psychological services. Within that context something I really try to take into account are the ways in which an individual’s unique culture identity—be it gender, ethnicity, sexual orientation—how it really impacts mental health issues and access to services and even the stigma surrounding mental health and an individual’s willingness to accept treatment. I think it’s important to make sure we’re putting that into context with things like DSM-V1 criteria and evidence -based intervention. SR: I would imagine it’s different for clinicians than researchers? JB: I agree, it’s different. I was trained as a clinical psychologist in French. Because of my background, I grew up in Haiti, completed my BA there, my Master’s degree and PhD in France and my postdoctoral fellowship in the U.S. My entire life has been seeing the world from different perspectives. I always try to approach my work with cultural humility. SR: I think you raised a really interesting point, Judite, that our own experiences to date with diversity/equity/inclusion really shape our approach to your work today. Everyone goes through so much training that it’s inevitable you collect these ideas, thoughts, experiences along the way. I think that’s really interesting as well—how it shapes you. SMB: Judite brings up another point, in terms of educating others, one of the important perspectives of diversity is helping students or trainees appreciate—in my case, the clinical setting—where they may be using their egocentric approach in examining a particular problem. Other dimensions of human behavior may affect how their patients present their symptoms, how they express their distress, and how treatments can be better tailored to address their particular needs which may come from a different background. That’s where diversity is important and it’s helpful to have a diverse staff who can help us bring those perspectives to bear in each individual clinical situation. SR: Do you think that meaning of diversity differs in psychiatry from other medical specialties? DJ: I would say yes. Our field is clinical in the sense that our diagnoses are clinical. Other specialties see patients presenting with visible issues—there’s a clear-cut identification, for example, of what constitutes diabetes or acne. But much of psychiatry and behavioral sciences is open to interpretation and I think having that diversity in terms of thought, personal histories, and backgrounds helps guide how we interpret our patients’ behaviors.
VP: I’m going to respectfully disagree with Danny. When I look at the question related to other specialties, I think of medicine in general. I would like to see a broader definition that we can use across specialties to identify that bio-psycho-social things affect all types of medical illness. Even if we can’t grasp it like diabetes, it’s a medical illness. There shouldn’t be a different meaning of diversity depending on what medical specialty you practice. SMB: Another way of thinking about this is that the definition of diversity doesn’t change in different specialties, it’s just we in the behavioral health sciences may have a better appreciation for the impact of diversity on the clinical situations that we see. After all, the biopsychosocial model was developed by a psychiatrist—George Engel— who was working in a consultation-liaison setting looking at disparities in clinical outcomes related to psychosocial determinants. I think in a sense because of our field, we are perhaps more attuned to that sense that diversity is important. But as Vanessa suggested, it pertains to all branches of medicine. SR: Do you feel certain medical specialties are more welcoming to underrepresented minorities (URMs) than others? How do you think diversity, or a lack thereof, impacts the field of psychiatry specifically in terms of treatments? Research? VP: I think it’s possible. Depending on what you practice, and how many people have access to the opportunities offered in that program. Unfortunately, there are more disadvantaged people who have not been able to explore several specialties because their programs don’t offer a rotation. Based on your exposure, I wonder if there are instances when you may not have access to an area you want to explore. VF: I knew I wanted to train to be a clinical psychologist, so I was always focused on clinical practice; I didn’t have a wealth of exposure to other specialties. I came to UM from a community mental health background providing services for free and I see a stark difference in the population I am treating now. Psychologists are not covered by Medicaid for treatment in an outpatient practice setting. By proxy, that leads individuals who are only eligible for Medicaid or unable to afford cash pay practices—that frequently leads them to seek mental health services from a different type of provider in community mental health, where the quality of resources and accessibility may not be as strong. 1 The DSM-V, or Diagnostic and Statistical Manual of Mental Disorders, is a manual for assessment and diagnosis of mental disorders and does not include information or guidelines for treatment of any disorder. It features the most current text updates based on scientific literature with contributions from more than 200 subject matter experts. It is published by the American Psychiatric Association.
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SR: What do you think has been the biggest barrier to recruiting/enrolling underrepresented minorities both as trainees and colleagues?
SR: There has been discussion about eliminating standardized tests for years. Why is it taking so long to get rid of them even after research has shown they’re an inaccurate, often biased indicator of ability?
SMB: I was reflecting on the question from my 30+ years in academia and one of the biggest barriers I’ve encountered in my career is a lack of diverse leadership. Walking into rooms I was the only student in my class of 100 and the doctors and Deans didn’t look like me, act like me, or come from the sort of background I came from. Though they were respectful and nice, it took awhile for them to open their eyes to a larger world, to expand their vision. Thankfully, here at MSOM, I think we have a way to go but we don’t have that particular barrier. We have others. Pipeline issues, socioeconomic factors that make it difficult to become even more diverse. But the problems we are dealing with now compared to the barriers I was dealing with decades ago illustrates that progress has been made, and offers hope that we can continue down this path to improvement.
SMB: Because it’s systemic. Multifactorial.American history shows us that for people of African descent, there has been 400 years of compounding laws, policies, and procedures which laid a foundation rife with disparities.. So, we are making slow inroads. Oftentimes the resources have not been committed in the ways that need to be done to really make lasting change. This is a work in progress.
DJ: To Steve’s point, I think here in Miami it’s different. I’ve been to other institutions and it’s not like here. I think the broader academic world is more reflective of that than it is here at UM. When Steve is talking about walking in and seeing no one who looks like him, that has been the majority of my experiences in academia. Academia can be a very unforgiving place in that regard. It’s very archaic sometimes in how you can progress. Also, it’s been my experience, those from a URM background tend to ask questions that are very interesting. But those questions won’t necessarily lead to research that gets published in the high-impact peer-reviewed scientific journals. SR: How do you envision a pathway to a more diverse psychiatric workforce? JB: We’re beginning to see universities investing more in URMs. I believe those initiatives must be reinforced. We need to start investing as of early childhood, not wait until later in life when people are pursuing medical careers or achieving faculty positions. It’s a systemic problem so we need to take systemic measures to fix it. DJ: I agree with Judite. Investing post-residency or fellowship is too late. We need to ensure these URMs know medicine is a viable career choice for them. We need to build excitement in these neighborhoods where individuals wouldn’t ordinarily see a pathway to a career in medicine. I also personally believe it’s long past time to get rid of arcane metrics such as standardized testing. They are not a good indicator of intelligence and too often the results stop bright individuals from pursuing medical careers. It would open the pipeline considerably.
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SR: Surveys have shown patients prefer to see physicians who reflect their same culture— who look like them. How does cultural background play a role in the treatment of a patient? VP: I think that it impacts the willingness of a patient in the clinical setting to accept treatment. Sometimes I feel that I can empathize and connect faster with a Hispanic person, especially a woman, compared to a physician from a completely different background who takes a different approach.This is not bad or wrong, it’s just different, and works both ways. I think a patient who feels more connected, validated, and is in an environment with a provider they can closely identify with may help them to accept recommended treatment options. JB: This is one of the most compelling reasons to invest in minoritized individuals as of early childhood. It is these people who will be taking care of others who share their same culture or background in the future. There is really an urgent need here. We simply must invest more in youth, students, and guide them towards career opportunities in psychiatry so we can grow and diversify our workforce and provide care and resources for those who need it most.
“Walking into rooms I was the only student in my class of 100 and the doctors and Deans didn’t look like me, act like me, or come from the sort of background I came from.” Dr. Steve McLeod-Bryant
SR: Clinical trials are the backbone of evidencebased medicine. Most require a specific subset of the population for targeted study. In terms of diversity, equity, and inclusion, what are the challenges faced when trying to recruit for trials, and how can we better encourage participation among URMs? In my career in health care over the last decade, I have seen studies fail or come close to failing and losing funding because this was a major struggle for them. They couldn’t lock in the population needed to conduct the research intended when they submitted the grant. JB: It’s thought that those communities are hidden, or hard to find. We have not found that to be true. It’s all about cultural practice, the way we, as researchers, approach them. People don’t always trust researchers; they picture someone who calls and takes data from them and then are never heard from again. In our lab, we don’t have such a problem. We try not only to hire a diverse team, but at the same time, we meet the people in their own communities. Homes, barber shops, beauty salons, churches.
Again, it’s all about tailoring the cultural approach. The interventions or clinical trials should be crafted according to the community you want to serve. DJ: I agree with everything Judite said. That’s the same approach I take in my research. Even after trials are done, I remain present in the community to show we aren’t just there to take data and leave, but we still have an interest in the community, that we are still visible members of the community, that we care about the community. VP: I’m not a primary researcher but I think education plays a big role. I love what you both said. For example, there is so much misinformation related to so many topics. We should consider how to use our own platforms to convey how important research is to advancing treatments; and helping the same populations we are trying to study by involving them in the discussion. SMB: Thank you to everyone for participating and contributing. SR: Thank you all.
The Biopsychosocial Model of Health
The biopsychosocial model is an inter-disciplinary model that looks at the interconnection between biology, psychology, and socio-environmental factors. The model specifically examines how these aspects play a role in topics ranging from health and disease, to human development.
Physical Health Disability
Biological Genetic Vulnerabilities
Temperament
Drug Effects
Mental Health
Peers
Social Family Circumstances School
Family Relationships
IQ Self-Esteem
Psychological Coping Skills
Trauma Social Skills
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Realizing the Power of Diversity in Research oday’s emphasis on diversity in research is not only in clinical trials looking at physical disease but also mental health. Ideally positioned to capture the diverse demographics of South Florida, the Department of Psychiatry and Behavioral Sciences is conducting mental health studies aimed at revealing differences among diverse populations and the determinants of why those differences exist, according to Deborah Jones Weiss, Ph.D., M.Ed., research professor.
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“Diversity in research in psychiatry enables us to look at differences, or disparities, between mental health in different ethnicities and races. The disparities are not borne of the fact that people are different colors or different ethnicities, but are borne from the fact that mental health is impacted by different non-medical living conditions, what is called the social determinants of health. And those social determinants are things like education, income, housing, access to care,” explained Dr. Weiss. The majority of mental health research was originally done with White people—primarily among White men—then generalized to everyone else. “That does not really make sense because we are all very different,” Dr. Weiss said. “We would no more generalize from one segment of the community to another than we would from men to women in terms of our lived experience. But that was originally very much the case in mental health.” Taking diversity into account can be complex because it might require that researchers look at such things as ancestry or the roots of health disparities. In Black populations, for example, the social determinants of health have been historically based. Black individuals experiencing those social determinants are impacted by the long-term effects of historical racism and systemic racism and unequal distribution of resources. So, it is important to look at those differences to better understand how Black individuals respond to and are affected by their environments, said Dr. Weiss.
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There are consequences for research and mental health care when studies do not take important aspects of diversity into consideration. “For example, measures that we use to assess depression, anxiety or cognitive functioning were originally normed on White males rather than general populations,” she said. “We have had to make adjustments and sometimes change measures completely to make them more accurate.” The push to make research more diverse and applicable to all races and ethnicities is in full force. The National Institutes of Health (NIH) requires that grant applications include meaningful comparisons between racially diverse groups and look at the impact of the social determinants of health. The comparisons have to be meaningful to be compliant with NIH standards. “In other words, comparisons are not made to just say Blacks have more this and Whites have more that, but rather actually understand why these differences are occurring. That’s what is really important because once we know why they are occurring then we can start to target the causes rather than just the conditions,” Dr. Weiss said. South Florida offers a unique environment for diversity in research. In fact, Dr. Jones Weiss said she came to the Miller School specifically to be able to work in South Florida, which has the highest population nationally of HIV-positive women, the majority of whom are Black. But achieving true diversity in research means not only capturing study subjects of different races and ethnicities but also having underrepresented minorities as faculty to conduct the studies. To address the issue of faculty
recruitment and diversity in research in general, Dr. Henri Ford, Dean and Chief Academic Officer of the Miller School, started the Diversity Council and the Task Force on Racial Justice. “In Miami, about 70% of our population is Spanish speaking, and we have a large Spanish-speaking population working at the University,” said Dr. Jones Weiss, who is on the University’s Research subcommittee on the Task Force on Racial Justice. “However, we have nowhere near the number of Black faculty needed to reflect our local communities, so we are actively focusing on increasing our representation of underrepresented minorities, specifically Blacks, on our faculty.” Studies, Programs Underway Department of Psychiatry and Behavioral Sciences faculty have several studies and programs underway focused on diversity in research. Among those: The Center for HIV and Research in Mental Health (CHARM), part of Dr. Weiss’s lab at the Miller School, led by Dr. Steven Safren, conducts studies looking at mental health disparities among different ethnic, race and gender groups. One of CHARM’s goals is to reduce the impact of mental health disparities as barriers to behavioral and biobehavioral approaches in HIV prevention and care. Dr. Weiss is also a leader of the NIH-funded MACS/WIHS Combined Cohort Study (MWCCS), a collaborative research effort to understand and reduce the impact of chronic health conditions that affect people living with HIV. The study is exploring the differences between men and women affected with HIV. Girardin Jean-Louis, Ph.D., one of the world’s leading experts on advancing the science and practice of sleep and circadian sciences, is directing the new Center for Translational Sleep and Circadian Sciences. The program will look specifically at how interventions aimed at better sleep quality can improve the health of minority populations that are disproportionately affected by problems associated with sleep.
“Disparities are not borne of the fact that people are different colors or different ethnicities, but the fact that mental health is impacted by different social determinants of health, education, income, housing, access to care.”
From left, Raymond Balise, PhD, Victoria Mitrani, PhD, Adam Carrico, PhD, Steven Safren, PhD, Daniel Feaster, PhD, Deborah Jones Weiss, PhD, M.Ed., Allan E. Rodriguez, MD, and Maria Alcaide, MD.
Much of Dr. Jean-Louis’s work and other research focused on diversity requires that faculty get out into communities to better understand behaviors, gain trust and potentially mobilize mental health related change. Dr. Daniel Jimenez is also conducting research on health disparities, working with older Latino men, building on social relationships and exercise as a strategy to improve mental health. Dr. Weiss is among the researchers at the Miller School led by Dr. Sonjia Kenya looking at the roles of peer navigators and community health workers in terms of helping people from the Black community become more integrated into the health care system, thereby reducing barriers to health care. In recent years, Dr. Weiss and her colleague Dr. Maria Alcaide have conducted research on COVID-19, looking at differences between men and women and among races. “Our research highlighted how people coped with the stress of COVID, and we found that some populations had higher levels of resilience,” she said. “In the Black community, and among women, for example, we found resilience was related to social relationships. That’s really important. That means that when people are able to stay connected at the societal level in the Black community, they are better able to cope with adversity and to be more resilient to manage the stress of things like the lockdown and COVID-associated stress.” A bright future for diversity in research Leadership at the Miller School and University of Miami are supporting the Dean’s Task Force on Racial Justice in its goal to fuel diversity in research, including establishing funding pipelines for those interested in conducting research on health disparities. “They have already earmarked funding at the University level for people who are interested in conducting research in health disparities,” Dr. Weiss said. “And the University, itself, has really committed to recruiting more people from underrepresented minorities on our faculty, which may also stimulate and support research in these populations.”
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Activities & Awards Dr. Marcela Kitaigorodsky Speaks at Michael-Ann Russell Jewish Community Center Annual Senior Health Fair
Dr. Marcela Kitaigorodsky, Assistant Professor, spoke to participants at the Michael-Ann Russell Jewish Community Center Annual Senior Health fair in March. Dr. Kitaigorodsky's lecture was entitled Healthy Aging vs. Dementia. The goal was to educate senior citizens on the differences between normal aging, and the early onset of dementia. She also taught the participants about the warning signs for Alzheimer's disease, and the risk factors associated with the disease.
training in geriatric psychiatry to meet the mental health needs of the expanding population of older Americans. The theme for this year’s AAGP Annual Meeting was Addressing Disparities in Geriatric Mental Health: Caring for Our Patients and Communities, acknowledged the challenges older adults from underrepresented racial and ethnic groups experience within our mental healthcare system. Dr. Liz Crocco, Chief of Geriatric Psychiatry and Director of the Geriatric Psychiatry Fellowship Program along with Dr. Zelde Espinel, Assistant Professor of Clinical Psychiatry, attended the conference. To date, all of our residents nominated by Drs. Crocco and Espinel have been accepted to the AAGP Scholars Program. Congratulations to our 2022 members!
2022 Diversity, Equity & Inclusion Leadership Award Presented to Dr. Girardin Jean-Louis
Dr. Girardin Jean-Louis has received the 2022 Diversity, Equity & Inclusion Leadership Award, presented by the Academy of Sleep Medicine. The award recognizes an individual who has who has made significant contributions to the field of sleep medicine and/or sleep and circadian science. The ceremony will be held in June. Congratulations to Dr. Jean-Louis!
UM/JMH Residents Accepted to Scholars Program at American Association for Geriatric Psychiatry Annual Meeting
Dr. Marcela Kitaigorodsky Speaks at Michael-Ann Russell Jewish Community Center Annual Senior Health Fair
Residents Jafar Ashy (PGY-1), Moayad Kabli (PGY-2), Omar Munoz (PGY-2), and Kendyl Stewart (TBD) were recognized as 2022 AAGP Scholars! The AAGP Scholars Program provides scholarship funding for eligible medical students and psychiatry residents to attend the AAGP Annual Meeting and supports a special educational program for trainees. The aim of the Scholars Program is to encourage trainees to pursue specialized
Dr. Marcela Kitaigorodsky, Assistant Professor, spoke to participants at the Michael-Ann Russell Jewish Community Center Annual Senior Health fair in March. Dr. Kitaigorodsky’s lecture was entitled Healthy Aging vs. Dementia. The goal was to educate senior citizens on the differences between normal aging, and the early onset of dementia. She also taught the participants about the warning signs for Alzheimer’s disease, and the risk factors associated with the disease.
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Dr. Maria Rueda-Lara Awarded at American Psychosocial Oncology Society Conference Dr. Maria Rueda-Lara, Assistant Professor of Clinical Psychiatry, received the Top Clinical Poster Award at the APOS conference! Her poster, Psychiatric Symptoms masking craniopharyngiomas in African American Patients, addressed health inequities among underserved and Black, indigenous, and people of color (BIPOC) communities and examined why despite recent efforts to improve health services for African Americans and other minority groups, barriers remain regarding access to and quality of care. Dr. Rueda-Lara was also selected to chair the Symposium on Supportive Cancer Care in a Culturally Diverse population along with three other speakers. The symposium featured speakers who provide innovative culturally health interventions to patients from diverse cultural backgrounds with the goal to eliminate barriers to access of care. The theme of this year’s conference was Moving Forward Together: Achieving Equity in Psychosocial Oncology. Congratulations to Dr. Rueda-Lara!
Dr. Rosie Curiel Cid Appointed Member of U.S. Consortium of Aging, Dementia and Latino Studies The main goal of the Consortium is to promote collaborations among investigators working on aging, Alzheimer’s disease and related dementias (ADRD) in the U.S. Latino/Hispanic population to accelerate research and the discovery of biomarkers, new diagnostics, prevention and treatment.The Consortium will focus on key areas: 1) Genomics and biomarkers; 2) Diagnosis and assessment; 3) Dementia risk and prevention; and 4) Clinical trials and therapeutics 5) Caregivers and psychosocial support. Dr. Curiel Cid also presented at The Alzheimer’s Association Latinos and Alzheimer’s Symposium. Her session was “remote assessments” and the topic was entitled: Computerized cognitive challenge tests for detection of preclinical and prodromal AD. The Symposium addressed updates to research and practice knowledge in order to better inform the care of Latino/Hispanic individuals living with dementia and their families.
Fellows Present Posters, Receive Recognition at Florida Psychiatric Society Conference Child and Adolescent Psychiatry Fellows Dr. Sindhura Kompella and Dr. Christy Vadakkan presented posters at the Florida Psychiatric Society (FPS) Spring 2022 Meeting and Expo. Dr. Vadakkan presented a case report about a patient with seclusion-induced psychosis, and Dr. Kompella received Second Place in the John Adams Poster Competition for her poster Case Report: Catatonia in a 16-Year-Old. Congratulations!
Dr. David Loewenstein Appointed to the National Alzheimer’s Coordinating Center (NACC) The NACC was established in 1999 by the National Institute on Aging/NIH to facilitate collaborative research. Using data collected from NIA-funded Alzheimer’s Disease Research Centers (ADRCs) across the United States, NACC has developed and maintains a large relational database of standardized clinical and neuropathological research data. Dr. Loewenstein will serve a four-year term on the Scientific Review Committee.
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While the CNSA has actively been following over 800 individuals in followup, have deeply phenotyped individuals using novel cognitive challenge tests, amyloid PET, tau PET, advanced MRI imaging we have continued to up our game. Our team has developed Cognitive Challenge Tests (CCTs) that have shown great promise as outcome measures to enhance screening, diagnosis, and clinical monitoring in AD clinical trials.
Cognitive Challenge Tests (CCTs) The conceptual underpinnings of these CCTs include: 1) facilitating learning using semantic category cues during both encoding and retrieval; 2) implementing the same cues used to facilitate learning to induce inhibition of learning new semantically competing information; 3) measuring the persistence of this inhibited learning state (e.g., failure to recover from proactive semantic interference); 4) stress cognitive systems that are known to be vulnerable in prodromal Alzheimer’s disease; 5) relate CCT performance to brain biomarkers of AD. In addition to the Loewenstein-Acevedo Scales which have been used both internationally, translated in different languages and digitized by Dr. Curiel Cid and her computer science team, our group has improved the LASSI delayed recall condition to powerfully delineate source memory from other aspects of inhibitory processed, have developed even more challenging measures (Cognitive Stress Test: CST, Loewenstein et al., 2021) and a new paired associate semantic memory binding test that presents a cognitive challenge in unbinding previously learned semantic associations. State-of the Art Plasma-Based Biomarkers for AD and Other Disorders of Neurodegeneration We have partnered with colleagues using Single Molecular Array (SiMoA) technology and mass spectroscopy to examine sensitive blood-based biomarkers of AD (e.g., p-tau 231,
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Aβ42/40) as well as neurodegenerative markers such as plasma Neurofilament Light (NfL) and Glial Fibrillary Acidic Protein (GFAP). The newer SIMOA techniques provide a 1000-fold sensitivity to these plasma biomarkers relative to Elisa assays. We are also working on genetic and epigenetic factors including GWAS with our UM Human Genetics Center. Several very large NIH grant applications will be submitted by the CNSA to combine our novel CCT measures (licensed by UM to i-Function which just received an SBIR) with our deeply phenotyped diverse population. Drs. Curiel Cid and Loewenstein were recently appointed to a number of important committees including Consortium of Aging, Dementia & Latino Studies and the National Alzheimer’s Coordinating Center Scientific Review Committee. Team Science Our post-doctoral fellows and graduate students have been extraordinary in their work and benefit from a team science approach which allows them to interface with UM investigators in Psychiatry, Neurology, General Radiology, Nuclear Medicine, Human Genetics, Ophthalmology, Computer Science, Otolaryngology, Anesthesiology and Public Health. To learn more about how CNSA and our 1FL ADRC consortium are leading scientific discoveries in Alzheimer’s disease and related dementias, please visit our website https://med.miami.edu/cnsa. Sincerely, David E. Loewenstein, PhD The 1FL ADRC is a consortium of Florida institutions collaborating on Alzheimer’s disease research. It is largely focused on bringing together top researchers to better understand how to diagnose, treat, prevent, and potentially cure Alzheimer’s in diverse populations.
UHealth, the Miller School of Medicine, and the Department of Psychiatry and Behavioral Sciences are committed to fostering an inclusive environment, one where everyone feels represented and respected. As the LGBTQ + community grows and evolves, we too are adapting. As individuals find new and comfortable ways to express their identity, we are creating and implementing systems and services that provide support and promote inclusivity. Below, some recent highlights: UHealth Designated LGBTQ+ Human Rights Campaign Foundation Healthcare Equality Leader In 2022, UHealth was again designated a LGBTQ+ Healthcare Equality Leader, receiving the top score of 100 on HRC’s Healthcare Equality Index. The index promotes equitable and inclusive care for lesbian, gay, bisexual, transgender, and queer patients and their families. Facilities were assessed on four criteria: non-discrimination and staff training, patient services and support, employee benefits and policies, and patient and community engagement. UHealth has received this recognition for the last five years.
Miller School of Medicine MedicOUT Program MedicOUT aims to create a more supportive environment for LGBTQ + individuals both on the medical campus and in the medical community. They do this by raising awareness of LGBTQ + health issues and advocating for the rights of LGBTQ + patients. In addition, MedicOUT works with the administration to change the curriculum so that it accurately reflects the health needs of the LGBTQ+ population. MedicOUT welcomes and encourages involvement from LGBTQ + allies in order to help achieve set goals. LGBTQ+ Medical and Mental Health Care UHealth firmly believes all patients should have access to high quality, comprehensive medical and mental health care with compassion and sensitivity in a confidential setting, regardless of sexual expression or gender identity. Our health care providers offer medical and mental health services specifically designed to meet the needs of lesbian, gay, bisexual, transgender and questioning patients, including: primary medical care including routine health care physicals, comprehensive gender affirmation procedures, and individual psychotherapy around all mental health issues including transitioning issues. Enhanced system software options for personal identification The UHealth enterprise uses a cloud-based business management system for all employees. Now, individuals can voluntarily designate a pronoun, gender identity, and whether they identify as a member of the LGBTQ+ community. Activating these features for members of our community have proven to promote an inclusive environment while protecting the confidentiality of personal information; feedback has been extremely positive.
What to Do & Where to Go
Common Purpose Transforming lives through teaching, research and service.
For a Mental Health Emergency, CALL 911
if you believe someone is in danger of hurting themselves or others. Jackson
Silver Alert is a statewide initiative to involve the public in locating a cognitively impaired person who has gotten lost driving or while on foot. For more information visit florida silveralert.com.
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For updates on UM actions and policy changes related to coronavirus please visit umiamihealth.org
In addition to UM, these organizations are offering mental health support and information during the pandemic.
Our Center for Cognitive Neuroscience and Aging’s statement on COVID-19 cnsa.med.miami.edu World Health Organization Follow the WHO’s global response to the coronavirus pandemic www.who.int Centers for Disease Control and Prevention The latest guidance and recommendations for fighting coronavirus in the U.S. www.cdc.gov National Institute of Allergy and Infectious Diseases Emerging research on the novel coronavirus www.niaid.nih.gov
The University of Miami Leonard M. Miller School of Medicine Department of Psychiatry and Behavioral Sciences is committed to:
Offering
Conducting
outstanding mental health education and multidisciplinary training to the next generation of healthcare providers and investigators.
comprehensive treatment and consultation to our patients, their families, and the community. Providing
research that deepens our understanding of the development, pathophysiology, and prevention of psychiatric illness and the nature of human behavior, and apply this knowledge to the development and delivery of more effective, evidence‐based treatments.
DIRECCT
Core values l Diversity l Integrity l Responsibility l Excellence l Compassion l Creativity l Teamwork
American Foundation for Suicide Prevention www.afsp.org National Suicide Prevention Lifeline 1.800.273.8255 suicidepreventionlifeline.org National Alliance on Mental Illness www.nami.org/Home Mental Health America www.mhanational.org/covid19
The publication of the University of Miami Department of Psychiatry and Behavioral Sciences Executive Editor Samantha Richter
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