Posted on: Friday, May 6, 2005
Hawaiian psychology training provides vital connection
By Jan TenBruggencate
Advertiser Kaua'i Bureau
KAPA'A, Kaua'i — A 5-year-old program that trains Native Hawaiian psychology students and provides counseling at low-income clinics in rural areas with large numbers of Hawaiians is bridging significant gaps in care, organizers said.
"We tend to greet with hugs rather than handshakes, and our sessions are more talk-story than asking pointed questions. They'll often ask about me where I went to school. If there's a personal connection, it can save a lot of time," Yano said.
Psychologist Kamana'opono Crabbe concurred. "It's important local people get to know you not only as a professional, but as a person," he said.
Yano is a Tripler Army Medical Center staff psychologist and part of a unique program aimed at providing counseling services to underserved communities in Hawai'i — generally rural, low-income areas with a high percentage of Hawaiians. Crabbe is a graduate of the program who is studying for his licensing exam.
Native Hawaiian Psychology Training Program at Tripler Army Medical Center • Provides internships and fellowships to Native Hawaiian students studying psychology; offers counseling services at low-income clinics in rural areas with large numbers of Hawaiians. • Established in 2000 with two trainees and serving two clinics; now with five trainees working at six clinics statewide. • Graduated nine psychologists, with a goal of 30 by 2010. • Financed by the U.S. Department of Defense. • Provides counseling services at community health centers in Hana, Maui, and Hilo, Hawai'i, on Kaua'i and Moloka'i, and in Wai'anae, Waimanalo and Kalihi-Palama. "We are now in seven of the community health centers in the state," said Ray Folen, chief of behavioral medicine services at Tripler.
The Native Hawaiian Psychology Training Program, which gets about $500,000 annually in federal money, has two full-time psychologists, a half-timer and two more who work one day a week with the program.
Since it was launched in 2000, several graduates have taken full-time counseling positions at the rural health centers where they trained, he said.
The trainees get a rich on-the-job experience in the centers, Folen said. "You get everything possible walking in the door, and we're providing them with the tools that they need to adaptively function in life," he said.
Crabbe came to Western psychology with training in traditional Hawaiian ho'oponopono, a cultural process for putting things right. The combination of techniques can be effective in rural areas, he said.
"I try to use Western techniques, but provided in a local manner," Crabbe said.
Yano said some folks need help with pain management, sleeping problems, diet, anxiety, depression, substance abuse and much more. About half her patients are referred by their physicians for help with ways to approach issues related to their medical conditions.
For example, diabetes is a particular problem in the Hawaiian community, and it is often linked to being overweight. Often, a counselor needs to work with the patient's family, since how they respond has an impact on the patient.
"A lot of family and personal issues are interwoven. Some professionals from a Western modality would concentrate on the individual, but family intervention or at least meeting them can help," Crabbe said.
In another medical-related case, Yano said a dentist referred to her a child whose teeth-grinding was related to anxieties associated with family life.
Since the start of the Iraq war, Yano has seen an increased number of Vietnam veterans suffering from posttraumatic stress disorder. The new war "brought a lot of feelings back," she said.
One of the keys to the success of the Native Hawaiian Psychology Training Program is to develop techniques for approaching the people who need help in Hawai'i's most rural communities.
"Because a lot of the rural communities have not had consistent services over time, there still are stereotypes and stigmas. And because of the history of no services, the problems seem to have a long history and people seem wary of coming out about them," Crabbe said.
Reach Jan TenBruggencate at jant@honoluluadvertiser.com or (808) 245-3074. Correction: The Native Hawaiian Psychology Training Program at Tripler Army Medical Center is financed with U.S. Department of Defense money through Tripler Army Medical Center. A Local News story on May 6 indicated another funding source.
Psychologist Beth Yano said a different approach is often needed when working with patients in the most rural parts of the state. Many won't easily accept a traditional office or an impersonal counselor, and often they want to know a little about the psychologist before they'll open up.
Beth Yano
The Native Hawaiian Psychology Training Program approaches its goal in two ways. It provides direct counseling by trained, licensed psychologists, and it provides an opportunity for new psychologists to intern and gain experience while providing direct services to clients in these areas.
CLINICS ON FIVE ISLANDS
