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The Catalyst

Nursing psychologist has a heart for the community

By J. Ryne Danielson
daniejer@musc.edu

Dr. Cristina López participates in a Georgetown County. health fair As part of the Ethnic Minority Preventative Outreach and Web-based Education for Risk Reduction (EMPOWERR) program, she hands out information on HIV and AIDS prevention and substance abuse and helps connect families to the mental health resources they need.

Building healthy communities is a key pillar of Imagine MUSC 2020, but to Cristina López, Ph.D.,  it is much more than that. It’s her mission in life.

“One thing I’ve learned is that you can’t complain about how things are if you’re not going to get dirty and put in the effort to improve them,” Lopez said.

When López first came to MUSC as an intern in 2009, she fell in love with Charleston — the people, the weather, the food — but she quickly recognized the unique challenges of working as a psychologist in the Lowcountry. Seeing the many barriers standing between the area’s most vulnerable citizens and access to life–changing mental health care, she immediately set to work tearing those barriers down. Now, she is being honored for that work as part of MUSC’s celebration of Women’s History Month.

López

Growing up in Miami, the daughter of Cuban émigrés, López has been drawn to Latino populations whose immigrant experiences have been so unlike her own. “A lot of my own ethnic identity has changed depending on where I was,” she said. “In Miami, if you’re Cuban, you’re in the majority. There are plenty of Spanish–speaking services. When I applied to college at Washington University in St. Louis and started receiving minority scholarships, I was sort of taken aback. I never saw myself as a minority.”

In St. Louis, López said, she first felt what it was like to be an outsider. “Luckily, I had a very healthy ethnic identity. When people were culturally insensitive, I knew they weren’t trying to be mean — at least I hoped not — they were trying to learn. And I got to learn about other cultures as well. I went to a school that was 40 percent Jewish and knew nothing about the Jewish culture before I started asking questions. I was in college during the September 11 attacks, and I had a lot of friends who were Muslim, so I learned from their experience as well.

“My anthropology background is probably coming out right now,” she laughed.

It was in St. Louis that López first saw the effects of racial discrimination and health care disparities among underserved populations. “People said it was one of the most segregated cities in the country, and at the time Ferguson hadn’t even happened yet,” she said, referring to the St. Louis suburb’s racial unrest following a police shooting in 2014. 
 
While attending Florida State University for graduate school, López was struck by how different the immigrant experience was for local migrant worker populations than it was for her growing up.

“I saw a dire situation,” she said. “The population wasn’t just underserved. Many migrant workers faced language barriers or barriers of citizenship, most lacked health insurance and many refused to seek help for fear of being deported.”

The situation in Charleston was even worse, she said. “When I came to MUSC, I found myself in the role of psychologist, social worker and translator all in one. I was doing hours of Spanish–speaking therapy. There was such a waitlist of people who couldn’t be seen because there wasn’t a Spanish–speaking psychologist available. Charleston has a huge unmet need in mental health services, particularly for underserved populations. It is very hard to access mental health services, not only for Latino populations, but for African–American and rural populations as well.”

Because of a boom in agricultural jobs and an influx of migrant construction workers after Hurricane Katrina, South Carolina has one of the fastest–growing Latino communities in the country. As demographics shift over the coming years, López believes one of the main challenges of the health care system will be adapting to serve a more diverse population. For those in the field of mental health, that challenge is even tougher.

A stigma against seeking mental health services affects all populations, López said, but when combined with the barriers that face Latino, African–American and rural populations, the hurdles can seem insurmountable.

“When I started my career, my research was focused on identifying factors that led to the development of anxiety and depression in adolescents, but once I started working at MUSC, my focus shifted toward the more clinical goal of increasing engagement with mental health services and getting evidence–based interventions out to the populations that needed them the most.”

López explained that a brutal cascade of health effects can result from leaving mental trauma untreated. Patients suffering from mental trauma are at higher risk for cardiovascular diseases and metabolic issues that can lead to diabetes or obesity. Likewise, illness–related anxiety can lead to depression and other mental conditions in patients suffering from cancer, heart disease, HIV and AIDS and many other chronic conditions, creating a vicious cycle virtually impossible to escape from without proper interventions.

At the conclusion of her internship, López decided to remain at MUSC and dedicated herself to making sure those interventions reached the people who needed them, first as a postdoctoral fellow in the Department of Psychiatry’s Diversity and Mental Health Disparities Program, then as a faculty member in the College of Nursing.

Department of Nursing chairwoman Julie Barroso, Ph.D., RN, praised López for her zeal. “Cristina is a researcher with a bright future, who cares passionately about helping young African–American and Hispanic women,” Barroso said. “We have had many lunchtime conversations about her research, and I always come away having learned something from her.”

One of López’s projects to address health care disparities is called Meeting Kids Where They’re At. Its goal is to design and deliver a culturally–tailored HIV and teen–pregnancy prevention program for African–American girls living in rural areas, and López is quite proud of it.

Cristina López presents at the South Carolina Campaign to Prevent Teen Pregnancy’s annual Summer Institute conference held in Columbia, South Carolina last June. She spoke of the importance of trauma-focused mental health care in mitigating risky behaviors that lead to unplanned pregnancies.

“People who have emotional regulation problems more often engage in high-risk behaviors like substance abuse, unprotected sex and other activities that lead to a higher likelihood of contracting HIV and other sexually–transmitted diseases,” López explained. “This program attempts to short–circuit those cascade effects especially in trauma–exposed populations.”

One unique feature of this project is that it incorporates telemedicine in the delivery of prevention services online. “We want it to work much like Apple’s Facetime where you can sign in and talk to a live person,” López said. “Eighty–five percent of high–school aged populations have Internet access via their smartphones. Why not use the infrastructure that’s already there? That’s why the project is called Meeting Kids Where They’re At, because you can meet them in their homes, in their schools, at their grandmother’s house, without the logistical nightmare of taking time off from work and school and fighting traffic to come to the downtown peninsula.”

It also enables sex education and substance abuse educators to reach kids outside of schools, where comprehensive sex education is seldom a priority. “Research shows that not talking about it is doing your child a disservice,” López said. “The more parents and care providers talk about sex and substance abuse, the better the outcomes are in preventing substance-use disorders and sexually–risky behaviors.”

Ron Acierno, Ph.D., College of Nursing’s associate dean for research, has been López’s mentor on the project and praised her dedication and commitment to breaking down silos. “Cristina is one of the most collaboratively–oriented researchers I know,” he said. “She embodies the spirit of team science by genuinely appreciating that which she can learn from others.”

In addition to facilitating the Meeting Kids Where They’re At program, López serves as the director of the mental health rotation for Stall High School, a Title I school in North Charleston. Schools like Stall are subject to Title I of the federal Elementary and Secondary Education Act, which provides assistance to schools with high percentages of children from low–income families. The student enrollment at Stall High School is greater than 80 percent low-income and almost 90 percent minority. The dropout rate is around 50 percent. “This is definitely a high–needs community,” López said.

López also volunteers as a translator at the Harvest Free Medical Clinic in North Charleston. “It’s been an eye-opening experience,” she said. I often find myself giving referrals and dealing with mental health needs in the course of interpreting for the doctor. I’m not there in my capacity as a psychologist, but I find myself wearing multiple hats because that’s what’s needed.”

Angela Moreland, Ph.D., an assistant professor in the Department of Psychiatry and Behavioral Sciences who works with MUSC’s National Crime Victims Research and Treatment Center, knows López and her work well. “I have worked closely with Cristina on multiple projects focused on reducing health disparities for adolescent and young adult girls,” she said. “I have been consistently impressed with Cristina’s passion for the work that she does and her genuine drive for reducing health disparities and improving the lives of adolescents and young adults.”

Another aspect of López’s work is working with attorneys to process U visa applications, which allow victims of criminal activity such as domestic violence, sexual assault or trafficking to remain in the country legally. “Many victims of domestic violence come from countries where domestic violence is not a crime,” she said. “They don’t know how to come forward or even that they should.”

The current political climate with heated rhetoric around undocumented immigration, she said, makes it even less likely crime victims will come forward.

While many of López’s colleagues praise her selflessness, she doesn’t necessarily see it that way. “I always remember thinking being a psychologist is very selfish,” she said. “Even though it’s very draining sometimes, it’s very gratifying work.”

To be doing that work in Charleston is even better. When she’s not working, López can often be found exploring Charleston’s food and wine scene, taking Zumba classes or recharging at the beach. “I really live in other people’s vacations,” she said. “I’d love to help Charleston become a place where everyone can feel comfortable and safe, enjoying everything this wonderful city has to offer.”

March 18, 2016

 

 
 
 

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