Massachusetts Psychology Ebook Continuing Education

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MASSACHUSETTS Psychology Continuing Education

Elite Learning

This book satisfies all 20 hours of your requirements

20-hour Continuing Education Package $120.00 ELITELEARNING.COM/BOOK Complete this book online with book code: PYMA2024


Chapter 1: Cultural Humility for Behavioral Health Professionals [6 CE Hours] 1 The purpose of this education program is to present an introduction to cultural humility and offers tools for psychologists and mental healthcare professionals to use when working with diverse patients in a culturally humble manner. Chapter 2: Mental Health Concerns and the Older Adult [4 CE Hours] 41 The healthcare worker meeting mental health needs will be able to view the older adult within the context of aging theories and identify interpersonal connection, biopsychosocial elements, and the assessment and treatment for common mental health problems in the older adult. The target audience is any healthcare worker who will assess, intervene, or treat mental health needs of an older adult client. Registered nurses, mental health technicians, mental health providers, case managers, and primary care healthcare workers can benefit from the perspective provided by this course. Chapter 3: Pain Assessment and Management [2 CE Hours] 69 The purpose of this basic-level course is to elaborate on the definition of pain and its perception, factors hampering pain management, assessment of a client for pain, and interventions to improve function in clients with pain. The goal is to provide evidence-based practices that the health professional can use when working with clients who have pain. Chapter 4: Suicidal Ideation and Behavior in the Global Youth Population [4 CE Hours] 85 This course explores suicidal thoughts and behavior in the global youth population. The course aims to merge different research analysis and summaries from different peer-reviewed literatures, therapy guidelines and research institutions with primary focus on the local and urban drivers of suicidal ideation and outcomes in the global youth population. Earlier research attempts to understand the drivers of suicidal trends globally identified a few key risk factors. However, in recent years, general population surveys centered on suicidal thoughts has identified a complex interplay of factors actively driving the triggers, method, and outcomes of suicidal behaviors. Chapter 5: Understanding Obesity and Eating Disorders [4 CE Hours] 117 Eating disorders and obesity are issues that healthcare workers confront on a regular basis. This course provides current information about the disorders, triggers, and strategies to help clients recover from eating disorders and overcome obesity and achieve and maintain a healthy lifestyle for their height and age.

©2024: All Rights Reserved. Materials may not be reproduced without the expressed written permission or consent of Colibri Healthcare, LLC. The materials presented in this course are meant to provide the consumer with general information on the topics covered. The information provided was prepared by professionals with practical knowledge in the areas covered. It is not meant to provide medical, legal or professional services advice. Colibri Healthcare, LLC recommends that you consult a medical, legal or professional services expert licensed in your state. Colibri Healthcare, LLC has made all reasonable efforts to ensure that all content provided in this course is accurate and up to date at the time of printing, but does not represent or warrant that it will apply to your situation or circumstances and assumes no liability from reliance on these materials.



Book Code: PYMA2024


What are the requirements for license renewal?

License Expires

Contact Hours Required

Mandatory Subjects

20 (All allowed through home-study)

Licenses expire June 30 of even years




Chapter 1: Cultural Humility for Behavioral Health Professionals

6 $44.95 PYMA06CH

Chapter 2: Mental Health Concerns and the Older Adult

4 $44.95 PYMA04MH

Chapter 3: Pain Assessment and Management

2 $19.95 PYMA02PA

Chapter 4: Suicidal Ideation and Behavior in the Global Youth Population

4 $34.95 PYMA04SI

Chapter 5: Understanding Obesity and Eating Disorders

4 $34.95 PYMA04ED 20 $120.00 PYMA2024

Best Value - Save $59.75 - All 20 Hours

How do I complete this course and receive my certificate of completion? See the following page for step by step instructions to complete and receive your certificate. Are you a Massachusetts board-approved provider? Colibri Healthcare, LLC is approved by the American Psychological Association to sponsor continuing education for psychologists. Colibri Healthcare, LLC maintains responsibility for this program and its content. Are my hours reported to the Massachusetts board? No, the Massachusetts Board of Registration of Psychologists requires licensees to certify at the time of renewal that he/she has complied with the continuing education requirement. The board performs audits at which time proof of continuing education must be provided by the licensee. Is my information secure? Yes! We use SSL encryption, and we never share your information with third-parties. We are also rated A+ by the National Better Business Bureau. What if I still have questions? What are your business hours? No problem, we have several options for you to choose from! Online at you will see our robust FAQ section that answers many of your questions, simply click FAQs at the top of the page, e-mail us at , or call us toll free at 1-866-653-2119, Monday - Friday 9:00 am - 6:00 pm, Saturday 10:00 am - 4:00 pm EST. Important information for licensees: Always check your state’s board website to determine the number of hours required for renewal, mandatory topics (as these are subject to change), and the amount that may be completed through home-study. Also, make sure that you notify the board of any changes of address. It is important that your most current address is on file.

Licensing board contact information:

The Board of Registration of Psychologists 1000 Washington Street, Suite 710 Boston, MA 02118-6100 Phone (617) 727-9925 | Fax: (617) 727-1627 Website:


Book Code: PYMA2024



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• Follow the online instructions to complete your final exam. Once you finish your purchase, you’ll receive access to your completion certificate. IF YOU’RE ONLY COMPLETING CERTAIN COURSES IN THIS BOOK: • Go to and enter code that corresponds to the course below, then click GO . Each course will need to be completed individually.




All 20 hours in this correspondence book

20 $120.00

Cultural Humility for Behavioral Health Professionals


$44.95 PYMA06CH

Mental Health Concerns and the Older Adult


$44.95 PYMA04MH

Pain Assessment and Management


$19.95 PYMA02PA

Suicidal Ideation and Behavior in the Global Youth Population


$34.95 PYMA04SI

Understanding Obesity and Eating Disorders


$34.95 PYMA04ED

By mail • Fill out the answer sheet and evaluation found in the back of this booklet. Please include a check or credit card information and e-mail address. Mail to Elite, PO Box 37, Ormond Beach, FL 32175 . • Completions will be processed within 2 business days from the date it is received and certificates will be e-mailed to the address provided. • Submissions without a valid e-mail will be mailed to the address provided.

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Book Code: PYMA2024

Chapter 1: Cultural Humility for Behavioral Health Professionals 6 CE Hours

Release Date: July 10, 2023 Expire Date: July 10, 2027 Upon successful completion of this course, continuing education hours will be awarded as follows: Social Workers and Psychologists: 6 Hours Professional Counselors: 6 Hours Author

Dr. Jameca Woody Cooper is a Counseling psychologist, educator, entrepreneur, author, and civic leader. Dr. Jameca holds a master’s and Ph.D. in Counseling Psychology from the University of Missouri Columbia. Her company, Emergence Psychological Services, has served the Saint Louis community for

the past sixteen years. She is a Fulbright Fellow in Global Health and has been featured in The Washington Post, The Wall Street Journal, CNBC, NBC, ABC news, WebMD, and USA Today. Dr. Jameca Woody Cooper has no significant financial or other conflicts of interest pertaining to this course. ● Provide required personal information and payment information. ● Complete the mandatory Course Evaluation. ● Print your Certificate of Completion. Sponsorship/commercial support and non-endorsement It is the policy of Colibri Healthcare, LLC not to accept commercial support. Furthermore, commercial interests are prohibited from distributing or providing access to this activity to learners.

How to receive credit ● Read the entire course online or in print.

● Answer the final examination questions at the end of the course. A passing grade of 75% is required. Test questions link content to learning objectives as a method to enhance individualized learning and material retention.

Disclosures Resolution of conflict of interest

Colibri Healthcare, LLC implemented mechanisms prior to the planning and implementation of the continuing education activity, to identify and resolve conflicts of interest for all individuals in a position to control content of the course activity. Disclaimer The information provided in this activity is for continuing education purposes only and is not meant to substitute for the independent medical judgment of a healthcare provider relative

to diagnostic and treatment options of a specific patient’s medical condition.

©2024: All Rights Reserved. Materials may not be reproduced without the expressed written permission or consent of Colibri Healthcare, LLC. The materials presented in this course are meant to provide the consumer with general information on the topics covered. The information provided was prepared by professionals with practical knowledge of the areas covered. It is not meant to provide medical, legal, or professional advice. Colibri Healthcare, LLC recommends that you consult a medical, legal, or professional services expert licensed in your state. Colibri Healthcare, LLC has made all reasonable efforts to ensure that all content provided in this course is accurate and up to date at the time of printing, but does not represent or warrant that it will apply to your situation nor circumstances and assumes no liability from reliance on these materials. Quotes are collected from customer feedback surveys. The models are intended to be representative and not actual customers. Learning objectives After completing this course, the learner will be able to: Š Describe dimensions of diversity in the United States (U.S.).

Š Explain cultural humility as an essential part of counseling, including core components and key considerations. Š Describe the role of societal and institutional accountability within the counseling context. Š Differentiate cultural humility and multicultural competency. Š Illustrate the different elements of cultural humility. Š Examine the cultural variables that impact help-seeking. Addressing implicit bias in healthcare is crucial for achieving equity in medical treatment. Strategies to combat these biases involve education and awareness programs for healthcare professionals. These programs help individuals recognize and acknowledge their biases, fostering a more empathetic and unbiased approach to patient care. Additionally, implementing policies and procedures prioritizing equitable treatment for all patients can play a pivotal role in reducing healthcare disparities. Ultimately, confronting implicit bias in healthcare is essential to creating a more just and equitable healthcare system where everyone receives fair and equal treatment regardless of their background or characteristics.

Š Identify factors that can interfere with the counseling relationship between a clinician and clients of diverse cultural backgrounds, including issues related to oppression, privilege, and marginalization. Implicit in Healthcare Implicit bias significantly affects how healthcare professionals perceive and make treatment decisions, ultimately resulting in disparities in health outcomes. These biases, often unconscious and unintentional, can shape behavior and produce differences in medical care along various lines, including race, ethnicity, gender identity, sexual orientation, age, and socioeconomic status. Healthcare disparities stemming from implicit bias can manifest in several ways. For example, a healthcare provider might unconsciously give less attention to a patient or make assumptions about their medical needs based on race, gender, or age. The unconscious assumptions can lead to delayed or inadequate care, misdiagnoses, or inappropriate treatments, all of which can adversely impact health outcomes. Course overview The purpose of this education program is to present an introduction to cultural humility and offers tools for psychologists

and mental healthcare professionals to use when working with diverse patients in a culturally humble manner.

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Book Code: PYMA2024


The American population is highly diverse. In the upcoming years, the U.S. will continue to increase in diversity. The U.S. Census Bureau projects that by 2050 the U.S. population will look different. Estimates say that Hispanic, Asian, and African American populations will grow (Culverhouse College of Business, 2019). “In 2020, 33.8 million people reported being more than one race, more than a threefold increase from 2010, when 9 million people, or 2.9% of the population, identified that way.” (Quarshie & Slack, 2021). Professionals engaged in counseling must become increasingly self-aware. They must understand how their unique individual experiences influence their worldviews and values and how the unique personal experiences of their clients influence each client’s worldviews and values. Further, various ethnic and racial groups may have diverse beliefs, social structures, interactional patterns, and expectations. There are various types of diversity, including age, economic class, sexuality, gender identification, and disability. Because of these factors, counselors should cultivate cultural humility skills. Counselors who practice cultural humility use four intersecting elements of ongoing self-reflection, self-critique, lifelong learning, and a commitment to advocacy and institutional change to guide their work with clients (Hook et al., 2013; Ratts et al., 2015). The cultural humility framework recognizes the concepts of power, privilege, and oppression and, thus, calls on counselors to be agents for change and promoters of social justice (Ratts et al., 2015). Counselors with humility can be “other-focused” and accurately view themselves, their values, and their biases (Davis et al., 2013). These qualities allow counselors to practice as partners with clients from various ethnic and racial backgrounds and other dimensions of diversity. Culturally humble counselors can recognize their own beliefs and values and act as allies with clients working toward positive personal and more considerable societal change (Hook et al., 2013). It helps develop cultural humility that counselors understand the sociopolitical landscape in the U.S. concerning issues of race, immigration/refugee status, disability, sexual orientation, gender identification, and socioeconomic class (Ratts et al., 2015). The 2016 presidential election has revealed the continued deep divisions within our country regarding attitudes toward racial and ethnic diversity, disability, sexual orientation, and

gender identification. The Southern Poverty Law Center (2016) has reported an increase in incidents of both harassment and intimidation during and after the election. These incidents have been perpetrated against various minority groups, including African Americans, immigrants, and the lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ) population, Jewish individuals, and Muslims (Miller & Werner-Winslow, 2016). In the U.S., there are significant economic, health, education, employment, and housing disparities based on minority status (Agency for Healthcare Quality and Research [AHQR], 2015; Orfield, Frankenburg, & Siegel-Hawley, 2016; Proctor, Semega, & Kollar, 2016; Turner et al., 2013). Minority status, as used in this course, pertains to race and ethnicity and belonging to any marginalized group, such as having a disability; identifying as transgender, lesbian, gay, or bisexual; ascribing to a minority religion; and so on. Social disparities in access to resources and experiencing acts of racism and discrimination can lead to higher stress and a higher risk of developing mental health issues. Despite an increased need for services, clients with marginalized identities have less access to quality mental health services (AHQR, 2015, 2016). This highlights the ethical responsibility of counselors to develop multicultural and social justice counseling competencies to work with clients effectively. Cultural humility in counseling goes beyond counselors knowing specific cultural and minority groups with whom they work. It is a way of practicing counseling that requires counselors to be aware of how their own culturally embedded ideals, beliefs, and prejudices affect their interactions with diverse clients (Hook et al., 2013). This requires counselors to reflect on themselves and their interactions continually and critically with clients. Through reflection, counselors can improve interactions with clients through honest appraisals of how their personal biases and deficits play into each counseling session and each relationship, allowing them to address power imbalances within the counseling relationships and institutional levels. This intermediate-level course presents an introduction to cultural humility and offers tools for practitioners. It offers mental health counselors, marriage and family therapists, and psychologist’s tools to use in working with diverse clients in a culturally humble manner.


What is cultural humility? Cultural humility is defined as having an open-minded attitude when learning about the elements of other cultures (MasterClass, 2022). Cultural humility is going beyond the regular diversity training and being intentional about learning about different cultures instead of relying on one’s own reading or study. It is not enough to think about our values, beliefs, and social position in today’s context. To practice true cultural humility, a person must also be aware of and sensitive to historical realities like legacies of violence and oppression against certain groups of people. According to Tervalon and Murray-Garcia (1998), cultural humility is defined as a “process that requires humility as individuals continually engage in self- reflection and self-critique as lifelong learners and reflective practitioners.” Tervalon and Murray-Garcia represent cultural humility as a lifelong commitment to self-evaluation and self- critique, balancing power, and advocacy. When practitioners commit to lifelong self-evaluation, this implies a position of humility and willingness to learn, even when learning may be difficult or uncomfortable. Balancing of power suggests a respectful partnership with patients and families that values their self-knowledge and lived experiences alongside our expertise in our field. Finally, advocacy involves individuals moving beyond the interpersonal to impact larger (i.e., institutional, structural) systems. Figure 1 shows the different components of cultural humility defined by Tervalon and Murray-Garcia.

Figure 1. The Five Rs of Cultural Humility

Note . Adapted from “Cultural humility versus cultural competence: A critical distinction in defining physician training outcomes in multicultural education,” by Tervalon, M., et al.,1998. Journal of Health Care for the Poor and Underserved, 9(2), 117–125.

Book Code: PYMA2024

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Diversity is a multidimensional concept that refers to many aspects of an individual that combine to comprise an overall sense of self. The U.S. continues growing and becoming a country where all cultural groups are represented. The past several censuses have shown increased racial and ethnic diversity among the U.S. population. The latest Census Bureau estimates indicate that nearly 4 of 10 Americans identify with a race or ethnic group other than White and suggest that 2010 to 2020 will be the first in the nation’s history in which the White population declined in numbers. In 2019, most of the nation’s population under 16 identified as a racial or ethnic minority. This group, Latino or Hispanic and Black individuals, comprise nearly 40% of the population (Frey, 2020). Moreover, diversity occurs within a cultural and social context where variances within the general population are treated differently based on society’s social, political, and cultural constructs. Some dimensions of diversity include race, socioeconomic class, gender, sexual orientation (i.e., identifying as lesbian, gay, bisexual, transgender, queer/ questioning [LGBTQ]), gender identification (i.e., identifying as transgender), and disability. Although this is not an exhaustive list of all elements of individual diversity, it does address many prominent diversities dimensions an individual may have and determine where that individual falls within the societal hierarchy. Dimensions of diversity also empower some members of society while oppressing and marginalizing other members of society (Sue & Sue, 2016). Counselors need to understand the effects of diversity on a client in multiple domains, including a client’s mental health and well-being. In some instances, a client’s identity constructs may be a source of great strength, and in other contexts, they may contribute to increased stress. For example, on a micro level, simply being different increases the threat of victimization and bullying (Tippett & Wolke, 2014). When individuals differ from the majority group, a concept referred to as “person–group dissimilarity” (Juvonen & Galvan, 2009, p. 300), they are at risk of victimization. For instance, being the only individual in a school, workplace, or community group who possesses a particular trait increases the risk of victimization, Race and Ethnicity Race is a human-invented, shorthand term used to describe and categorize people into various social groups based on characteristics like skin color, physical features, and genetic heredity. Cultural humility is essential as it relates to diversity. People think diversity in the U.S. and automatically only associate diversity with racial or ethnic differences. In 2020, the White population is still the majority race in the U.S. representing 59.7% of the U.S. population (Frey, 2022).

regardless of the trait (e.g., race, religion, socioeconomic status, LGBTQ, appearance). Children with special needs and physical disabilities are consistently at an increased risk of victimization (Fegert et al., 2020). Adults who are members of a minority group suffer from higher rates of bullying (Lewis, Giga, & Hoel, 2011). Some minority workers have been shown to endure a bullying rate that is two to three times higher than that of their nonminority coworkers (Lewis et al., 2011). Namie, Christensen, and Phillips (2014) found that Hispanic Americans, African Americans, and Asian Americans all experienced higher rates of workplace bullying, both witnessing and targeting, than White Americans and that their group rates were each higher than the national average. As in school settings, differences of any type increase a person’s risk of being bullied or experiencing other forms of victimization. For decades, “social psychologists have repeatedly demonstrated that individuals who do not belong to the group are devalued.” They are more likely to be used as scapegoats in the workplace (Zapf & Einarsen, 2011, p. 188). Being isolated, bullied, or oppressed can negatively impact your mental health. Bullying and mental health are closely related. Victims of teenage bullying tend to go through severe emotional trauma. They often feel helpless, lonely, bitter, isolated, angry, frustrated, vulnerable, and anxious. Victims of depression from bullying often carry the after-effects deep into adulthood. They might have ongoing self-esteem issues, continue struggling to form lasting relationships, and start avoiding social interaction as much as possible. They often also find it difficult to trust others, impacting their personal and career relationships. Likewise, adult victims of workplace bullying, or community oppression, will show signs of severe stress (Warszewska-Makuch, 2020). In a study examining the effects of workplace bullying, findings reveal perceived bullying was associated with mental health problems, including psychological distress, depression, and burnout, and physical health problems, including insomnia and headache (Lever et al., 2019). They show that bullied staff took more sick leave. As such, the context of a client’s diversity elements may directly affect the client’s reasons for presenting to counseling in the first place. However, numbers in that demographic in the U.S. have been dropping since 1950 and will continue to go down. By 2030, estimates state that White people will have dropped to 55.8% of the population, and Hispanic peoples will have grown to 21.1%. The percentage of Black and Asian American peoples will also increase significantly. Also, between now and 2030, White people as a proportion of the population will get smaller, and the minority race groups will all keep getting bigger (Frey, 2022). See Figure 2.

Figure 2. United States Growing Diversity 2010-2020

Note . Adapted from Frey, W. H. (2022). According to new census data, the nation diversifies even faster than predicted. ( research/new-census-data-shows-the-nation-is-diversifying-even-faster-than-predicted/)..

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Book Code: PYMA2024

Immigration The U.S. is a nation of immigrants. In the past decade, there has been increasing attention focused on immigrants and refugees in this country. While the racial, ethnic, and immigrant diversity within American society is often cited as one of its greatest strengths, it has also been a challenge for America and for Americans in terms of fully accepting and embracing the broad array of immigrant groups that have become American. Since 1965, the number of immigrants in the U.S. has quadrupled (Budiman, 2020). Individuals from all different parts of the world desire to immigrate to the U.S. in search of increased opportunities. Immigration can be a hazardous, long, and dramatic process. Thus, many immigrants will have various experiences of loss, adjustment, and abuse (Budiman, 2020). Historically, every new immigrant group has experienced various degrees of prejudicial and discriminatory treatment and exclusion from mainstream society. However, the experience of many European (e.g., Irish, Italian, German) immigrants was one of initial discrimination followed by swift acculturation and assimilation, likely aided by the physical appearance and language similarities to those of earlier settlers (Brown & Bean, 2006). Asian and Latina/o immigrants have experienced prejudicial treatment due to readily identifiable physical and language differences. Historical evidence of mistreatment is well documented, with perhaps one of the most egregious examples being the internment of Japanese Americans during World War II (Nagata, Kim, & Nguyen, 2015). Americans often think of the journey of voluntary immigration of the many ethnic groups that come to America to build a “better” life. However, many immigrants arrive in this country due to war, famine, and natural disasters (Bunch, 2016; Coates, 2014). For instance, the legacy of the forced immigration of enslaved Black Americans is often overlooked. Black Americans endured 250 years of enslavement followed by 60 years of “separate but equal” status and continuing racist practices in our education, housing, health, and criminal justice systems (Bunch, 2016; Coates, 2014). Black Americans’ systemic and continuous oppression is a direct legacy of this forced immigration and has resulted in enduring educational, health, and wealth disparities (Bunch, 2016; Coates, 2014). Culture plays an extremely relevant role in counseling and psychotherapy. Immigration is a dominant event in a person’s life, shaping and distorting everything that comes before and after. Changing countries results in unique challenges at any age. Neighborhood relationships are particularly critical for new immigrants because many aspects of the new environment can be disorienting (Bunch, 2016; Coates, 2014). Living in ethnic communities protects immigrants from cultural isolation and benefits their initial psychological adjustment. However, pressure to assimilate may be strong outside their ethnic group, resulting in discrimination and its negative consequences. Within immigrant and refugee communities, collectivist cultural backgrounds prevail. The experience of psychological illness is often attributed to culture-specific or religious phenomena or both. Thus, in many immigrants or refugee cultures, conditions or disease are not considered positioned in the body or mind alone but may be seen as drawing on physical, supernatural, and moral realms (Sue & Sue, 2016). Mental illness may be understood heavily by ancestors and spirits rather than internal emotional factors. This creates an exciting position that workers need to both acknowledge and respect. While practitioners do not need to agree with or practice these beliefs, providers are expected to withhold judgment and support clients and their values. Even immigrants who have lived in the U.S. for a long time and who appear to have adopted the American lifestyle may maintain strong identification with, and hold the values of, their culture of origin (Korngold, 2009). Integrating the social and cultural values, ideas, beliefs, and behavioral patterns of the culture of origin with those of the new culture may lead to acculturation stresses. These stresses can cause or

increase mental health difficulties, such as anxiety, depression, post-traumatic stress disorder (PTSD), substance abuse, suicidal ideation, and others (Korngold, 2009). Acculturation involves changes in many aspects of immigrants’ lives, such as language, cultural identity, attitudes and values, ethnic pride, types of food and music preferred, media use, social and ethnic relations, cultural familiarity, and social customs (Korngold, 2009). Acculturation may occur in stages, with immigrants learning the new language first, followed by gradual participation in the new culture (Korngold, 2009). While some settings, such as workplaces or schools, are predominantly culturally American, others, such as an immigrant’s ethnic neighborhood and home environment, predominantly comprise the heritage culture (Korngold, 2009). Many immigrants and refugees are also unaware that there are professionals, such as counselors, who can help them navigate this strange new landscape (Korngold, 2009). Those who work with these populations say that as part of the cultural diversity that the counseling profession has embraced, counselors have a responsibility to help immigrants and refugees with everyday challenges associated with community, school, work, health care, and other systems. Therefore, as a mental health professional, you must adopt an open mind regarding the immigration experiences the individuals have. Challenges Immigrant communities encounter many challenges, including discrimination, such as being told to “go back to your own country,” language difficulties as many immigrants do not speak English upon their arrival, lower access to healthcare due to lower-paying jobs without benefits, and visa issues as some immigrants are undocumented, among many others (NAMI, 2019). There is also the added challenge of isolation from the larger national community. Many immigrant families live close to their immigrant community, which may reinforce a sense of separation (NAMI, 2019). Coping with these challenges can lead to mental health issues or mental illness, particularly for those with a pre-existing biological vulnerability to a mental illness. Common stereotypes of immigrants that they are less educated, more blue-collar, and more conservative can adversely impact mental health (NAMI, 2019). To avoid these perceptions, immigrants may feel a need to disassociate from their immigrant community. This may lead to a loss of network support, a risk factor for mental health issues (NAMI, 2019). Immigrants may not feel accepted in the U.S. Finding their “tribe” and developing an identity could be a long and challenging process, complicated and troublesome for mental health. A sense of belonging can be critical to good mental health. A lack of cultural competency and confidence is also a challenge for immigrants. Many immigrants and refugees report that when they have discussed their cultural upbringing and experiences with practitioners, they have been minimized, misunderstood, and dismissed (NAMI, 2019). The challenges are even more significant for those who cannot speak when and when they see a doctor or therapist; expressing emotions in their nonnative language can be challenging (NAMI, 2019). Translation can help, but a therapist might provide a more robust understanding of cultural context to help a patient. Different dialects can also complicate translation. Many immigrants are far less likely to seek treatment or trust a healthcare provider due to a lack of cultural understanding and competency. Cultural competence involves learning and maturation processes related to children’s inborn unique capacity to adapt to various social and cultural circumstances, including bi- and multicultural contexts. By mentally switching between different cultural codes (scripts or schemas), they accommodate their behaviors to the demands of the context. Counselors’ understanding of the differential treatment of current and past immigrant groups based on their ethnic, racial, religious, and linguistic backgrounds is paramount to their

Book Code: PYMA2024

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knowledge of their clients. How individuals and groups are treated from a sociopolitical (macro) level and a daily individual interactional level (micro) affects their views and understanding of the world in which they live. From a person-in-environment perspective, individuals act upon the environment, and the environment acts and reacts to the individual. Thus, while individuals help shape the environment around them, the environment also shapes the individual (Zastrow, Kirst-Ashman, & Hessenauer, 2019). A demographic breakdown of the diversity in the U.S. is provided in Table 1. This breakdown may help counselors better conceptualize clients’ diverse experiences. Table 1 summarizes the U.S. population by race/ethnicity. Table 1: U.S. Population by Ethnicity and Race: 2020 Race/Ethnicity Percentage White 57.8% Hispanic 18.7% Black 12.4% Asian 6% Note : Adapted from US Census: US sees unprecedented multiracial growth, the decline in the White population for first time in history. USA TODAY. politics/2021/08/12/how-2020-census-change-how-we-look-america- what-expect/5493043001/ Poverty The percentage of individuals living in poverty in the U.S. is 13.5% (Proctor et al., 2016). However, poverty is not equally distributed throughout the American population. Women, children, and racial and ethnic minorities experience poverty more often than men, working adults, and White people; individuals with disabilities experience poverty more often than those without current disabilities (Institute on Disability, 2016; Proctor et al., 2016; Tucker & Lowell, 2016; U.S. Census Bureau, 2015). The unequal distribution of poverty across the population reflects the disparities in opportunities these populations experience throughout their lives. Some examples of the difference in opportunities include a disproportionate number of racial and ethnic minorities living in low-income neighborhoods and experiencing insufficient educational opportunities, as well as women continuing to earn less than men (the most current data concludes that women earn 81 cents for every dollar men earn; Bureau of Labor Statistics, 2016; Mode, Evans, & Zonderman, 2016). Research shows that the poverty rate in the U.S. is increasing. Healthcare professionals must be aware of data relating to poverty and work to decrease the growing problem of poverty. Poverty is closely connected with poorer mental health in societies across the world (Ridley et al., 2020). Poverty is associated with volatile income and expenditures. Poverty can strain a person’s physical and mental health. Many low-income people work long hours to pay bills and provide for their families. This lifestyle can impose immense stress and reduce a person’s cognitive ability. The resulting worries and uncertainty can exacerbate mental health. Ridley et al. (2020) examine the connection between poverty and mental illness. They note that poor mental health can result from the fear and reality of poverty. “The anticipation of economic shocks, not just their occurrence, may cause mental illness. People living in poverty face substantial uncertainty and income volatility and juggle what are, in effect, complex financial portfolios, often without access to formal insurance… Sustained long-run exposure to stress from managing this volatility may threaten mental health.” Ridley concludes that mental illness could increase a person’s risk of poverty, for example, “by capturing attention, causing excessive rumination and distorting people’s memories and beliefs about their abilities.” Depression, they suggest, may cause people to

Clinicians must be careful not to make sweeping generalizations regarding any population. For instance, Latin American immigrants (the most significant number of immigrants in 2010) come from many countries: 29.3% from Mexico, 7.6% from other Central American countries, and 9.3% from the Caribbean Islands (U.S. Census Bureau, 2012). Further, clients are influenced by various factors, including the level of acculturation (to be discussed later), immigration experience, experiences with discrimination, and ability to speak English. Therefore, clinicians must ask clients about their personal experiences and significant life events. Some cultural generalizations may help clinicians increase their knowledge of specific cultures and enhance their understanding of a portion of clients’ differing experiences. However, this is not intended to shift the clinician’s focus away from developing a better understanding of the dynamics of race, immigration, and other facets of diversity within the current social, economic, and political environment of the U.S. Clinicians are better prepared to understand and understand and help the natural climate in which their diverse clients live and that climate’s role in accommodating or marginalizing them. Moreover, it will be better for counselors to help their clients if they understand how they are accommodated and marginalized by American culture. Race, ethnicity, and immigration status are a few facets of diversity affecting clients. Diversity includes socioeconomic status, disability, sexual orientation, religion, and gender identification. These facets of diversity can serve as dimensions that marginalize and oppress individuals. have diminished belief in their abilities, while anxiety may cause someone to be more risk-averse in the labor market. Women in Poverty More women than men are living in poverty in the U.S. Men who have migrated for employment or to avoid conscripted military work often have left women behind. Migrating across hundreds of miles and rugged terrain is not feasible for women and children. Basic information about women in poverty includes the following (Bleiweis et al., 2020): ● Of the 38.1 million people living in poverty in 2018, 56%, or 21.4 million, were women. ● Nearly 10 million women live in deep poverty, falling below 50% of the federal poverty line. ● The highest poverty rates are experienced by Native American Indian or Alaska Native (AIAN) women, Black women, and Latinas. About one in four AIAN women live in poverty. This is the highest poverty rate among women or men of any racial or ethnic group. ● Unmarried mothers have higher poverty rates than married women, with or without children, and unmarried women without children. Nearly 25% of unmarried mothers live below the poverty line. ● Women with disabilities are more likely to live in poverty than both men with disabilities and persons without disabilities. Women with disabilities have a poverty rate of 22.9%, compared to 17.9% for men with disabilities and 11.4% for women without disabilities. Reasons Why Women Live in Poverty. The impact of sexism and racism on society limits women’s employment opportunities. Some of the causes of poverty in women include the following issues. Occupational Segregation into Low-Paying Jobs. Women are disproportionately represented in certain occupations, especially low-paying jobs. This is due, in part, to the perception of gender roles that assume women’s work is low-skilled and undervalued. This is especially true for women of color (Bleiweis et al., 2020). Lack of Work-Family Policies. Issues such as insufficient paid family and medical and earned sick leave impact women’s ability to manage work and caregiving. Childcare is expensive and sometimes hard to access.

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Book Code: PYMA2024

COVID-19 and Poverty According to new research, 74.7 million people have lost work since the start of the pandemic, with the majority of jobs lost in industries that pay below-average wages. Many who lost work and income are running out of money and savings. In January 2022, some 24 million adults reported experiencing hunger, and more than 6 million said they feared being evicted or foreclosed on in the next two months due to their inability to make housing payments. By contrast, higher-income people have been relatively unscathed economically (United States: Pandemic Impact on People in Poverty, 2022). Living in a stressful state of poverty can worsen mental illness or ignite it. The instability that often accompanies mental illness can also lead to poverty. The cycle continues and grows as more people deal with the pandemic’s physical, financial, and emotional impacts. low, as research consistently documents the challenges of obtaining accurate measures of mental health in older adults due to underdiagnosis, varied definitions of the terms “mental health” and “older adult,” and different sampling methods for individuals living in the community compared to those who are homeless or living in nursing home settings (Krajci & Golden, 2019). According to the National Institute of Mental Health (NIMH), major depression is one of the most common mental disorders in the U.S., and it carries the heaviest burden of disability among mental and behavioral disorders (Depression, 2022). Along with cognitive symptoms, experiencing a depressed mood, loss of pleasure in activities, significant weight loss or gain, decrease or increase in appetite, sleeping too much or too little, fatigue, feelings of worthlessness, or excessive or inappropriate guilt, is a serious situation and requires intervention by a professional. But depression, like many other ailments, often manifests differently in the elderly compared with younger people. For example, an older person who is depressed doesn’t necessarily feel sad but may complain of lack of energy and attribute symptoms to age. That can make it trickier for doctors, loved ones, and older people themselves to spot depression. The fact that certain medications and medical illnesses can bring on depression or mimic it also complicates matters, making it tough to know when to get crucial help. The complex interaction between age-related conditions and mental health symptoms frequently complicates accurate identification, diagnosis, and treatment in older adulthood (Krajci & Golden, 2019). The impacts of these circumstances often mimic formal mental health diagnoses that need treatment and vice versa. For example, in an older adult with multiple losses, it may be difficult to determine if his or her reactions are normative grief or depression. Memory problems may be depression, early signs of dementia, or complications from medical conditions or medication side effects. Isolation and withdrawal from usual activities may be due to depression, dementia, physical impairments, or hearing loss (Krajci & Golden, 2019). These confusing overlays, especially when coupled with ageist stereotypes, complicate assessment and care planning. In fact, studies show that 40–90% of older adult mental health concerns are not detected in primary care, the setting where the majority of individuals, regardless of age, obtain mental health treatment (Krajci & Golden, 2019). Suffering from a mental illness as an older adult is associated with a great deal of stigma. One issue that can make older people reluctant to get treatment for depression or make it tough for those who love them to coax them to go to a doctor is the belief that getting treatment for depression is a sign of weakness or lack of moral fiber. Due to stigma, misinformation, and false beliefs about aging, they frequently go without

These issues further compound problems associated with work–family challenges. The coronavirus has exacerbated the caregiving burden on women because of essential school and childcare provider closures, which contribute to job loss among women (Bleiweis et al., 2020). Disability. A disability may cause, as well as be a consequence, poverty. People with disabilities must deal with barriers to employment and lower earnings. Only 16.4% of women with disabilities were employed in 2018, compared with 60.2% without a disability (Bleiweis et al., 2020). Self-Assessment Question 1 Which of the following persons is most likely to live in poverty? a. A woman who self-identifies as Alaska Native. Age Aging is a gradual, continuous process of natural change that begins in early adulthood. During early middle age, many bodily functions begin to gradually decline. People do not become old or elderly at any specific age. Traditionally, age 65 has been designated as the beginning of old age. The U.S. is getting older each decade. Estimates state that there will be almost as many older adults as young people ten years from now. People worldwide are living longer. Given the size of the Baby Boomer population, older adults are a growing proportion of our nation. People live longer, healthier, and more productively than previous generations. Today most people can expect to live into their 60s and beyond. Every country in the world is experiencing growth in both the size and the proportion of older people in the population. (Aging and Health, 2022). Older adults in this country are living longer. According to demographers at the U.S. Census Bureau, the number of centenarians in the U.S. grew from over 53,000 in 2010 to over 90,000 in 2020. By 2030, there will most likely be over 130,000 centenarians in the U.S. (Poston, 2020). The average life expectancy of Americans has been increasing dramatically over the past century. A male child born in 1900 could expect to live only 46 years, and a female child, 48 years. In 2019, the average life expectancy in the U.S. for the total population was 79 years. Although much of this gain can be attributed to the significant decrease in childhood mortality, life expectancy at every age beyond 40 has also increased dramatically. For example, a 65-year-old man can now expect to live to about age 83, and a 65-year-old woman to about age 86 (Stefanacci, 2022). Overall, women live about 5 years longer than men (Stefanacci, 2022). b. A man who is 45 years of age. c. A married man with two children. d. An unmarried woman without children. Exactly what constitutes normal aging is not always clear. Nevertheless, aging leads to a gradual decrease in physical and mental capacity, a growing risk of disease, and death. Common conditions in older age include hearing loss, cataracts, refractive errors, back and neck pain and osteoarthritis, chronic obstructive pulmonary disease, diabetes, depression, and dementia. As people age, they are more likely to experience several conditions simultaneously. While these circumstances can occur at any time during a person's life, they are more likely both to occur and to be a consistent presence in the life of an older adult. If the older adult is not able to cope effectively with the cumulative effects of these stressors, mental health concerns may be triggered or perpetuated. Mental health issues impact older adults. Mental health is a key element of overall health and well-being in older adulthood. Individuals with mental health needs face significant impacts on daily functioning, socialization, meaningful relationships, and health and safety. While not a normal part of aging, in 2017 roughly 20% of adults over 60 suffered from a mental health or neurological disorder. In fact, this estimate may be

Book Code: PYMA2024

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