Hogg Foundation Moore Fellowship Recipient Completes Dissertation

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Courtney Valentine
Courtney Valentine

by Ike Evans

Courtney Valentine, a doctoral candidate in the Department of Educational Psychology at The University of Texas at Austin, and a 2014 recipient of the Harry E. and Bernice M. Moore Fellowship from the Hogg Foundation, has recently completed her dissertation, “The Impact of Post-Traumatic Stress Symptoms and Protective Factors on Transition Factors for Youth Investigated for Maltreatment During Adolescence.” Her study is an important contribution to the literature on transition-age youth (TAY), young adults who are transitioning out of the foster care system.

Since its establishment in 1995, the Harry E. and Bernice M. Moore Fellowship has been awarded to students from The University of Texas at Austin to complete a dissertation on the human experience in crises resulting from natural or other major disasters or, in a broader sense, stress and adversity.

In recent years, the Hogg Foundation has made identifying and addressing the needs of TAY a strategic priority of its grantmaking. This interest is driven by research and experience that shows that TAY with mental health conditions require special services and supports in order to cope with the challenges of aging out of one system and transitioning into a new adult system that may not be prepared to meet their developmental needs. In 2013, the foundation launched its Transition-Age Youth and Families initiative, with a focus on Houston/Harris County.

We spoke with Courtney Valentine about her research.

Tell us about yourself. At what point did you decide to pursue this particular line of research, and what influenced that decision?

I joined the Jesuit Volunteer Corps after college and spent the year a case manager in a group home for foster and probation adolescents. My job was to help many of the youth transition out of foster care. I realized then how vulnerable this population is and how many services are needed to help these youth. I have continued to work with transitioning aged foster youth as a CASA volunteer and therapist for many years.

Your dissertation is titled, “The Impact of Post-Traumatic Stress Symptoms and Protective Factors on Transition Factors for Youth Investigated for Maltreatment During Adolescence.” What questions are you trying to answer with this work?

I was interested in better understanding things that influenced youth’s successful transition to adulthood from foster care. Specifically, I was interested in the role of trauma and other protective factors impacting this transition.

What gap in the literature will be filled by your study? Who stands to benefit from it?

I hope that this study will highlight the importance of protective factors for adolescents in the foster care system. This study is unique in its inclusion of both risk and protective factors in the process. The aim of this study is to inform both future research and practice for this vulnerable population.

How do you think your research methods and approach will help you to answer the questions that you’re posing?

I chose to use latent variable structural equation modeling (SEM) for my analysis because it allows for the construction of causal models based on previous research and theory to estimate not only direct effects between variables, but also indirect effects of mediating variables, which allows further understanding of how one variable affects another. In addition, latent variable SEM allows for the estimation of latent variables using multiple measured indicators to more closely approximate the construct being tested.

Are there any suggested readings you can recommend for those who might be interested in learning more about the topic?

The National Child Traumatic Stress Network’s website has many wonderful free resources for children, parents, teachers, and clinicians.

Creating Model Healthy Communities

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Dr. Martinez, executive director of Hogg Foundation
Dr. Octavio N. Martinez, Jr.

by Octavio N. Martinez, Jr.

In September and October of 2014, the Hogg Foundation — along with the Bernard and Audre Rapoport Center for Human Rights and Justice at the UT School of Law, the Dell Medical School, and the St. DavidCenter for Health Promotion and Disease Prevention Research in Underserved Populations —brought together scholars and a diverse group of leaders in health promotion for two half-day summits on the theme of “Creating Model Health Communities.”

The goal for both summits was to build on the tremendous work that had already been done by many people and organizations inside and outside the university to address health inequities, and to catalyze new ideas and innovative collaborations that might contribute to the future of Austin and Travis County as model health (and healthy) communities.

Because the events were among the first in which the Dell Medical School would participate, the goal was also to help the new school connect with existing health stakeholders in Austin-Travis County and to begin the process of defining the particular role it would play within the broader health ecosystem.

This report aims to distill the presentations and conversations that took place at the summits. It also offers some recommendations for harnessing the wealth of expertise and resources among medical, academic, and community partners in Central Texas to ensure future coordination and cooperation. These recommendations include:

  • Any AustinTravis County model health community must be guided by principles of equity and social justice, focused on the social determinants of health. 
  •  Innovative, interdisciplinary pilot programs should be fostered to address priority health concerns.
  • To ensure the integration of existing work with new diverse collaborations and partnerships, an advisory committee should be created with the goal of making AustinTravis County a model health community.
  • The advisory committee should consider the feasibility of developing ainformationsharing platform to be built from existing databases in AustinTravis County.
  • Interdisciplinary and crosssectoral (education, housing, racial equity) working groups should be formed around specific priority health issues to encourage further collaboration among individuals and entities working on seemingly disparate areas.

These principles and recommendations aren’t intended to be a rigid prescription for how to move forward, toward the shared goal of model healthy communities, but rather to add to the ongoing conversation. To that end, I’d also like to encourage readers to attend the upcoming conference (October 1) hosted by Partners in Austin Transforming Health (PATH), which consists of academic, health service and community partners committed to developing collaborative efforts to promote health equity.

The conference, which is free and open to the public, is on the theme of Social Inequality and Health. To register please go to: http://centexpath.org/conference.

Celebrating National Recovery Month

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sunlit road

by Rick Ybarra

National Recovery Month (Recovery Month) is a national observance held every September to increase awareness that mental health services and substance use treatment can enable those with a mental and/or substance use condition to live a healthy, productive and rewarding life and become a contributing member of our community and society.

Not only does the Hogg Foundation for Mental Health wholeheartedly embrace these convictions, but through our grantmaking and advocacy, we are ensuring that these convictions gain a secure foothold in the Texas mental health and health care landscape.

Here is the evidence: there are millions of people whose lives have been transformed through recovery. Contributing to the recovery movement are the advances of psychosocial treatments, evidenced based practices, innovations such as integrated health care, peer and recovery supports, and improved psychopharmacological interventions. But the main driver is people: people who begin their journey of recovery, families that support their loved ones, and communities who embrace that recovery is possible.

The main take-away is this: behavioral health is essential to overall health, prevention works, treatment is effective, and people can and do recover.

The Substance Abuse and Mental Health Services Administration (SAMHSA) has a webpage dedicated to National Recovery Month: http://www.recoverymonth.gov/home.

Spread the word and let’s celebrate National Recovery Month together! Recovery happens! Recovery is possible!

Parity: The Basics

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by Alison Mohr

The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) is one of the most impactful pieces of legislation in recent decades.

Enacted in 2008, MHPAEA was meant to ensure that individuals with a mental health or substance use condition would receive benefits equal to the medical/surgical benefits covered by their individual health plan. The law does not require plans to offer mental health or substance use disorder benefits, but if the plan does so, it must offer the benefits equally with the other medical and surgical benefits covered under the plan otherwise known as “parity”.[1]

The Patient Protection and Affordable Care Act (ACA) requires marketplace plans to provide ten categories of Essential Health Benefits (EHB), which includes mental health and substance use conditions.[2] Through the intersection of MHPAEA and the ACA, many health plans should offer mental health and substance use disorder benefits, creating a new group of individuals in the U.S. who could gain access to treatment if needed.

Yet, seven years later many individuals with health plans still have difficulty gaining access to treatment when it should be legally provided.

The issue of parity under MHPAEA focuses on individuals who have health insurance. Even if a plan covers mental health benefits there are often ways of limiting treatment. Before MHPAEA, insurers would place caps on the quantity of treatment, high copays, or separate deductibles for people seeking mental health treatment. Now some insurers will claim that a mental health visit is not “medically necessary” or require prior authorization to meet with mental health professional, which may not be required for other medical diagnoses.[3]

According to the Department of Labor, to date, the U.S. government has not taken a single public enforcement action against an insurer or employer for violating the laws established through MHPAEA. [4]

Former Congressman Patrick Kennedy, who helped write the parity legislation, boiled down the government’s enforcement into two words: slow and sparse.[5] Kennedy stated that the ACA took attention away from the newly implemented parity law, which resulted in little enforcement. Insurance companies were on coalitions that helped pass the ACA, which means that enforcing the parity law against the same companies could complicate political ties.

Mental Health America released a report highlighting the challenges faced in achieving true parity. The report found that among the 50 state benchmark plans*, 22 of the plans had quantitative limits on mental health services.  Some plans guarantee more coverage than others, while some exclude certain services, like family or marital counseling or bereavement counseling, explicitly in their fine print. Further limitations exist on the type or severity of the condition that qualifies for treatment. Often exclusions occur for “non-biologically based” conditions or certain types of disorders like a learning disability or eating disorders.[6]

Texas was ranked 47th on rates of access to mental health care and 44th on adults with any mental illness who received treatment.[7] When we look at the numbers, it is hard to deny that Texans need the enforcement of MHPAEA for greater access to desired treatment.

Enforcement of current parity laws is both necessary and dire if we want to promote recovery and mental wellness both in Texas and across the country.


*A benchmark plan is a health plan selected by each state as a standard for other health plans. Any health plan that wants to be sold on the state’s health insurance marketplace must cover the same benefits as a benchmark plan, thought it may require higher deductibles and copayments. The benchmark plan is usually based on a typical health plan offered by a large employer in that state.

[1] United States Department of Labor. (n.d.). Mental Health Parity. Retrieved from http://www.dol.gov/ebsa/mentalhealthparity/

[2] National Alliance on Mental Illness. (2015). A Long Road Ahead: Achieving True Parity in Mental Health and Substance Use Care. Retrieved from https://www.nami.org/About-NAMI/Publications-Reports/Public-Policy-Reports/A-Long-Road-Ahead/2015-ALongRoadAhead.pdf

[3] Gold, Jenny. (2015). Health Insurers Face Little Enforcement of Federal Mental Health Parity Law. Retrieved from http://www.wbur.org/npr/427464632/health-insurers-flout-federal-parity-law-for-mental-health-coverage

[4] Ibid.

[5] Ibid.

[6] Mental Health America. (2015). Parity or Disparity: The State of Mental Health in America. Retrieved from http://www.mentalhealthamerica.net/sites/default/files/Parity%20or%20Disparity%202015%20Report.pdf

[7] Ibid.

Hogg Policy Fellows Take D.C.

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U.S. Capitol

by Alison Mohr

When in D.C., do as the Washingtonians do: eat, sleep, and drink public policy!

Last month the Hogg Policy Fellows had the opportunity to participate in the Hogg Foundation Federal Policy Institute in Washington, D.C. It was a week-long immersion in federal mental health policy. The Hogg Fellows primarily focus on mental health policy change in Texas, so this week was a welcomed break from the norm. The fellows spent five days engaged in conversations with key stakeholders and policymakers in the field.

The Hogg Fellows met with leaders from both national advocacy organizations and federal agencies related to mental health. Notable presentations included: National Association of County Behavioral Health and Developmental Disability Directors; University of Maryland School of Medicine – Department of Psychiatry; National Association of State Mental Health Program Directors; Bazelon Center for Mental Health Law; National Council for Behavioral Health; The Kennedy Forum; National Association of State Medicaid Directors; Mental Health America; the Assistant Secretary for Planning and Evaluation – U.S. Department of Health and Human Services; Substance Abuse and Mental Health Services Administration; National Institute of Mental Health; and the National Alliance on Mental Illness.

There were several recurring topics, including Medicaid and its role in accessing behavioral health treatment and services, the history of mental health policy in the United States, and cutting-edge research related to recovery. Conversations around the Affordable Care Act (ACA) and the Mental Health and Addiction Equity Act of 2008  zeroed in on existing barriers to treatment. Lastly, the fellows learned more about proposed legislation, such as Congressman Tim Murphy’s Helping Families in Mental Health Crisis Act, and its implications for the nation’s mental health system.

The Hogg Fellows left D.C. with a greater understanding of mental health policy at the federal level and how it impacts Texans experiencing a mental health condition.

Into the Fold, Episode 14: An African American Minister Speaks On Mental Health

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Pastor A.J. Quinton

Even in an increasingly secular society, faith leaders play a large role in the lives of millions of people.  In African American communities in particular, there are many who will discuss their problems with their pastors before ever stepping foot in a therapist’s office. For this reason, the Hogg Foundation and others have begun to recognize the invaluable role that faith community leaders can play as both conduits of useful information as well as facilitators of conversation around mental health issues. But what about faith leaders who have their own lived experience of mental illness?

In this episode of Into the Fold,  Pastor A.J. Quinton of Diakonos Ministries in Austin, Texas opens up about his own recovery from mental illness, a journey that included multiple suicide attempts and a diagnosis of bipolar disorder, and dispels the myth that pastors can only be useful by maintaining a stoic facade that denies their own vulnerable humanity:

“This is my journey; I am no different from anyone else, and to be able to make that plain to everybody around me sort of allowed some of that pressure to come off,” said Quinton about the benefits of disclosing his own struggles with mental illness. He then adds pointedly, “Number two, if God still loves me I’m really not overly concerned about whether you do or not.”

“Pastor Q” first entered the Hogg Foundation fold several years ago as a member of the Austin Area African American Behavioral Health Network. Since that time, he has emerged as a powerful voice in favor of judicious self-disclosure for black religious leaders. He also demonstrates how faith in a higher power does not preclude self-advocacy or personal responsibility, but in fact reinforces them.

Want to hear more? Download this episode on iTunes U!

Read the rest of this entry »

Hogg Foundation Awards UT Austin Doctoral Candidate Moore Fellowship

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Shannon Johnson
Shannon Johnson

The Hogg Foundation for Mental Health has selected Shannon Johnson, a doctoral candidate in the School of Social Work at The University of Texas at Austin, as the 2015 recipient of the Harry E. and Bernice M. Moore Fellowship. Johnson was awarded $20,000 to complete her dissertation research.

Since its establishment in 1995, the Harry E. and Bernice M. Moore Fellowship has been awarded to students from The University of Texas at Austin to complete a dissertation on the human experience in crises resulting from natural or other major disasters or, in a broader sense, stress and adversity.

Johnson’s dissertation is titled, “A Sequential Exploratory Mixed Methods Study of Post-Homicide Spiritual Change.” The dissertation is a study of post-traumatic spirituality in the lives of homicide survivors — i.e. the loved ones of homicide victims. Johnson believes that her work will yield greater insights into the unique experiences of homicide survivors, and that a deeper understanding of spiritual change among practitioners will lead to more effective interventions.

“The Moore Fellowship’s namesake, Harry E. Moore, had an abiding interest in advancing public understanding of human adversity,” said Dr. Octavio N. Martinez, Jr., executive director of the Hogg Foundation. “At the same time, the Hogg Foundation has an interest in furthering research that results in more effective mental health interventions. Shannon Johnson’s dissertation speaks to both of those concerns.”

We spoke with Shannon Johnson about her research.

Tell us about yourself. At what point did you decide to pursue this particular line of research, and what influenced that decision?

I completed my undergraduate degree in psychology at Kenyon College in 2001, and my masters in social work (MSW) at the University of Michigan in 2008. I have always had a strong drive to help others and a particular interest in mental health, so I fell naturally into these disciplines. After finishing my MSW, I worked as an addictions and mental health counselor for several years. It was during this time that I developed an interest in trauma and spirituality. Many of my clients had experienced severe psychological traumas in their lives. I noticed that, among those who experienced dramatic growth in the process of recovery, spirituality seemed to be the force that was driving change. I was bothered that spirituality tended to be relegated to the 12-step realm and was not something that was systematically addressed in clinical interventions. My desire to enhance the effectiveness of interventions motivated me to engage in the scientific study of post-traumatic spiritual change.

Your dissertation is titled, “A Sequential Exploratory Mixed Methods Study of Post-Homicide Spiritual Change.” What questions are you trying to answer with this work?

The research question that guides my dissertation study is, what is the process of spiritual change in the lives of survivors of homicide victims. My dissertation consists of two phases. The methodology for Phase 1 is grounded theory, an inductive approach that I am using to generate a developing theory of post-homicide spiritual change. In Phase 2, I will use a survey methodology to test the theory that emerges in Phase 1.

What gap in the literature will be filled by your study? Who stands to benefit from it?

There are fairly decent literature bases pertaining to trauma and spirituality and to grief and spirituality. However, there is a complete lack of research looking at spirituality in the lives of homicide survivors. This study will provide much-needed insights into the individual experiences of homicide survivors, insights that can be used to enhance the sensitivity and effectiveness of services.  By yielding a theory of the process of spiritual change after homicide, this study will also enable the development of an intervention that is specifically targeted to the homicide survivor population. Such an intervention is sorely needed and will be of benefit to the homicide survivor population.

How do you think your research methods and approach will help you to answer the questions that you’re posing?

Grounded theory is an inductive approach involving the generation of theory from data and is a natural fit for the purpose of this study. Grounded theory will be utilized first with a small sample of participants to develop the theory in Phase 1. Use of a survey methodology in a second phase of the research will enable the testing of the emerging theory among a larger sample. This mixed methods approach is superior to use of grounded theory alone, as it combines the best of both qualitative and quantitative approaches.

Are there any suggested readings you can recommend for those who might be interested in learning more about the topic of post-homicide spiritual change?

To my knowledge, there is no existing research that looks specifically at post-homicide spiritual change. However, I have found literature on post-traumatic growth to be very relevant. Spiritual change is considered a domain of post-traumatic growth, and the constructs overlap quite a bit. An article by Parappully and colleagues (2002)1 explores post-traumatic growth among parents of murdered children. It is highly relevant, and I would definitely recommend it. Armour (2003)2 conducted a great study on meaning-making among homicide survivors. Park (2005)3 provided important perspective on the role of religion and spirituality in meaning-making in general, while Wortmann and Park (2008)4 wrote a great piece on the role of religion and spirituality in the meaning-making among the bereaved specifically. A final article I would recommend is by Armour (2002)5. It provides an in-depth qualitative understanding of the post-homicide experience that I have not found elsewhere.

References Cited

  1. Parappully, J., Rosenbaum, R., van den Daele, L., & Nzewi, E. (2002). Thriving after trauma: The experience of parents of murdered children. Journal of Humanistic Psychology, 42(1), 33-70.
  2. Armour, M. P. (2002). Journey of family members of homicide victims: A qualitative study of their posthomicide experience. American Journal of Orthopsychiatry, 72(3), 372-382.
  3. Park, C. L. (2005). Religion as a meaning‐making framework in coping with life stress. Journal of Social Issues, 61(4),707-729.
  4. Wortmann, J. H. & Park, C. L. (2008). Religion/spirituality and change in meaning after bereavement: qualitative evidence for the meaning making model. Journal of Loss and Trauma, 14(1),17-34.
  5. Armour, M. (2003). Meaning making in the aftermath of homicide. Death studies, 27(6), 519-540.