Graduate student wins competition with proposal for culturally adapted care
When Cara Zhu, a third year in the Master of Social Work program, was a teenager struggling with anxiety and depression, the assistance she received from social workers not only gave her support but also inspired her to become someone like them, kick-starting her dream to pursue social work. With the lack of Asian representation in the social work field, making up less than 3.5% of social workers in the United States, Zhu felt obligated to tackle mental health issues specific to Asian Americans.
Now, more than ever, with anti-Asian racism rampant in the United States, the unique challenges the older Asian population are facing need to be addressed — that’s why Zhu wrote a proposal for the Sunrise Project and submitted it to the Schmidt Futures Reimagine Challenge.
The Sunrise Project is a culturally-adapted community-based online mental health service for Asian adults who are 65 and older in Los Angeles County, and provides a telehealth service delivered in Asian languages, since most American social work services are only offered in English and Spanish.
Her proposal features three components: drop-in telehealth sessions with therapists, technology workshops that teach older adults how to access technology and a community outreach service where social workers perform monthly home visits to chat with older people in their native language, as well as interpret over-the-counter medication instructions.
Zhu’s primary goal is to provide family therapy and support to youth and troubled teens who are suffering from depression, anxiety and mental illness. Though her long-term goal is to establish child protective services in China, Zhu focused on the older Asian community for her proposal to the Reimagine Challenge because of the heightened racial tensions she observed against the Asian community throughout the pandemic. The recent shootings of Asian-Americans in Atlanta are a striking example of the growing anti-Asian hate as a result of the pandemic.
Zhu said currently, older Asian adults are hesitant to go to the park, pharmacy or even the gas station to fuel their car because they are scared they will be attacked. For adults who are not living with their children, and have a partner who has passed away, loneliness is a major struggle, which Zhu learned about in her “Loss, Grief and Bereavement” class that she recently took with Dr. Dawn Joosten-Hagye.
“I took a class called Loss and Grief, and we learn a lot about how to work with older adults who are coping with a loss in their life,” Zhu said. “It’s very inspirational, and also I would say, my father is one of my most important inspirations. Because I told him that I wanted to participate in this scholarship, but I didn’t know what to write about, [and] I said, ‘oh, my father is next to me. I can write something about you.’”
“Loss, Grief and Bereavement,” taught by Joosten-Hagye, a clinical associate assistant professor of social work specializing in working with disabled adults, is a class about normative and non-normative types of loss that happen throughout the life course. Hagye also emphasized the importance of providing culturally appropriate support and validation for disenfranchised patients. This class greatly inspired Zhu when she noticed the lack of culturally-appropriate services for older Asians amid the racial tension of the pandemic.
“In the class they learn about loss, grief and bereavement theories, and then they also learn about the importance of culture and spirituality in terms of how it helps people work through and understand the loss,” Joosten-Hagye said. “Loss related to the pandemic [is] something that we talked a lot about collectively in the course, because everyone was experiencing the pandemic and having many of the routines of day-to-day life changing pretty much overnight … created these normative types of grief responses [which are] very tied to what we learn from our own culture, spirituality and family.”
Zhu conducted extensive research on the current services and limitations Asians and Pacific Islanders across L.A. face, and found a lack of accessibility, availability and data regarding mental health services for older Asians. While writing her proposal, Zhu sought help from Dr. Michal Sela-Amit, a clinical associate professor of social work specializing in child, youth and family social work.
“She’s onto something really important here because I’m telling you, this is a big issue in terms of Asian communities here in the area of Los Angeles,” Sela-Amit said. “There is a need for more care, more information, more support, so they’re not going to be dealing with such loneliness and anxiety and depression and the feeling of really not being in your home country but still not being at home here either, fully.”
According to Zhu, China’s social work industry is still in its infancy because there is a lack of funding and awareness for the importance of social work. Because the family unit used to be the support system for Chinese individuals, migration to big cities and development caused that social fabric to break, leading to the need for education around a culturally-sensitive social work system. Sela-Amit, who worked in China at Nanjing University through the Council of Social Work Education, saw firsthand that China needed to develop the profession of social work in response to the rapid urbanization changes.
“The saying that I kind of adopted over the years is that you can change the way you dress, you can change the way you talk, but the cultural values stay with you the longest,” Sela-Amit said. “Sometimes we don’t see [culture] clearly, particularly in the United States, with all the ideas about individualism … but culture is the ingredient that gives us richness and meaning, and a lot of the time, direction, life, what’s important and what’s less important.”
Especially in the field of social work, cultural humility is important when interacting with clients who have an immigrant background, Joosten-Hagye said.
“It’s really important that we talk about cultural humility, allowing our clients’ narratives and lived experiences … to come forward,” Joosten-Hagye said. “Our client is the expert over their experience, and though we’ve got some knowledge on some health resources, it’s important for us to be able to make sure that we establish a good fit between what our client’s preferences and values are, so that it’s more patient-centered, versus an assistant practitioner imposing something on them that may not be a good fit for them.”
As someone with a Chinese background, cultural sensitivity is something Zhu excels in — allowing her to bring her in-depth understanding of the mental health stigma present in some Asian cultures to the table.
“Usually, older adults will be scared of the term ‘mental health,’ so we use a more friendly term like ‘emotional well being,’” Zhu said. “We use ‘emotional well-being,’ ‘physical health,’ and ‘emotional health’ instead of being very straightforward [and] telling them, ‘oh, you need to join mental health services.’”
Though Zhu’s focus is on providing mental health treatment services to troubled youth and their families, she is passionate about providing social work services intergenerationally, and winning Sunrise Project is a major step forward in addressing both current and long term needs of the older Asian population, who have gone overlooked for far too long. She felt very honored to have been selected as a winner, and became even more motivated to continue developing her social work career and finding ways to assist marginalized communities in need.
“I saw the winner’s email before Christmas, so I think that it was the best Christmas present ever,” Zhu said. “I was very honored, but somehow, I do feel that actually I [could have done] it better. I think there’s still a lot of room for improvement.”