Lincoln Leads Outreach to African-American Elders

October 12, 2012
by Eric Lindberg
Karen Lincoln

When Associate Professor Karen Lincoln joined the USC School of Social Work, she quickly noticed a critical issue in the lower-income areas of Los Angeles. Despite experiencing high rates of mental illness and other chronic health conditions, older African-American residents were struggling to access care and seemed to be slipping through the cracks.

“I’ve always been involved in the community, and I really see a need here,” Lincoln said. “I don’t see advocacy for African-American elders in particular. We have a very diverse city, but there seems to be a lack of visibility of this population.”

In an effort to boost awareness and help older African Americans advocate for their own health and mental health needs, Lincoln has launched a collaborative effort with an impressive array of governmental, nonprofit and community groups.

The outreach and engagement partnership, known as Advocates for African-American Elders, includes community activists and leaders from the Los Angeles County Department of Mental Health, Pacific Clinics, Alzheimer’s Association, AARP, Ward Economic Development Corporation, California Senior Leaders and local churches.

Officials with the Edward R. Roybal Institute on Aging at the USC School of Social Work, where Lincoln serves as associate director, are also offering their strong support and will work to bring visibility to the project.

In addition to general advocacy efforts to improve services in African-American communities, Lincoln said the group will seek stronger collaboration between agencies and community organizations, develop training programs and mental health interventions specifically tailored for older African Americans, and increase education among the target population.

“There is a need for more mental health services for older African-American adults in particular, but there is also a need for more education around the stigma of mental health issues,” she said. “We really want to get the word out that there is treatment available for mental illness. We want people to recognize the symptoms and get help.”

As much as Lincoln is concerned about the current state of affairs, she is even more troubled by the prospects for the future. By 2050, it is estimated that there will be more than three times as many African-American elders in the Los Angeles region, she said, requiring a much higher level of care.

That rapidly expanding need, when coupled with cuts to adult day care services and the increasing necessity for health services for other low-income and disadvantaged populations in the community, spurred Lincoln to action.

“I decided this is something I just had to do,” she said.

This isn’t new territory for Lincoln. As an assistant professor at the University of Washington in the mid-1990s, she developed a similar effort known as the African-American Elders Project, now a freestanding community agency in Seattle that helps isolated and hard-to-reach residents access social services and health care.

Similar to the population in Los Angeles, older African Americans in Seattle were facing high rates of dementia, depression and chronic health conditions.

“There were just very few services that were culturally competent that were available to seniors in the community,” Lincoln said.

In 1995, the mayor of Seattle, Norman Rice, launched a council on issues related to African-American elders designed to develop a comprehensive continuum of services. Mayor Gregory Nichels later appointed Lincoln, whose research at the university was focused on the mental health needs of older African Americans, to serve as chair of the advisory council.

“As a result of our advocacy efforts, we were able to get this particular program serving African- American elders,” she said.

Lincoln hopes to replicate that success in Los Angeles. Initial discussions with the Department of Mental Health proved fruitful and led to funding for the project, which has been in development for approximately six months.

Although still in its infancy, the collaborative is already starting to spread the word among community organizations and other agencies that work closely with older adults.

By sharing information and partnering on various events, Lincoln is hopeful that the advocacy group will be able to create a strong network of services and boost awareness of critical issues for African- American elders.

For example, at Alzheimer’s Association events, officials might address depression and mental illness alongside discussions of Alzheimer’s disease and dementia. During gatherings hosted by AARP, participants may learn about health literacy and technology as well as mental health.

“We really do need to deal with the issue of education, just in terms of what is mental illness,” Lincoln said. “There is a lot of stigma around mental illness in African-American communities.”

Members of the advocacy group plan to highlight particular symptoms that are unique among older African Americans and focus on co-morbid health and mental health conditions.

Participants will also work with providers, primarily in South Los Angeles, to develop culturally competent ways to treat mental health issues. Lincoln noted that despite having the highest prevalence of mental distress and chronic health conditions in the region, South Los Angeles is particularly underserved.

“People aren’t sure what to do because the resources just aren’t there,” she said.

In addition to outreach and engagement strategies, Pacific Clinics has offered support for a part-time therapist to work in community-based organizations. Lincoln said efforts are also underway to tailor a cognitive behavioral therapy intervention provided by the Department of Mental Health.

In addition to adapting the mental health training module to fit the specific needs of older African- American adults, group members will also seek to train agency staff and others in the community to deliver the intervention.

Accountability is a critical component as well, and Lincoln is submitting a grant proposal to study whether health and mental health outcomes improve as a result of efforts by Advocates for African- American Elders. If funded, the project could begin pilot testing as early as next spring.