For this installment, we introduce a clinical/community psychologist (CP) who, after moving from place to place for her education, is now settled in the Bay Area, working as an implementation scientist in the largest health care system in the U.S. – the Veterans Health Administration. She also has played a critical role in encouraging and implementing SCRA’s emerging presence online and in social media, thereby providing wider opportunities for younger members to participate in the organization.
What does a community psychologist do?
Living Community Psychology highlights a community psychologist through an in-depth interview intended to highlight the personal and professional lives of those working in our field. The intent is to personalize Community Psychology as it is lived by its diverse practitioners. These past columns contain a wealth of life advice gleaned from over 60 profiled community psychologists, from graduate students to retirees, representing an invaluable resource for community psychologists.
*All columns are available online, at http://www.scra27.org/publications/tcp/tcp-past-issues.
Lindsey Zimmerman believes that her interest in CP was partly impacted by her upbringing as a “pastor’s kid.” Raised as a very conservative, evangelical Christian, her beliefs included a commitment to caring for others. A second impact was growing up in the tanking economy of mid-Michigan. “I had an acute awareness of the huge structural factors beyond individual control constraining people’s resources. I was hungry to address the systemic causes of disenfranchisement or inequality based on what I saw in Michigan.”
Her hometown is in an area of industry and agribusiness, between Flint and Lansing. Her mother, a music teacher with a master’s degree in oboe performance, stopped teaching for a while to raise her and her brother. Beginning when Lindsey was age 11, her father (who had a little college and some formal biblical training) became a fulltime pastor for a Conservative Congregational church. “My parents identified as born again, evangelical fundamentalist Christians, and I was ‘all in’ until I was a late teen.” During spring breaks, Lindsey did humanitarian missionary work in Haiti and Ecuador, motivated by her religious convictions. “At the time, I did not view my work as being for social justice ends.”
In high school, she was class president, honor society member, played sports and performed in music groups. Lindsey applied only to Christian colleges, enrolling at Wheaton College near Chicago, a conservative Christian college whose most famous alumnus was Billy Graham. But she began to grapple with a misfit between her views and conservative interpretations of religious principles, in particular, the exclusion of women from church leadership. After reading leading scholars with discrepant views on the subject, she could no longer reconcile her own beliefs with this culture. “I didn’t seek to be an iconoclast but I kept finding issues of cultural dominance that I could not reconcile.” She met with the Dean to discuss her evolving theological and scientific views which were inconsistent with “the pledge” (the school’s statements and covenants). Her assertion that she had come to college not to reinforce her existing beliefs but to expand her thinking, was met with kindness but steadfastness to “the pledge.”
Lindsey withdrew from Wheaton and—money being tight at home—began working at a photography studio in her home town while figuring out next steps. Over the next 8 years, she earned credits from 6 undergraduate universities while working fulltime as a manager at professional photo labs, before finishing her BA in 2005. She commuted to Michigan State University; moved to Chicago and then to San Francisco to a now-defunct college; then to City College of San Francisco.
A turning point occurred in a statistics class, in which Professor Esther Nzewi’s examples of social phenomena clicked for Lindsey. CP’s language resonated even more in a course taught by Ken Miller at San Francisco State University, from which she eventually graduated cum laude after 3 years. Lindsey applied to only 4 doctoral programs, all with a mix of clinical and community psychology training, using the example of Dr. Miller, who was trained as a clinician but was formatively shaped by CP. She was pragmatic in choosing a graduate program – for example, excluding from consideration any university without student health insurance and a full stipend.
Her decision to attend graduate school was met with skepticism from her mother. Equally problematic for her mother was Lindsey’s decision to embark on a round the world tour to trace her ethnic heritage. Her mom cautioned: “Lindsey, people of our class don’t just pick up and travel around the world.” However, Lindsey was committed, having saved money and airline miles for the trip for over 3 years.
The backpacking world tour began as soon as her graduate school applications were submitted. The plan was to travel until the time for school interviews, which turned out to be 4 ½ months. She traveled with a friend through 9 European countries, tracing their grandparents’ countries of origin. Her trip of self-discovery then took her to India for two months, training to be a yoga instructor. While at a remote location in Kerala, India, she had scheduled a telephone interview for Georgia State University (GSU). Lindsey traversed down a mountainside through tea plantations for miles in the moonlight to an outdoor telephone booth, which was surrounded by curious villagers who had followed her and her guide on their trek. Her guide shushed the chattering villagers, saying “interview!” Above the payphone was a lit sign, saying “Atlanta” – surely a sign!!
The interview was with Dr. Lisa Armistead who later became her primary mentor at GSU. Lisa had adapted family HIV prevention efforts in high-risk ethnic minority communities by developing strong partnerships with community advisory boards. “I told Lisa that I did not care exactly what programs or problems I would be working on. But I had a heart for vulnerable populations and was drawn to her scientific values and her mode of working, establishing genuine relationships with people impacted by the problem.”
Lindsey’s decision to attend GSU also was based on its urban location and its emphasis on diversity, among both faculty and trainees. She was especially attracted by GSU’s approach to combining Ph.D. training in (APA accredited) clinical and community psychology. This approach, however, involved a heavy course load, requiring four courses each semester for four years. Nevertheless, she wanted to be equally trained in both fields and is now convinced that was the right choice for her— “This training prepared me for the full range of skills I apply in my work.”
Before entering GSU, Lindsey encouraged her best friend, Erin, a photographer she had worked with in San Francisco to join her in Atlanta. “I said that I would love to have a close friend there.” It only slowly dawned on them that, after years of a friendship, they had romantic feelings for each other. Both are hardworking and love music and the arts, but Lindsey is serious and planful, plotting her life with spreadsheets, while Erin is creative and can get lost in the moment. Shortly after arriving in Atlanta, they became a couple. “We were both in our late 20s and knew what we wanted. We’ve been together ten years.”
Lindsey had her first same-sex relationship when she was 21 years of age, “which is kind of late nowadays.” Coming out and later marrying Erin were difficult for her family. Nevertheless, her loving parents try their best to understand and accept Lindsey, even though they do not agree. “Over the years, neither of us gave up on our relationship. They are willing to talk through the difficult emotions, but my mother explains me to her hometown Christian circles as: “Lindsey is not a ‘biblical literalist.’”
GSU had a flexible mentoring model, so in addition to Dr. Armistead’s mentorship, she trained with Jim Emshoff, Rod Watts and Sarah Cook, with whom she focused increasingly on violence and trauma. Her training was mostly funded via these professors’ research, but she also worked for Drs. Barbara Rothbaum and Nadine Kaslow at Emory Medical School /Grady Memorial Hospital, both experts in recovery after trauma. At Grady’s emergency department, she was on call for 4 years for suicide, intimate partner violence, and sexual assault cases. “I felt SO useful and vital in this role. A patient wants someone who is at the top of her game, who will advocate and fight for you in the system. This is my strength.”
Lindsey’s dissertation on HIV prevention with families, part of an NICHD trial, was conducted with a local team in the oldest Black separated township in Capetown, South Africa. The task was to adapt programs that had been successful in the U.S. to the South African context. This involved establishing community input through partnerships, learning what people felt was needed locally and then making program adaptations. Some intervention aspects had no cultural equivalent locally. “Families told us that to tackle HIV in their community, we had to address youth-directed sexual violence. We updated what we were doing, bringing in this trauma component as directed by the community.”
In considering clinical internships, Lindsey developed another spreadsheet, the primary cell being what would benefit Erin, who had moved her photography business to Atlanta and now had to relocate again. Lindsey traveled to interview at 13 internship sites, all of which included protected research time. She chose to return to the San Francisco area to intern at the Veterans Administration Palo Alto Health Care System. “I wanted to focus on some kind of system change using research, and the VA Palo Alto program protected more research time than anywhere else, up to halftime towards the end.” In choosing the VA, she had to forego her prior training on family systems and children to work exclusively with adults. But the VA was a natural fit for her emphasis on trauma and her passion for justice for underserved and vulnerable populations.
“PTSD is the only diagnosis in the DSM manual that requires a stressor in the environment,” a perfect focus for CP’s values of person-environment fit and normative resilience. “The trauma field is advancing; in just 30 years, the field went from not even having a PTSD diagnosis to having more than one possible treatment that might work for 60% of the people who complete it.” When in training back at Grady Hospital, a safety net hospital with a Level I Trauma Center, she learned about the relationship between PTSD admissions and substance abuse comorbidity, which is also prevalent among Veterans.
Her next career stop – an NIAAA research fellowship at the University of Washington (UW) School of Medicine – was in a setting where seminal research had been conducted on preventive alcohol screening and trauma. As many as 50% of people who show up in an emergency department for trauma were drinking during the event. This UW research led to policy mandates that every Level I Trauma Center must include alcohol screening, because this system-wide brief intervention was found to reduce re-injury and readmission. “Unfortunately, preventive intervention screening is often conducted in the context of the deficit and risk focused medical model. My focus was on improving interventions by identifying strengths and enhancing resilience.”
Nearing the end of her fellowship in 2014, Lindsey was faced with a difficult decision: Whether to stay at UW on soft money, resubmitting a K award grant application to further develop an electronic tablet application for brief alcohol intervention after trauma, or to accept a newly-announced fulltime, hard money implementation science research position at the National Center for PTSD back at VA Palo Alto. The latter choice would uproot her and Erin a fourth time in four years, but she decided to return to the Bay Area and the team she had earlier worked with as an intern.
Now in her current job for over a year and not being so dependent on obtaining the next grant, she is better able to honor commitments made to patient and provider partners in the VA healthcare community. “The trust developed in me is moot if I cannot sustain the work. Working in four places in four years is no way to build community. It was hard to be true to myself.” Moving from place to place since high school also affected Lindsey’s personal sense of rootedness. “The many moves I made taught me a lot, but it came at a cost in community connections and service, each of which were undermined with each move I made. My professional creds were getting a boost, but at personal cost, a trade off.”
At the VA, her fundamental job as an implementation scientist is to improve the delivery of care and identify ways to optimize patient access and quality. This includes the development of The Veterans Advisory Partnership, a genuine sharing of information and power with Veterans, in contrast to the “expert’s stance” that undervalues their opinions. “Their experience is just as important as my professional expertise. Not that Veterans’ experience is ‘kind of important,’ but it is equally important.”
Lindsey has always tried to innovate methodologically and continually takes advanced methodological training. Her fortuitous attendance at an SCRA biennial conference presentation by David Lounsbury (Albert Einstein School of Medicine) introduced her to systems dynamics modeling as a tool for systems change. She recognized that this approach would be ideal for studying practical problems in VA health care, and she has collaborated with David ever since. She empowers the frontline staff to use this tool, combined with a participatory process, to identify and make the improvements in their settings that have eluded them because they could not achieve consensus or decide among competing alternatives as to which would be more effective. Her Center is involved in a large national effort to improve the quality and effectiveness of mental health care. The potential for wide impact is substantial, being that she is situated in the largest health care system in the U.S.
Lindsey’s training in clinical psychology is useful in her job, having exposed her to different evidence based psychotherapies. She is licensed and has hospital privileges. “But my wheelhouse day to day is 100% community psychology. The skills that I use to consult with organizations to engage in second order level change efforts are from my CP training. I am always mindful of how I can help find solutions to frontline problems experienced by VA staff and Veterans.” For example, Lindsey facilitates staff meetings and consults with local leaders and national program offices, getting input from frontline staff and patients all the time.
Lindsey joined SCRA as an undergraduate student and was elected in 2009 to be the national student co-representative, serving on the Executive Committee for two years. She is committed to the field’s vitality, visibility and sustainability and also actively promotes “new blood” for leadership positions, retaining graduates when they transition to early career. Nowadays, on a daily basis, she provides substantial organizational support to SCRA. In addition to her service on multiple task forces, she has drafted several reports for the EC. She assisted SCRA in establishing an online and social media presence including development of the new SCRA website. But she is probably best known within SCRA for organizing the annual video contest and the webinar series – her efforts to provide new opportunities for meaningful involvement for people who wish to participate in SCRA.
Says Lindsey: “There are millions of people who are 35 years and younger for whom community organizing primarily occurs online, so SCRA’s entry (although late) into online media and content is crucial for our future.” The video contest attracted submissions from all over the world. She asks: “How better to show people what CP is than to have a video of what you’re actually doing in your community and, thereby also raise the community’s profile by SCRA’s recognition?” And the webinars are joined by many who log in from distant time zones, sometimes at outgodly hours. “We need to recognize these accessible, public-facing resources as being just as important to our organizational viability as building up our programs on the academic side. I’m always trying to find innovative methods to expand democracy.”
Written by Gloria Levin