Shari Miles-Cohen & Caroline Signore: On Women With Disabilities

This is the latest in a series of interviews with APA Books authors. In this interview, Tyler Aune, Editorial Supervisor at APA Books, spoke with Shari Miles-Cohen PhD, Senior Director of the Women’s Programs Office at the American Psychological Association, and Caroline Signore, MD, MPH, a board-certified obstetrician-gynecologist and a fellow of the American College of Obstetricians and Gynecologists (ACOG).  Their book, Eliminating Inequities for Women with Disabilities: An Agenda for Health and Wellness was recently released by APA Books.   

Note: The opinions expressed in this interview are those of the authors and should not be taken to represent the official views or policies of the American Psychological Association.

 

 

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Shari E. Miles-Cohen, PhD, is Senior Director, Women’s Programs Office (WPO) at the American Psychological Association (APA).  Dr. Miles-Cohen has received funding from the National Science Foundation and the US Department of Health and Human Services, Office of Women Health to explore the educational needs and health care needs of women with disabilities. Prior to joining APA, she served in leadership positions with university-based and independent non-profit organizations working to improve the lives of women and girls, including the African American Women’s Institute, the Society for the Psychological Study of Social Issues, and the Women’s Research and Education Institute. Dr. Miles-Cohen holds a Bachelor of Arts from the University of Colorado at Boulder, and a Master of Science and a Doctor of Philosophy in Personality Psychology from Howard University.

 

Caroline Signore

Caroline Signore, MD, MPH, is a board-certified obstetrician-gynecologist, and a Fellow of the American College of Obstetricians and Gynecologists (ACOG).  Her interest in the reproductive health care needs of women with disabilities arose in 1996, when, shortly after completing her residency training, she sustained a traumatic cervical spinal cord injury. Since then, she has delivered a number of presentations on reproductive health and wellness in women with disabilities, served as a guest reviewer for a handbook on health for women with disabilities in developing countries, and authored chapters for women’s health textbooks. From 2004 to 2009, Dr. Signore served as an Advisory Board member to an American College of Obstetricians and Gynecologists committee to produce resources to assist ACOG members with providing quality reproductive health care to women with disabilities.

What’s great about your book is that you don’t just describe the problem: You also lay out a very detailed agenda for reform, with specific information about what needs to change, and where. And I was really struck by how hopeful the language in that chapter is.  Did you feel hopeful all the way through this project?

Shari: I think we’re both hopeful people by nature, so that helps.  But I also think, if I can name the problem, I can solve the problem.  We may need a lot of people, we may need a lot of money, but there is a solution out there for almost everything.  And for me, the solution is trying to meld the behavioral and physical health structures to better serve women with disabilities.

Caroline: Well, sometimes I didn’t think this book would ever get finished!  But that aside, I agree with Shari, we are hopeful people, and I also believe that if you name the problem you can start to fix it.  We realistically know nothing’s going to change overnight, but there are incremental steps, and this book will serve a guide for people who may be drawn into the field, or who are already here, doing the work that needs to be done.

Shari: I feel like I learned a lot, coming to these issues from a psychologist’s background.  I have a better understanding now of physicians and what they need, and how they think, and what challenges they may have with integrated care.  Because you lose a little bit of autonomy when you start to share, and that can be challenging for people from different disciplines.  And so that was really helpful, because it’s much easier to communicate that path forward when you have a better sense of what the other people who will be part of the team are thinking.

Caroline: I have to say I came into the project not understanding what integrated care is, and Shari has been a patient teacher.  But the more I understood it, the more I thought: This makes so much sense! Why are we so siloed?  Integrated care is especially important for underserved populations, who could really use extra care and guidance.  Particularly in areas like biopsychosocial models of care that aren’t taught in medical school, that physicians may feel poorly equipped to handle on their own.  I’m hopeful that this book can educate physicians about how to provide better care to women with disabilities.

 

Shirley Chisolm, the first black female member of the U.S. congress, said that she faced more obstacles in her life because of her gender than her race. At the risk of oversimplifying a very complex issue, do you think women with disabilities face more discrimination because of their gender, or because of their disability?

Caroline: Without question, in the health care setting, especially in the reproductive health care setting, women with disabilities feel a-gendered. They feel that their caregivers don’t think of them as women.  And that’s very troubling, for them and for me.  Not only are there physical barriers to actually getting to a doctor’s office.  But to not get information, or careful, complete care [in reproductive and sexual health] because of an assumption on the part of the caregiver that’s wrong, is really galling.

Shari: It’s hard for me to separate the gender and the disability, or the gender and the race. A woman with a disability is intact, a gestalt; she is one person.  It’s all in there together, and you can’t really separate them out.  You have to work hard to separate them.  In some ways, physicians and psychologists and others are working against human nature when they a-gender a person coming into the office.

 

So it takes effort to discriminate. I never thought about it that way before.

 Shari: I think it does, yeah.  You have to work at it, right?  I think you have to work hard to see people in that way.

 

Research shows that women with disabilities who live in poverty and particularly in rural areas are at especially high risk for poor outcomes. And these are outcomes that may be difficult to change, given that many of the accommodations you describe in this book will be made to medical facilities that are far away from where they live.  What can we do for these people? 

Caroline: Telehealth is really promising.  Today you can FaceTime with most anybody, almost everybody has a smartphone now.  And even in rural areas, if you can’t physically go to the physician’s office—heck, I’d rather FaceTime with my doctor than actually have to go to his office, it’s just so much easier.  I have high hopes for the incorporation of telemedicine into care in general, and especially care for people who have

difficulty traveling—not just women with disabilities, all people with disabilities, geriatric populations; there’s a lot of care we can give without actually putting two people physically in front of each other.

Shari: Along with technology, infrastructure also has to change.  The smartphone and the monitor are important, but so are the wires and conduits running to rural communities.  So is educating doctors (and psychologists) that it’s a good thing to do, and educating patients that they can still get good care via telehealth.  But all of that’s doable, it just takes education.  We need to educate policymakers here [in Washington], and in the States, using the State Psychological Associations and State Medical Associations to get them engaged in the conversation.

 

Making people aware of the urgent challenges that this population faces, as you’ve done in this book, is obviously enormously beneficial. What are the next steps? 

Shari: We’re seeing women with disabilities across the country who are really engaged in making change.  The book can help give them have a better sense of what the entire map looks like, and how they can be most strategically engaged.  Because one of the things that Caroline and I talk a lot about is, how do you change the ways that physicians and psychologists are educated?  It’s all about teaching hours.  Well, how do you get a school to dedicate teaching hours to the issues women with disabilities face?  One way is that you change the standards: What’s gonna be on the board exam, right?  So how do you get that done?  There are all these steps.  In addition to public education efforts which bring  attention to the issue, raising visibility, there are other complementary activities, such as professional development, research, and policy efforts, which we discuss at some length in the book’s recommendations section, that together can help to bring about change.

Caroline: This is not a completely ignored issue.  But it is underrecognized.  And understudied.  It isn’t just a matter of psychological care or medical care.  It is also a matter of civil rights, and politics, and policy, and that makes it a little more complex.  We must have patience, as each person tries to get the word out.  My hope is that our work will be viewed as a standard textbook for disabilities studies.  I would love to see it in medical schools, nursing schools, psychology classes, graduate education.  The more people know about it, the more we can get done.

 

 

 

 

 

 

 

Hans Toch: On Policing

This is the second in a series of interviews with APA Books authors and editors. For this interview, Tyler Aune, Editorial Supervisor, interviewed Dr. Hans Toch, Distinguished Professor Emeritus, School of Criminal Justice at the State University of New York, Albany.

Note: The opinions expressed in this interview are those of the authors and should not be taken to represent the official views or policies of the American Psychological Association.

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Hans Toch is a social psychologist whose pioneering work with police departments and prisons in the US and abroad has led to reform based on humane principles and participatory change.  Of his book, Organizational Change Through Individual Empowerment, Criminal Justice Review noted “Toch’s ability to provide real examples of not only what is possible within the field of corrections and offender programming but the impact these programs can have on the lives of offenders and officers leaves the reader finishing the last page and eagerly wanting to know how they can be a part of these efforts too.”

His many books include Organizational Change Through Individual Empowerment: Applying Social Psychology in Prisons and Policing (2014); Cop Watch: Spectators, Social Media, and Police Reform (2012); Police as Problem Solvers (Revised Edition) (2005); Acting Out: Maladaptive Behavior in Confinement (2002), Stress In Policing (2001), and Violent Men: An Inquiry Into the Psychology of Violence (1992).

There is widespread belief now, as there was among some in the ’60s and ’70s, that police unfairly single out and brutalize minorities.   In your book Cop Watch: Spectators, Social Media, and Police Reform, you show how social media has amplified what was once common knowledge only on the street. 

The belief that you allude to is indeed widespread, and unfortunately is especially prevalent among members of minority groups, for whom the perceived risk of being victimized by the police is far from an academic question.  Persons who hold this view about the police being a malevolent threat to them are apt to cite many instances of horrendous encounters with actual, real-life police officers that document their point.  Even where many such persons may not be able to recall having been recently singled out and victimized by the local constabulary, they can easily come up with a convincing humiliating encounter or two involving a relative, friend, or close acquaintance.

Has public perception of these issues changed over time?

This sort of intimate personal documentation is obviously very powerful documentation, even if it may rest—as it usually does–on statistically unrepresentative experiences.  And such documentation is much more available nowadays than it used to be decades ago.  The fact is that while accounts featuring the proverbial brutal or racist cop have always been widely available (largely because brutal and racist cops have always existed to some measure in most police departments, despite efforts not to hire them if possible, or to screen them out), the dissemination of the predations of such officers via social media has provided us with mountains of incriminating documentation.

In other words, what we have seen is not a proliferation of deployments of widely excessive force but a huge change in the availability of incriminating illustrative material, compared with the days in which comparably tragic or farcical exemplars of police malfeasance had to be drawn from newspaper headlines or individually passed on by word of mouth on street corners, in barber shops and play areas, and among intimates across the dinner table.

Many today are calling for changes in the way police departments operate. You have worked with police departments that made good strides toward reform.  What was that process like?  

Longstanding practices are always hard to modulate or to modify.  And I believe that the worst way to attempt to get anyone, anywhere to change is to issue peremptory edicts or orders, and to back these with threats.  Unfortunately, police departments pride themselves in being “paramilitary” organizations, and are therefore attracted to this approach.

Operating in this fashion turns out to be a mixed bag.  It might get you initial compliance and give you the illusion that you are making headway.  But what you are getting is surface conformity, which invariably invites lots of grousing and lingering resentment.  And you are very likely to eventually end up back on square one.

I suspect the second worst way to try to institute police reform or any other kind of reform is by lecturing to folks in classrooms, which is how I happen to have spent most of my working life. The sad fact here is that one cannot change people’s deep-seated habits by preaching to them—no matter how informative and how scintillating and entertaining one might think one is.

And yet, “training” is by far the most frequent recommendation you will run across in police reform proposals—or any other reform proposals.  “Training” is the prevailing mantra, and to be sure, classroom training can do no one any harm.

After the riots of the sixties, you and Doug Grant worked directly with individual cops most prone to provoke violence, creating a way for them to examine what set them off and come up with more constructive behavior.

I think the long and the short of it is that you get people to change [by getting] them to face and to understand the problems they may be creating through their current maladaptive behavior—very much including problems for themselves—and to help them to discover and rehearse more appropriate responses to the situations they are likely to run into on the job.  In relation to off-putting police practices, this means working with rank-and-file officers who intersect with citizen on daily basis, and getting them involved in the process of improving the way they operate in relating to citizens (including suspects) on the street.

This also has come to mean doing counterpart work out in the community, to get the customers of police service to react with less blind hostility in responding to police officers– to give the officers a chance to establish positive relationships with citizens.

This two-pronged approach to reform is called “community policing,” and it has been available as a successful reform strategy for several decades.