Spotlight On: Zoe Smith
Zoe Smith, Assistant Professor of Psychology, awarded $250,000 grant to improve mental health equity for Chicago teenagers
Dr. Zoe Smith, Assistant Professor in the Department of Psychology in the College of Arts and Sciences at Loyola University Chicago, received a two-year, $250,000 grant from the Robert Wood Johnson Foundation Health Equity Scholars for Action Program. The grant supports her ongoing efforts to increase mental health equity by providing mental health treatment and resources to adolescents who hold identities that are systemically oppressed. As Director of the ACCTION Lab, Dr. Smith and her team focus on providing community-based assessment, intervention development, and treatment for Black and/or Latina/e/o adolescents in the Chicago area with attention-deficit/hyperactivity disorder (ADHD) and cognitive disengagement syndrome (CDS) through a cultural responsiveness and a healing-focused lens.
"Dr. Smith is a rising star in the field of psychology and we are grateful to have her in our Loyola community,” said Peter J. Schraeder, Dean of the College of Arts and Sciences at Loyola University Chicago. “Her dedicated research efforts will not only directly benefit the Chicagoland area but also the next generation as we continue to strive for mental health equity. Dr. Smith’s work truly embodies Loyola’s mission of social justice.”
Read on to learn more about Zoe Smith and her plans for the grant. Be sure to follow Dr. Smith on Twitter and the ACCTION Lab on Twitter, TikTok, Instagram and Facebook.
What is the focus of your work at Loyola?
The primary goal of my work is to increase mental health equity for Black and/or Latina/e/o youth in the Chicagoland area. One thing I’ve noticed in the field of ADHD is that it often misses ADHD or misdiagnoses these kids with externalizing diagnoses. This pattern prevents kids and their families from getting the care they need and is directly contributing to the school-to-prison pipeline and other negative outcomes.
The specific focus of my current work is creating culturally responsive psychodiagnostic assessments, or in other terms, psychological evaluations specifically created for these teens who identify as Black and/or Latina/e/o More broadly, I’m working to decrease health inequities as well as advocating for systemically oppressed individuals in the Chicago area.
How did you become interested in psychology and addressing mental health inequity?
I always wanted to work with kids, even as a kid myself. I knew I didn’t want to be a K-12 teacher and my dad suggested I think about being a psychologist. I majored in psychology in college, and it just felt natural to me.
I became interested in ADHD because I often saw peers, classmates, and kids I worked with during college and grad school who had been left behind in school. They were missed and weren’t getting the services and accommodations they needed. I wanted to be a partner for those kids. I went to a larger public high school, which worked really well for me. But my brother was the opposite. He was just missed by the system. My parents were really strong advocates to get him the support they needed, but not everyone has that knowledge or ability to do that. I wanted to use the experiences and knowledge I had to help families that are struggling.
Understandably, many families don’t know how to navigate the Individualized Education Program (IEP) process. Navigating the United States’ school system can be really complicated and difficult for first generation families and students, especially in Chicago where we have selective enrollment and tons of forms. I want to be an advocate and partner for those who are struggling within this system and help alleviate or avoid the damage that the system can do to their mental health.
Why is it important to study and treat ADHD in Black and Latina/e/o youth with extra support?
The answer to this question is long and complicated. First, ADHD is incredibly debilitating, but a lot of people are unaware of this. Most assume that because they have trouble paying attention sometimes that they understand what it’s like to be someone with ADHD, but that just isn’t true. Often, what people think ADHD is not how it manifests in other kids. Most of the ADHD field’s research has been on White, upper-class boys and masculine presenting kids. So, the people missed the most are girls or feminine presenting people as well as people of color, particularly Black, Latina/e/o, South Asian, and Indigenous kids.
Even with White, feminine presenting individuals, if they have more feminine characteristics or present more inattentive symptoms than hyperactive, they often will get on their report card that they are not reaching their potential or applying themselves. That’s not accurate – people with ADHD are trying really hard. It’s a debilitating neurodevelopmental diagnosis. By missing or misdiagnosing these kids, we are creating disparities in who is receiving the treatment they need and, ultimately, their health on top of other systems of oppression.
Why are there inequities in treating ADHD? It’s racism. And, depending on each child, the intersectionality of racism, ableism, and gender affects those who refer kids to mental health treatment. We’re much more likely to get referrals from parents, teachers, and schools for boys and hyperactivity than anything else. But that’s not accurate to what ADHD truly looks like if you look at a community sample. We need to use health equity methods to focus on kids getting missed because of this intersectionality of oppressive systems.
This grant will allow us to partner with community-based organizations and schools to help them better understand what ADHD looks like. We use different language, like ‘having problems with school,’ ‘inattention,’ ‘different mental health,’ ‘academic problems,’ and ‘social problems.’ These terms are less technical, more accessible to teachers and families, and they are all related to ADHD.
It’s been hard because of COVID – families and schools are overburdened right now. Everyone we’ve talked to has said ‘yes, we want this for our kids,’ but struggle to follow up because they’re overextended, overworked, undervalued, etc.
But the inequities are also strong with who provides the diagnoses. It’s also on the clinicians. We as mental health providers need to have a better understanding of systems and how systems affect symptoms and diagnoses. I teach psychopathology at Loyola and I teach my students that we need to be using context and systems to understand diagnoses. But that’s not how I was taught and that’s not often how psychology thinks. We need to be more interdisciplinary with sociology, social work, and public health, and we need to be thinking in a much bigger lens.
My hope is this grant will provide the opportunity to create guidelines for clinicians and providers on specific aspects to look for when making these diagnoses, to check their own bias, the reasons for making a certain diagnosis, and the potential consequences of misdiagnosis or the treatments associated with a diagnosis. For example, a diagnosis like oppositional defiance disorder (ODD), that can lead to more negative outcomes than ADHD. More Black and Brown kids are diagnosed with externalizing diagnoses like ODD, because they’re interacting in a racist environment and are acting or reacting to a system that is working against them.
But we can’t just blame our clinicians. We’re in the middle of a mental health crisis – we always have been, we’re just more aware of it now – and the primary cause is that we’ve undervalued and underfunded mental health for centuries. A lot of work has been done to reduce the stigma of mental illness, so people are more likely to reach out and get care. The problem is insurance companies and funding. We need insurance providers to cover and pay more for mental health services. If the services are underfunded, providers are underpaid, which leads to turnover and burnout. We need to tell our legislators to pass policies that fund mental health. We need to provide access to free mental health care in areas where it’s needed most. Yet, the free mental health clinics on the South and West sides of Chicago have been closed with no intention of reopening them. Until we have insurance coverage and access to free services, we will continue to see this crisis.
What are your plans for the grant you received?
This grant from the Robert Wood Johnson Foundation has helped me really focus in on health equity work. My plans for the grant are to create, develop and conduct culturally responsive psychological evaluations as well as work with the families to provide psychoeducation on the evaluation results and integrated reports that will help them receive accommodations at school, access to therapy services, medication, and whatever else they may need. We want to remove as many barriers are possible for the families.
Then, we’ll follow up with the families once a month for a year to see how they’re doing, help them problem solve, and act as a general resource for any mental health, psychosocial, or Chicago-related question and be known here at Loyola as a person they can reach out to when they need help.
Are there any opportunities for undergraduate students to get involved?
Yes! I already have a few wonderful undergraduate students who are working on this project. We train all of them on the academic and executive functioning assessments, so anyone interested in clinical psychology or neuropsychology can get cool experience in the lab. Students can help perform these assessments, help create our mental health directory, and work on
What else is on the horizon that you are excited for?
I practice something called radical hope, which is understanding the context that we live in, like systems of oppression and privilege, while envisioning a world without racism, mental health crises, etc.
Our Loyola students give me radical hope. I look at the news and get disheartened, but then I talk to my students and their passion, knowledge, and advocacy gives me that radical hope. I feel like we’re moving toward a time where we can be hopeful, and I think our students are going to help change the world.
Once we work with more families, I’m hoping to do more to address the mental health crisis by working with advocacy groups like Collaboration for Community Wellness to analyze and demonstrate how community safety is negatively impacted by divesting from public mental health clinics. By proving this, we can help increase access to mental health resources here in Chicago. On a larger scale, I want to write guidelines to show insurance companies what needs to be covered in order to create positive health outcomes for families and eventually move the tide of mental health coverage forward.
Learn more about Zoe Smith’s work here and the ACCTION Lab here.
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