By Eric Lindberg
As a licensed clinical social worker in Los Angeles in the 1980s, María Aranda grew weary of hearing a common refrain.
Every time she tried to find evidence-based solutions to the problems facing her older patients with mental health challenges, she was told there just wasn’t any research on that topic, particularly pertaining to people from racial and ethnically diverse communities.
“I got tired of listening to that, so I made a conscious choice to pursue my education so I could contribute to that body of knowledge,” said Aranda. “I wrote a lot at the beginning regarding the dos and don’ts of working with certain older ethnic and racial minority populations. There had been very little rigorous research.”
Several decades later, that field has blossomed and Aranda is considered a leading scholar on issues surrounding mental health and services for older, low-income adults from communities of color.
As an associate professor and associate director of clinical and behavioral intervention research at the USC Edward R. Roybal Institute on Aging, she has led multiple federally funded studies focused on issues such as the interplay between depression and chronic health problems among older Latinos, how to build a therapeutic relationship based on cultural values, and how caring for older adults in marginalized populations can affect family members.
The seeds of her successful clinical and research career were planted at a young age. Growing up a stone’s throw away from Dodger Stadium just north of downtown Los Angeles, she had a close relationship with her maternal grandmother, who lived with her for the first five years of Aranda’s life.
“My parents also reinforced the value of respecting elders and seeking them out and hearing their stories,” Aranda said. “I developed at a very young age the patience that is needed to lend an empathetic ear to the life stories of older people.”
As the first-born child of two monolingual Spanish speakers, Aranda also found herself thrust into the role of mediator early in life. She would help translate correspondence from government agencies such as the Department of Motor Vehicles and ensured that her parents would attend teacher-parent conferences.
“I was basically living in two worlds—the world my parents lived in as monolingual speakers and very much allied with their Puerto Rican roots, but also living in this world, in mainstream America,” she said. “It was a challenge, but I learned analytical skills and how to navigate two worlds that would sometimes collide.”
As a result of developing strong interpersonal abilities at a young age, she excelled in school, ultimately earning a bachelor’s degree in social work from California State University, Los Angeles, and a master of social work degree from USC in 1982.
As a clinical social worker, Aranda’s work again spanned two worlds: medical social work with a focus on home-based care and a mental health practice in the public sector with local community-based agencies and the Los Angeles County Department of Mental Health.
She was quickly drawn to working with older adults, exploring how they are affected by severe mental health disorders such as schizophrenia, Alzheimer’s disease, and depression. When she returned to USC in the mid-1990s to earn a doctorate in social work, interest in research on older populations, chronic health conditions, and mental health had started to grow.
But Aranda was well aware that many biases and stigma about older individuals remained.
“Services for older adults are the last to get funded and the first to get defunded,” she said. “It’s a forgotten population and ageism is alive and well in our society.”
In particular, she noted a widespread belief that racial and ethnic communities take care of their aging family members and are inherently opposed to outside help.
“Many believe there is a high respect and reverence for older adults and that we take care of our own,” Aranda said. “Although some of that is true, there are still some overarching problems, such as access to services and pockets of poverty that still have been intractable to change. There is still a lot of work to be done.”
She also dismissed the notion that communities of color are not accepting of therapies developed and delivered by mainstream researchers and practitioners. A recent study she led on a depression care program for older Latinos with chronic medical conditions found that participants not only embraced a form of psychosocial care known as problem-solving therapy, but they also attended nearly every treatment session and reported high levels of satisfaction.
That pilot study, known as Programa Mano Amiga, focused on developing strong practitioner-patient relationships and embracing the cultural values and linguistic preferences of older Latino participants. Aranda said clinicians need to show warmth and personalismo, or a sense of prioritizing and recognizing the importance of each patient-provider relationship.
“You give them the therapy in their language of preference, you recognize and incorporate their cultural values, you break down barriers to access to care, and voila,” she said. “It’s an obvious phenomenon, but one that people need to change their initial perceptions about.”
Results of the pilot study, which ended in 2012, fed into two new projects funded by the Patient-Centered Outcomes Research Institute— to study the ability of community health workers to assist low-income individuals with depression and chronic health problems, and another known as Programa Esperanza that will explore whether culturally tailored therapy can reduce depression among older Spanish-speaking Latinos with multiple medical issues who receive care from AltaMed Health Services, a large health provider in Los Angeles and Orange counties.
If the approaches prove to be successful, cost effective, and acceptable to both patients and clinicians, Aranda said she would like to see them brought to scale in systems of care across the United States.
In addition to her research at the Roybal Institute, Aranda is a national problem-solving therapy trainer and is currently serving on two Institute of Medicine committees, one focused on family caregiving for older adults and the second on the decision-making capacity of Social Security beneficiaries.
She said she is gratified to see social work being brought into the fold of those discussions.
“More people understand that social workers have a pivotal role in bringing people together, in using relationships to effect change, and the value of serving people from vulnerable communities,” she said.
Aranda made it a point to emphasize that individuals in those communities should not be viewed as weak and unable to handle adversity.
“They are very resilient. It’s the system that is recalcitrant and reinforces barriers to quality care,” she said. “I remember my work early on when I used to do home visits as a young social worker and see people who had very little but who had developed alternative resources to be able to survive and thrive. I don’t want to lose sight of that.”
Although she acknowledged that funding and general support for research to address barriers to care for older adults have been historically inadequate in her eyes, Aranda said she was encouraged by the creation of the Roybal Institute five years ago at the USC School of Social Work and an increased focus on translational and applied research across the university.
“Los Angeles is the quintessential research laboratory and hub of innovation,” she said. “And USC is an enormous engine that really respects and values the community, innovation, and making a difference, not only for the community now but for decades to come.”