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Tuesday, February 11, 2014

Q and A with David Leake, Ph.D.

                                         Who is "David Leake"?

I am a father of three flourishing young adults, husband of a wonderful wife who is a nurse practitioner specializing in diabetes at Queens Hospital, and a player of West African drums as my main hobby. I ended up in Hawaii by a route that began with joining the US Peace Corps as a way to see the world after graduating from college with a Bachelors in psychology. I worked for two years on clean water supplies in the Malaysian state of Sarawak and two years on health education in the state of Sabah. Then I stayed on to work as an editor on English-language newspapers in Sabah and the neighboring Sultanate of Brunei. After several years I decided that journalism was not the career for me and came to UH Manoa on an East-West Center fellowship to pursue a PhD in medical anthropology. This choice was inspired by my cross-cultural experiences in the health field in Malaysia. Enroute to the PhD I also got a Masters of Public Health specializing in international health. However, my East-West Center fellowship ran out in 1989 before finishing the PhD, so I had to find a paying job which turned out to be with the Center on Disability Studies (CDS) where I have worked ever since.

You have been working with the UH Manoa Center on Disability Studies for more than 20 years! What is your most memorable project? Please share with us.

The most memorable was the Hawaii Ohana Project, conducted 1994 to 2000, which I believe remains the highest value CDS project to date at about $13 million. When the grant competition was announced in early 1994, Hawaii’s service system for youngsters with serious mental health challenges was rated among the lowest in the country, largely because Hawaii’s Child and Adolescent Mental Health Division (CAMHD) was seriously underfunded and understaffed. I became acquainted with the CAMHD director as a result of directing a CDS project on transition-to-adulthood for youth with serious mental health challenges, and this led to my taking on the task of being the lead grant writer on behalf of CAMHD. When the application was approved, CAMHD contracted CDS to conduct the project, and I served on the project management team. The Hawaii Ohana Project demonstrated a new service model called the system of care, based on the values that services be integrated across agencies, community-based in preference to office-based, and responsive to youth and family input into policy and practice decisions. The project served the Leeward Coast area of Oahu, where I also had the opportunity to conduct my dissertation research. It so happened that, as the project was launching, the State of Hawaii agreed to a Federal Court consent decree to improve its child and adolescent mental health services by also instituting system of care values. The Hawaii Ohana Project was an important component of efforts to meet the Consent Decree, as our staff did initial demonstrations of how the system of care should operate and conducted trainings around the state. As a result of these efforts and a great increase in funding approved by the State Legislature, Hawaii now ranks among the country’s top states in child and adolescent mental health services.

From the perspective of a medical anthropologist, can you explain how culture affects youth regarding mental health service needs?

A major concern of medical anthropology is to explore how different cultures tend to view the causes of mental or physical illnesses and the best ways to treat to them. Beliefs about these issues guide how people respond to different illnesses and decide whether and where to seek help. Sets of cultural beliefs may be understood as forming “cultural models” that are widely shared in the culture and allow its members to easily understand each other. Some examples from my own dissertation research may help illustrate. While working with the Hawaii Ohana Project, I interviewed numerous people and identified three common cultural models about why youth in the community (in which Native Hawaiians are the majority) might develop mental health challenges and what should be done about them. Native Hawaiians who value their cultural traditions often identify loss of connection with the land and traditional values as a major cause, and part of the solution would be regaining connection and strengthening the Native Hawaiian identity of youth through cultural activities such as hula and growing taro. Members of the community mainstream tend to blame the parents of “troubled and troubling” youngsters for not giving their children needed love and attention (which may need to include strict discipline). And service providers (teachers, psychologists, social workers, etc.) tend to trace mental health problems to the social environment, especially the effects of poverty on families, and recommend services they can provide (therapy, special education, etc.).

What projects are you working on right now?

I am working on several grant proposals to improve educational outcomes for youth with disabilities; preparing a conference presentation on data gaps on postsecondary students with disabilities; and co-chairing the Diversity, Disability and Public Health topic area of the CDS’s 30th annual Pacific Rim International Conference on Disability and Diversity in May 2014. I’m also collaborating with my CDS colleague Steve Brown on a workshop for the Hawaii Psychological Association’s 2014 Conference on Diversity, with a focus on Disabilities. This workshop is intended for anyone in the helping professions (including graduate students) who works with people with disabilities, and offers four Continuing Education credits. It will be held on April 12, 2014 in the University of Hawaii at Manoa’s Campus Center. For more information, please visit

What are the weaknesses of how we do research in the field of disabilities? Can you elaborate on one example?

People with disabilities may face difficulties in establishing social relationships due to such issues as communication barriers (e.g., hearing or speech impairments) and experiences of discrimination. This can be significant because social support networks are the main source of “social capital” which refers to resources people can use to achieve their self-determined goals (e.g., people often find jobs through friends or relatives). However, social supports and social capital seldom seem to be the focus of research in the field of disabilities. Instead, most research seems to focus on “technical” issues like assistive technology, diagnostic procedures, accommodations, and so on. Even if social issues are considered, the focus tends to be on “technical” fixes such as teaching social skills to people with disabilities rather than how to transform social environments so they are more inclusive. An example I know well is research on college students with disabilities. It has been shown that students who feel like they are socially integrated and “belong” on the college campus are much more likely to persist and graduate compared to students who feel socially isolated. I did a review of the literature that involved classifying over 1,000 research articles as social oriented, technical oriented, or mixed. The results showed that fewer than 10% of articles on students with disabilities had a social focus, compared to nearly 25% of articles on other student subpopulations or students in general. It was notable that a major research topic for at-risk populations besides those with disabilities, such as ethnic minorities or low income, was how to promote their social inclusion. I believe there’s a great need for more research on that topic for students with disabilities.

If you were granted a magic wish, what would you like to ask for?

I’d wish for an end to money in politics!