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Hey y’all, welcome back to The Testing Psychologist podcast. Today is another episode in the Out-There assessment series. My guest today is Dr. Vicky Lomay. She is a Dinè/Navajo psychologist in Arizona and focuses her clinical practice on developing and interweaving culturally appropriate methods into assessment testing [00:01:00] and individual therapy.
For over two decades, she has worked with tribal communities in the Southwest United States and maintains strong ties to her tribal homelands and traditions. The guiding principles and values of her Dinè identity continue to inform and guide her personally and professionally.
Dr. Lomay co-edited the book, Understanding Indigenous Perspectives: Visions, Dreams & Hallucinations. And she co-authored chapters about multicultural neurorehabilitation and neuropsychology.
She got her doctoral degree at Arizona State, her clinical internship at the Missouri Health Sciences Psychology Consortium, and her postdoc residency and fellowship in clinical neuropsychology at Barrow Neurological Institute, St. Joseph’s Hospital & Medical Center in Phoenix, Arizona.
If you missed the other episodes in this series, the Out-There Assessment series is meant to have relatively short, but [00:02:00] hopefully meaningful conversations with psychologists and practitioners who are in relatively unique settings or those who hold relatively unique specialties. Vicky is no exception. This was a fantastic conversation. She’s doing fabulous, meaningful work. I enjoyed this greatly.
Without further ado, let’s get to my conversation with Dr. Vicky Lomay.
Hey Vicky, welcome to the podcast.
Dr. Vicky: Hello. Good to be here today.
Dr. Sharp: Thank you for being here. I am excited to talk with you. It’s been really fun to do these Out-There Assessment episodes and [00:03:00] after our pre-podcast conversation, I know that we have some cool stuff to chat about today. So thanks for being here.
Dr. Vicky: I’m glad to share.
Dr. Sharp: Let’s jump right into it. Tell me about your unique or unorthodox work environment or specialty.
Dr. Vicky: Well, I am a clinical psychologist and I work in a… Well, I do two things. The main thing I do is I do work for a tribal health clinic in Arizona. Our service population is all American Indians. I also have a private practice where I provide consulting, some training, speaking, and things like that. Again, also, that is mostly all to American Indian communities or [00:04:00] talking about working with American Indian communities.
Dr. Sharp: Yes. It jumped out to me, one of the things that you said in our previous conversation about how few native psychologists there are in the U.S. Can you say a little bit about that? How many folks like you are practicing?
Dr. Vicky: Yes, we are very few and far between. I believe the last time a group of us… I’m a member of the Society of Indian Psychologists of North America. That’s a group of American Indian psychologists in the US and Canada. We did an informal count several years ago where we volunteered our information, but also people that were not on our listserv. We’re like, oh, yeah, this person is a psychologist. Oh, and I know this one [00:05:00] too. And so it came out to be, I think it was less than 400 across all of North America.
Dr. Sharp: Well, truly unique. That’s the aim of this Out-There series.
Dr. Vicky: Yeah. It is a small group of psychologists. And again, across the span of career; we have some early career folks and we have some of our elders who have been in the business for quite a number of years.
Dr. Sharp: Sure. It’s nice to have some of those generations, I suppose, in our profession where you can learn and teach and connect on different levels. Tell me about your work in the tribal health clinics. What does that look like?[00:06:00] Dr. Vicky: This particular tribal clinic that I work for currently is in an urban area in Scottsdale, Arizona, but I have worked in other similar places as well. My experience has been working in different tribal clinics or Indian health service hospitals for the last 15 years or so.
For those who may not be familiar with tribal communities or American Indian populations, a lot of the health care is provided by the Indian Health Service, which is a division of the Health and Human Services, provided by the government. The Indian Health Service is the provider of health care [00:07:00] for tribal communities across the U.S. And that goes back to government relationships that tribes have with the U.S. Government through treaties, laws, executive orders, and such. Indian Health Service provides the majority of health care for tribal communities and tribal members across the nation.
There are different hospitals and clinics across the U.S. that provide these health care services. Some tribes have chosen to, this could be a whole other discussion, but they’ve chosen to take over their own health care. So, they get the money and then they run their own clinics. So the tribe that I work for now has their own health clinic and it’s not under the Indian Health Service.
With Indian Health Service, you work for the government. You’re a federal [00:08:00] employee and you have to go through the whole process; the bureaucracy of working for a federal entity. I’ve worked for both. I’ve worked for the Indian Health Service for a number of years. And then now I work for the tribal clinic.
My work environment here is like working in a small town, actually, even though we are in Scottsdale, Arizona which is right there in the Phoenix metro area. You cross the street that divides the reservation from Scottsdale and it’s like night and day. It’s fields and fields and empty and then all of a sudden completely urban area.
Like I said, it’s a small town. They have their own police department, fire department, administrative [00:09:00] offices for all the tribal services and things like that. And then we have the health clinic where I work. It is not a hospital, so it’s not like 24-hour, no emergency department or anything like that, but it does provide a lot of outpatient services. So, I work for the Behavioral Health Division as a Clinical Psychologist. The majority of my work is providing direct clinical service psychology-related.
In the health clinic, I am the only clinical psychologist that does this. Now, my supervisor is also a clinical psychologist, but they’re mainly an administrator role. So, I’m the psychologist.
Dr. Sharp: I got you. Where does assessment come into play [00:10:00] in your work?
Dr. Vicky: When I first started working here, I was a generalist psychologist. Providing therapy was the bulk of my work. And then over time that changed as I was able to do more and more assessments for our patients coming in over the past 8 years. Pretty much what I do full-time now is doing assessments.
And the assessment is again, like a generalist approach. It covers quite a bit. Sometimes I get referrals from primary care doctors. Sometimes I get referrals from other therapists. Sometimes I get referrals like our behavioral health consultants that work in the primary care clinic. Like I said, [00:11:00] it is a small community that has a lot of different services there. So, sometimes I may get referrals, maybe from adult protective services. I might get some questions from legal services, maybe even the senior services department. So I get all kinds of patient referral questions.
The questions also are quite varied, but all have some sort of assessment component to it. Let’s say an adult comes in and they have a history of special education services, but that was from 20 years ago. They want updated documentation. Maybe they want to go back to the school. They want to go back to work. They want to request accommodations, but they need documentation. That would be one possibility.
Sometimes there [00:12:00] are questions about maybe like memory with some of our elder folks- whether that’s something that needs to be further evaluated. Sometimes, I get people who need further evaluation, who have some serious mental illness, and whether their symptoms are… how much it’s interfering with their day-to-day functioning. So there may be questions from other therapists about that or how they could help.
Sometimes, people do come in, they have attention problems and they want to know what that’s about. They have a hard time focusing. They want to know what that’s about. Sometimes it’s differential.
And then sometimes I do get neuropsychological type of questions like someone had a TBI or someone is recovering from a stroke. They had [00:13:00] an aneurysm or something like that, and they want to know a little bit more about how things are going for them, and what I might be able to recommend for for them and their families. So it’s a little bit of everything.
Dr. Sharp: It sounds like a little bit of everything. It sounds like you have to be a jack of all trades in some way…
Dr. Vicky: Yes.
Dr. Sharp: … a real-life psychologist to be able to address all these questions. The way you describe it, I’m getting the impression that even though you’re in an urban environment or city environment, there’s a rural component to this and that you are the only psychologist doing assessment for this population in a big area. Am I thinking of that the right way or not?
Dr. Vicky: Yes. And not only just for this community, but in the greater Phoenix metro area. There are only a [00:14:00] few native psychologists in addition to myself. I think there’s just very few of us and those that are psychologists, most of them do not do assessments like I do. So sometimes I get referrals from even outside our clinic because people know that I can do assessments.
Dr. Sharp: Well, that’s a valuable skill. We do good work. Yes.
Dr. Vicky: Yes.
Dr. Sharp: You talked a bit in our brainstorming conversation about how you have to be pretty flexible in terms of administration and sometimes going off script and nonstandardized administrations depending on language or other communication styles, or individual factors. I would love for you to talk just a bit about that aspect of the work [00:15:00] and needing to be flexible.
Dr. Vicky: Sometimes, in other places that I’ve worked, even now, as a part of my… I do consulting also in a private practice that I’ve had for about 12 years now. That’s more of a smaller part of my day to day work. But I do sometimes get requests from other agencies, other organizations outside of the one that I work for to do different types of assessments. And it does take flexibility.
Most definitely, like I said, I mainly work with adults over 16, usually over 18, all the way to elder status, like, I think, into the mid 80s and stuff like that. With with American Indian communities and tribal communities, for me is, having a good understanding of the [00:16:00] population that I’m working with, because there can be a range of language differences. There are some communities that they still speak their tribal language. There are still some older folks who still prefer to speak their tribal language rather than English. And again, formal education can vary. Exposure to English can vary. So, taking that into consideration. Sometimes, the most common assessments that we psychologists may be used to may not be appropriate for certain people.
For example, when I worked for one of the other clinics, a majority of our population, or I guess, some of my referrals, which were for elderly folks, and most of them were bilingual [00:17:00] or preferred to speak their native language. So, as far as doing memory testing, I couldn’t use any of our most commonly used assessments. So that was where I couldn’t use any standardized instruments. I had to do again, clinical interview, speaking with family and then also homebrewing my own assessments for memory, cognitive screen type of thing. Having to work with a challenging environment is not unusual for me, I shall say that. It happens more often than not.
Dr. Sharp: Yeah. I think so many of us try to stay bound to standardized assessment. Can you comment on that process of getting more comfortable with [00:18:00] non-standardized assessment? What was that like for you if you can remember?
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Dr. Vicky: For example, as far as memory… in speaking with them, getting a sense of what I would do for anybody else, how well are they following the conversation? Are they following my questions? Or [00:19:00] how they answering, so on and so forth. So more of a clinical diagnostic interview. And then as far as doing my own versions of like memory, there was one, you just show the pictures of animals and then asking them, one is to identify the animal and asking them to remember them. And then later, after I had talked with them again, did some other things, and say, hey, those animals that I showed you earlier, tell me as many of those as you can remember. So, like I said, you’re trying to do the best I can with what I have.
That’s the one example of where, like I said, obviously it’s not standardized. There’s no normative data, but again, giving me a quick sense of where they’re at with retention, recall.
Dr. Sharp: Absolutely. [00:20:00] What are some of the unique challenges that you think this population may work with or run into?
Dr. Vicky: There are quite a few. And I think, again, it depends on which tribal community that you are working with. Here in Arizona, we have well over, I think, 22, 24, I can’t remember offhand, tribal communities, tribal reservations here in the state. I think a quarter of our state is tribal lands. So, the likelihood in Arizona of working with a Native American is pretty high. And each community is also different.
So, like I said, the community that I work for currently is fairly urban. You just drive two miles away and you’re in downtown Scottsdale. Arizona [00:21:00] State University is literally across the river. So, you could be somewhere very urban very quickly, whereas in other places like where I grew up, I grew up on the Navajo reservation in Northern Arizona, it takes 6 hours to drive across. It’s usually compared to the size of West Virginia, and some parts of the reservation are very rural.
Right now, as we’re recording this, I’m actually at my family home here on the reservation. The highway is about 4 miles away and it’s a dirt road to get here to where I’m talking to you now. So, each travel community, some of them are very rural, some of them are very urban. So that in itself [00:22:00] can present some challenges.
The other challenges that I often see because of those factors can be access to health care. Where I am, literally right now, the nearest Indian Health Service Hospital with an emergency department is 70 miles away. So we do have an outpatient clinic which is closer, but from where I’m at right now, it’s still about 15 miles away. We have the regular city emergency department. There’s a border town, not far away from where I am right now. They have a hospital there and such.
Again, transportation can be an issue. Even things like access to Internet or electricity, water, [00:23:00] stuff like that can definitely present some challenges. And those are definitely some things that I take into consideration. Once I learn more about the person that I’m doing an assessment for is, getting a sense of where they live, resources that they have, because that can also inform what recommendations that I might give to them and their family. Telling them, here’s some websites you can look up, if they don’t have internet, then that’s useless.
Dr. Sharp: Sure. I think providing helpful recommendations is one of the hardest and most crucial parts of our job. It’s really easy to do a shotgun approach and see what sticks, but it’s even more important with folks who may not have access to many resources, right? Rural environments or elsewhere.
Dr. Vicky: Yeah, exactly. I think [00:24:00] for working with this population, one important part of the work is finding out more about the community or the people that you’re working with. And then again, in that individual data gathering of finding out more about what resources that they do have available to them, where they live and gathering a lot of that information to help inform the recommendations that you might provide for them.
Dr. Sharp: Yeah. Well, let’s switch gears a little bit. I would love to just hear maybe quickly, how you ended up in this work environment. Was this a purposeful career choice for you? Was it something that fell in your lap more by circumstance or what?
Dr. Vicky: I would say purposefully by accident, if that makes sense.
Dr. Sharp: I love it.
Dr. Vicky: When I was in graduate school [00:25:00] and completing my doctoral program for psychology, I was in counseling psychology and I always knew that I would work for a tribal community or working with American Indian folks. I always knew that was my goal. Where I would do it and how I would do it, not so much. So I always knew that I would be working somewhere with a tribal community.
The assessment part was where the by accident came through is because when I was in my graduate program, that was not something that I thought about pursuing. We had our basic psychological assessment course and stuff like that. And that was about it. But when I got into my internship year, that’s when I became interested in assessment because my [00:26:00] internship was newer rehab focus, health psychology focus. I worked in a lot of hospital settings for my internship and where assessment and testing was a part of that. I did rotation in neuropsychology. So that’s where I became interested in assessments. So I did that in a roundabout way. And then when I did my postdoc, that was completely all clinical neuropsychology.
Dr. Sharp: I feel like that’s the story for a lot of us, at least for me too. I had an idea of what I thought I wanted to do and then opportunities present themselves and take a different path and then you integrate and then…
Dr. Vicky: Yeah. Right now, after I finished my postdoc and I started working for Indian Health Service, assessment and testing in the places that [00:27:00] I’ve worked with, was not something that was usually offered. I think it comes back to the clinical experience of the psychologist working there. And again, as we probably know, some people don’t like to do assessments. We all have the basic training in it, but some people just choose, I don’t want to do this. I’d rather refer to someone else.
And then also sometimes the clinical need in some of these tribal communities also informs what services can be provided. So a lot of it is trying to get people in to access individual therapy or counseling or other services to help them from more of like a mental health, behavioral health perspective of being able to provide those services.
So, testing and assessment seemed an extra special type of service [00:28:00] which in prioritizing what health needs could be met, usually it was more towards counseling type of stuff. So, with assessment and testing, knowing that I could provide that, I definitely did start to do that in the different places that I’ve worked.
So it was definitely a welcome addition to the services that they could provide because it was something that, for a lot of folks, they wouldn’t be able to get that kind of service anywhere. And the longer that I do it, and especially where I am now, I’m beginning to see how how difficult it is for a certain population just to get a basic testing assessment service. It’s really difficult.
So being able to provide [00:29:00] that service, I feel like, is definitely something I really enjoy doing because I’m providing something that they would otherwise not be able to get. And especially with the population too, a lot of them are on public health insurance, sometimes even those are limited in what kind of specialty services that can be provided, that hierarchy of prioritizing what their health needs are. Sometimes testing or assessment is at the bottom. There’s other health needs that need to be met. And those are the priority of, okay, let’s go down the list of what we can recommend. Testing would be nice but we can’t do that or can’t provide that. So, for me to be able to do that for some of the patients that come through our clinic I think is really helpful for them.[00:30:00] Dr. Sharp: Yes. Well, you’re touching on this, but I would love to hear the aspects of this work that you really love, that you really enjoy.
Dr. Vicky: The one thing I really love about it, like I said, is being able to provide a service that this certain communities would not otherwise be able to get. Also, for some of my patients, like I said, the population is all American Indian tribal folks, and I think the other part of that is for them to also be able to get the service from someone who looks like them. So knowing that there’s a native psychologist here that is providing the service.
And then in some of the other communities where I’ve worked, like I said, I grew up on the Navajo reservation. I speak the language, not fluently, but I understand it much [00:31:00] better than I can speak it.
So, sometimes for patients to be able to switch over to Navajo and start to tell me things and knowing that I understand what they’re saying is valuable not only to them having this experience like, oh, this person understands me, this healthcare provider understands exactly what I’m saying, and sometimes some patients will switch back and forth between English and Navajo again, knowing that I can understand what they’re saying. So, I think that’s another part of this that I love is, like I said, being able to provide a much-needed service in a culturally sensitive, and I guess some culturally competent way.
Dr. Sharp: Yeah, that sounds incredible. I’m certainly not an expert on working with this population at all. I can only imagine that the value of [00:32:00] feeling seen and feeling connected to a clinician who looks like them. That’s so important for many of us.
Any things that you don’t love about this work?
Dr. Vicky: I think some of the things I had touched upon earlier that there’s lack of there’s some lack of resources and some things are just beyond my control. I don’t have control over certain things like infrastructure or transportation needs. Sometimes it’s frustrating to try to work around those as best as I can. I think that’s the main thing.
And then I think also just sometimes the underfunding of services because, like I said, the majority of it is [00:33:00] provided through Indian Health Service. Again, I think that that also varies from community to community of what services are available. So, again, that varies very much from community to community, so every tribe is different in what they have. Again, access to resources, what services that they can provide to their tribal members? So, wherever you’re working again, like I said, having some understanding of what is available- just having some knowledge about the community definitely goes a long way.
Dr. Sharp: Absolutely. What would you recommend for folks if there are people listening who want to get into this area of practice? Any resources, any career paths, any choices, anything [00:34:00] that may support folks and going this direction.
Dr. Vicky: I’m going to divide that into three separate answers. One is, it depends on if they are a tribal member of a tribal community or not. If they are, if there’s someone out there listening who’s native and like, wow, this sounds really interesting, I really want to learn more about this, breaking that down also into, are they a student or are they currently a professional?
If they are a student and looking to learn more, there are some programs at some different universities in the U.S. that specialize in working with American Indian students who want to go into psychology. So there’s specific programs. There’re two universities that have mentorship programs and mentor students through a[00:35:00] graduate degree in psychology.
Dr. Sharp: That’s great.
Dr. Vicky: So, there’s that if the person was a student and interested in this field.
Dr. Sharp: Sure. Do you know those programs off the top of your head even just two?
Dr. Vicky: I know there’s one at the University of North Dakota. I think Oklahoma State University had one. I know University of Utah has another program. I know there’s another, I think […] Minnesota has a program, but I think that might be a bachelor’s program. The other ones are graduate school programs. I think there’s a few more.
A person was interested, and they are a tribal member, if they’re a student, those are some options. If they are professional, if they are not already a part of the Society of Psychologists in North America, that would be an organization to [00:36:00] join or get more information from. There is a website. There’s an annual meeting conference. We have a listserv- very active. So a lot of information there for folks that are either Native psychologists themselves, or who work in a tribal community and they are a psychologist. So you can join a listserv even or get some information and consultation for that.
If a person is not native, not a tribal member, but they’re interested in this, definitely doing what you can to learn and seeking out resources of things like society being a psychologist or speaking with other psychologists like myself and finding out more information on what could be helpful because I think, if a [00:37:00] non-native comes into a community like this, there can be some layers there that need to be worked through, and being able to do it in a culturally appropriate way. Those would be my recommendations.
Dr. Sharp: That’s fantastic. I’m guessing there’s at least a few folks out there who are listening and would love to find their way into this kind of work. So super helpful. We’ll list all those resources in the show notes, of course, like usual.
I really appreciate this. I think this is a good point to wrap up, but I am grateful to you for diving into it and sharing a little bit about this work that you do. It’s incredibly important for the folks you work with and pretty unique. There aren’t a whole lot of people doing this kind of work. [00:38:00] Thank you for being here.
Dr. Vicky: I certainly appreciate it. And thank you for having me.
Dr. Sharp: All right, y’all. Thank you so much for tuning into this episode. Always grateful to have you here. I hope that you take away some information that you can implement in your practice and in your life. Any resources that we mentioned during the episode will be listed in the show notes, so make sure to check those out.
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