Combining Passions to Improve Health Outcomes at NC Maternal Mental Health MATTERS – with Stephanie Forlemu

Hello everyone! My name is Stephanie Forlemu, and I am a senior neuroscience major, with a minor in women’s and gender studies. And, according to my father, anyone with our last name is intertwined within our family tree in some way.

Initially, I didn’t believe him. Why would we be the anomaly?

I was already no stranger to the unconventional. I grew up in a single parent household, which is not uncommon. However, being raised by a single father nuanced my perspective on gender roles indefinitely. I was primarily exposed to my father doing everything: corporate work, housework, and taking on the emotional labor of raising two children that didn’t know to recognize his efforts that grounded our privilege to comforting and intricate home-cooked dinners or our eventual opportunity to explore our academic and professional passions at a prestigious university: UNC Chapel Hill.

There is a caveat, though: I am a second-generation immigrant. My father and his brother immigrated to the United States from Cameroon years before I was born. Their list of sacrifices goes on, and every single one paid off, as they had caught the elusive “American Dream” in a death-grip. And because of their perseverance and luck, I inherited said privilege.

But, as I get older, there are times throughout my life when I wonder what it would take to bridge the gap between my family, my blackness, and the country I live in.

Here’s another caveat: I am still unsure of what professional “success” looks like for me. Growing up while looking up to family members who were engineers, doctors, or directors in finance or IT industries, I was slow to realize my affinity for neuroscience and psychology, and most interestingly, how these concepts intertwine. Admittedly, declaring my major in a field I knew close to nothing about was both scary and exhilarating – the interdisciplinary nature of neuroscience meant there was an opportunity to explore the relationship between neurocircuitry and the environment in a multitude of ways that I didn’t even know to consider.

In my sophomore year, while completing an academic project in NSCI 290, a CURE course, I gained introductory experience with immunofluorescence assays and cryostat sectioning to formulate a research hypothesis on regional microglial responses to an administered immune challenge. Learning about the role of microglia in brain inflammation excited my interest in the bidirectional role of neurobiology in the pathology of neurodegenerative diseases and psychological disorders. From this simulation of laboratory-based research, I gained valuable knowledge: how to apply basic statistical models to quantitative data, conceptualize its implications, and communicate my results in a clear and intentional manner – a cumulative poster presentation at Carolina’s 23^rd Annual Celebration of Undergraduate Research.

However, I learned something else equally valuable: pre-clinical research is not where my interests in neuroscience lie.

It wasn’t until taking WGST 101 in my first semester of my junior year that my experience – balancing my gender and racial identities – was defined to me in one deceivingly simple word: intersectionality. Moreover, I was enlightened in the way it informs dominant epistemologies that mediate research methods, impacting their results, and thus their generalizability to a population filled with people like me – who have a multiplicity of identities that uniquely intersect to guide our interpersonal experiences within business, politics, education, and healthcare.

The summer before my senior year, my developing curiosity in research, psychology, and disparities lead me to my internship at the Carolina Population Center, wherein I worked as a full-time research assistant for a population-based research project. Specifically, I supported data collection and management for a clinical research study that explores the effects of anti-Black racism on the brain and immune system – revealing a door to the fascinating field of psychoneuroimmunology – facilitated by Dr. Keeley Muscatell, the Principal Investigator of the Social Neuroscience and Health lab at UNC. Accompanying my (now ongoing) work on this project, I drafted a research proposal inspired by my work on the present study that aimed to piece apart intrapopulation differences that contribute to disparities in mental health outcomes. In essence, my questions were (1) How is discrimination related to both inflammation and depression? (2) How do cultural factors interact with this relationship? In my desire to delineate psychosocial contributions to racial disparities in physical and mental health, I gained a deeper understanding of my own professional passions: to raise awareness to how identity mediates the effectiveness and accessibility of mental health interventions.

Finally, this brings me to my present and fulfilling work as a Clinical Psychology Gil Intern NC Maternal Mental Health MATTERS (i.e., Making Access to Treatment, Evaluation, Resources, and Screening Better). NC MATTERS is a collaborative program between the UNC School of Medicine, Duke’s Department of Psychiatry & Behavioral Sciences, and the North Carolina Department of Health and Human Services. The program’s primary initiative is to build the capacity of healthcare providers and professionals across the state so that they are more informed, confident, and comfortable with treating perinatal mental health in their respective settings. Thus, the program provides real-time consultations, toolkits, webinars, and community-based resources to educate providers and their staff on diagnostic screenings, referrals, medications, and treatment options for depression, substance use, and other behavioral health disorders in their perinatal clients.

One month in as a Gil intern at NC MATTERS, the confidence and trust I receive from my amazing worksite mentor, Karen Burns, is already reflected in the important projects that I now support. This includes assisting with content development for a perinatal substance use disorder webinar that will add to their growing body of provider-facing educative materials, conducting data management and cleaning tasks with a MATTERS assistant to improve data quality, reviewing previously collected qualitative data and proposing its potential contributions to the improvement of provider-patient relationships, and contacting healthcare providers to promote and assess their satisfaction with the program. Later in my internship, I plan to observe therapy sessions with a clinical social worker and collaborate with the MATTERS team to jumpstart the development of training materials for their new educative programs. By contributing to work that helps to bridge the gap of effective care for pregnant and postpartum people, this internship has demonstrated to me an important example of how the consideration of intersectionality is critical to enable equitable access to effective mental health care.

Throughout my time at Carolina – exploring topics from neurotransmitter transduction to psychopathology to the lives of women in ancient Rome – and now, applying my diverse outlook to my internship experience, my interests have narrowed to the investigation of mental health outcomes for individuals whose identities uniquely intersect to engender their systemic invisibility in healthcare. Specifically, in pursuit of a Ph.D. in Clinical Psychology, I plan to contribute to the development or implementation of evidence-based clinical practices that better conceptualizations of psychopathology, thus improving psychiatric interventions for marginalized populations.

I understand that achieving these goals will be an iterative process – my research interests may narrow and change, or I may uncover an entirely different path. But if I am now certain of one thing, it is that my “success” is not defined how well I can merge my identities into one. It is in how I can use their intersections as a springboard for creative change.