Week 9 Discussion Response to Classmates

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SocialChangeportfoliok.mclean.docx

COUN 6785: Social Change in Action:

Prevention, Consultation, and Advocacy

Social Change Portfolio

Kimberly Mclean

Introduction

In my community, the suicide rate has risen again.  Many teenagers, adolescents, and adults are committing suicide.  Tennessee suicide rate is the highest it has been in 5 years according to the Tennessee Suicide Prevention Network.  They stated the most deaths were white, middle-aged males that have decided to terminate their life.  This is a deep concern that needs to be addressed at every level. If we do not create an effective prevention plan to reduce the suicide rate our communities will suffer greatly. Although the rate is high for the middle-aged males I want to expound on the adolescent's and teens' suicide and how we can reduce the numbers.

Scope and Consequences

The adolescent's and teenagers' numbers for suicide have risen and the people that are terminating their lives are not your typical individuals.  These are leaders in different positions at school, in academics, sports, and on the honor roll. We are also seeing children that have experienced trauma committing suicide as well.  We are seeing adolescents and teens that have been victims of bullying mentally and/or physically committing suicide. Although when a peer committed suicide it affects other students from the school that knew the victim. It can have a different effect on people, one person can cry and keep going where the other person may break down and cannot concentrate or function in school for a while. So many different things go through the survivor’s mind especially if they were close to the suicide victim.

According to Rollinghilldhospital.org, teen suicide has risen from 2005 at 855 that year to 1163 in 2017.  In the U.S. more than 47,137 adolescents or teens have committed suicide from the ages of 10 years to 24.  They have listed suicide by age groups and the highest rate ages were from 35 years to 54 years of age.  Then they listed them by Race/Ethnicity; Black-6.0%, Hispanic-7.3%, White-19.9%.  

Suicide is not restricted nor unknown within the religious, ethnic or socioeconomic group. People from different walks of life can suffer the devastation that leads to mental illness or severe emotional trauma that can lead them to terminate their life.

Mental health problems are very costly to the one that suffers and to society. Personal costs of these issues are, mental anguish, financial and relationship strain, difficulty struggling to perform day to day activities, Conyne and Horne, (2013). Suicide ideations can affect their role within the family especially if it is a parent.

An examination of workplace costs of major depressive disorder which can lead to suicide is estimated $36.6 billion per year in salary equivalent to lost productivity (Kessler et al., 2006).

Other ways the community is affected by the individual that is suffering from a mental illness local clusters of suicide that have a contagious influence. The unemployment rates suffer because of the ones that are hurting and do not want to work or cannot mentally. We have some people that have suicidal ideations that have access to lethal weapons and can and do hurt others in their community.

If we do not get a hold on this epidemic it can become a contagious influence on many. Also, if we don’t help the hurting individuals our communities will suffer from the lack of participation with politics, laws, and policies. Just as homelessness is hurting the community so is suicide and people suffering from major depression.

People bereaved by suicide are likely to go through a lot of negative feelings such as guilt, grief, they may feel responsible for the death, anger, questioning of why, abandonment and rejection (Jordan, 2011: Sveen & Walbym 2008). It has been reported that some people have a lack of energy and anger toward somebody else. Again, if we do not get a handle on people terminating their life our communities will suffer from job loss because people do not have the energy or motivation to work.

Goal Statement

I would like to offer an education group in school for students that are having suicidal thoughts and depressive feelings in hopes to reduce any suicide occurrences. Also, I would like to offer a curriculum on the dangers of suicidal ideations and what it can do.

Social-Ecological Model

In the U.S one of the leading methods that suicide victims are using is firearms. In the last decade, over 399,157 people terminated their lives and 201,875 died by using a firearm (Allchin, Chaplin & Horwitz, 2019). Firearm methods for suicide are raising and males used firearms six times more than females. Age-adjusted males 11.95 per 100,00 and females 1.93 per 100,00 in 2016. The rate of males suicide by age peaked at 85 years 37.44 per 100,00 in 2016. The rate of female’s suicide by ages peaked at 50 and 54 years that is 3.55 per 100,00 in 2016, after 54 years it starts to decline (Allchin, Chaplin & Horwits, 2019).

Race differences using firearms are white males are the highest at 13.54, next is American Indian at 8.69 and Alaskan Native at 5.50; Blacks, Asian and Pacific Islander males at 3.03 per 100,00 in 2016. It is the same pattern for females, Whites 2.28, American Indian at 1.28, Alaskan Native at 0.79 and Blacks, Asian and Pacific Islander at 0.37 per 100,000 in 2016.

The public sector health influence of suicide on households and m=communities is huge, and suicide loss survivors are at a higher risk to commit suicide themselves (Allchin, Chaplin & Horwitz, 2019). As well as the one bereaving over the loss it can affect them mentally to limit their social functioning and their mortality. There are several risk factors as to why people commit suicide, alcohol and substance abuse, major mental issues, and or some type of trauma within the last few weeks. There has been a lot of research conducted that states it is to easy for people to get firearms which is why they use them. One study found that gun ownership and state-wide suicide numbers state gun ownership attributed 92%. A meta-analysis was conducted that stated of individual access to guns in the home was three-fold. Almost all lethal use for suicide is successful. We need restrictive laws on access to lethal weapons. We need to educate our children on the harm and dangers of using firearms. We need to go to the policyholder and the government to make stricter laws on the purchase of weapons. As well as teach parents on the security and hiding and locking the weapons in the home.

The key factor leading to suicide is unbearable mental anguish. According to the CDC, approximately 45% of people who died by suicide visited their primary physician within a month of their death without talking about their suicide desires and ideations.

The CDC gives valuable guidelines based on the assumption that prevention efforts for any health or disease problems require integrated multi-level efforts within a Social-Ecological Model (SEM) (Centers for Disease Control Prevention, 2017).

A risk factor is something that creates problems and a protective factor is something that prevents issues.

Individual

Biological risk factors: male sex (terminate life) female sex (attempted) Serotonin dysfunction, family history of suicidal behavior, access to lethal weapons, and pills. Biological protective factors: SSRI practice, Lithium mood support treatment, and clozapine use. Education on depressive moods and suicidal ideations.

Socio-Demographic

Risk factors: LBQT status, thinking suicide is the answer, culture ethnicity, older and middle-aged adults, high-risk jobs, like law enforcement and military, Firearms businesses, being Incarceration, high-stress levels, job loss/unemployed, financial burden, recently discharged from a mental institution and bullying. Protective factors: heterosexual sexual orientation, religiosity/spirituality thoughts on suicide perceived wrong

Interpersonal/Relationship

Risk factors: living in homes that have firearms, subjection to suicide, family conflict or violence, family history of mental illness or suicide and/or attempts, death of a loved one, withdrawal and social isolation, and someone exposed to combat.

Protective factors: social support, knowledge on suicide and is harmful to the family, social connection, help pursuing actions, connecting to healthcare providers, and cognitive behavior therapy and DBT (Caine, 2013).

Theories and Prevention

Cognitive Behavioral Intervention for Trauma in Schools (CBITS); Proven, Promising Programs. The target areas they are addressing are Safe and Healthy children and helping children succeed in school. Types of the outcome reached behavior issues, cognitive enhancements, school performance, and their mental overall health. The evidence level for this program is proven. This program is helping students that have experienced traumatic events. Some examples of traumatic experiences are individuals that have been a victim of a violent crime or seen a violent crime, students that have been in a disaster, a victim of a fire or in a car accident, an individual suffering from an injury or experienced physical abuse.

Study Conducted

This program has been successful with students in the 3rd to the 12th grade. CBITS program was conducted by Stein et al., (2003). He used two elementary schools in East Los Angeles, sixth graders with a total of 759 students. He used a self-report questionnaire regarding symptoms of PTSD and their exposure to violence. For them to participate they had to have been exposed to violence which they could talk about in a group setting and they can actively participate in a group therapy intervention program.

One hundred and fifty-nine students were randomly assigned to ten sessions of the CBITS group or a waitlist group, 65 students were chosen which only 56 participated. Students were evaluated before the intervention then at the 3rd and sixth month a redistribute on the mechanism of PTSD, and depression. The teacher stated all classroom issues and the parents stated the psychological dysfunction at home. At 54 CBITS and 63 control students were used in the 3 months analyses, 117 altogether 93% and 53 CBITS, and 60 controls were added in the sixth-month analyses: 113 total 90%. At baseline 13 students' non-completers had higher depression and PTSD results which they showed behaviors in the classroom and learning issues.

Results

According to Stein et al., (2003), 117 students at the three-month follow-up CBITS students showed a greater decrease of PTSD conditions than the waitlist control participants, with a 64% less from the beginning in comparison with a 34% reduction from baseline. In the 3rd month phase, students showed lower levels of depression than the control students with a 47% decrease from the beginning compared to a 24% reduction from the start. In the 6th month of completion, both groups received CBITS intervention, they showed no differences among the groups for depression and PTSD. The teacher showed no difference in classroom behaviors and parents did not show any psychological dysfunctions.

A Stepped Care Approach to Clinical Suicide Prevention

The collaborative assessment and management of suicidality (CAMS) have launched a program called “Zero Suicide” that has a systems-level response to the suicidal risk within health care and it is yielding positive results (Hogan & Goldstein Grumet, 2016). Then a stepped care approach developed by Jobes (2016) to use with the ‘Zero Suicide’ program which is suicide specified, evidence-based, lowest conflicting, and cost-effective. Collaborative Assessment and Management of Suicidality CAMS by Jobes, (2016). Data collected states that over 9.8 million Americans have destructive thoughts yearly and 1.4 million have performed destructive attempts with success (Piscopo, Lipari, Cooney & Glasheen, 2016). Suicide is the 10th major source of death in the United States and is rising rapidly (Center for Disease Control & Prevention, 2015).

Assessments

CAMS initial session the patient takes the SSF- based assessment and they will receive an SSF-based treatment planning at the end of their treatment program. In the initial session, the therapist sits beside the client to complete the SSF together and both qualitative and quantitative questions are used to help the client express their suicidal thoughts in their own words. The client is asked to classify what degree of psychological pain they are experiencing, agitation level, their pain level, stress level, hopelessness level, self-hate level, and their underlying risk to suicide.

Treatment Plan

The goal of CAMS is to keep suicidal people from committing suicide and keeping them from going into the hospital.  They have a program to help the client, not to self-harm that is called CAMS Stabilization Plan (CSP).  The CSP is equivalent to safety planning (Stanley & Brown, 2012) and the CRP (Bryan et al., 2017).  When they finish the program, the therapist focuses on two of the most important issues with the client.  They will collaborate and devise a plan that will help them cope with the issues. Then they give the patients copies if their CSP, and their finished SSF which they used throughout the program so they can see their results, and they can have something to look at in their time of crisis if any.   

One Study Conducted

This is one of the many studies conducted, Authors of the Empirical Support for the SSF and CAMS researched 106 college students at a university counseling center which the name is not mentioned (Jones, Jacoby, Cimbolic and Hustead, 1997).  Their design used was Correlational, and the results showed a considerable pre-post decrease in total distress and considerable pre-post decrease in SSF base assessment numbers.  This Zero Suicide program has been proven to reduce suicidal episode that is cost-effective, least restrictive, and is evidence-based.   

 

Diversity and Ethical Considerations

LGBT 

In my portfolio, I am addressing suicide and depression in my community.  This week we are asked to target two groups that are impacted within the suicidal and depression states.  The first group I am targeting is the LBGT community because they are 2nd on my list for adolescent and teen suicide.  There have been many studies conducted on LGBT from psychologists, psychiatry, health services, and the American Foundation for Suicide Prevention, etc.  The question that was raised why suicide affects the queer people in greater dynamics than heterosexual peers.  Researchers have noted that they have given out prevention strategies, policy changes, and different interventions to try to decrease discrimination among the queer communities (Mullaney, 2016).  They have some programs that educate LGBT adolescents and teens about positive identity (Haas el at., 2011, pp. 12 & 36).   

According to Teen health, they state that 30% of LGBT students have attempted suicide because of bullying and mistreatment against them which is 4 times more than heterosexuals.  The U.S. Department of Health and Human Services wrote queer youth are 2 to 3 times more inclined to attempt and achieve suicide than others.  Then they stated 30% of the teens that commit suicide are likely lesbian or gay, LGBT is an extreme risk (Sedgwick, 1993, p.1).  Through the 1st Bush administration, they reported that youth should be educated about LGBT problems in secondary schools (Sedgwick, 1993 p. 1).    

Prevention plans for people that are suicidal or depressed are in place for everyone all over America.  People can reach the crisis hotline and different programs in their areas.  Brochures, billboards, and public buses give out information about suicide and where they can call for help.   

 

      Bullying  

The second target group that is impacted by the suicidal and depression state is bullying.  Whether it is physical or mental it is affecting people to the extent they are terminating their life.  Bullying is a well-known risk factor for suicide with adolescents.  China is having high levels of incidence of bullying through victimization, witnessing and perpetration at 26.10%, 28.90%, and 9% (Han et al., 2017).  

It’s been recorded that bullying leads to unproductive mental health which leads to suicide (hertz et al., 2013; Peng et al., 2019). In 47 meta-analysis studies (Holt et al., 2015) states bullying perpetration and victimization in any amount relates to suicidal and ideations with adolescents.   

Two studies showed victims that were involved in bullying had a higher threat of suicide and depression (Bauman et al., 2013; Klomek et al., 2007). Another study showed that victims of bullying had negative coping strategies than the students that were not bullied.  Another study was conducted to see how school bullying, depressive thoughts, negative coping thoughts, and risk for suicide correlate together.  In their study, they concluded if adolescents have a better coping mechanism in place, they may handle the situation better, and therefore they would not become depressed or suicidal.  They are teaching the students in China how to deal with stressful situations like bullying in hopes it will change the number of students attempting to commit suicide.  

 

 

 

           Ethical Guidelines 

The ethical guideline I would use in this case is A.2.c. Developmental Cultural Sensitivity; counselors must communicate information that is developmentally and culturally appropriate for the client(s). Counselors must provide whatever is needed for the client to understand or comprehend the information you are providing.  

B.1.a. counselors must maintain awareness and sensitivity regarding the cultural meaning of confidentiality and privacy.  

Helping the people in my community I would have to be culturally competent.  There are many diverse groups of people in my community.  I need to reach everyone, so I need to have access to different cultures' information and be able to obtain services for individuals that do not speak the English language.  

 

 Advocacy 

Advocacy seeks to make sure that people, especially those who are most undefended in society, to be heard on the pressing issues to them.  Advocacies guard and protect their human rights. Having their voice heard on the decisions being made on their lives.  Advocacy tries to influence decisions within the social institutions, and political arenas.   

From another article states in 2004, the FDA saw an increase in suicide behaviors and thinking from the adolescents that were taking SSRI antidepressants (SSRI, 2007).  The FDA stated to change the black box label, they wanted individuals 25 years and older to only take the antidepressants.  Then another study showed that many of the adolescents that died did not have an SSRI antidepressant in their system when they died.   

SPANN Suicide Prevention Action Network, states ages 10 to 24 is the third rank in suicide deaths in America.  They are pushing for the “Garrett Lee Smith Memorial Act’ to be reinstated.  The Federal legislation must provide the funds for the program.   

Several programs are active in helping to prevent suicide in America.  Here is another program called the National Violent Death Reporting System (NVDRS) they gather information from the coroners and medical examiners to know the circumstances involving the suicide.  The NVDRS is active in 17 states across America with 450 sites.  The CDC wants the program in 9 more states where suicide is the cause of death.  They need the funds to do so from the Federal government.   

Individual Level 

          To help individuals that are depressed and/or suicidal we need to get them assessed while they are at school.  We would ask permission from their caregiver before we conduct the assessment.  I have noticed while working at the Crisis Hotline that many adolescents say their parents are not taking them seriously.  As advocacy for the children, we must reach the parents to educate them on what signs to look for in their child.  We had over 2 thousand adolescents per month calling thinking about suicide and some were committing the act while on the phone with us.  Here in Memphis TN, we have a CIT team from the police station that we call to go out where the individual is in the act of killing themselves.  I would push for more money for the Crisis Center because we help so many people.  I would give the numbers of people we have helped and the numbers of the ones we failed with.  I would let the Federal government know the statics and what we can do with the extra money.  As well as the CIT team have more people working at night because that is the time when most individuals think about it.   

Institutional Level 

           As advocacy for suicide prevention I mentioned the Crisis Center there is more program in Memphis that need more funding.   At the Crisis Center, we have sent suicidal individuals to Lakeside for treatment and therapy.  Their program is well-known, and I would push for them to have more people on staff and different programs to reach the parents of the suicidal adolescent.  

Community Level 

Getting the community involved with this huge problem comes with educating everyone on what signs to look for and the places they can go to obtain help.  We need more free programs for minorities in our city.  We need the Federal government to give the funds to incorporate more programs for the depressed and suicidal in our area.  We need money for brochures and pamphlets and people to distribute them in schools, community centers, churches and libraries, and/or any place adolescents are present.   

         Public Policy Level  

Federal and State laws can give resources for prevention of suicide, open doors for collaboration, promote training, increase more awareness and knowledge of this issue.  The State laws in Tennessee states that each public health professional, teachers, and school counselors be trained and licensed to help in the prevention of suicide.  

Policies in place for school districts, and any place where students are present to adopt preventions and recognizing suicidal behaviors at the local level.  Data Collection from several organizations that helps the states to understand the range and concepts of suicide in a state and rate their prevention actions.  It is documented that the state must report suicide to the public health department. Tennessee legislatures have started several suicide preventions programs in our state normally within the mental and public health departments and/or suicide prevention hotlines, postvention teams, and crisis response.   

Effective Suicide Programs 

All the suicide programs we have in Memphis Tn are needed and used greatly.  Teachers, first responders, school counselors, school districts, colleges, and universities should have a suicide prevention program in place. All the programs should incorporate the parents of the suicidal individual in an education program about suicide.  

 

References

Allchin, A., Chaplin, V., & Horwitz, J. (2019). Limiting access to lethal means: applying the social-ecological model for firearm suicide prevention. Injury Prevention: Journal of the International Society for Child and Adolescent Injury Prevention, 25(Suppl 1), i44–i48. https://doi-org.ezp.waldenulibrary.org/10.1136/injuryprev-2018-042809

Bauman, S., Toomey, R.B., Walker, J.L., 2013. Associations among bullying, cyberbullying, and suicide in high school students. J. Adolescents. 36, 341–350

Bryan, C. J., Mintz, J., Clemans, T. A., Leeson, B., Burch, T. S., Williams, S. R., . . . Rudd, M. D. (2017). Effect of crisis response planning vs. contracts for safety on suicide risk in U.S. Army soldiers: A randomized clinical trial. Journal of Affective Disorders, 212, 64 –72. http://dx.doi .org/10.1016/j.jad.2017.01.028

Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. (2005). Web-based injury statistics query and reporting system (WISQARS). Retrieved from http://www.cdc.gov/injury/wisqars/index.html

Centers for Disease Control and Prevention. (2015). Web-based Injury Statistics Query and Reporting System (WISQARS). Retrieved from http://www.cdc.gov/ncipc/wisqars

Conyne, R. K. (2010). Prevention program development and evaluation: An incidence reduction, culturally relevant approach. Thousand Oaks, CA: Sage.

Duan, S., Duan, Z., Li, R., Wilson, A., Wang, Y., Jia, Q., Yang, Y., Xia, M., Wang, G., Jin, T., Wang, S., & Chen, R. (2020). Bullying victimization, bullying witnessing, bullying perpetration, and suicide risk among adolescents: A serial mediation analysis. Journal of Affective Disorders, 273, 274–279. https://doi-org.ezp.waldenulibrary.org/10.1016/j.jad.2020.03.143

Government study cites worrying suicide increase in youth: advocacy concerns fueled by FDA mandate of warning labels on SSRIs. (2007). Brown University Child & Adolescent Psychopharmacology Update, 9(3), 1–7.

Han, Z., Zhang, G., Zhang, H., 2017. School bullying in urban China: prevalence and correlation with school climate. Int. J. Environ. Res. Public Health 14.

Hertz, M.F., Donato, I., Wright, J., 2013. Bullying and suicide: a public health approach, J. Adolescent. Health 53, S1–S3

Hogan, M. F., & Goldstein Grumet, J. (2016). Suicide prevention: An emerging priority for health care. Health Affairs, 35, 1084 –1090. HTTP:// dx.doi.org/10.1377/hlthaff.2015.1672

Holt, M.K., Vivolo-Kantor, A.M., Polanin, J.R., Holland, K.M., DeGue, S., Matjasko, J.L., Wolfe, M., Reid, G., 2015. Bullying and suicidal ideation and behaviors: a meta-analysis. Pediatrics 135, e496–e509

Jobes, D. A. (2016). Managing suicidal risk: A collaborative approach (2nd ed.). New York, NY: Guilford Press

Jobes, D. A., Jacoby, A. M., Cimbolic, P., & Hustead, L. A. T. (1997). Assessment and treatment of suicidal clients in a university counseling center. Journal of Counseling Psychology, 44, 368 –377. http://dx.doi .org/10.1037/0022-0167.44.4.368

Jordan, C. E. (2011). Building academic research centers to advance research on violence against women: An empirical foundation. Violence Against Women, 17, 1123–1136. DOI:10.1177/1077801211419086

Kessler, R. C., Akiskal, H. S., Ames, M., Birnbaum, H., Greenberg, P., Hirschfeld, R. M. A. Wang., P. S. (2006). Prevalence and effects of mood disorders on work performance in a nationally representative sample of U.S. workers. American Journal of Psychiatry, 163, 1561–1568.

Klomek, Brunstein, A., Marrocco, F., Kleinman, M., Schonfeld, I.S., Gould, 2007. Bullying, depression, and suicidality in adolescents. J. Am. Acad. Child Adolescent. Psychiatry 46,40–49

Mullaney, C. (2016). Reshaping Time: Recommendations for Suicide Prevention in LBGT Populations. Journal of Homosexuality, 63(3), 461–465. https://doi-org.ezp.waldenulibrary.org/10.1080/00918369.2016.1124712

Shagle, S. C., & Barber, B. K. (1995). A social-ecological analysis of adolescent suicidal ideation. American Journal of Orthopsychiatry, 1, 114.

Stanley, B., & Brown, G. K. (2012). Safety planning intervention: A brief intervention to mitigate suicide risk. Cognitive and Behavioral Practice, 19, 256 –264. http://dx.doi.org/10.1016/j.cbpra.2011.01.001

Media

https://www.sprc.org/sites/default/files/resource-program/FromthefieldLegislation.pdf