HN 430 Advocacy for Families and YouthUnit 6 seminar

Unit 6 – Special Populations• In this unit, you will examine the needs of

special populations, including grief services, emotional and mental health services, and suicide.

• Special populations – often more than other populations – really need multidisciplinary interventions (collaboration with many resources)

The bio-psycho-social model• Interrelated, integrated roles of biology, psychology,

and social/cultural factors• Biological components• Physical, biochemical, genetic factors

• Psychological components• Patterns of thinking, coping skills, perceptions,

emotional intelligence, temperament, personality characteristics

• Social/cultural components• Family relationships, support systems, work

relationships, broader cultural environment

Suicide - scope of the Problem

• Suicide is the third leading cause of death among adolescents in the United States

• Every year, 20% of teens contemplate suicide, and between 5% and 8% attempt suicide.

• While girls are more likely to report attempting suicide, boys are more likely to complete suicide

• Differences partly due to lethality of methods

Suicide Rates

• Native Americans have the highest teen suicide rate of any ethnic group

• However, research shows that having a strong ethnic cultural identity has a protective effect on suicide characteristics

• LGBT teens are 2 to 3 times more likely to commit suicide than heterosexual peers.

Interpersonal and PsychosocialCharacteristics

• Substance Abuse

• Under-over achievement

• Catastrophic Worldview

• Disruptive and violent families

• Connectedness and poor communication

• Gay, lesbian, bisexual and transgender youth

• Loss and Separation

Intrapersonal and Psychological Characteristics

• Self-Image

• Anger

• Loneliness

• Impulsivity

• Depression and hopelessness

• Thinking patterns

Faulty Thinking of Suicide

Cognitive Constriction The inability to see options for solving problems; thinking “this will never end”

Dichotomous thinking Only able to see two solutions to the problem: 1) continue to exist in living hell or 2) find relief through death

Cognitive rigidity A rigid style of perceiving and reacting. See the problem as catastrophic “I have no place to live and not one to help me and there’s nothing I can do about it”

Cognitive distortion Overestimating the magnitude and insolubility of problems. Difficulties are generalized to the rest of life. Often assume they are the cause. “I didn’t get an A on the test, so I must be stupid and everything in my life is a mess.”

Cognitive Characteristics

Warning Signs of Suicide

• Suicide Motivations

• Verbal messages

• Behavioral changes

Suicide Motivations

• The reasons that young people attempt suicide can themselves be warning signs

• a means of self-punishment to deal with guilt or shame (pregnancy, conflict w/sexual orientation)

• Absolution for past behaviors

• Perverted revenge (to get back at someone)

• Retaliatory abandonment

• A cry for help (although not intending to end their lives, these attempts can still be lethal)

Verbal Messages

• Most children give verbal hints, such as

• I don’t see how I can go on; I wish I were dead

• You’ll be sorry you treated me this way

• Pretty soon my troubles will be over

• Suicidal children also talk about death and may also joke about killing themselves.

• Verbal warning should be taken seriously – if ignored, may be interpreted as confirmation that the child is expendable and unloved.

Behavioral Changes

• Mood swings or fluctuations

• A change from positive interactions with others to withdrawal and negativity

• Apathy or a lack of activity

• Changes in sleep or eating patterns

• Giving away prized possessions

Suicide MYTHS

• A person who has considered/attempted suicide will always be suicidal

• After a suicide crisis has passed, the child is no longer at risk for suicide

• Talking about suicide can make people more inclined to make an attempt

• Suicide happens without warning

• A person who talks about committing suicide never actually does it.

• Suicidal people are mentally ill or severely depressed

Interviews for Suicide Lethality

• The interviewer should attempt to assess• The history of the presenting problem (i.e. loneliness,

depression)

• The family constellation and relationships

• A developmental, medical and academic history

• The status of interpersonal relationships

• Verbal and behavioral warning cues

• Any current stressors that may trigger a suicide attempt

Interviews for Suicide Lethality

• Pay special attention to these factors• Symptoms of clinical depression and hopelessness

• Recent loss of an important relationship or life goal

• Serious family problems, such as divorce or abuse

• Personal history of physical disability, drug abuse or psychiatric treatment

• Interpersonal impoverishment, or the absence of friends, family, and other who can provide emotional support

Interviews for Suicide Lethality

• Severity of threat depends on the specificity and lethality the method of choice.

• Major red flags• Ideation with a plan, including a time, place and method

• A lethal method (such as a gun)

• Accessibility of a means to commit suicide (such as a loaded gun in the house)

• A history of previous suicide attempts

Suicide Treatment

• Listen an show respect for the feelings a suicidal youth expresses

• Reinforce the child for seeking help

• Be specific about assessing lethality

• Make decisions (need to be hospitalized?)

• Have the youth sign a written contract

• Use the resources that are available

• Obtain counseling and psychotherapy for the young person

Grief and Loss• Grief – the feeling that occurs when one loses

someone or something

• Loss – not necessarily a person– Parent or other family member– Friend– Pet– Terminal Illness– Status (social status, SES status)– Material things

Stages of Grief• Denial, numbness, and shock

– “This did not happen. She is not dead, just went away.”

• Bargaining – “I promise I’ll be good if she will come back.”

• Depression – “I really miss her; I feel alone now.”

• Anger – “Why did this have to happen? I hate her! She left

me!”• Acceptance

– “Grandma is gone but it is ok.”

Factors that interfere with the grief process (Worden, 1991)• Relational: what type of relationship did the

person have with the deceased?

• Circumstantial: what was the circumstance that surrounded the death? Such as a person who is missing and is there evidence that the person is dead?

• Historical: did the bereaved person have complicated grief reactions in the past?

Factors that interfere with the grief process (Worden, 1991)• Personality: the bereaved person’s character

and how he or she copes with emotional distress.• Social: if the nature of the death has any social

stigma, such as suicide (“complicated bereavement”). If the bereaved person and those around him or her acts as if the loss did not happen. If the bereaved person does not have a support system.

Some Signs and Symptoms• Sadness• Anger• Withdraw• Confusion• Guilt• Regression• Fear of being alone or dying• Physical complaints• Changes in sleeping and eating patterns

Depression• Depression is one of the most common client issues a

counselor encounters. • Nearly 15 million, or approximately 7%, of adults in the

United States experience depression annually • Depression is characterized by:• Persistent feelings of sadness or irritability • Loss of interest in hobbies, work, and sexual activity• Sleep disturbance • Appetite increases or decreases • Isolating from family and friends• Crying spells• Feelings of hopelessness• Neglect of personal hygiene

The Depression Gene

• A study, published in the Archives of General Psychiatry (January 2011), examined evidence from 54 studies that identified a particular gene variant, often referred to as the depression gene, as a possible determinant in who will and who will not suffer from clinical depression.

• http://abcnews.go.com/Health/MindMoodNews/depression-gene-revisited-predicting-mental-health-dna/story?id=12529575

Anxiety• Anxiety is another commonly encountered client

issue. • In the United States, 3% of the adult

population experiences Generalized Anxiety Disorder, 3% experiences Panic Disorder, and 7% experiences Social Phobia in their lifetime

• Anxiety is characterized by:• Excessive or constant worry• Restlessness• Irritability• Disturbed sleep

Eating Disorders Two common types of eating disorders are

Anorexia Nervosa and Bulimia Nervosa. Anorexia Nervosa is characterized by a client’s

refusal to maintain minimally normal body weight, a fear of gaining weight, and distorted perceptions of body size and shape.

Bulimia Nervosa involves binge eating and inappropriate compensatory measures to prevent or reduce weight gain.

Mental Health Treatment Settings

Inpatient or hospital-based treatment facilities provide 24-hour care to clients in acute crisis situations, such as:Clients who are suicidal or homicidalClients with mental illnesses such as Schizophrenia or

Bipolar Disorder who are dealing with psychosis or manic episodes

Clients who suffer from severe eating disorders and are at risk medically

Clients with substance dependence issues who need inpatient detoxification to reduce the medical risk associated with withdrawal symptoms

Mental Health Treatment Settings

• Intensive outpatient treatment is appropriate for clients who are functioning at a high level but need more intensive treatment than outpatient therapy is able to provide.

• Outpatient treatment typically consists of weekly or bi-weekly sessions with a professional counselor and the sessions usually are an hour in length.

Services and interventions include the following:

• Collaboration with local agencies• Work place support• Life skills training• Supportive counseling• Socialization opportunities• Community Involvement• Placement and support in community living

situations

Peer Support • Peer mentoring/self help approaches• Primary agent of change as young people can

serve as positive role models • "Recovery for Life" (self help program)• Enhances decision making skills • Improves overall psychological adaptation• Promotes Self Advocacy • http://

www.scshare.com/recoveryforlifeprogram/about.html