1. HN 430 Advocacy for Families and Youth Unit 6 seminar

2. 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)

3. 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

4. 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 - scope of the Problem

5. 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.
Suicide Rates

6. Interpersonal and Psychosocial Characteristics
Substance Abuse
Under-over achievement
Catastrophic Worldview
Disruptive and violent families
Connectedness and poor communication
Gay, lesbian, bisexual and transgender youth
Loss and Separation
Interpersonal and Psychosocial Characteristics

7. Intrapersonal and Psychological Characteristics
Self-Image
Anger
Loneliness
Impulsivity
Depression and hopelessness
Thinking patterns
Intrapersonal and Psychological Characteristics

8. Faulty Thinking of Suicide
Cognitive Characteristics
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.”
Faulty Thinking of Suicide

9. Warning Signs of Suicide
Suicide Motivations
Verbal messages
Behavioral changes
Warning Signs of Suicide

10. 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)
Suicide Motivations

11. 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.
Verbal Messages

12. 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
Behavioral Changes

13. 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
Suicide MYTHS

14. 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

15. 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

16. 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
Interviews for Suicide Lethality

17. 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
Suicide Treatment

18. 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
Loss – can be loss of a parent’s job, parent, pet, friend

19. Stages of Grief Denial, numbness, and shock Bargaining Depression
“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.”

20. 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?

21. 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.

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

23. 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

24. 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.
The Depression Gene

25. 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

26. 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.

27. 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 homicidal
Clients 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

28. 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.

29. 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

30. 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