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HN 430 Advocacy for
Families and Youth
Unit 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 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
• 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
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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
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Self-Image
Anger
Loneliness
Impulsivity
Depression and hopelessness
Thinking patterns
Intrapersonal and Psychological
Characteristics
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
• Suicide Motivations
• Verbal messages
• Behavioral changes
Warning Signs of Suicide
• 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
• 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
• 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
• 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
• 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
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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
Interviews for Suicide
Lethality
• 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
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
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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:
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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
• 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/depressio
n-gene-revisited-predicting-mental-healthdna/story?id=12529575
The Depression Gene
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 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
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:
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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/recoveryforlifeprogr
am/about.html