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COUN 6785: Social Change in Action:

Prevention, Consultation, and Advocacy

S Danziger

Contents

Introduction

Scope and Consequences

Social-ecological Model

Theories of Prevention

Diversity and Ethical Considerations

Advocacy

For many who identify themselves with the LGBTQ community coming out as an adolescent can be a painful process. They risk family rejection and as a result are much more likely to suffer from depression and suicide attempts. Moreover, the prejudice that they experience from society at large can lead to substance abuse and engaging in risky sexual behavior as methods of coping. Some other negative aspects of coming out can be discrimination in school and a feeling of not belonging or being ostracized from the spiritual home (Murray, Pope, & Willis, 2017). The focus of this portfolio will be the youth in this community and how to best support them. This can be especially challenging considering that Tennessee is part of the “Bible Belt” and has a history of intolerance.

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The target problem that will be addressed is the rate of mental health issues in the LGTBQ youth community. For the purpose of this portfolio, the scope of mental health issues will include, but not limited to; depression, anti-social behavior, risky sexual behavior, suicide risk behaviors, alcohol and drug addiction.

Growing up in the South has memories attached to it, just as all regions do. The typical ones that come to mind are football, Church on Sundays, minding your manners and dating your heterosexual high school sweethearts. The South historically does not bring up images of tolerance for those who did not fit the mold. That being said, growing up under the LGBTQ umbrella in the South has gotten progressively better over the years and this is something that as Southerners we can be proud of. However, the GLAAD organization also reports that people in the South are more uncomfortable with the LGBTQ community then the US as a whole (glaad.org). This of course trickles down to the younger generation and that has a negative impact. The result being that coming out can be a risky and scary prospect to an adolescent, which in turn has an effect on the mental health of the LGBTQ youth of my community here in Memphis.

What is being shown statistically is that there is a relationship between teens that are coming out as LGBTQ to their parents, being rejected and mental health issues. The result is a marked increase in depression and suicidality because of this experience. Moreover, this situation can also lead to some of the issues mentioned above such as risky sexual behavior and drug or alcohol abuse (Rusow, Goldbach, Rhoades, et al 2018). While on the national level, gay rights have improved greatly the numbers of LGBTQ youth who are struggling with mental health are still rising.

The consequences of these situations are multifaceted and impact many areas of the community. The first causalities of course, are the families that are either broken or even destroyed by abending a child for being who they are. The child who is now cast out of their home may have no other place to live other than a shelter which may or may not be a safe place. Typically, though the youth will decide to live on the streets and live as homeless which impacts their ability to remain healthy both mentally and physically. Secondly it impedes their ability to attend let alone be successful in school or hold down a job. The teens can also be at a higher risk for drug and alcohol abuse which can increase crime in the community. This in turn impacts the neighborhoods and communities. In other words, the impact is felt throughout the community when a child is rejected.

The goal is offering services for both teens and their parents that can offer educational and counseling services. These services can then be used to guide teens in the coming out process and support the parents once their teen has come out. Then hopefully the rise in mental health issues and suicide can be prevented.

The main risk factor that LGBTQ youth face when coming out is rejection. Looking at this issue from the social – ecological model, is that the risk is a concern at all levels. When a youth comes out as LBGTQ they are risking rejection from family, friends, their community and their cultural affiliation. Moreover, the chronic stress of knowing that they may be rejected or ostracized once they do come out that can be one of the factors that lead to negative mental health outcomes (Taylor, 2019). There are other risk factors that these youth face such as victimization, discrimination, self-blame and substance abuse. What is important for the adults supporting LGBTQ youth is knowing what protective factors are necessary to mitigate these dangers.

The first protective factor comes from the individual, and that can be gained from feeling pride and a strong sense of self. The development of self-esteem and self-identity ties into having resilency when there is negative feedback about being a part of the LGBTQ community (Murphy & Hardaway 2017). Moreover, these protective factors help shield the youth from negative mental health issues, substance abuse and homelessness.

A risk that is taken by an LGBTQ youth when coming out to their family is being rejected. This rejection leads to higher rate of homelessness and suicidality which is a major public health heath issue for the youth in this community (Rusow, Goldbach, Rhoades, et al, 2018). The most important protective factor for teens is acceptance of their LGBTQ status by their family. The statistics demonstrate that this acceptance leads to higher levels of self confidence, physical and mental health. Moreover, teens who remain at home in a safe environment are significantly more protected from depression, substance abuse, suicidal ideation, self-harm and of course homelessness (Taylor, 2019).

During the stage of life that is adolescence, the peer group and the school setting are frequently the same. When a teen comes out the importance of their peer group and school community cannot be downplayed. Similar to the teen who is accepted by the family, the teen who is accepted by their peers has a lower risk and is more protected from depression, suicidal thoughts and substance abuse. Again, they also report a higher level of self esteem, better physical health and a higher level of achievement in school. Interestingly, LGBTQ youth who have friends are less likely to suffer from the effects of victimization, that is not to say that they will not encounter it, it is just less painful and inflicts less damage.

In terms of the school setting, when the school sets the tone for being open and accepting of their LGBTQ youth it does have a tendency to trickle down to the student body (glaad.org). For example when there is a Gay Straight Alliance Club on school property, it is a strong example of the school being a safe place for their LGBTQ youth. This can lead to a better sense of belonging and less victimization for the youth who has come out. Secondly, when the school teaches inclusive curriculum about the LGBTQ community as a whole this also leads to a feeling of inclusion and safety (Taylor, 2019).

The issue of culture and community for LGBTQ youth is complicated, because it is dependent on how the youth defines those words. If a youth defines themselves as part of a minority, for example as a African – American, Asian – American, Latino or Jewish and they feel pride and connection to their heritage then their culture and community could be a protective factor for them. LGBTQ youth who felt pride in their culture had a statistically better chance of graduating high school, not facing substance abuse and not being homeless (Murphy & Hardaway, 2017). However, the flip side of this is that youth in these minorities were less likely to come out to their families because they would face rejection from their familes and their communities (Sue & Sue, 2016). Therefore they make the choice to stay connected to who they are in one aspect, but hide their sexuality because the consequences are too great.

From the greater community stand point the change has to come from all of us, from the community as a whole. While steps are being made, such as gay marriage being legalized in 2015 and the latest ruling of the Supreme Court which bans discrimination based on sexual orientation or gender identity. These changes are important, but changes must also be made on the local and state level. However, just as importantly are the shifts in attitudes that are necessary in every home that have negative or discriminatory attitudes toward the LGBTQ community as a whole. Until that is done the battle will not be won.

This portfolio works to establish the betterment of LGBTQ youth in Memphis, Tennessee. The goal is offering services for both teens and their parents that can offer educational and counseling services. These services can then be used to guide teens in the coming out process and support the parents once their teen has come out. Then hopefully the rise in mental health issues and suicide can be prevented. In other words, to address the fact there is a problem a work to create interventions to solve that issue before it becomes a public health issue.

Within the realm of prevention there is one theory that most directly works with goal stated here, that is the Ecological Theory. That theory addresses that health requires a multilevel approach and is not flat, so to speak. More tightly defined, that can be said to mean that the levels are;

• Intrapersonal Level where the person’s individualities are what drives the process

• Interpersonal Level where people’s processes within primary groups such as friends and family give support, identity and definition of roles.

• Community Level, which include institutional factors, community factors and public policy. Within these are norms of society, recommended behaviors and government policies (cancercontrol.cancer.gov)

A second important aspect is that within this Ecological model, we influence those around us. Of course the modern example being wearing of masks. Should the majority of an interpersonal group set the example of wearing masks, then the reciprocal causation can be that others do and that moves to other interpersonal groups.

Within the scope of this portfolio, and the prevention of mental health issues with LGBTQ youth, this Ecological Theory model fits quite well. The first step for a youth to come out begins with themselves, the Intrapersonal Level. Their own characteristics, knowledge, personality and beliefs will be some of the driving factors in how to handle their own personal situation. Is their belief in themselves strong enough that they will be able to withstand possibly being ostracized from their peer group for example? On the Interpersonal Level, does the youth have connections to friends or peers who are also LGBTQ that provide support and help them define their identity before, during and after the coming out process? Lastly, at the Community Level, what has been done and what is being done to change the homophobic behavior in the Memphis community? What legislation is on the table at the local and state level? What steps are being take on social media to change the homophobic attitude that is still prevalent in our community.

The Ecological Perspective Theory is successful in numerous situations as a theory because it does employ the three levels mentioned of intrapersonal, interpersonal and community level. Moreover, researches subscribe to this theory because of its ability to combine different levelts of country (community), family structure (interpersonal) and intrapersonal. Thus making it a sound theory (Perry & Wadsworth 2017).

An evidence based program typically can be demonstrated in balance sheets and number of success stories. For the argument of the portfolio, evidence based program will be reliant on the published information of the organization OUTMemphis. The organization offers a to LGBTQ youth Health & Wellness offerings that have grown through donations and community support. From its inception in 2009, the program has added; sexual health, mental health, intimate partner violence, spiritual health and substance abuse (outmemphis.org). Moreover the program has increased in the numbers of community members it can service on a daily basis.

While all LGBTQ have a history of being subject to mental health issues, the subgroup of transgender youth has had an even tougher road. The term transgender can be defined as a person who is gender incongruent, in other words their gender identities do not match their sex assigned at birth (Anderssen, Sivertsen, Lønning, et al, 2020). As mentioned previously, LGBTQ youth have higher rates of depression and suicidality. Moreover, they also are faced with issues such as risky sexual behavior and drug or alcohol abuse (Rusow, Goldbach, Rhoades, et al 2018). Youth who are transgender face additional situations of being stigmatized and bullied because they do not conform to their assigned birth sex. As a result, they have even more significant rates of isolation, loneliness, victimization and discrimination which in turn leads to higher levels of mental health problems (Weinhardt, Xie, Wesp, et al 2019).

A prevention program that would address the specific problems that transgender youth face would include two specific mechanisms. The first mechanism would be teaching the community at large, and the family specifically that the respecting of gender variance with acceptance and flexibility is critical. Moreover, that being cisgender is not the defining characteristic of a person (Weinhardt, Xie, Wesp, et al 2019). The second mechanism is the teaching of educators that children who are trans need support within the educational systems. How teachers should appropriately react to the transgender child and protect them from peers, administrators and the system itself who may not be advocating appropriately (Murray, Pope, & Willis 2017). This in turn would set the example for the children within the classroom and therefore normalize the experience of being transgender.

Prevention programs also bring within them ethical considerations that must be dealt with appropriately. One of the first ethical dilemmas that can be brought up is that of informed consent. Prevention programming typically involves large groups, so who does provide the program the consent (Hage, & Romano, 2013)? This issue can be especially sensitive when dealing with youth, and specifically transgender youth when parents may feel that it is not their consent to give depending on the age of the child, even though legally they have the right up until the age of eighteen.

A second issue to consider is confidentiality. Confidentiality is a cornerstone of the therapeutic relationship, so how does that factor into a prevention program? Moreover, prevention programs can and do frequently deal with sensitive issues. How to balance intervening with a prevention program for an individual when it would be a breach of confidentiality is an ethical dilemma (Hage, & Romano, 2013)? In the case of a transgender youth, if a counselor knew that a child was having a difficult time in class and the parents were unaware it would be breaking the confidentiality to speak to them. Moreover, there was program within the school for parents of transgender kids to help learn to be an advocate. Therefore, it would be in the best interest of the child speak to them, because they could be engaged in the program and better protect their child.

Lastly, stakeholders are critical to the consideration of a prevention program. A stakeholder is a person or organization who has a vested interest in the success of the program. For the transgender youth, those can be parents, educators, LGBTQ organizations, community leaders and legislators. All have reason to make sure that this subgroup is protected from isolation, bullying, victimization and discrimination.

[Insert the content for this section here. See the instructions for the Advocacy section in Week 7 and follow the instructions this section closely. Be sure to attend to all bullet-points for this section found in the “To Prepare” area in week 7. Please write in full sentences using APA style].

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Murray, C., Pope, A., & Willis, B. (2017). Sexuality counseling: Theory, research, and practice. Thousand Oaks, CA: Sage 

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Weinhardt, L. S., Xie, H., Wesp, L. M., Murray, J. R., Apchemengich, I., Kioko, D., Weinhardt, C. B., & Cook-Daniels, L. (2019). The Role of Family, Friend, and Significant Other Support in Well-Being Among Transgender and Non-Binary Youth. Journal of GLBT Family Studies, 15(4), 311–325

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