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COUN 6785: Social Change in Action:

Prevention, Consultation, and Advocacy

Social Change Portfolio

J Herring

Contents

Introduction

Scope and Consequences

Social-ecological Model

Theories of Prevention

Diversity and Ethical Considerations

Advocacy

The phrase school-to-prison pipeline is now trite, overused, and watered down, although the seriousness of the practice remains a real concern. Across the country, suspensions and expulsions from school, referrals to alternative schools, and school-based arrests have increased, especially among minority students, which blurs the line between the education and criminal justice systems. The consequences adolescents face for their behavioral issues address only the behavior but not the cause of the behavior. The socioeconomic disadvantage of minority adolescents can have significant adverse effects on their mental health, including depression and behavior problems, anxiety disorders such as posttraumatic stress disorder, and a range of other adjustment difficulties. Many minority adolescents also experience “compounded community trauma” which has been defined as the experience of children when they witness violence in both their homes and their neighborhoods. Additional factors that increase the risk for mental illness for minority youth are neighborhood exposure to violence, repeated experiences of discrimination, and chronic exposure to racism. As a result, early interventions for minority adolescents, intended to maximize their effective coping in these disadvantaged and at-risk environments, can be advantageous for their future mental health. Thus, effective adovacation that push for early prevention and intervention are essential to reduce the burden of mental disorders for minority adolescents (El Bouhaddani, et. al., 2019).

PART 1: SCOPE AND CONSEQUENCES

Advocating for Minority Adolescents in Sanford, Florida

The conditions in which a person is born, grows, lives, and works have a significant impact on his health, both physical and mental. Sanford is the County Seat of Seminole County, Florida. Sanford has an African American population of 30.5%. The high school and its cluster schools reflect the dichotomy that exists within the community of Sanford. While Seminole High (where I once taught English Language Arts) was awarded the Silver ranking in 2015 by US News & World Report, the percent of disadvantaged students who were determined proficient was 46.5%, whereas the proficiency of non-disadvantaged students was 74.5%. In addition, the suspension and graduation rates for students of color are disproportionate when compared to white students.

Sanford became the center of national and international media attention following the February 2012 fatal shooting of Trayvon Martin, a 17-year old African American high school student. However, when the marches and protests dissipated, so did the care and concern of the youth in Sanford. They were left with the invisible scars from the overt racism they faced and continue to face for looking, acting, and existing like Trayvon Martin. These children need effective mental health care to teach them coping and anger management strategies and tools, not expulsion from school.

The mental health needs of minority adolescents are not well served: they are treated less frequently, and when they are treated, the services they receive are less frequently and adequate. Recent studies show that 6.6% of ethnic minority children and youth receive services compared to 20% of white children (Yasui, 2014). The result of insufficient mental healthcare for minority adolescents is that they are more likely to engage in problematic behaviors later in life, such as increased depression, anxiety, engagement with deviant peers, involvement with violent crime, poor academic performance, school dropout, drug and alcohol abuse, unsafe sex, and unemployment (Alegria, Vallas, & Pumariega, 2010). Therefore, my goal is to push for effective adovacation that provides resources for early prevention and intervention to reduce the prevalence of mental disorders for minority adolescents.

One cannot deny that disparities exist in the mental health care arena, much like in general healthcare. Strategies to lower or remove discrepancies involve improving access to care, improving quality of care, and reducing the stigma associated with mental healthcare.

Because of these discrepancies, some of the risk factors exist. However some risk and protective factors for minority adolescents are common for all adolescents, as this is an important time for physical, emotional, and mental development. However, if this stage of development does not occur in a safe, supportive environment, then a mental disorder may occur.

Individual

Some of the risk factors on the individual level for adolescents include having low self-esteem, insecure attachment, difficult temperament (poor concentration, inflexibility, low positive mood), poor social skills, and extreme need for approval and social support. Although effective treatments exist for many mental disorders, unfortunately, over half of adolescents in the U.S. who need mental health treatment never receive it. Further, compared with their white counterparts, growing evidence indicates that racial/ethnic minority adolescents are more vulnerable to mental disorders but less likely to use mental health services. Minority adolescents’ underutilization of mental health services is exacerbated by their tendency to withdraw prematurely from treatment. Adolescents will not fully benefit from mental health services if they terminate treatment early (Yasui, 2007).

Another risk factor is the idea that minorities may also receive inferior care because there may be little to no diversity among the mental healthcare workers who have a decreased understanding about the different mental health needs across minority groups. This insufficient or lack of diversity begets cultural insensitivities that lead to negative health outcomes, including lower treatment retention rates (“Understanding barriers to minority mental health care,” 2018).

On the other hand protective factors include having physical development, high self-esteem, academic achievement, emotional self-regulation and good coping and problem-solving skills on the individual level. Sufficient mental healthcare programs must be in place to teach minority adolescents how to implement such protective factors.

Family

Some risk factors on the family level are parental depression, parental divorce, poor parenting, negative family environment, child abuse, parent(s) with mental disorders, and sexual abuse. When taking a closer look at the negative family environment factor, one cannot ignore that African American umemployment rates are typically double that of Caucasian Americans. In addition, African American men working full time only earn 72 percent of the average salary of their white male peers and 85 pecent of the earnings of white women (“Ethnic and racial minorities & socioeconomic status,” 2008. With this information, it is not hard to understand why mental health disorders may occur, as hierarchical needs are not being fulfilled.

Protective factors on the familial level include strong family structure with clear expectations, limits, rules, and monitoring on the family level. Adolescents must feel connected to and supported by their families, specifically their parents. Parents must be able to provide a stable home environment through sufficient employment, adequate housing, and sufficient access to medical and mental healthcare.

School and Peers

Risk factors at this level are the environment in which the minorities receive their education and their level of academic achievement. African-Americans and Latinos are more likely to attend high-poverty schools than Asian-Americans and Caucasians (National Center for Education Statistics, 2007). This results in a higher dropout rate, as the schools lack valuable resources, teachers with lowered expectations, and less rigorous curricula.

In order to combat these risk factors, schools must provide mentors for support and the development of skills and interests. School systems must begin to see the connection between adequate mental healthcare and academic achievement. A protective factor is to implement evidence-based interventions for disruptive behavior versus disciplinary actions that might suspend the child from school. This only places the child back into a dysfunctional home, where he will not receive the proper care for his mental and emotional needs.

Community

When it comes to minorities, the aforementioned risk factors are heightened because socioeconomic barriers prevent access to care. It must be understood that socioeconomic defines more than the ability to attain proper education, financial stability, and a perception of social class. It also emcompasses the opportunities and privileges afforded to people within their community. When a community has high poverty rates, high unemployment rates, several locations that encourage risky behaviors (e.g. liquor stores, high-interest payday loan businesses), then there is little to no emphasis placed on education, proper healthcare, and positive social connections.

Community protective factors provide opportunities for engagement within the school and community to create and reinforce positive norms, enforce expectations for positive behavior, and promote psychological safety (O’Connell, Boat, & Warner, 2009). While these are community protective factors, they begin in individual homes with the community providing the resources and support to prevent the perpetuation of abuse and dysfunction.

Albert Bandura's social learning theory is popular among current prevention programs. According to Bandura, learning is acquired and shaped by positive and negative reinforcements (rewards and punishments), as well as by observation of other people's behavior (Johnson, 2018). This theory is based on the idea that people can predict the consequences to certain behaviors and earn the rewards or endure the punishments. Bandura recognized the potential for using modeling as a way of directing and changing behavior.

This theory can serve as a framework for a mental health awareness program for minority youth as it emphasizes “using the team or buddy approach, teaming individuals, small groups, families, and even communities, in which new health related behaviors can be modeled and reinforced, helping to set new norms” (Johnson, 2018, p. 579). In this way, peer mediation and group therapy principles can be utilized to help the adolescents learn and adapt new behaviors, thus helping reduce the chances of depression, drug-use, and/or expulsion from school.

In addition to school, the social learning theory can also be applied in the home-setting. Bandura believed that children learn vicariously by observing their surroundings, so if family violence is present in the home, then the children are at risk for imitating these behaviors. They are also at a higher risk for developing mental health disorders (Abbassi & Aslinia, 2010). According to the theory, once mental health professionals learn more about the home and school ennvironment, then they can put curricula in place that will prevent cycles of abuse, mental health disorders, suicidal ideation, and antisocial behaviors.

Conducting research with minors in a school setting for preventive purposes and investigating risk or self-destructive behaviors such as deviance, drug abuse, or suicidal behavior, is ethically sensitive. This is because prevention specialists may be tempted to impose their values on this marginalized group (Hage & Romano, 2013, p. 39), although they do not have any shared experiences. Another reason mental health professionals must exercise caution is because of the historial mistreatment of ethnic minorities in a medical research setting. Historical events may bring about skepticism about the real purpose of a prevention program. The well-known Tuskegee Experiment, where over 600 African American men were intentionally injected with syphilis and not given antibiotics, which would cure them. Instead, they were given placebos, aspirin, or herbal suppliments, so the medical community could observe the disease’s natural progression in the body. As a result, the men either died, went blind or insane or incurred severe health problems due to the untreated syphilis (Green, et.al., 2013). While the Tuskegee Experiment is not an isolated incident, it does serve as a symbol of how minorities can be taken advantage of under the guise of programs of help and prevention.

In addition to the exploitative research and prevention programs, there is also evidence of medical and mental health-related programs that are designed to support racist ideology. In other words, these programs are designed to show the “physical, intellectual, and emotional inferiority of minorities to justify slavery, discriminatory immigration policies, and educational segregation” (Alvidrez & Arean, 2002, p.104). Because of the aforementioned, mental health professionals must work hard to establish rapport, especially building trust, with the minority youth they are aiming to help. They must also work carefully to validate the experiences of people who may be culturally different from them.

Informed consent and confidentiality are especially important with this population of adolescents because they do not have the legal right to consent, nor do they have the emotional maturity to understand the benefits and the possible dangers of participating in mental health programs. They must also understand the confidentiality has its limitations and it must be broken in some cases. Mental health professionals must understand that many minority adolecents seek validation and acceptance. If they feel these needs are being met in a therapeutic setting, but they disclose information that must be shared, then the trust that has been established may be irretrievably broken.

In addition to informed consent and confidentiality, collaboration are some of the the core ethical considerations that should be taken into account when working with minority adolescents. The type of change defined in this proprosal will require systemic change; therefore, ethical considerations indicate that not only should the target population be involved in the prevention plan, but also their individual families, entire communities, and the entire school (Hage & Romano, 2013). This type of collaboration will promote trust and prevent opposing values being placed on the adolescents.

Advocacy in mental health serves to promote the voice of clients, represent their interests, and encourage collaboration in decision-making. Because inequities and disparities for mental health and medical health coverage abound between minorities and their caucasian counterparts, minorities, especially adolescents, may find it difficult accessing quality mental health care. For this reason, in order to advocate for the minority youth in Sanford, Florida, certain barriers at the institutional, community, and public policy levels must be identified and dismantled. The Multicultural and Social Justice Couseling Competencies (MSJCC) provides guidance through an outline in which counselors may follow in order to identify resources and implement change.

The institutional level includes schools and community programs that provide specific services and programs for adolescents. A barrier at this level is being able to provide adequate financial resources for mental health programs. The Florida Legislature created the Florida Education Finance Program (FEFP) to fund public education in a manner that would “guarantee to each student in the Florida public education system the availability of programs and services appropriate to his or her educational needs.” Funding for the FEFP combines state funds – primarily generated from sales tax revenue – and local funds – generated from property tax revenue (“Florida's K-12 funding formula,” 2016). Many schools that service the needs of minorities are located in low-income neighborhoods, which means they do not generate enough property taxes to provide funding for extra programs, such as one that provides mental health care for the adolescents that attend the school. Any extra money the school receives is likely to go towards building maintenance, classroom resources, or academic remediation resources. Mental health care is not high on the priority list for any principal.

Another barrier that was a common trend during my time as a classroom teacher is transportation. While the students may express the desire to participate in several programs offered by the school, the lack of transportation was a hindrance. However, it is feasible to expect school administrators to allocate funds for buses (gas and driver) when the building is falling apart or the school does not have adequate teachers. Mental health is not high on the priority list.

The community in which these adolescents lives also set the level of importance in which mental health and mental health care is placed. According to concepts listed in the MSJCC, these values either have a positive, empowering influence or a negative, oppressive influence (Multicultural and Social Justice Counseling Competencies, 2015). As previously stated, the property taxes have a direct impact on the amount of financial resources available to certain communities. These poorer communites have residents who mostly live paycheck to paycheck, only meeting basic needs of living—food, water, shelter, and clothes. Mental health care is seen as an unattainable luxury reserved for more financially stable residents. The first step in overcoming this obstacle is the acknowledge that it exist. Oftentime, people are expected to “overcome” or “rise above” their circumstances, even when they are not provided the proper tools in which to rise above. When community leaders, such as the city council, school board, and even church leaders acknowledge the disparity of resources between the residents, then interventions may be implemented.

Another barrier that likely carries the most opportunity for intervention is at the public policy level. This level involves state and federal laws and policies that directly impact communities and how well they are able to grow and thrive (Multicultural and Social Justice Counseling Competencies, 2015). Poor health outcomes for minority health, especially when it comes to mental health care, is apparent when it comes to Florida’s general population. Documented research shows that minority populaitons experience higher rates of illness and death from health conditions such as heart disease, stroke, specific cancers, diabetes, HIV/AIDS, mental health, asthsma, hepatitis, and obesity (“Minority health and health equity | Florida Department of Health,” 2020). For this reason, the Office of Minority Health was established established in 2004 by the State Legislature 20.43(9), which works alongside the Department of Health to provide consultation, training services, program development and implementation, and other necessary resources to address all of the healt needs of Florida’s minority populations statewide.

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