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RE: SOCW6090 – DIscussion – Response to 2 Students (wk3)

Respond to at least two colleagues in the following ways: (Be detailed in response, Use 2 APA references and use sub-headings in response)

  • Provide suggestions to manage the emotional responses your colleague identified.
  • Explain why consideration of culture is important when working with diverse clients.

Response to Lisa

Identify elements of Dr. Sommers-Flanagan’s suicide risk assessment.

During Dr. Sommers-Flanagan’s suicide risk assessment he attempted to assess Tommi’s mood and depression, factors that influence her mood, thoughts on her environment/others, sleeping habits, and social environment. He started with exploring her culture as a member of the Yupik tribe. He delved into the frequency, duration, and intensity of the client’s suicidal thoughts and even her attempts. Dr. Sommers-Flanagan addressed her motives and helped create a safety plan for the client. He was respectful and culturally sensitive.

Describe any personal emotional responses you would have to Tommi’s revelations and reflect on reasons you might experience these emotions.

Responses I would have had to Tommi’s revelations were of understanding and empathy. As a minority, I can relate to being in a group that highly stigmatizes mental illnesses and share negative traits, such as substance abuse. Chu et al. (2013) have written that there is a need for assessment in interdependent cultures, such as Asian Americans and Latinos, for family conflict as they may play a major suicide risk (p. 425). There is a need for cultural sensitivity when assessing individuals that belong to minority groups as they are least likely than Whites to self-report any suicidal ideation. Another moment when I had an emotional response was when she disclosed her personal attempts at suicide and her friend’s death. Again, I could feel an overwhelming sense of understanding as, personally, it feels normal to have somewhat conflicting thoughts. She talked of suicide as if it were easy and then how it was a selfish act. She admitted, “I don’t know what I’m trying to say” which I believe can be common to those who have some suicidal ideation but may be experiencing more major depressive symptoms (Sommers-Flanagan & Sommers-Flanagan, 2014). Her age and the characteristics she shows throughout the video does provoke a sense of needing to protect, but really, to not cause further harm.

Describe the elements of safety planning that you would put in place as Tommi’s social worker in the first week and in the first months.

If I were Tommi’s social worker, I would incorporate working on a Patient Safety Plan Worksheet similar to that posted on the US Department of Veteran Affair’s website. The worksheet includes support contacts, scenarios, contact information for crisis lines, and other information that may be pertinent or serve as a reminder to the client in times of need. This may be completed within the first week with Tommi since she appeared to be receptive and cooperative. The worksheet can be updated whenever Tommi or I saw fit. I especially liked the VA’s worksheet as it did include triggers, reminders of how the client acts when triggered, and effective strategies (U.S. Department of Veterans Affairs, 2013). to overcome those negative feelings. These sections can provide physical reminders to the client and possibly help them with their feelings and thoughts.

Identify a suicide risk assessment tool you would use at future sessions to identify changes in her risk level. Explain why you would use this tool.

The Cultural Assessment of Risk for Suicide (CARS) measurement could be an effective tool to use with Tommi. The CARS measurement includes the influence of cultural beliefs, norms, practice and culture on suicidal behaviors (Chu et al., 2013, p. 426). The CARS measurement has four categories of cultural sanctions, idioms of distress, minority stress, and social discord that is broken down into to measure specifically the levels of each cultural factors as suicide risks (Chu et al., 2013, p. 426). These factors were not present in existing suicide assessment tools, which is not culturally sensitive and can be misleading to the clinician. Without a proper assessment tool, there may be more severe consequences and treatment plan will not adequately help the client reach the goal of positive change. The categories in the CARS measurement would be able to point out the factors and their influence in Tommi’s suicidal behaviors and thoughts. For instance, in the category of social discord, it measures the alienation, conflict, or lack of integration in the client’s social environment including family (Chu et al., 2013, p. 426). Measuring the level of social discord would be high for Tommi as she has reported her family to be a motivation for suicide.

Explain any adjustments or enhancements that might be helpful given Tommi’s cultural background. Support your ideas with scholarly resources.

An addition to measure levels of adversity or resiliency may be noted in assessment tools. Brockie et al. (2015) noted that various types of childhood adversity had been found to have an increased risk of suicidal behaviors and thoughts (p. 412). With a population who has endured discrimination and hardships, it may be necessary to measure the influence of their environment and levels of resiliency. The results may correlate with their everyday behavior and thought patterns. Wexler et al. (2015) have also observed a correlation between childhood adversity and American Indian/Alaskan Native suicidal behaviors and ideation (p. 382). Even for Tommi, she mentioned that she would much rather call her sister in times she needed to talk because they had the same upbringing (Sommer-Flanagan & Sommer-Flanagan, 2013). Furthermore, there does need to be an adjustment to include comorbidity, possible victimization, and substance use as there appeared to be an increase of suicide risks in American Indian/Alaskan Natives (Wexler et al., 2015, p. 892). Understanding that in this particular culture, it may be more of a societal/environmental problem than an individual issue, or at least, there is a large societal influence. Thus incorporation of positive support may be an effective tool for better change.

References

Brockie, T. N., Dana-Sacco, G., Wallen, G. R., Wilcox, H. C., & Campbell, J. C. (2015). The Relationship of adverse childhood experiences to ptsd, depression, poly-drug use and suicide attempt in reservation-based native american adolescents and young adults. American Journal of Community Psychology, 55(3/4), 411–421. Retrieved from https://doi-org.ezp.waldenulibrary.org/10.1007/s10…

Chu, J., Floyd, R., Diep, H., Pardo, S., Goldblum, P., & Bongar, B. (2013). A tool for the culturally competent assessment of suicide: The Cultural Assessment of Risk for Suicide (CARS) measure. Psychological Assessment, 25(2), 424–434. doi:10.1037/a0031264

Sommers-Flanagan, J. & Sommers-Flanagan, R. (Producers). (2014). Clinical interviewing: Intake, assessment and therapeutic alliance [Video file]. Retrieved from http:www.psychotherapy.org/stream/waldenu/video?vid=276

U.S. Department of Veterans Affairs. (2013). Assessment and management for patients at risk for suicide. Retrieved from https://www.healthquality.va.gov/guidelines/MH/srb/

Wexler, L., Chandler, M., Gone, J. P., Cwik, M., Kirmayer, L. J., LaFromboise, T., … Allen, J. (2015). Advancing suicide prevention research with rural american indian and alaska native populations. The American Journal of Public Health, (5), 891. Retrieved from https://ezp.waldenulibrary.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=edsgea&AN=edsgcl.412683025&site=eds-live&scope=site

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Response to Latrice

After listening to Dr. Sommers-Flanagan’s suicide risk assessment, I have established that there were some to strengths and weakness to some of the techniques that were identified. One of the strengths of Dr. Sommers-Flanagan’s point in the video was to identify culture and the individual characteristics of the client are very important in the clinical interviewing process. According to Chu, Cultural risk factors are particularly salient for suicide assessment in diverse ethnic, gender, and sexual minority populations, and have been shown to be influential in creating culturally competent treatment plans for suicide management (Chu, 2013). Another strength that was described in the video was to listen to the clients. I think this a universal technique. Listening shows the client that you empathize with his/her feelings, and this can make a difference to the response the client gives. On the other hand, I think it is good to empathize to clients. Empathy shows that you are listening, but you also can connect to the client’s emotions. This brings to the video in which Dr. Sommers-Flanagan suggest to stay quiet when clients are expressing or talking. I would say this is a weakness. Staying quiet can be beneficial; however, this should be done with emotions such as being empathic.

In the case of Tommi, if I were Dr. Sommers-Flanagan, I would feel sincere for her. Tommi seems to feel hopeless and wishes she wasn’t alive. Some techniques that I would introduce to Tommi is coping skills. For example, I would suggest or come up ways to get the mindset of suicide out of her mind. Tommi stated that when she sings, she does not think about suicide; therefore, I would suggest for her to continue singing or join a singing recreation. In addition, I would also suggest socializing with friends and relatives to help her elevate some of the lonely state of mind. I would suggest that this put in place for the first few weeks, and the final step would suggest professional help such as therapy after a month. In a month or so I would measure Tommi’s level of depression using a Patient Health Questionnaire (PHQ-9) and the Beck Depression Inventory which helps measure depression. Tommi first had signs of being depressed; therefore, this tool would first measure her levels of depression. The results of the questionnaire will determine if another suicide risk assessment is needed.

Tommi seems to be greatly proud of her heritage; therefore, incorporating her cultural background in her treatment would be helpful. During Tommi’s interview she seem reserved. This can possibly be a sign of the way she was raised. According to an article in Psychology Today, the importance of honor—that is statistically related to suicide rates. An honor culture is a society or social group that emphasizes the importance of an individual’s reputation or “honor.” This can be used help Tommi identify with her cultural and intervention in her suicide assessment (Psychology Today, n.d).

References

Chu, J., Floyd, R., Diep, H., Pardo, S., Goldblum, P., & Bongar, B. (2013). A tool for the culturally competent assessment of suicide: The Cultural Assessment of Risk for Suicide (CARS) measure. Psychological Assessment, 25(2), 424–434.

Cultural Values and the Likelihood of Suicide Retrieved from https://www.psychologytoday.com/us/blog/culture-co…

Sommers-Flanagan, J. & Sommers-Flanagan, R. (2014). Clinical interviewing: Intake, assessment and therapeutic alliance [Video file]. Retrieved from http://www.psychotherapy.net.ezp.waldenulibrary.org/stream/waldenu/video?vid=276

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