SOCW 6200: Human Behavior and the Social Environment I
Discussion: Indicators of Suicide
Increased stress levels, feeling hopeless and alone, being bullied, or experiencing repeated physical or sexual abuse could all be reasons why some adolescents consider suicide. Adolescent suicide has far-reaching consequences on families, friends, communities, and schools. For this Discussion, use the Parker Family case study to consider the indicators of suicide. While Stephanie is now an adult talking about her experience as a youth, image how you would have responded to her at the time she tried to kill herself in adolescence. Also think about how you might react to students in this situation if you were a social worker in a school.
Post your answer to the following:
The Parker Family
Sara is a 72-year-old widowed Caucasian female who lives in a two-bedroom apartment with her 48-year-old daughter, Stephanie, and six cats. Sara and her daughter have lived together for the past 10 years, since Stephanie returned home after a failed relationship and was unable to live independently. Stephanie has a diagnosis of bipolar disorder, and her overall physical health is good. Stephanie has no history of treatment for alcohol or substance abuse; during her teens she drank and smoked marijuana but no longer uses these substances. When she was 16 years old, Stephanie was hospitalized after her first bipolar episode. She had attempted suicide by swallowing a handful of Tylenol® and drinking half a bottle of vodka after her first boyfriend broke up with her. She has been hospitalized three times in the past 4 years when she stopped taking her medications and experienced suicidal ideation. Stephanie’s current medications are Lithium, Paxil®, Abilify®, and Klonopin®.
Stephanie recently had a brief hospitalization as a result of depressive symptoms. She attends a mental health drop-in center twice a week to socialize with friends and receives outpatient psychiatric treatment at a local mental health clinic for medication management and weekly therapy. She is maintaining a part-time job at a local supermarket where she bags groceries and is currently being trained to become a cashier. Stephanie currently has active Medicare and receives Social Security Disability (SSD).
Sara has recently been hospitalized for depression and has some physical issues. She has documented high blood pressure and hyperthyroidism, she is slightly underweight, and she is displaying signs of dementia. Sara has no history of alcohol or substance abuse. Her current medications are Lexapro® and Zyprexa®. Sara has Medicare and receives Social Security benefits and a small pension. She attends a day treatment program for seniors that is affiliated with a local hospital in her neighborhood. Sara attends the program 3 days a week from 9:00 a.m. to 2:00 p.m., and van service is provided free of charge.
A telephone call was made to Adult Protective Services (APS) by the senior day treatment social worker when Sara presented with increased confusion, poor attention to daily living skills, and statements made about Stephanie’s behavior. Sara told the social worker at the senior day treatment program that, “My daughter is very argumentative and is throwing all of my things out.” She reported, “We are fighting like cats and dogs; I’m afraid of her and of losing all my stuff.”
During the home visit, the APS worker observed that the living room was very cluttered, but that the kitchen was fairly clean, with food in the refrigerator and cabinets. Despite the clutter, all of the doorways, including the front door, had clear egress. The family lives on the first floor of the apartment building and could exit the building without difficulty in case of emergency. The litter boxes were also fairly clean, and there was no sign of vermin in the home.
Upon questioning by the APS worker, Sara denied that she was afraid of her daughter or that her daughter had been physically abusive. In fact, the worker observed that Stephanie had a noticeable bruise on her forearm, which appeared defensive in nature. When asked about the bruise, Stephanie reported that she had gotten it when her mother tried to grab some items out of her arms that she was about to throw out. Stephanie admitted to throwing things out to clean up the apartment, telling the APS worker, “I’m tired of my mother’s hoarding.” Sara agreed with the description of the incident. Both Sara and Stephanie admitted to an increase in arguing, but denied physical violence. Sara stated, “I didn’t mean to hurt Stephanie. I was just trying to get my things back.”
The APS worker observed that Sara’s appearance was unkempt and disheveled, but her overall hygiene was adequate (i.e., clean hair and clothes). Stephanie was neatly groomed with good hygiene. The APS worker determined that no one was in immediate danger to warrant removal from the home but that the family was in need of a referral for Intensive Case Management (ICM) services. It was clear there was some conflict in the home that had led to physical confrontations. Further, the house had hygiene issues, including trash and items stacked in the living room and Sara’s room, which needed to be addressed. The APS worker indicated in her report that if not adequately addressed, the hoarding might continue to escalate and create an unsafe and unhygienic environment, thus leading to a possible eviction or recommendation for separation and relocation for both women.
As the ICM worker, I visited the family to assess the situation and the needs of the clients. Stephanie said she was very angry with her mother and sick of her compulsive shopping and hoarding. Stephanie complained that they did not have any visitors and she was ashamed to invite friends to the home due to the condition of the apartment. When I asked Sara if she saw a problem with so many items littering the apartment, Sara replied, “I need all of these things.” Stephanie complained that when she tried to clean up and throw things out, her mother went outside and brought it all back in again. We discussed the need to clean up the apartment and make it habitable for them to remain in their home, based on the recommendations of the APS worker. I also discussed possible housing alternatives, such as senior housing for Sara and a supportive apartment complex for Stephanie. Sara and Stephanie both stated they wanted to remain in their apartment together, although Stephanie questioned whether her mother would cooperate with cleaning up the apartment. Sara was adamant that she did not want to be removed from their apartment and would try to accept what needed to be done so they would not be forced to move.
The Parker Family
Sara Parker: mother, 72
Stephanie Parker: daughter, 48
Jane Rodgers: daughter, 45
Stephanie reported her mother is estranged from her younger sister, Jane, because of the hoarding. Stephanie also mentioned she was dissatisfied with her mother’s psychiatric treatment and felt she was not getting the help she needed. She reported that her mother was very anxious and was having difficulty sleeping, staying up until all hours of the night, and buying items from a televised shopping network. Sara’s psychiatrist had recently increased her Zyprexa prescription dosage to help reduce her agitation and possible bipolar disorder (as evidenced by the compulsive shopping), but Stephanie did not feel this had been helpful and actually wondered if it was contributing to her mother’s confusion. I asked for permission to contact Jane and both of their outpatient treatment teams, and both requests were granted.
I immediately contacted Jane, who initially was uncooperative and stated she was unwilling to assist. Jane is married, with three children, and lives 3 hours away. At the beginning of our phone call, Jane said, “I’ve been through this before and I’m not helping this time.” When I asked if I could at least keep in touch with her to keep her informed of the situation and any decisions that might need to be made, Jane agreed. After a few more minutes of discussion around my role and responsibilities, I was able to establish a bit of rapport with Jane. She then started to ask me questions and share some insight into what was going on in her mother and sister’s home.
Jane informed me that she was very angry with her mother and had not brought her children to the apartment in years because of its condition. She said that her mother started compulsively shopping and hoarding when she and Stephanie were in high school, and while her father had tried to contain it as best he could, the apartment was always cluttered. She said this had been a source of conflict and embarrassment for her and Stephanie all of their lives. She said that after her father died of a heart attack, the hoarding got worse, and neither she nor Stephanie could control it. Jane also told me she felt her mother was responsible for Stephanie’s relapses. Jane reported that Stephanie had been compliant with her medication and treatment in the past, and that up until a few years ago, had not been hospitalized for several years. Jane had told Stephanie in the past to move out.
Jane also told me that she “is angry with the mental health system.” Sara had been recently hospitalized for depression, and Jane took pictures of the apartment to show the inpatient treatment team what her mother was going home to. Jane felt they did not treat the situation seriously because they discharged her mother back to the apartment. Stephanie had been hospitalized at the same time as her mother, but in a different hospital, and Jane had shown the pictures to her sister’s treatment team as well. Initially the social worker recommended that Stephanie not return to the apartment because of the state of the home, but when that social worker was replaced with someone new, Stephanie was also sent back home.
When I inquired if there were any friends or family members who might be available and willing to assist in clearing out the apartment, Jane said her mother had few friends and was not affiliated with a church group or congregation. However, she acknowledged that there were two cousins who might help, and she offered to contact them and possibly help herself. She said that she would ask her husband to help as well, but she wanted assurance that her mother would cooperate. I explained that while I could not promise that her mother would cooperate completely, her mother had stated that she was willing to do whatever it took to keep living in her home. Jane seemed satisfied with this response and pleased with the plan.
I then arranged to meet with Sara and her psychiatrist to discuss her increased anxiety and confusion and the compulsive shopping. I requested a referral for neuropsychiatric testing to assess possible cognitive changes or decline in functioning. A test was scheduled, and it indicated some cognitive deficits, but at the end of testing, Sara told the psychologist who administered the tests she had stopped taking her medications for depression. It was determined Sara’s depression and discontinuation of medication could have affected her test performance and it was recommended she be retested in 6 months. I suggested a referral to a geriatric psychiatrist for Sara, as she appeared to need more specialized treatment. Sara’s psychologist was in agreement.
Because they had both stated that they did not want to be removed from their home, I worked with Sara and Stephanie as a team to address cleaning the apartment. All agreed that they would begin working together to clean the house for 1 hour a day until arrangements were made for additional help from family members. In an attempt to alleviate Sara’s anxiety around throwing out the items, I suggested using three bags for the initial cleanup: one bag was for items she could throw out, the second bag was for “maybes,” and the third was for “not ready yet.” I scheduled home visits at the designated cleanup time to provide support and encouragement and to intervene in disputes. I also contacted Sara’s treatment team to inform them of the cleanup plans and suggested that Sara might need additional support and observation as it progressed. Jane notified me that her two cousins were willing to assist with the cleanup, make minor repairs, and paint the apartment. Jane offered to schedule a date that would be convenient for her and her cousins to come and help out.
Key to Acronyms
APS: Adult Protective Services
ICM: Intensive Case Management services
SSD: Social Security Disability
We then discussed placement for at least some of the cats, because six seemed too many for a small apartment. Sara and Stephanie were at first adamant that they could not give up their cats, but with further discussion admitted it had become extremely difficult to manage caring for them all. They both eventually agreed to each keep their favorite cat and find homes for the other four. Sara and Stephanie made fliers and brought them to their respective treatment programs to hand out. Stephanie also brought fliers about the cats to her place of employment. Three of the four cats were adopted within a week.
During one home visit, Stephanie pulled me aside and said she had changed her mind—she did not want to continue to live with her mother. She requested that I complete a housing application for supportive housing stating, “I want to get on with my life.” Stephanie had successfully completed cashier training, and the manager of the supermarket was pleased with her performance and was prepared to hire her as a part-time cashier soon. She expressed concern about how her mother would react to this decision and asked me for assistance telling her.
We all met together to discuss Stephanie’s decision to apply for an apartment. Sara was initially upset and had some difficulty accepting this decision. Sara said she had fears about living alone, but when we discussed senior living alternatives, Sara was adamant she wanted to remain in her apartment. Sara said she had lived alone for a number of years after her husband died and felt she could adjust again. I offered to help her stay in her apartment and explore home care services and programs available that will meet her current needs to remain at home.
Please use the Learning Resources to support your answer.
Miranda-Mendizábal, A., Castellví, P., Parés-Badell, O., Almenara, J., Alonso, l., Blasco, M. J., & … Alonso, J. (2017). Sexual orientation and suicidal behaviour in adolescents and young adults: Systematic review and meta-analysis. The British Journal of Psychiatry, 211(2), 77–87. doi:10.1192/bjp.bp.116.196345
Plummer, S.-B., Makris, S., Brocksen S. (Eds.). (2014). Sessions: Case histories. Baltimore, MD: Laureate International Universities Publishing. [Vital Source e-reader].
· The Parker Family
SOCW 6051: Diversity, Human Rights, and Social Justice
· Discussion: Developing Alliances in Social Work Practice
· Have you ever heard the term or saying “straight but not narrow”? This is an example of a statement of being an ally—recognizing one’s unique position of privilege yet standing with others who are oppressed. By taking this course, you have started the process of becoming an ally. Evan and Washington (2013) identify the steps toward being an ally, which include being supportive of those who are unlike you, learning about other cultures, becoming aware of the oppression and marginalization, and becoming aware of one’s own privilege. Getting involved in issues is part of that process. You will consider how to become an ally this week.
· To prepare: Review “Working With Survivors of Human Trafficking: The Case of Veronica.” Think about how one might become an ally to victims of human trafficking . Then go to a website that addresses human trafficking either internationally or domestically.
· By 08/10/2021
· Post a brief description of the website you visited. Explain how you might support Veronica and other human trafficking victims incorporating the information you have found. Explain how you can begin to increase your awareness of this issue and teach others about human trafficking victims. Describe opportunities to get involved and become an ally to those who have been trafficked. Identify steps you can take to begin to support this group.
Working With Survivors of Human Trafficking: The Case of Veronica
Veronica is a 13-year-old, heterosexual, Hispanic female. She attends high school and is in the ninth grade. She currently lives in an apartment with her biological mother and her sister, age 9. She came to this country 7 months ago from Guatemala. Veronica is a sex trafficking survivor and was referred to me for individual therapy by a human trafficking agency in the United States.
Veronica’s biological mother and father separated when Veronica was 3 years old. She lived with her maternal aunt and biological mother until she was 6 years old, and her mother left Guatemala to come to the United States. At that time, Veronica stayed in the care of her maternal aunt and kept in touch with her biological mother via phone and through the visits that her mother made to Guatemala. Veronica would visit with her father, who lived nearby, on occasion, although she stated they did not have much of a connection. When Veronica was 12 years old, her maternal aunt forced her into prostitution, using the money from the sex acts as her main source of income. Veronica reported that her maternal aunt began treating her “like a slave” and would make her smoke an unknown substance before obligating her to perform sexual acts on countless men for money. This took place for close to a year before Veronica was able to sneak a phone call to her mother and explain what had been happening to her. Her mother quickly arranged for Veronica to be picked up by a “coyote” (a person who smuggles people into the United States). The coyote successfully smuggled Veronica into the United States within 2 months of that phone call. However, while crossing the border from Mexico to the United States, Veronica once again became the victim of sex trafficking crimes. The coyote was also a pimp who arranged for men crossing the border in the same truck as Veronica to engage in sexual acts with her for which the coyote collected money. U.S. immigration officers caught most of the people traveling in the truck, including Veronica, and placed them in a detention center. However, the coyote got away. Three weeks after Veronica was detained, after much questioning and investigation, she was reunited with her mother.
I met with Veronica weekly for individual therapy in my role as a social worker at an agency serving individuals who have experienced human trafficking. Veronica reported having occasional flashbacks and fear that “it will all happen again,” and she was diagnosed with post-traumatic stress disorder (PTSD). The goals agreed upon in therapy included building Veronica’s support system, building her self-esteem, and managing her symptoms of trauma. Building rapport with Veronica in therapy took several weeks as she reported not trusting anyone and not wanting to think about what happened to her. After about 9 weeks of relationship building and safety planning, I was able to engage her through education on the dynamics of human trafficking. She reported that it was especially hard for her to trust men and that she often had a hard time speaking up. I worked with her on these issues by teaching her how to be more assertive and by modeling assertive behaviors. We worked on self-affirmations to help build her self-esteem. Because Veronica is very self-conscious, practicing self-affirmations was challenging for her. I often utilized a trauma-informed curriculum for adolescents called S.E.L.F. (Safety, Emotions, Loss, and Future) to facilitate healing and trauma reduction. Veronica reported that grounding techniques taught via this curriculum helped take her out of her thoughts and bring her back to the present moment. Some of the grounding techniques she continues to engage in on a daily basis include tapping her feet, stretching, writing, walking, and washing her face when she feels she is becoming numb or getting lost in thoughts of what happened to her.
Veronica has demonstrated great resiliency. She is attending a church close to her home and reports having faith in God. She recently enrolled in swimming and volleyball and has made several friends in the community. I continue to meet with Veronica on a weekly basis and will be stepping down with her to biweekly sessions now that she is stable and connected to her community. Because Veronica does not speak English and is a child, there are no support groups available in her area for human trafficking survivors. I am presently working on connecting her with a mentor.
Veronica is currently working with the human trafficking agency that referred her, Immigrations and Customs Enforcement (ICE), and an attorney to obtain a visa specific to human trafficking (T-Visa). A T-Visa grants survivors of human trafficking a visa in the United States. In 2000, Congress passed the Victims of Trafficking and Violence Protection Act (VTVPA), which strengthens the ability of law enforcement agencies to investigate and prosecute human trafficking and also offers protection to victims via a T-Visa. The T-Visa is for those who are or have been victims of human trafficking. It protects victims of human trafficking and allows victims to remain in the United States to assist in an investigation or prosecution of human trafficking.
Veronica’s mother is also attending weekly individual therapy. She has been working through the heavy guilt and trauma of this experience. Veronica and her mother continue to heal, and with each passing day, they grow stronger.
Adams, M., Blumenfeld, W. J., Castaneda, C., Catalano, D. C. J., DeJong, K., Hackman, H. W,… Zuniga, X. (Eds.). (2018). Readings for diversity and social justice (4th ed.). New York, NY: Routledge Press.
Plummer, S.-B., Makris, S., & Brocksen S. M. (Eds.). (2014). Social work case studies: Foundation year. Baltimore, MD: Laureate International Universities Publishing. [Vital Source e-reader].
Responsiveness to Directions
9.45 (27%) – 10.5 (30%)
Discussion posting fully addresses all instruction prompts, including responding to the required number of peer posts.
Discussion Posting Content
9.45 (27%) – 10.5 (30%)
Discussion posting demonstrates an excellent understanding of all of the concepts and key points presented in the text(s) and Learning Resources. Posting provides significant detail including multiple relevant examples, evidence from the readings and other scholarly sources, and discerning ideas.
Peer Feedback and Interaction
7.88 (22.5%) – 8.75 (25%)
The feedback postings and responses to questions are excellent and fully contribute to the quality of interaction by offering constructive critique, suggestions, in-depth questions, additional resources, and stimulating thoughts and/or probes.
4.72 (13.5%) – 5.25 (15%)
Postings are well organized, use scholarly tone, contain original writing and proper paraphrasing, follow APA style, contain very few or no writing and/or spelling errors, and are fully consistent with graduate level writing style.
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