Discussion 2: Depression And Suicide Intervention

When working with adolescents you will likely be faced with issues of depression, anxiety, and suicidal ideation and even attempts. For youth between the ages of 10 and 24, suicide is the third leading cause of death in the United States (Centers for Disease Control and Prevention, 2012). It is essential to understand the risks associated with teen suicide and intervention strategies to address this issue.

By Day 4

Post a review of the literature on adolescent depression and suicide and identify an evidence-based intervention that addresses these issues. Then, apply that intervention to either the Brady or Tiffani case. Describe the possible risk factors the client presents that would make him or her at risk for depression and suicide. Then, plan an intervention for that client to address these issues.

 

Required Readings

LeCroy, C. W., & Williams, L. R. (2013). Intervention with adolescents. In M. Holosko, C. Dulmus, & K. Sowers (Eds.), Social work practice with individuals and families: Evidence-informed assessments and interventions (pp. 97–124). Hoboken, NJ: Wiley.

Plummer, S.-B., Makris, S., & Brocksen, S. M. (Eds.). (2014a). Sessions: case histories. Baltimore, MD: Laureate International Universities Publishing. [Vital Source e-reader].
The Bradley Family (pp. 17–19)

Plummer, S.-B., Makris, S., & Brocksen, S. M. (Eds.). (2014b). Social work case studies: Concentration year. Baltimore, MD: Laureate International Universities Publishing. [Vital Source e-reader].

Working With Families: The Case of Brady (pp. 26–28)

Note: Depending on your concentration, you may not receive a case study book until a later term. Therefore, if you did not receive a copy of Social Work Case Studies: Concentration Year in your previous course, use the linked PDF provided here. If you did receive the book referenced above, you may find the cases there or use the PDF.

Centers for Disease Control and Prevention. (2018). Youth violence. Retrieved from https://www.cdc.gov/violenceprevention/youthviolence/index.html

Austin, A., Craig, S. L., & D’Souza, S. A. (2018). An AFFIRMative cognitive behavioral intervention for transgender youth: Preliminary effectiveness. Professional Psychology: Research And Practice49(1), 1-8.
Retrieved from the Walden Library databases.

Lindsey, M. A., Brown, D. R., & Cunningham, M. (2017). Boys do(n’t) cry: Addressing the unmet mental health needs of African American boys. American Journal Of Orthopsychiatry87(4), 377-383.
Retrieved from the Walden Library databases.

Required Media

Laureate Education (Producer). (2013a). Bradley family: Episode 2 [Video file]. Retrieved from https://class.waldenu.edu
Accessible player –Downloads–Download Video w/CCDownload AudioDownload TranscriptCredit: Provided courtesy of the Laureate International Network of Universities.

Optional Resources

Use this link to access the MSW home page, which provides resources for your social work program.

Working With Families: The Case of Brady Brady is a 15-year-old, Caucasian male referred to me by his previous social worker for a second evaluation. Brady’s father, Steve, reports that his son is irritable, impulsive, and often in trouble at school; has difficulty concentrating on work (both at home and in school); and uses foul language. He also informed me that his wife, Diane, passed away 3 years ago, although he denies any relationship between Brady’s behavior and the death of his mother. Brady presented as immature and exhibited below-average intelligence and emotional functioning. He reported feelings of low self-esteem, fear of his father, and no desire to attend school. Steve presented as emotionally deregulated and also emotionally immature. He appeared very nervous and guarded in the sessions with Brady. He verbalized frustration with Brady and feeling overwhelmed trying to take care of his son’s needs. Brady attended four sessions with me, including both individual and family work. I also met with Steve alone to discuss the state of his own mental health and parenting support needs. In the initial evaluation session I suggested that Brady be tested for learning and emotional disabilities. I provided a referral to a psychiatrist, and I encouraged Steve to have Brady evaluated by the child study team at his school. Steve unequivocally told me he would not follow up with these referrals, telling me, “There is nothing wrong with him. He just doesn’t listen, and he is disrespectful.” After the initial session, I met individually with Brady and completed a genogram and asked him to discuss each member of his family. He described his father as angry and mean and reported feeling afraid of him. When I inquired what he was afraid of, Brady did not go into detail, simply saying, “getting in trouble.” In the next follow-up session with both Steve and Brady present, Steve immediately told me about an incident Brady had at school. Steve was clearly frustrated and angry and began to call Brady hurtful names. I asked Steve about his behavior and the words used toward Brady. Brady interjected and told his dad that being  PRACTICE 31 called these names made him feel afraid of him and further caused him to feel badly about himself. Steve then began to discuss the effects of his wife’s death on him and Brady and verbalized feelings of hopelessness. I suggested that Steve follow up with my previous recommendations and, further, that he should strongly consider meeting with a social worker to address his own feelings of grief. Steve agreed to take the referral for the psychiatrist and said he would follow up with the school about an evaluation for Brady, but he denied that he needed treatment. In the third session, I met initially with Brady to complete his genogram, when he said, “I want to tell you what happens sometimes when I get in trouble.” Brady reported that there had been physical altercations between him and his father. I called Steve in and told him what Brady had discussed in the session. Brady confronted his father, telling him how he felt when they fight. He also told Steve that he had become “meaner” after “mommy died.” Steve admitted to physical altercations in the home and an increase in his irritability since the death of his wife. Steve and Brady then hugged. I told them it was my legal obligation to report the accusations of abuse to Child Protective Services (CPS), which would assist with services such as behavior modification and parenting skills. Steve asked to speak to me alone and became angry, accusing me of calling him a child abuser. I explained the role of CPS and that the intent of the call was to help put services into place. After our session, I called CPS and reported the incident. At our next session, after the report was made, Steve was again angry and asked me what his legal rights were as a parent. He then told me that he was seeking legal counsel to file a lawsuit against me. I explained my legal obligations as a clinical social worker and mandated reporter. Steve asked me very clearly, “Do you think I am abusing my son?” My answer was, “I cannot be the one to make that determination. I am obligated by law to report.” Steve sighed, rolled his eyes, and called me some names under his breath. Brady’s case was opened as a child welfare case rather than a child protective case (which would have required his removal  SOCIAL WORK CASE STUDIES: CONCENTRATION YEAR 32 from the home). CPS initiated behavior modification, parenting skills classes, and a school evaluation. Steve was ordered by the court to seek mental health counseling. One year after I closed this case, Brady called me to thank me, asking that I not let his father know that he called. Brady reported that they continued to be involved with child welfare and that he and his father had not had any physical altercations since the report.

The Bradley Family

Tiffani Bradley is a 16-year-old heterosexual Caucasian female referred to me after being arrested for prostitution. I worked with Tiffani at Teens First, a brand new court-mandated teen counseling program for adolescent victims of sexual exploitation and human trafficking. At Teens First we provide a holistic range of services for our clients. Tiffani has been provided room and board in our residential treatment facility and will meet with a number of social workers to address her multiple needs and concerns. Tiffani has been arrested three times for prostitution in the last 2 years. Right before her most recent charge, a new state policy was enacted to protect youth 16 years and younger from prosecution and jail time for prostitution. The Safe Harbor for Exploited Children Act allows the state to define Tiffani as a sexually exploited youth and therefore the state will not imprison her for prostitution. She was mandated to services at our agency, unlike her prior arrests when she had been sent to detention. Tiffani had been living with a man she has identified as Donald since she was 14 years old. She had had limited contact with her family members and had not been attending school. She described Donald as her “husband” (although they were not married) and her only friend. She had contacted her sister, Diana, a few times over the previous 2 years and stated that she missed her very much. Donald had recently sold Tiffani to another pimp, “John T.” Tiffani reported that she was very upset that Donald did this and that she wanted to be reunited with him. She had tried to make contact with him by sending messages through other people, as John T. did not allow her access to a phone. During intake it was noted that Tiffani had multiple bruises and burn marks on her legs and arms. She reported that Donald had slapped her when he felt she did not behave and that John T. burned her with cigarettes. Tiffani has been treated for several sexually transmitted infections (STIs) at local clinics and is currently on an antibiotic for a kidney infection. Although she was given condoms by Donald and John T. for her “dates,” there were several “Johns” who refused to use them. It appears that over the last 2 years, Tiffani has had neither outside support nor interactions with anyone beyond Donald, John T., and some other young women also being prostituted. Other members of the Bradley family include Tiffani’s 33-year-old mother, Shondra; Tiffani’s 38-year-old father, Robert; and Tiffani’s 13-year-old sister, Diana. Shondra and Robert have been separated for a little over a year and have started dating other people. Diana currently resides with her mother and Anthony, her mother’s new boyfriend. Shondra and Anthony abuse a variety of drugs, including marijuana and methamphetamine. Robert also abuses a number of drugs and has recently been arrested for possession of crack cocaine. Robert has been arrested several times over the last 5 years: twice for domestic violence calls and twice for drug possession. He is currently in jail awaiting sentencing. The goals Tiffani and I set in our initial sessions centered on helping her feel safe and secure in her new home and utilizing as many of the available resources as possible. Through individual and group counseling, Tiffani will have the opportunity to discuss her experiences prior to coming to Teens First, including what led to her relationship with Donald. A long-term goal I presented was to help her understand that Donald, the person who she maintained “is the love of my life,” had actually had a negative impact on her life. Tiffani listed some of her own long-term goals, including obtaining a General Education Development (GED) credential, getting her own apartment, getting a job, and reunifying with her sister. During our sessions over the year, Tiffani gave a rather in-depth description of her childhood. At first Tiffani provided a family history that was filled with only happy memories. She remembered her life up to age 8 as filled with moments of joy. She remembered going to school, playing with her sister, and her mother and father getting along. As we continued to meet, Tiffani shared what she remembered as a gradual but definitive change in the family dynamics around the time when she turned 8 years old. She remembered being awakened by music and laughter in the early hours of the morning. When she went downstairs to investigate, she saw her parents along with her uncle Nate passing a pipe back and forth between them. She remembered asking them what they were doing and her mother saying, “adult things” and putting her back in bed. Tiffani remembered being woken up by noise several times after that and seeing her father and her uncle passing the pipe between them. Sometimes her mother was there and sometimes she was not. Often when her mother was not there, Nate would see her and ask her to come over. Her father would sometimes ask her to show them the 17 SESSIONS: CASE HISTORIES • THE BRADLEY FAMILY dance that she had learned at school. When she danced, her father and Nate would laugh and offer her pocket change. Sometimes they were joined by their friend Jimmy. For years the music and noise downstairs continued, later accom panied by screams and shouting and sounds of people fighting. One morning, Shondra yelled at Robert to “get up and go to work.” Tiffani and Diana saw Robert come out of the bedroom and slap Shondra so hard she was knocked down. Robert then went back into the bedroom. The Bradley Family Robert Bradley: father, 38 Shondra Bradley: mother, 33 Nate Bradley: uncle, 36 Tiffani Bradley: daughter, 16 Diana Bradley: daughter, 13 Donald: Tiffani’s self-described husband and her former pimp Shondra currently lives with her boyfriend, Anthony Tiffani also noticed significant changes in her home’s appearance. The home, which was never fancy, was almost always neat and tidy. Tiffani noticed that dust would gather around the house, dishes would pile up in the sink, dirt would remain on the floor, and clothes would go for long periods of time without being washed. Tiffani remembered cleaning her own clothes and making meals for herself and her sister during this period. Sometimes Tiffani and her sister would come downstairs in the morning to find empty beer cans and liquor bottles on the kitchen table along with the pipe. Her parents would be in the bedroom, and Tiffani and her sister would leave the house and go to school by themselves. Tiffani was unclear if her parents were working or how the bills were paid. Often there was not enough food to feed everyone and she would go to bed hungry. During one session, Tiffani described an incident of sexual abuse. One night she was awoken by her uncle Nate and his friend Jimmy in her room. Her parents were apparently out, and they were the only adults in the home. They asked her if she wanted to come downstairs and show them the new dances she learned at school. Once downstairs, Nate and Jimmy put some music on and started to dance. They asked Tiffani to start dancing with them, which she did. While they were dancing, Jimmy spilled some beer on her. Nate said she had to go to the bathroom to clean up. Nate, Jimmy, and Tiffani all went to the bathroom. Nate asked Tiffani to take her clothes off so she could get in the bath. Tiffani hesitated to do this, but Nate insisted it was okay since he and Jimmy were family. Tiffani eventually relented and began to wash up. Nate would tell her that she missed a spot and would scrub the area with his hands. After this incident, others occurred, with increasing levels of molestation each time. Tiffani felt very bad about this, but had difficulty explaining why, even to herself. She was very afraid of everyone in her family except her sister Diana. She was also afraid that Diana might be subjected to the same thing. The last time it happened, when Tiffani was 14, she pretended to be willing to dance for them, but when she got downstairs she ran out the front door of the house. Tiffani ran down the block to her school because, as she said, it was one of the few places where she felt safe. She said she was barefoot and in her pajamas and it was very cold. About halfway to her school, a car stopped, and a man inside asked her where she was going. When Tiffani replied that she was going to school, the man asked why she was going to school in the middle of the night. Tiffani did not want to tell him the whole story, so she told him that there was trouble at home and she just wanted to go to school early. The man introduced himself as Donald and asked her why she did not go to her boyfriend’s house. When Tiffani said she did not have a boyfriend, Donald replied that if she had a boyfriend, she would have somebody to take care of her and keep her safe when these things happened. He then offered to be her boyfriend. Tiffani did not say anything, but when Donald then offered to give her a ride, she agreed and got in the car. Donald took Tiffani to his apartment, explaining that the school would be closed for hours. When they got to his apartment, Donald fed Tiffani and gave her beer, explaining that it would help keep her warm. Tiffani did not like the taste of the beer, but at Donald’s insistence, she drank it. When Tiffani was drunk, Donald began kissing her, and they had sex. Tiffani knew about sex from school and some of her girlfriends but she had never had it with anyone before. She was grateful to Donald because he had helped her get away from Nate and Jimmy. Donald had also told her that he loved her and they would be together forever. Tiffani was also afraid that if she did not have sex, Donald would not let her stay and she had nowhere else to go. For the next 3 days, Donald brought her food and beer and had sex with her several more times. Donald told Tiffani that she was not allowed to do anything without his permission. This included watching TV, going to the bathroom, taking a shower, and eating and drinking. Donald bought Tiffani a dress, explaining to her that she was going to “find a date” and get men to pay her to have sex with her. When Tiffani said she did not want to do that, Donald hit her several times. Donald explained 18   SESSIONS: CASE HISTORIES • THE BRADLEY FAMILY that if she didn’t do it, he would get her sister, Diana, and make her do it instead. Out of fear for her sister, Tiffani relented and did what Donald told her to do. Key to Acronyms GED: General Education Development STI: Sexually Transmitted Infection Tiffani and I met over the course of a year for individual sessions. We talked often about her continued desire to be reunited with Donald. We discussed what Donald represented for her and why he was such an important part of her life. She often described him as the person who “saved” her and felt she owed much to him. She vividly remembered the fear she felt the nights Nate and Jimmy touched her, and she was convinced they would have raped her that last night. My efforts were to help her recognize that Donald was not a savior, but someone who did, in fact, rape her and then force her into prostitution. A lot of time and discussion went into changing this cognition around Donald and their relationship. After about six months at Teens First, Tiffani said that she had a strong desire to see her sister and her mother, and I helped to arrange a family session at the agency. Tiffani and I talked about what her hopes were for the meeting and her intent for scheduling this session. Tiffani first and foremost just wanted to see them and hug them. She had not seen either of them in over two years and missed them very much. Tiffani also felt some anger toward her mother that she wanted to able to share in a safe environment. She said she felt that both her parents did not do enough to protect her and that they should have known better than to have let Nate and Jimmy into the house when they were not home. She also said she felt her mother should have tried harder to find her when she was with Donald. I wanted her to be realistic about the potential outcome of the meeting, so I did my best to explain that the session might not provide all of the answers she hoped for. We were aware, through a conversation with her sister, that her mother was still using drugs, and we talked about how this might cloud her mother’s ability to engage in a substantial conversation. In the family session, Shondra was very critical of Tiffani and her current situation. She ultimately blamed Tiffani for her current state. When Tiffani confronted her mother about the drug use and the lack of parental guidance and protection, Shondra denied ever having used drugs. She told Tiffani she was exaggerating and a liar and that neither she nor Tiffani’s father ever put her in harm’s way. Throughout our time working together, Tiffani utilized all of the services at the agency and stopped trying to contact Donald. She had learned that he had actually gotten married to one of the other women that worked for him, and this made her very angry. She has passed her GED test and started working at a local fast food restaurant. She plans on applying to a community college and a fashion institute.

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