Social Change Portfolio, Ponte, A

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COUN 6785: Social Change in Action: Prevention, Consultation, and Advocacy Social Change Portfolio Alicia Ponte

Contents Overview Introduction Scope and Consequences Social-ecological Model Theories of Prevention Diversity and Ethical Considerations Advocacy References ScholarWorks Contributor Agreement

OVERVIEW Keywords: [Depression, Preventative Program, Child & Adolescent, Depression Literacy, Snohomish County [Child & Adolescent Depression Literacy] Goal Statement: Prevention Program known as depression literacy to equip parents and caregivers with the knowledge and tools necessary to recognize, understand, and address child and adolescent depression to prevent further depressive symptoms. Significant Findings: There has been an increase in depressive symptoms shown in children and adolescents, with an increase of 7.7% as seen between 2009 and 2019 (Wilson & Dumornay, 2022). Due to this increase, Snohomish County requires more mental healthcare services for children and adolescents and more tools and resources for families. Recent studies show that certain risk factors, such as environment and relationships, increase the likelihood of depression (Wahid et al., 2021). Further studies show a correlation between depression and low emotional self-efficacy in adolescents (Tak et al., 2017). Prevention Programs such as depression literacy workshops provide resources to families and caregivers and bring awareness to the early signs of depression in their child or adolescent. Objectives/Strategies/Interventions/Next Steps: Identify a need for depression literacy workshops in the community. Programs such as PEDALS in school work to increase emotional development through age-based activities that improve emotional and social skills. Ethical and Diversity considerations, such as cultural views on mental health and the likelihood of engagement, must be addressed to establish successful prevention programs. Identifying barriers

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such as funding and availability and advocating for more services in the area can promote future prevention programs. INTRODUCTION Child & Adolescent Depression Literacy Depression, known as Depressive Disorder, is a mood disorder that impairs an individual’s occupational, social, and everyday life. Symptoms can include irritable or depressed mood, loss of interest in activities, low energy or fatigue, sleep disturbances, and mental impairment (American Psychological Association, 2017). Recent studies show that depressive disorders are at an all-time high, especially in children and adolescents (2023). This Social Change Portfolio will discuss the importance of depression literacy for parents and caregivers in the Snohomish County area to prevent increased depressive symptoms in children. Focusing on identifying early warning signs and symptoms of depression, discussing psychological, biological, and social factors that can contribute to depression, and providing resources for evidence-based interventions can assist in preventing depression from increasing. I will also discuss theories of prevention, diversity and ethical considerations, and advocacy in addressing this mental health problem. PART 1: SCOPE AND CONSEQUENCES [Child & Adolescent Depression Literacy] The mental health problem affecting Snohomish County that I will be focusing on is the increase in depression among children and adolescents. According to the CDC, approximately 2.7 million children between the ages of 3 and 17 were diagnosed with depression in 2016-2019

(2023). Further studies have shown that the age at which mental health disorders emerge occurs at younger ages than in past years (Solmi et al., 2022). The rate of children and adolescent depressive symptoms showed an increase from 8.1% in 2009 up to 15.8% in 2019 in the United States (Wilson & Dumornay, 2022). I believe that there is a lack of resources and tools available for parents and caregivers to recognize and assist in helping children and adolescents combat depressive symptoms in the Snohomish County area. According to data collected for Snohomish County, the ratio of mental health providers to individuals registered is 1 to 260 ( County Health Rankings & Roadmaps, 2018) . Although this is slightly lower than the national average, no data has been shown regarding mental health providers who specifically treat children and adolescents. Because depressive symptoms can affect a child’s social, family, and educational functioning, both the family and community can be negatively impacted. Without preventative measures in place to combat depressive symptoms, the likelihood of increased symptoms into adulthood may occur, with the risk of recurring episodes of depression and an increase in the severity of symptoms. The goal of my Social Change Portfolio is to equip parents and caregivers with the knowledge and tools necessary to recognize, understand, and address child and adolescent depression to prevent further depressive symptoms. PART 2: SOCIAL-ECOLOGICAL MODEL [Child & Adolescent Depression Literacy] Child and Adolescent Depression not only affects the individual but is governed by relationships, communities, and societal factors as well. When considering preventative measures for child and adolescent depression, we must first look at risk factors and protective factors that influence an individual’s well-being. Risk factors refer to the potential increase in the

likelihood of developing depression in children and adolescents. Protective factors, on the other hand, serve as safeguards to assist families in finding support, resources, and coping strategies to help their child and adolescent’s depression. A recent consensus study was conducted to determine the risk factors for adolescent depression (Wahid et al., 2021). Known as the Delphi method, it entailed collecting experts from around the globe. It consisted of three rounds of surveys that questioned and ranked risk factors that were seen in adolescent depression. Results of the surveys showed that the three highest risk factors were genetic disposition, exposure to bullying, and dysfunctional family environments. Other risk factors included substance abuse, trauma exposure, low self-esteem, gender, academic stress, cognitive distortions, and social difficulties (Wahid et al., 2021). Individual factors for depression include biological factors such as genetics. Studies show that heritability rates for depression influence the severity of depression and the onset of depressive symptoms by as much as 37% ( Shadrina et al., 2018). Gender also plays a role in developing depression, and studies have shown that females are twice as likely to be diagnosed with depression, especially during puberty (Albert, 2015). Protective factors for individuals at risk of developing depression include counseling and learning effective problem-solving and coping skills, as well as encouraging a healthy lifestyle and recognizing positive behaviors that lead to happier thoughts. Relationship risk factors that influence the onset of depression can include family environment and social environments. Dysfunctional families hinder the support and communication needed for a child or adolescent to address their emotions before they become unmanageable. Creating a safe space for the child or adolescent to express their emotions without fear of judgment or dismissiveness can be the first step in preventing depression.

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Support from outside resources for families, such as workshops, counseling referrals, and school counselors, can guide parents on how to talk to their child or adolescent about depression. Risk factors of child and adolescent depression include bullying at school, which can trigger low self-esteem, resulting in social distancing and increasing the risk of depressive symptoms. During COVID-19, prolonged social isolation was shown to be a common source of depression. Establishing supportive relationships among peers can improve mental well-being, recognize mental health needs among students, and create opportunities to invest in mental well- being resources and activities. Community risk factors include a lack of community support and perceived notions of mental health due to cultural beliefs that can create reluctance to seek help with depressive symptoms. Encouraging and promoting mental health within the community can encourage families and children to discuss their concerns. Creating economic opportunities and financial help for community families helps ensure access to mental health services. It provides stable housing and necessities that help to elevate stress, which can translate to depression. Society Levels On a societal level, depression is one of the biggest mental health challenges facing youth today. However, due to perceived norms in the stigmatization of mental illness, not being able to afford such healthcare (in-patient or out-patient), or discrimination and marginalization of minorities, many do not seek treatment. To create protective factors that prevent the onset of depression, it is essential to first create a safe, welcoming environment for those at risk of depression. Encouraging the importance of mental health and wellness while recognizing society's shortfalls of dismissing mental health needs is the first step to decreasing depression.

PART 3: THEORIES OF PREVENTION [Child & Adolescent Depression Literacy] Prevention theories create the groundwork needed to support prevention interventions. While several theories can be applied when creating a prevention program, the social cognitive theory best fits creating a prevention program for child and adolescent depression literacy. The social cognitive theory dictates that an individual’s experience, environment, and interactions with others can affect behaviors. Six components create the framework for the social cognitive theory that teaches individuals how to regulate their behavior and initiate positive behaviors, which include behavioral capability, expectations, self-efficacy, and observational learning. Components such as self-efficacy in the social cognitive theory explain one of the reasons behind depressive symptoms. Self-efficacy is the belief that individuals can control negative behaviors and execute positive behaviors related to their environment. A lack of self- efficacy can lead to feelings of low self-esteem and difficulty managing emotional regulation, which are precursors to depression. Recent studies investigated prospective associations between depression and emotional self-efficacy in adolescents (Tak et al., 2017). During six months, 1,341 adolescents were assessed to determine if self-efficacy contributes to depression. Through a prevention program based on cognitive behavioral therapy that sought to improve self-efficacy, the results of the study showed that depressive symptoms were associated with low levels of emotional self-efficacy. Using social cognitive theory to create a prevention program for child and adolescent depression can help to prevent further depressive symptoms. Prevention-focused programs aim to help groups and individuals develop the skills and knowledge necessary to engage in healthier, positive behaviors while increasing awareness of destructive, negative behaviors that may impact the mind and body. When it comes to creating a

prevention program for children and adolescents that focuses on depression literacy, education, and community involvement create a strong foundation for preventing depression and depressive symptoms. Social-emotional learning programs combine evidence-based curriculum for teachers and families to increase positive emotional development. One program, PEDALS, was created for Southeast Michigan, Western, and Central New York providers to increase emotional development through activities and teaching skills in small five-minute lessons that improve social and emotional skills. According to the Health Foundation for Western and Central New York, the program's result was that the first year showed a 57% decrease in social-emotional needs and a 31% drop in children who had self-control problems (2022). While more studies need to be conducted, prevention programs such as PEDALS can be beneficial in teaching kids, teachers, and parents skills that decrease the symptoms of depression while also teaching families and the community what factors can contribute to depression. PART 4: DIVERSITY AND ETHICAL CONSIDERATIONS [Child & Adolescent Depression Literacy] When establishing a prevention program, it is essential to understand diversity and ethical considerations that may arise. Two specific groups come to mind within the population working with children and adolescents. A percentage of the population in the area where the depression literacy program will be conducted is from the Pacific Islands, a large portion of which are from the Marshall Islands. Statistics from the US Department of Health and Human Services Office of Minority Health showed that in 2019, suicide was the leading cause of death among Pacific Islanders aged 15-24 (2020) and that they were three times less likely to receive mental health services.

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Research also showed that the COVID-19 pandemic alone emphasized the need for more mental health treatment among Pacific Islanders (Subica et al., 2022). The University of California School of Medicine conducted research to assess substance abuse patterns, depression, anxiety, and alcohol use and the need for treatment. The study showed specifically that depression, major depression, and generalized anxiety disorder rose 27% during COVID-19. Although this study focused on adults, depression literacy among children and adolescents can help to prevent depressive symptoms from arising going into adulthood, especially given the challenges the past few years due to a worldwide pandemic. When creating the depression literacy program for depression prevention among children and adolescents, it is essential to consider cultural factors such as view of mental illness and likelihood of engagement. Offering community-based programs focusing on Pacific Islander engagement by encouraging input on their thoughts and suggestions on depression and how it affects their community while working with community leaders of their organization, such as the Everett Marshallese Association, to provide more ideas on how prevention programs can be most effective in their community. Another mechanism that would encourage the involvement of the Pacific Islander community would be to offer depression literacy workshops that bring together local teachers, the community, and families to discuss how their culture is affected by depression and how counselors and treatment centers can better help when working with these communities, along with specific tools that they can use in their home to provide positive emotional development to decrease the risk of depression. As a counselor, it is important to recognize the cultural differences that can occur when attempting to implement a prevention program. Under the American Counseling Association, section C.5. discusses nondiscrimination in which the clients will be treated fairly and offered the

same level of treatment as everyone else (2014). A.7 a and b dictates that counselors advocate for individuals, groups, and societal levels and uphold confidentiality to break down obstacles that may be interfering with the development and growth of the client (American Counseling Association, 2014, p.5). This also relates to working with families and the community when developing a prevention program in that the counselor will be an advocate to ensure that each member of the program has the same access and level of care at all times during the program. PART 5: ADVOCACY [Child & Adolescent Depression Literacy] A major building block when creating a depression literacy prevention program is advocacy. Advocacy is important in influencing community and institutional levels to create change or establish public policies that assist the development of programs. Barriers are created when individuals, groups, and communities do not advocate enough for change. According to studies, 3.2 percent of children and adolescents in the United States are diagnosed with depression (Yale Medicine, 2022). This number continues to rise, as was seen during the recent COVID-19 pandemic. Individuals and groups can work to advocate for more mental health resources for families to improve depression among children and adolescents in the community. Community care is vital to establishing available mental healthcare for children and adolescents suffering from depression. According to the Centers for Disease Control and Prevention, only 20% of children who suffer from mental or behavioral receive healthcare services. This is partly due to difficulties finding providers in their area, high costs, time, and lack of insurance coverage. Providing more services in communities through the school district, such as referral programs, creating more job opportunities for mental health providers, and

creating community support groups are some of the ways communities can support families. On a public policy level, creating and developing funding to provide services to low-income families can increase the amount of resources available for families to get help before their child and adolescent’s depressive symptoms get worse. REFERENCES American Counseling Association (2014). 2014 ACA Code of Ethics.Links to an external site. https://www.counseling.org/Resources/aca-code-of-ethics.pdf Albert P. R. (2015). Why is depression more prevalent in women? Journal of psychiatry & neuroscience: JPN, 40(4), 219–221. https://doi.org/10.1503/jpn.150205 American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM- 5. (2017). American Psychiatric Association. Centers for Disease Control and Prevention. (2023, March 8). Anxiety and depression in children: Get the facts. Centers for Disease Control and Prevention. https://www.cdc.gov/childrensmentalhealth/features/anxiety-depression-children.html Centers for Disease Control and Prevention. (2023, March 8). Improving access to children’s mental health care. Centers for Disease Control and Prevention. https://www.cdc.gov/childrensmentalhealth/access.html County Health Rankings & Roadmaps (2018). How healthy is your community? Robert Wood Johnson Foundation. http://www.countyhealthrankings.org/.

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Health Foundation for Western & Central New York. (2022, March 24). PEDALS. https://hfwcny.org/program/pedals/ Promising Practices Network (2014). What works for children and families. http://www.promisingpractices.net/. Shadrina, M., Bondarenko, E. A., & Slominsky, P. A. (2018). Genetics Factors in Major Depression Disease. Frontiers in psychiatry, 9, 334. https://doi.org/10.3389/fpsyt.2018.00334 Solmi, M., Radua, J., Olivola, M., Croce, E., Soardo, L., Salazar de Pablo, G., Il Shin, J., Kirkbride, J. B., Jones, P., Kim, J. H., Kim, J. Y., Carvalho, A. F., Seeman, M. V., Correll, C. U., & Fusar-Poli, P. (2022). Age at onset of mental disorders worldwide: a large-scale meta-analysis of 192 epidemiological studies. Molecular psychiatry , 27 (1), 281–295. https://doi.org/10.1038/s41380-021-01161-7 Subica, A. M., Guerrero, E. G., Martin, T. K. K., Okamoto, S. K., Aitaoto, N., Moss, H. B., Morey, B. N., & Wu, L.-T. (2022). Native Hawaiian/Pacific Islander alcohol, tobacco, and other drug use, mental health, and treatment needs in the United States during COVID‐19. Drug and Alcohol Review , 41(7), 1653–1663 https://doi.org/10.1111/dar.13522 Tak, Y. R., Brunwasser, S. M., Lichtwarck-Aschoff, A., & Engels, R. C. (2017). The Prospective Associations between Self-Efficacy and Depressive Symptoms from Early to Middle Adolescence: A Cross-Lagged Model. Journal of youth and adolescence, 46(4), 744–756. https://doi.org/10.1007/s10964-016-0614-z

United States: Challenges and Opportunities in the 2020s. The Journal of adolescent health: official publication of the Society for Adolescent Medicine , 70 (3), 354–355. https://doi.org/10.1016/j.jadohealth.2021.12.003 US Department of Health and Human Services Office of Minority Health . (2022). Mental and behavioral health - Native Hawaiians/pacific islanders. Office of Minority Health. https://minorityhealth.hhs.gov/mental-and-behavioral-health-native-hawaiianspacific- islanders Wahid, S. S., Ottman, K., Hudhud, R., Gautam, K., Fisher, H. L., Kieling, C., Mondelli, V., & Kohrt, B. A. (2021). Identifying risk factors and detection strategies for adolescent depression in diverse global settings: A Delphi consensus study. Journal of Affective Disorders , 279 , 66–74. https://doi.org/10.1016/j.jad.2020.09.098 Wilson, S., & Dumornay, N. M. (2022). Rising Rates of Adolescent Depression in the United States: Challenges and Opportunities in the 2020s. The Journal of adolescent health: official publication of the Society for Adolescent Medicine , 70 (3), 354–355. https://doi.org/10.1016/j.jadohealth.2021.12.003 Yale Medicine. (2022, August 11). Depression in children and teens. Yale Medicine. https://www.yalemedicine.org/conditions/depression-in-children-and-teens#:~:text=An %20estimated%203.2%20percent%20of,year%2Dold%20can%20experience %20depression. SCHOLARWORKS CONTRIBUTOR AGREEMENT

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Social Change Portfolio, Ponte, A

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