Suicide is one of the leading causes of death in the United States. The rate of suicide attempts among veterans in the United States has increased tremendously since 2001, which has left the Department of Veterans Affairs deeply concerned. The purpose of this study was to examine if there is an association between suicide attempts among African American/Black veterans and mental health support, income level, marital status, education level, and unemployment status. This quantitative study used the socio-ecological model to explain the association of the contributing factors to suicide attempts. Descriptive statistics, chi-square, and logistic regression were used to analyze the 2014 National Survey on Drug Use and Health from the United States Department of Health and Human Services, Substance Abuse and Mental Health Services Administration and Center for Behavioral Health Statistics and Quality. The publicly available dataset contains 55,271 cases with 6,698 Blacks/African American in the study. The findings of the study show 20% of African American veterans who seek support received it and 80% did not in suicide attempts among African American/ Blacks veterans and mental health support, income level, marital status, education level and unemployment status. The study showed there is a need for greater support for African American veterans through either policy or access to more mental health care. The social change implication is that need to be greater advocacy for support for African Americans who experience suicidal thought seeking support. Providing the support, they need can possibly help save lives.

Studies have shown that emergency mental health trauma (EMHT) services can significantly reduce the long-term effects of trauma after a disaster. However, rural municipalities may find they do not have the capacity to create such a service, or may not realize that their disaster planning includes no provision for emergency mental health care. Such was the case in a rural island community in the state of Washington, where, in 2014, several residents initiated a discussion that helped to identify the community's lack of EMHT services. This project, framed by action research and based on collaboration theory, sought to advance the potential for the community's 21 resident social workers to address this issue collaboratively. Accordingly, the project's research question asked how social workers on south Whidbey Island perceived the issue of a rural EMHT service in their community. Data consisted of responses from 8 participants who completed mailed questionnaires and participated in brief telephone interviews. Descriptive coding analysis of the data confirmed a nearly universal lack of knowledge about an EMHT service, a clear perception of the need for such a service, and a unanimous commitment from the respondents to participate in addressing this problem. Such collaborative activity is expected to have a positive impact on the micro, mezzo, and macro levels of social work practice in south Whidbey, as well as on the community itself, not only in spearheading a dialogue about EMHT but also in activating a group of social workers who had no prior association.

Legislation concerning California residents with intellectual and developmental disabilities (ID/DD) requires recipients of services to be treated as independent individuals while emphasizing self-determination. At the same time, under regulatory procedures, recipients are considered dependent on the delivered services and not self-determinant. Neither the California Department of Developmental Services nor the trade associations representing community service providers have established a unified, systematic practice to support self-determination. This phenomenological study explored the experience of adults with ID/DD working toward self-determination. Specifically, it explored how medical and social models contribute to shaping and actualizing the independence of this population. Interviews with eight adults with ID/DD explored the perceived barriers to, and opportunities for, achieving independence through self-determination. Under the current statutory regulations, the study viewed two conceptual lenses. The first lens, social role valorization, is based on the study of normalization. The second lens, social reaction, emphasizes a response to the disparities that acknowledge the political, cultural, and social beliefs associated with theories of deviance and social role valorization. The findings demonstrated that self-determination requires collaboration between coordinated services, primary social systems, and theoretical services supporting social role value. The discovery of these key elements may help California's disability service system fulfill legislative requirements to increase opportunities for personal choice.

The proportion of Canadian prisoners with mental illnesses is rising. Prison administrators are legally responsible for funding and providing access to mental health services for prisoners. Models of service delivery are organized differently in prisons across Canada, and limited scholarly research exists on the efficacy of different approaches to delivering prison mental health care services. The purpose of this case study was to explore the organization and delivery of mental health services in a provincial prison (APP) in Canada. The research question considered how to organize the delivery of these services to meet the needs of prisoners with mental illnesses. The right to health, which holds that services should be available, accessible, appropriate, and of good quality (AAAQ), was applied as the conceptual framework. Data were collected from public documents, observations of the medical clinic and a meeting of a multidisciplinary committee, and individual interviews and focus groups. A total of 31 participants from APP, the provincial health care system, and community-based organizations participated in this study. The data were inductively coded and subjected to pattern matching with emerging themes from multiple sources. Findings indicated that the provincial health care system, not prison administrators, should be responsible for the oversight and management of prison mental health services. Collaboration between the systems is needed in program design and delivering these services. Application of the AAAQ framework against mental health services revealed that the services did not satisfy the right to health and need enhancement. These findings suggest that policy makers could use the AAAQ framework to design and deliver mental health services equivalent to services in the community for the benefit of prisoners.

The purpose of this quantitative study was to examine whether the post-deployment screening instrument currently utilized to assess active-duty Marines for symptoms of PTSD upon their return from a combat deployment can be solely relied upon to accurately assess for PTSD. Additionally, this study sought to compare the number of Marines who have sought trauma-related mental health treatment based on their answers on the Post-Deployment Health Assessment (PDHA) to the number who have sought trauma-related mental health treatment based on their answers on their PTSD Checklist - Military Version (PCL-M). The participants in this study were comprised of a sample of active-duty Marines that had recently returned from a combat deployment. A quantitative secondary data analysis used Item Response Theory (IRT) to examine the answers provided by the participants on both the PDHA and PCL-M. Both instruments proved to be effective when assessing symptoms of PTSD and the participants identified as having symptoms of PTSD were referred for mental health services as required. According to the results, more Marines were identified as having symptoms of PTSD using both assessment instruments (PDHA and PCL-M) compared to those identified using just the PDHA. The result was a better understanding of predictors of Marines who may later develop PTSD. The results of this study can also assist the Marine Corps with its post-deployment screening for symptoms of PTSD which in turn can provide appropriate mental health referrals for Marines if deemed appropriate.

Billions of mental health care dollars for millions of children and adolescents in need has garnered significant attention within the behavioral health industry to reduce costs while improving treatment efficacy through the identification and implementation of evidence based practices with youth populations requiring therapeutic services. This hermeneutic phenomenological qualitative research approach in the field of psychology is a consumer driven one in the world of business. Line by line context and discourse analyses, which included both a prior and inductive coding, of the verbiage and phraseology of 10 boys and 10 girls, aged 8-12, actively engaged in outpatient psychotherapy, formed the foundation for 31 themes that captured a shared experience or a consumer driven “view inside the therapist’s office.” These results are represented through 6 main themes indicating that a) “knowledge fosters investment” upon entry into and initiation of mental health services when therapists and parents recognize that b) “words have power to facilitate success,” only if, guided by childhood development but chosen thoughtfully for each child. Further, c) “therapy is therapy across the lifespan,” such that therapeutic care for minors deemed legally dependent reflected treatment for legally independent persons with implementation methods influenced by age. Lastly, age, as a definitive factor, impacted the means by which the youth in my study experienced d) “autonomy… and developed e) “therapeutic rapport…” in references to e) “boundaries…” that mitigate the entire treatment experience. The outcomes of this study offer the research and practice community opportunity to move children from the “object” of the treatment to “agents” in their treatment by respecting the ideas expressed by youth themselves.

The growing global prevalence of dementia coupled with a shift in public perception from a hopeless disease to the possibility of living well with dementia has led to the formation of dementia friendly communities (DFC). DFCs are a new phenomenon in the United States, with a gap in knowledge on input from people living with dementia (PLWD). This study investigated DFCs from the perspective of PLWD in Western North Carolina, with the following research questions: How are interactions and relationships experienced by persons living with dementia in the community? How is community engagement experienced by PLWD? To what extent and in what way is the impact of stigma associated with dementia? What are the attributes of a DFC from the perspective of PLWD? Eighteen older adults with reported dementia or memory loss were recruited from support groups or community organizations. Semi-structured interviews were conducted in participants’ homes and analyzed using conventional qualitative content analysis. Three major themes emerged from the transcribed interviews (a) transitions in cognition: vulnerable identities, (b) social connections, and (c) engagement in life activities. The dynamic experience of living with dementia revealed by participants suggested the following attributes of a DFC: (a) social inclusion, (b) support for role continuity, (c) availability of meaningful and contributory activities, (d) flexible support as cognition transitions, (e) community dementia awareness (to combat stigma), and (f) a supportive diagnostic process. The presence of care partners in the interviews was supportive, and the evaluation to sign consent tool assisted in determination of participant capacity to self-consent. The findings were interpreted through the theoretical frameworks of personhood, the social model of disability, human rights and citizenship, the environmental press model, and transitions theory. DFC development requires a contextual lens focused on well-being with input from multiple stakeholders including PLWD. Collaboration among community organizations supported by local, regional, and national policy supporting flexible service provision through cognitive transitions has the potential to provide a strong social network on which to build a DFC.

Dexter Morgan is a serial killer, but he may not be blameworthy for his actions There are two possible explanations that could absolve Dexter of moral responsibility: (1) His inability to empathize with others makes it so that he cannot make appropriate moral decisions. Or (2) his serial killing tendencies are determined in nature, set off by events of which he had no control. I conclude that Dexter is, in fact, morally responsible for his actions because he is capable of second order desires

Archived data was utilized for the present study which examined self-injurious behaviors in a college population. College students, who engage in non-suicidal self-injury, or NSSI, were expected to evidence a higher knowledge base for the behavior than those who do not. The demographic variables of gender and sexual orientation were predicted to be over represented in the NSSI group. Further, this study examines the perceived riskiness of the behavior in individuals who self-injure, as well as their perceptions of others who engage in NSSI. The survey consisted of four sections: demographics, knowledge ofNSSI, experience with NSSI, and perceptions ofNSSI. Individuals who engage in or have a history of NSSI evidence a higher mean score or better knowledge of the behavior than those who do not. The NSSI population evidences disproportionate numbers of females and individuals with gay, lesbian, and questioning sexual orientations. Further, when examining the perceived riskiness of self-injury, the NSSI group views the behavior as less risky than the non self-injury group. Results are discussed in relation to the need for accurate knowledge about NSSI and additional research directions.

The engagement of families of children and adolescents with Serious Emotional Disturbance (SED) as full partners in individual treatment, organizational, and system level decision making has become an important focus for systems of care (SOCs) serving youth with emotional and behavioral challenges. SOCs typically include cross-agency partnerships with mental health, child welfare, juvenile justice, and education for the purpose of providing services and supports for youth with SED who have multi-agency needs. Implementation of a federal mandate requiring family driven care (FDC) within systems of care funded through the Children's Mental Health Initiative (CMHI) has revealed that most system of care leaders recognize the value of families as full partners in decision making at all levels of the system, strive to have meaningful family involvement, but are challenged by how to successfully engage families in this process. The purpose of this research study was to explicate more fully the roles of families by examining the structures, processes, and relationships characteristic of family involvement in system level service planning and delivery decisions within established system of care communities and to develop a framework that depicts how SOCs engage families in system level decision making. A qualitative secondary analysis (QSA) was conducted, using data collected through Case Studies of System Implementation, a five-year research study that used a multi-site embedded case study design to examine system of care development. Six well-functioning SOCs throughout the country participated in the original study. Team-based data collection from these sites included 307 system documents (e.g., state- and local-level reports; evaluation, grant and budget information; organizational charts), direct observations (41), and semi-structured interviews with key stakeholders (209), as well as stakeholder completion of 113 ratings exercises related to factors critical to system development and implementation. Interviews were conducted with policy makers, administrators, judges, service managers, direct care staff, families, and youth (>18) across all partner agencies within the SOC. Findings from the original study revealed not only information on system development but an emerging theme of the important role of families in planning and implementing the SOC. A team-based QSA was conducted to more thoroughly examine how families are engaged in system level decision making. Findings reveal the necessity of an engaged, locally developed, autonomous family organization that is regarded as an equal system partner, and at least one system of care leader who promotes FDC. Also present are collaborative activities such as training and coaching, evaluation, and grant writing; and family organization activities such as capacity building of families and strategic outreach to system partners. The SOCs also demonstrate specific relationship-building activities and exhibit a shared value of FDC throughout the system. A framework was developed to depict implementation of FDC based on study findings. The framework was then modified based on data collected during focus groups conducted with Lead Family Contacts, Principal Investigators, and Project Directors from system of care communities currently funded through the CMHI. Research results yield specific structures, processes, relationships, and a foundational shared value for FDC that are present in systems of care that engage families as partners in system level decision making.