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Prevention (Detroit) - Brielle Siskin, Alyssa Reese & Sara Zabawa

We have add to the Native Americans in the United States Wikipedia page under the Contemporary Issues Section. You can find the page here: http://en.wikipedia.org/wiki/Native_Americans_in_the_United_States#Contemporary_issues

Below is our Final Draft:

Prevalence of Suicide among Native Americans
Suicide is a major public health problem for American Indians in the United States. The Suicide rate for American Indians and Alaskan Natives is approximately 190% of the rate for the general population. Among American Indians/Alaska Natives aged 10 to 34 years suicide is the second leading cause of death with suicide ranked as the eighth leading cause of death for American Indians/Alaska Natives of all ages

Youth who have experienced life stressors are disproportionately affected by risky behaviors and at greater risk for suicide ideation. Suicide rates among American Indians and Alaska Natives youth are higher than those for other populations. The rate of suicide for American Indian/Alaskan Natives is 70% higher than for that of the general population and youth between age 10 and 24 are the most at risk.

College students are also among those most at risk for suicide; select data from the National College Health Association National College Health Assessment (ACHA-NCHA) found that approximately 15% of American Indian students reported seriously contemplating suicide over the past 12 months, compared with 9.1% of non-American Indian students; 5.7% of American Indian students reported attempting suicide, compared with 1.2% of non-American Indian students

Suicide Prevention
Prevention aims at halting or stopping the development of individual or social problem which are already evident. Prevention is different from intervention and treatment in that it is aimed at general population groups or individuals with various levels of risk. Prevention's goal is to reduce risk factors and enhance protective factors. Suicide prevention is a collective efforts of organizations, communities, and mental health practitioners to reduce the incidence of suicide. Social workers have an important role to play in suicide prevention. Social workers are the largest occupational group of mental health professionals in the USA, thus they play a significant role in national approach to preventing suicide. The social work approach to suicide prevention among Native Americans identifies and addresses the individual’s immediate clinical needs, community/environmental influences, and societal risk factors.

Risk Factors
Risk factors are defined as circumstances that increase the likelihood of negative outcomes. Risk factors that negatively affect the Native American population include historical trauma, substance abuse, mental illness, suicide contagion, isolation, and acculturation. These risk factors have their negative affects on clients which can be prevented or reduced through clinical social work practice. Before clinical social workers begin their work with Native American clients, it is imperative that they are providing culturally sensitive services.

Clinical Social Work Perspective to Suicide Prevention
When working with Native American clients in a clinical setting, it is crucial that social workers tailor their services to effectively meet the needs of this population. This would include being sensitive to and aware of the common risk factors that exist among the Native American population. For example, suicide contagion is a risk factor among Native Americans; therefore, post trauma counseling is needed as a method of prevention for individuals and groups in response to the large number of suicides on Native American reservations. Providing culturally sensitive services to clients is crucial. Overall, the clinical social work perspective to suicide prevention utilizes some form of an assessment and prevention plan. Clinical social workers working with suicidal clients should conduct an assessment of their client’s conditions and history. Then they should develop a suicidal prevention/treatment plan with their client. This multi-dimensional treatment plan includes the presenting problem, a working diagnosis, goals and objectives, treatment strategies and interventions, the client’s strengths and barriers to treatment, an assessment of suicide lethality, issues of safety, and criteria for ending treatment.

Mental illness and substance abuse are other serious risk factors prevalent in the Native American community that can lead to suicide. Suicide can be prevented through clinical social workers providing mental health services to clients in individual and group counseling sessions. Clinical social workers work towards alleviating mental health issues while maintaining their clients physical, psychological and social functioning through prevention work that empowers their clients (health). This prevention comes in the form of case management, referrals, working on an emergency crisis intervention team, and rights advocacy. Individual therapy specifically focuses on prevention through assessing the client’s mental health conditions, diagnosing the conditions, developing treatment plans, and treating them. A treatment plan approach is also taken with clients who have substance abuse issues. Clinical social workers do prevention work through assessing their client’s conditions and developing an effective treatment plan derived from the assessment which looks at the client’s concerns, goals, objectives, and outcome criteria.

Historical trauma is another risk factor among the Native American population that can lead to suicide. Clinical social workers have also done prevention work with Native American clients around the negative affects of historical trauma. Dr. Brave Heart, a licensed social worker, developed a clinical intervention to historical trauma for her Native Americans clients which includes having her clients watch videotapes depicting culturally relevant historical trauma followed by discussions and exercises to get the clients connected with their emotions and grief. Once this occurs, they then tell their stories and reflect on how unresolved grief has affected their lives. The clinical social worker’s role is to help his or her clients recognize where their emotions are coming from and help them deal with them in a healthy way. This prevention work is often done in larger groups, frequently followed with talking circles and focus groups.

Marco Social Work Perspective on Suicide Prevention
Unlike a clinical approach to suicide prevention, which addresses individual level risk factors such as mental illness and feelings of isolation, a macro social work approach to suicide prevention considers and addresses a broader spectrum of societal and cultural components and institutions that may prohibit a suicidal individual from seeking help and may ultimately lead to an individual taking their own life.

One of the most important elements that Social Workers should be aware of when doing suicide prevention work with the Native American population is the effect of historical trauma. Historical trauma is the cumulative emotional and psychological wounding over the lifespan and across generations, stemming from massive group trauma experiences. For the Native American community, historical trauma represents forced relocation, the removal of children who were sent to boarding schools, the prohibition of the practice of language and cultural traditions, and the outlawing of traditional religious practices. Prior to their forced acculturation, Native American societies had their own norms, values, customs, and traditions, all of which kept their life in balance with their community, with their individuality, and their families. Involuntarily losing this cultural and tribal unity may have removed many safeguards against suicide that Native American culture might ordinarily provide, damaging the ability of families, schools and the community to buffer and protect the individual from normal challenges. This lasting traumatic legacy impacts the entire Native American community and it is this dramatic and rapid social and cultural disruption that may account for the increased suicide rates among indigenous groups. .

While Social Workers cannot prevent the existence of historical trauma in the Native American community, Social Workers can help to prevent suicide on a macro level by helping Native American individuals to identify the existence and effects of historical trauma as well as help to strengthen aspects of the Native American culture and community that historical trauma has had a hand in wounding. According to studies of First Nations youth, cultural continuity appears to be a strong protective factor against suicide, asserting that the sense of belonging that a culture creates is basically prevention in itself. Social workers need to support and help to reconnect cultural traditions and ties in order to make people feel valued and encouraged to seek help. Feeling connected is vital for people at risk of committing suicide and Social Workers can help to reorient the community to the centuries-old spiritual beliefs, norms, values, customs, and traditions by organizing community dialogues and support groups and by creating/hosting culturally-oriented programs and events. These approaches will help to strengthen family and community and may help to create a community support system for individuals struggling with suicidal ideation.

Besides altering Native American’s cultural and community continuity, historical trauma has placed this group at greater risk for suicide because generations of forced acculturation have negatively affected the group’s help-seeking behavior. When seeking mental health care, some Native Americans avoid professional services as they represent the “white man” who was ultimately blameworthy for the historical and cultural trauma against their communities. In order to make Native American communities feel more comfortable utilizing mental health services, social workers must advocate for culturally appropriate services that specifically address the needs of the Native American population and are mindful to the community’s distrust of the “white man’s system”. Social workers should advocate at the local, state, and national level for policies that support culturally appropriate services and culturally competent mental health professionals.