One of the main elements of the mandate of the mental health profession is to guide individuals in their journey toward wellness. Every day, practitioners work tirelessly to provide their patients with the tools and resources that they need to find balance and develop a sense of fulfilment. Young individuals from minority communities are among those who deserve and have indeed received special attention from mental health and social workers. These individuals grapple with serious challenges that pose threats to their wellbeing. Poverty, substance abuse, crime and homelessness are some of these challenges. When dealing with these patients, it is critical for the social worker or mental health profession to begin their interaction with an assessment of the patient’s background. As part of the assessment, the practitioner should examine how such factors as race and gender influence the problem that the patient has presented with. The purpose of the assessment should be to identify risk and protective factors that are then used to inform the development of effective and appropriate interventions.
Psychosocial Assessment
The research and scholarly communities appear to have reached agreement on the importance of psychosocial assessments in social work. This observation is founded on the volume of literature that addresses the role that the assessments play in social work. For example, in their article, Carroll, Metcalfe, Steeg, Davies, Cooper, Kapur and Gunnell (2016) note that the psychosocial assessment allows practitioners to identify patients who are at risk of harming themselves and develop appropriate treatments. In recognition of the significance of psychosocial assessment, an evaluation of the background of JonTae Rivera, a 20-year old African American was conducted. The results of the evaluation are provided below.
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Presenting Issue
Before outlining Rivera’s biosocial profile, it is helpful to begin with a discussion of the issue for which he sought help. During the interaction, Rivera lamented that he felt depressed. He shared that he grappled with feelings of sadness and hopelessness. His situation is not unique since depression has been observed to be prevalent within minority communities. For example, Ward and Mengesha (2013) partnered to examine the prevalence and the risk factors for depression among African American men. They determined that the prevalence rate of this condition is between 5% and 10%, worryingly high. Another observation that they made is that such hardships as poverty, crime and limited access to mental health services collude to expose African Americans and other minorities to the risk of developing depression. Their study allows one to understand why Rivera struggled with depression.
Age
As already noted, Rivera is a 20 year old individual who has been placed in foster care. It was felt necessary to include his age in the psychosocial assessment. During the interview, it was observed that Rivera looked like a typical 20 year old and had invested some effort in his appearance. The inclusion of his age in the assessment was informed by the fact that one’s age usually plays a role in the state of their mental health. One would expect that since he is young, Rivera does not experience the stressors and pressures that set the stage for depression. However, as his presenting problem revealed, his age has not shielded him from this condition. Research indicates that in some contexts, young age can be a risk factor for depression. For instance, Addington et al. (2018) confirmed that adolescents and young adults face an elevated risk of such serious mental illnesses as depression. Their observation is consistent with the case of Rivera.
Culture and Racial Identity
Culture is an integral component of the psychosocial assessment. As Holden, McGregor, Blanks and Mahaffey (2012) noted in their text, by considering the cultural background and context of a client, practitioners are able to develop highly individualized care plans that leverage cultural resources while diminishing the impact of negative cultural practices. Furthermore, the evaluation of a patient’s culture allows the practitioner to identify and eliminate the barriers that could discourage the patient from seeking care. Holden and his team state that it is common for African Americans to be reluctant to seek mental health services and blame this reality on the culture of this community. On the question of his racial identity, Rivera responded that he is African American. Given the negative attitudes that African Americans hold regarding mental health services, it is rather surprising and encouraging that Rivera sought help. One would expect that the cultural beliefs and attitudes of his people would discourage him from appealing for help. He revealed that as part of his efforts to express his racial identity and cultural heritage, he participates in various African American activities. For example, he consumes food associated with the community and has developed an attachment to the community. The attachment is indeed critical as it facilitates the effectiveness of mental health interventions. Drake and Latimer (2012) are among the scholars who have asserted that community support is vital for mental health. As is the case with Rivera, communities provide the support and resources that patients and social work practitioners need to maintain positive mental health outcomes.
Sexual Orientation
One’s sexual identity can be a sensitive issue. For this reason, it is essential for the attending social worker to exercise caution and display wisdom. Researchers have established that there are links between sexual orientation and mental health. For example, Lee, Oliffe, Kelly and Ferlatte (2017) raised the alarm over the high rates of suicide and depression among gay men. Essentially, these researchers caution that being a member of the LGBT community means that one faces a greater risk of developing depression and other mental illnesses. Rivera shared that he is a heterosexual male. The implication of his sexuality is that depression is not confined to the gay community. Even heterosexual individuals can develop this condition and it is critical for social workers to target their interventions at all individuals, without giving undue regard to the sexual orientation. However, it is advised that they should focus most of their effort on the LGBT community whose members have been observed to be likelier to suffer depression.
Economic Status
Poverty is understood to be among the risk factors for poor mental health outcomes. For example, the stressors that low-income individuals face every day make them vulnerable to such conditions as depression. Poverty usually works in tandem with such other factors as homelessness and crime to increase the risk of depression. In an earlier section, it was pointed out that Rivera is African American and is in foster care. These two factors place him at great risk of developing mental health problems. Estimates place the poverty rate among African Americans at 27.4% (“Poverty”, n.d). Being a member of the African American community, it is unsurprising that Rivera complained of enduring years of abject poverty. In the different foster homes where he has stayed, he has experienced lack and deprivation. Currently, he is under the care of his foster mother, Ms. Hann Skinner who has imposed a curfew and strives to ensure that Rivera has access to opportunities and resources. While she is not wealthy, Ms. Skinner is generous and kind. Her warmth can be linked to the positive progress that Rivera continues to make and his decision to seek help. It can be argued that Rivera’s background of poverty has played some role in the development of his depression.
Education
Education is another issue that the psychosocial assessment addressed. Rivera proudly shared that he had passed his ELA regent in 2018 and that he had received an acceptance letter from the Bronx Community College. These educational achievements stand in sharp contrast to the historically low educational accomplishments among African Americans. Various studies have established that African Americans lag behind other communities with regard to graduation rates (Bohanon, 2017). It is indeed encouraging that despite the hardships that he faces, Rivera has remained committed to his studies. There appear to be no obvious connection between his education and his depression. His thirst for learning can be leveraged to enhance the effectiveness of the interventions that are adopted.
Medical and Substance Use History
Substance use has been observed to occur alongside mental health problems (Smith et al., 2017). It was indeed a relief when Rivera insisted that he did not consume any illicit or dangerous substances. In addition to leading to depression, the substances can also compound the symptoms that accompany this condition. His decision to shun drugs can be attributed to the guidance and encouragement that he receives from his foster mother. Rivera serves as evidence that the home environment is among the factors that influence one’s mental health. When a child or adolescent is provided with support and stern guidance from their parents, they are likely to make wise decisions that safeguard their mental wellness.
Psychosocial Frame of Reference
The psychosocial assessment allowed for a clear and comprehensive understanding of Rivera to be gained. In conducting the assessment, the psychosocial frame of reference was adopted. Basically, this is a concept that regards individuals as the result of the interactions of various social and environment factors (Bruce & Borg, 2002). For example, as the discussion above has revealed, education, poverty and sexual orientation are some of the environmental and social forces which influence mental health. The psychosocial frame of reference is critical as it allows practitioners to develop holistic plans of care and interventions. Instead of simply treating the problem that the patient presents with, using the psychosocial frame of reference, the practitioner integrates the social and environmental determinants of mental health into their approach. The assessment of Rivera’s situation involved an application of the psychosocial frame of reference. This frame was used to establish the association between Rivera’s depression and the social factors in his environment. It was determined that whereas some factors contributed to the depression, others served as protective factors. For example, his education was a protective factor while poverty was among the risk factors.
The assessment did not mark the end of interactions with Rivera. It simply set the stage and provided insights that were used to develop plans and interventions. Therapy was identified as a promising intervention. As part of the treatment plan, Rivera would be referred to a therapist who is to work closely with him until he has fully recovered from the depression. Another component of the treatment plan involves encouraging his foster mother to offer support and ensure that Rivera commits to the treatment. Additionally, since he indicated that he spends time with his peers, Rivera was encouraged to turn to his friends for support. Support from one’s social circle is among the key resources that facilitates recovery.
Psychosocial/Crisis Intervention
The purpose of the psychosocial assessment is to provide the social worker or the mental health professional with the insights that they need to deliver appropriate and effective interventions. As has been noted above, the psychosocial frame of reference served as the basis for the assessment and the development of the interventions. In recommending that Rivera should undergo therapy, the social and environmental factors were considered. It was determined that the therapy would only be successful if it accounted for Rivera’s hardships and leveraged the numerous strengths that he possesses. For example, Rivera proved to be remarkably resilient, confident and responsible. He continues to battle such illnesses as asthma and various allergies. Despite these hardships, Rivera has remained steadfast and unshaken in his pursuit of wellness. The psychosocial approach was employed in recommending therapy and when encouraging Rivera to lean on his friends and foster mother for support. The proposal that he should leverage his social circle for support was part of crisis intervention. It is hoped that the support that he receives will help to elevate his mood and tackle the negative feelings with which he continues to grapple.
Concepts and Interventions
When designing interventions and conducting psychosocial assessments, it is important for practitioners to be guided by theoretical frameworks, concepts and models. The self-efficacy theory is the primary model that was used to understand Rivera’s circumstances and struggles. Essentially, this theory holds that in order to succeed, individuals need to be motivated and recognize that they can leverage their skills and resources to overcome hardships. This theory underscores the importance of confidence and an unwavering belief in one’s ability to tackle hardships. Adopting this framework, it is possible for individuals to find wellness and to limit the damage caused by the hazards in their environment. The self-efficacy theory informed the assessment and treatment processes in various ways. One, this theory allowed for an identification of the protective factors in Rivera’s environment to be identified. For example, as already stated, his education and refusal to use dangerous drugs serve to shield him against harm. These resources were incorporated into the treatment plan. Two, the self-efficacy theory was used to enhance Rivera’s belief that despite the struggles that he endures, he will eventually find healing by remaining committed to the treatment process. Overall, the self-efficacy theory which forms part of the larger psychosocial framework, made it possible for a treatment plan that promises to deliver healing to be developed.
The learned helplessness theory is another psychosocial model that is routinely used in crafting mental health solutions. Basically, the main provision of this theory is that when individual efforts to overcome hardships fail, people are likely to quit and yield to the struggles that they face. For example, after one’s efforts to abandon a destructive habit prove futile, this individual may stop trying and accept that their problem is unsolvable. The learned helplessness theory was used to monitor Rivera and to ensure that he made progress in his treatment. It was feared that if little progress was made, Rivera would lose faith in the treatment process and this would only compound his depression. Focus was given to celebrating the milestones that he had achieved instead of directing attention at the struggles that he faces.
Conclusion
Rivera’s situation is similar to those of thousands of other young adults who are depressed, poor and living in foster care. He has a long history of being placed in foster care and this appears to have led to his depression. The psychosocial assessment that was conducted revealed that for the most part, his social environment protects him against mental health hazards. He is dedicated to his studies and is set to begin college education soon. Additionally, Rivera enjoys strong and unwavering support from his foster mother who offers warm care and guidance. However, since he is African American, Rivera is exposed to certain challenges that may complicate the treatment process. It is hoped that despite these challenges, Rivera will make good progress and that his depression will eventually be treated.
References
Addington, J., Goldstein, B. I. Wang, J. L., Kennedy, S. H., Bray, S., Lebel, C., Hassel, S., Marshall, C., & MacQueen, G. (2018). Youth at-risk for serious mental illness: methods of the PROCAN study. BMC Psychiatry, 18 (219). DOI: https://doi.org/10.1186/s12888-018-1801-0
Bohanon, M. (2017). New study finds African American students have lowest graduation rates of all ethnic groups. Insight into Diversity. Retrieved March 7, 2019 from http://www.insightintodiversity.com/new-study-finds-african-american-students-have-lowest-graduation-rate-of-all-ethnic-groups/
Bruce, M. A.,& Borg, B. (2002). Psychosocial frames of reference: core for occupation-based practice. Thorofare, NJ: Slack.
Carroll, R., Metcalfe, C., Steeg, S., Davies, N. M., Cooper, J., Kapur, N., & Gunnell, D. (2016). Psychosocial assessment of self-harm patients and risk of repeat presentation: an instrumental variable analysis using time of hospital presentation. Plos One. DOI: https://doi.org/10.1371/journal.pone.0149713
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Holden, K. B., McGregor, B. S., Blanks, S. H., & Mahaffey, C. (2012). Psychosocial, socio-cultural, and environmental influences on mental health help-seeking among African-American men. Journal of Mens Health, 9 (2), 63-9.
Lee, C., Oliffe, J. L., Kelly, M. T., & Ferlatte, O. (2017). Depression and suicidality in gay men: implications for health care providers. American Journal of Men’s Health. DOI: https://doi.org/10.1177/1557988316685492
Poverty. (n.d). The State of Working America. Retrieved March 7, 2019 from http://stateofworkingamerica.org/fact-sheets/poverty/
Smith, L. L., Charles, M., Mohiuddin, K., Tyrus, D., Adekeye, O., & Holden, K. B. (2017). Exploring the link between substance use and mental health status: what can we learn from the self-medication theory? Journal of Health Care for the Poor and Underserved, 28 (2S), 113-31.
Ward, E., & Mengesha, M. (2013). Depression in African American men: a review of what we know and where we need to go from here. American Journal of Orthopsychiatry,83 (203), 386-97.
