SIMPLE STEPS Model for Suicide Risk Assessment

Introduction

The SIMPLE STEPS Model (McGlothlin, 2008) for suicide risk assessment provides a simple mnemonic similar to others like SADPERSONS (Patterson, et. al., 1983) or IS PATH WARM (from the American Association of Suicidology). Each of these is correlated with increasing suicide lethality and so this can be a useful short-hand to remember these items.

Suicide risk assessment on the crisis line is mostly concerned with imminent risk, and many suicide screeners designed for lay people may miss important variables in a goal to be simplistic; the SIMPLE STEPS model appears to avoid both of these traps, by providing an assessment tool simple enough to be used in the crisis line environment but comprehensive enough to be used by counsellors or therapists for ongoing monitoring of suicide risk.

Items in the SIMPLE STEPS Model

  • Suicidal – Is the individual expressing suicidal ideation?
  • Ideation – What is their suicidal intent?
  • Method – How detailed and accessible is their suicidal method?
  • Perturbation – How strong is their emotional pain
  • Loss – Have they experienced actual or perceived losses? (Relationships, material objects)
  • Earlier Attempts – What previous attempts has the individual experienced, what happened after those attempts?
  • Substance Use – Is the individual abusing drugs, alcohol, or other substances?
  • (Lack of) Troubleshooting Skills – Are they able to see alternatives or options other than suicide?
  • Emotions / Diagnosis – “Assessment of emotional attributes (hopelessness, helplessness, worthlessness, loneliness, agitation, depression, and impulsivity) and diagnoses commonly associated with completed suicide (e.g., substance abuse, mood disorders, personality disorders, etc.)” (McGlothlin, et. al., 2016)
  • (Lack of) Protective Factors – What is keeping this person safe from suicide? Who are their supports (internal such as personal values and external like people), resources and agencies
  • Stressors and Life Events – What has happened in their life to lead them to suicide?

Sharp readers will identify that these elements map very neatly onto the DCIB Model of Suicide Risk Assessment, but perhaps provide a better mnemonic in order to make sure that clinicians who do not have the DCIB in front of them are able to perform that assessment.

Validation of the SIMPLE STEPS Model

McGlothlin, et. al. (2016) used 13,000 calls over six years to a crisis line and correlated the SIMPLE STEPS items with the lethality risk present in that call. One limitation of this study is that it used self-reported (by the helpline worker taking the call) lethality rather than using another evidence-based risk assessment in order to compare with. I am satisfied that McGlothlin addressed this in his limitations section, where he noted the difficulty with using data collected in this manner.

References

McGlothlin, J. (2008). Developing clinical skills in suicide assessment, prevention and treatment.
Alexandria, VA: American Counseling Association

McGlothlin, J., Page, B., & Jager, K. (2016). Validation of the SIMPLE STEPS Model of Suicide Assessment. Journal Of Mental Health Counseling, 38(4), 298-307. doi:10.17744/mehc.38.4.02

Patterson, W.M., Dohn, H.H., Patterson, J. & Patterson, G.A. (1983). “Evaluation of suicidal patients: the SAD PERSONS scale.” Psychosomatics 24(4): 343–5, 348–9. doi:10.1016/S0033-3182(83)73213-5. PMID 6867245

Cite this article as: MacDonald, D.K., (2017), "SIMPLE STEPS Model for Suicide Risk Assessment," retrieved on July 21, 2017 from http://dustinkmacdonald.com/simple-steps-model-suicide-risk-assessment/.

 

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Coping Skills Therapy for Managing Chronic and Terminal Illness

Introduction

I recently had an opportunity to read this excellent book written by Social Worker Kenneth Sharoff. It presents a model of therapy he calls “Cognitive Coping Theory” (CCT) and applies this model to working with individuals who have chronic (or life limiting) and terminal illnesses.

Below I present some of the content from the book I found particularly useful.

Executive, Policy and Operational Beliefs

The first concept in the book, after the discussion of how CCT fits in with CBT and other therapies and models is the idea of policy, executive and operational beliefs. Policy beliefs are the most high-level, and roughly match what is called schema in other therapies. Examples of executive beliefs given in the book include:

  • My body should not interfere with my ability to pursue my career
  • Doctors must find a cure for my disease. Doctors and modern medicine should be able to cure me

Executive beliefs are often “shoulds” or “musts” that frame an individual’s approach to a situation. They dictate rights and beliefs about what an individual will experience – even when those things are out of that individual’s control. These policy beliefs are then carried out by executive beliefs, which explore how the policy belief is carried out.

One example is someone who wishes to join the Police Service even though they have found themselves paralyzed after an accident. They may hold policy beliefs like “I should be able to do whatever I set my mind to” and “My body should not interfere with my ability to pursue my career”, the resulting executive beliefs might look like:

  • Get angry at those around me who do not recognize my struggle
  • Continue trying to join the Service even though I am not able to
  • Vent my jealousy at individuals who are not limited in this way

The policy beliefs influence the Belief part of the Cognitive Behavioural Therapy ABC scale, while the executive beliefs influence the Consequences part:

  • Activating Event – I am not able to pursue my chosen career
  • Belief – I am inferior if I can’t pursue my dreams
  • Consequences – I feel worthless, angry, jealous, etc.

The last type of beliefs are known as operational beliefs. These are the most concrete thoughts that an individual has related to their illness. Examples include:

  • I am worthless
  • My life is awful
  • It’s not fair that I am experiencing this

These might be compared to the unconscious thoughts typical of CBT. Changing the executive beliefs, which dictate coping strategies, or responses is a key part of CCT.

Phases of Coping with Disease or Disability

Sharoff dictates five phases of coping with disease or disability. They are:

  • Crisis
  • Postcrisis
  • Alienation
  • Consolidation
  • Synthesis

Like most models, this is presented linearly but an individual may move back and forth among the phases as they proceed through their illness or disease.

Crisis Phase

In the crisis phase, the individual is first experiencing symptoms. They may be experiencing feelings of threat or loss, and experiencing a loss of self-esteem, self-efficacy, and increases in physical discomfort or other direct impact by the illness.

Sharoff describes “dream crush” – the feelings experienced by someone who has discovered that their plan for themselves is no longer possible because of their illness. He identifies “self-placement” as a significant component of this. Self-placement is the task of comparing yourself to where you want to be in life at a particular point in time; realizing that you are not “living up” to this ideal causes significant distress.

Changes in identity are also common in the crisis stage.

Postcrisis Phase

In the postcrisis phase, an individual has become accustomed to their situation. They begin to stabilize in that things become routine. As they resume as much of their previous roles as possible, the feelings of “anomie” end. The postcrisis state may lead to alienation if they have not are still experiencing negative emotions as a result of their illness’s effect on the body.

Alienation Phase

The alienation phase involves a psychological disconnection from the body. An individual struggling with a chronic disability or disease may actually disscoiate themselves from their body and see it as distant or distinct from themselves. This provides short-term coping but will not allow the individual to progress past this state.

Hostility or indifference towards their body is common, as individuals seek to separate themselves from their disease. The major tasks of this phase are to neutralize bitterness and to work on beliefs of disfiguration. If individuals believe they are disfigured, the negative beliefs that lead tot his will need to be worked on in order to avoid a loss of self-esteem or feelings of inferiority.

Consolidation Phase

The consolidation phase may be entered into directly after the postcrisis phase if the individual is coping adequately, or may require significant work in the alienation phase if they are not. An individual in the consolidation phase feels more in control of their life, and may experience increased self-efficacy.

Although an individual may experience a loss of meaning, they can develop new goals and behaviours that work within the limitations of their body. If they are able to do this successfully they will begin to move to the Synthesis Phase.

Synthesis Phase

The final phase of coping is the Synthesis Phase. This phase is marked by a blending of the old and the new, and a recognition that although an individual is changed by their illness they can still find a quality of life and activities that bring them happiness.

Skills Training

Sharoff suggests a variety of coping skills and strategies for each phase that an individual that will pass through. For instance, for individuals who have magical thinking or wish that they could control things like what activities they can perform now that they are limited by their disability, focusing on “area thinking” is one strategy to work on this. In area thinking, an individual considers each goal and whether that is within their control. If it is not, it is consciously replaced by a different goal that is within their ability to control.

What is below is just a few of the many skills, subskills and microskills contained in each category. They are accompanied by detailed explanations and demonstrations of the skills and other tools to make them as useful as possible in therapy.

Assimilation and Rejection of Suffering

Assimilation of suffering means to cope with suffering and to accept that some degree of discomfort, pain or suffering is a necessary part of the process of coping. It is expressed by complaining and expressions of powerlessness, with an undercurrent of magical thinking that if one rejects or denies their reality or the future that it will go away.

This involves acceptance of the reality (without enjoyment of it), forbearance (accepting showing “patience, tolerance, and restraint” with themselves demonstrating endurance as a personal goal), and forgiveness of one’s body, self, their deity or others they may blame for the illness.

Other coping skills that may be used include guided imagery, therapeutic metaphors (such as David versus Goliath) deep breathing, self-encouragement and substituting automatic thoughts when they occur. Outcome enactment is borrowed from solution-focused therapy and asks clients to identify when they do not suffer, and then to note what thoughts or feelings underlie that lack of suffering.

Discomfort and Frustration Management

Sensory diversion training is used to cope with physical discomfort. It involves choosing a sense like sight, smell, or touch and mindfully focusing on an item involving that sense. For instance, if someone who is experiencing pain focuses on an object they can see, and follows it with their eye, tracing it and creating a mental map. Then, moving to the next object, continuing this process until they are no longer aware of their negative physical symptom.

“No Mind No Thing” is a technique borrowed from Buddhism to deal with frustration or other negative experiences by attempting to clear the mind of conscious thought. This is a meditative technique that involves staying in the present and taking in all sensory input. Use of a white noise machine may be helpful in this regard.

Self-instruction training involves using positive self-talk by examining the positive aspects of thinking well and maintaining mantras. Managing activities can help an individual avoid frustration but running up against the wall created by their illness.

Identity Management

An individual’s identity can be challenged by the onset of their illness. Identity is measured by one’s belief in their membership in a group, such as men, military veterans or construction workers. For instance, a woman who believes that in order to be a woman she must have breasts will experience distress when she loses a breast to a mastectomy as a part of breast cancer treatment.

Identity adulteration describes the process by which an individual’s identity has changed as a result of their condition. Identity alienation is indifference towards the individual’s changed body, while identity loss is the recognition that an individual has (rightly or wrongfully) lost their membership in a chosen group.

Reconciling identity involves realizing that we often adopt restrictive definitions of what it requires for membership in a category. Continuing the example of the woman missing her breast, reconstructive surgery may allow her to feel like she belongs to the group again, or seeing other elements of womanhood like nurturing behaviour.

This is especially important for men who often put high standards on themselves, believing a very narrow definition of manhood. Expanding that definition to include stability, being a provider, being confident and assertive, and other “soft skills” may help reduce the distress an individual feels when they cannot participate in their former vocation, if they are physically not as imposing as they were, or are experiencing other symptoms as a result of their illness.

Self-Support Training

Self-support training involves the reduction of self-criticism and building a strong internal support network so that individuals do not have to rely on others who may be inconsistent in their ability to provide support. Self-support training involves focusing on strengths (known as becoming a self-booster), holding self-compassion, self-advocacy and exoneration training.

Exoneration training is a skill that may be used when someone holds themselves responsible for their shortcomings. For instance, someone who cannot pursue a hobby of running because of their multiple sclerosis may blame themselves for that outcome – even though they have no control over it.

Sharoff recommends instead, staging a “mock trial” in an individual’s mind. Stack all the evidence for the belief, against all of the evidence against. Play prosecutor and defense, in order to stimulate a protective instinct in the client. If they steadfastly hold to their belief that they are responsible, he recommends taking it further and having them determine guilt or innocence, and even prescribe punishment! The reason for this seems paradoxical, but punishing themselves for their own maladaptive beliefs helps them to realize the futility of their thought processes and may enable them to begin moving towards a less blameful attitude.

Uncertainty Tolerance

Uncertainty is at the heart of chronic illness, disability and disease. Although an individual’s disease course may stabilize, in many cases there is an uncertainty about the future. Self-monitoring is suggested in order for clients to recognize when they are feeling uncertain.

Deep breathing and other relaxations exercises can be used to cope with high levels of anxiety, along with “worry management” where an individual decides to limit their thoughts about their illness to a certain time per day (such as 15 minutes in the morning and 15 minutes at night.) This management gives them permission to push those thoughts out of their mind at other points in time, and apply thought-stopping when necessary.

Bitterness Disposal Training

Bitterness is an extremely common part of coping with a chronic illness or disease. Bitterness can be experienced inwardly (such as bitterness with your illness or your body) and outwardly (such as challenges with friends or family.) Examining one’s identity as perceived by others is an element of this process, followed by comparing that image of others to one’s self-image in order to determine if others are making unrealistic demands on them.

Recognizing that the disease is the cause of their feelings may help them externalize those thoughts. Cognitive restructuring allows an individual to compare their thoughts and expectations about those around them with the reality, by examining the other person’s identity (the husband or wife, the brother or friend) and how that affects their behaviour.

Constructive mourning allows an individual to grieve the changes in their life, by allowing that person to ventilate those emotions.

Body Accommodation and Disfigurement Neutralization

Body accommodation is the process of recognizing that one’s body has changed and setting softer standards to accept the body as it is rather than rating it or comparing it with a previous body or someone else’s body. This can be a difficult process as it involves realistic expectations and changing negative attitudes.

Positive self-talk before engaging in activities can help mitigate automatic thoughts of weakness or worthlessness that may occur as a result of the disability.

Disfigurement neutralization involves evaluating the client’s beliefs about themselves, and the words that they use. Assigning meaning to those words as a severe negative evaluation, that can be changed. New beliefs about an individual should be proposed, that see the body objectively, the result of the illness and not the individual’s decisions.

Meaning-Making

Meaning-making is the process of making a new plan for one’s life after the onset of an illness. This can be because depression or physical/emotional limitations have caused an individual to be unable to pursue their dreams or because the onset of a terminal illness makes them feel like their existing plans are no longer powerful enough to satisfy their desire for meaning in their life.

This process involves deciding on new goals, starting from the very small (like waking up at a specified time or engaging in basic hygiene) to larger goals, like exploring new options. Instilling hope will help the client stay curious and continue to move towards their new goals.

This may also involve helping clients learn to be “alone” with themselves to stimulate creativity, and allow clients to explore new options.

Limitation Management

Finally, limitation management involves activities to help clients cope with their “new self.” Limitations caused by illness can create a feeling of helplessness and a lack of control that can cause depression, anger or other sensations. This involves skills previously discussed like deep breathing and relaxation, forbearance, and acceptance of things that one cannot change.

Focusing on elements that are within an individuals’control may help move individuals closer to the things that bring them happiness.  Self talk can also be helpful in this regard.

Cite this article as: MacDonald, D.K., (2017), "Coping Skills Therapy for Managing Chronic and Terminal Illness," retrieved on July 21, 2017 from http://dustinkmacdonald.com/coping-skills-therapy-managing-chronic-terminal-illness/.
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Introduction to Social Media for Non-Profits

Introduction

Social media has become an important part of outreach for nonprofits as well as customer/client/donor relation management for nonprofits and for-profit organizations. Social media provides agencies with a way to connect with their clients in a real-time way to provide updates, address complaints, and continue to engage stakeholders. (Young, 2017)

Before exploring social media for your nonprofit it is important to determine what you hope to achieve with your social media presence. For instance, some organizations post primarily organizational related information (such as links to their crisis line number and events), while others post pictures and motivational statements that go beyond official crisis line communications into general wellness.

Bernritter, Verlegh, & Smit (2016) discovered that brand warmth, and a desire to publicly affiliate with positive organizations made users more likely to “like” nonprofits on social media, rather than competence. This means that nonprofits have an opportunity to build a strong brand online.

Wyllie et. al. (2016) showed how social network analysis (SNA) can be used to identify new stakeholders and potential by donors by looking at who engages with your organization and who those people are connected to; this can provide avenues for expanding fundraising efforts; additionally, when posts go “viral” (experiencing wide distribution) they may be seen by potential future donors and supporters.

Finally, Goldkin (2015) identified multiple advantages to nonprofits who use social media including fundraising, advocacy and policy changes, and the ability to directly engage clients or service users.

Facebook

Facebook is the most common social network in the Western Hemisphere according to Vincos (2017); it allows users to “like” and comment on posts. Facebook Insights allows you to see the engagement that each post received, including likes, comments and shares.

The biggest advantage of Facebook is that it allows you to communicate deeply with your clients and potential donors, who may share your posts. Unlike Twitter, there is no 140 character limit so you can tell your story without feeling constrained or limited, including images or videos.

Huang, Lin & Saxton (2016) describe the social media marketing of HIV/AIDS nonprofits, in order to examine what strategies worked well. They explained one-way informational messages and calls-to-action or event messages generated less user interaction than two-way dialogues.

Twitter

Twitter, despite its fame, actually has fewer users than other social networks. At 300 million users, it pales in comparison to Facebook’s 1.59 billion, and even Instagram’s 400 million (Adweek, 2016) Twitter’s advantage is that nearly 3 in 4 of their users are outside of the US. For nonprofits that serve international audiences Twitter can help you match these donors and clients.

Twitter contains a 140 character limit, requiring message to be short and sweet.

Other Social Networks

There are a variety of other social networks that can be used for nonprofits to communicate with their clients. The exact networks chosen will depend on your audience. For instance, Instagram requires photos and videos, versus Facebook’s use of text, videos or photos – however Instagram’s engagement by user is higher than Facebook’s. (Nwazor, 2016)

Networks for nonprofits to consider include:

  • Instagram
  • LinkedIn
  • Pinterest
  • YouTube

Hootsuite

Hootsuite describes their goal as “managing all of your social media marketing efforts from a single dashboard. With Hootsuite’s platform, you get the tools to manage all your social profiles and automatically find and schedule effective social content.” (Hootsuite, n.d.)

Hootsuite allows you a dashboard in which you can see and make posts on all of your social media profiles at once; this makes it much easier for you to maintain regular posts on all your profiles in much less time, and to send a consistent message to your donors or clients.

References

Adweek. (2016) “Here’s How Many People Are on Facebook, Instagram, Twitter and Other Big Social Networks”. Retrieved on April 2, 2017 from http://www.adweek.com/digital/heres-how-many-people-are-on-facebook-instagram-twitter-other-big-social-networks/

Bernritter, S. F., Verlegh, P. W., & Smit, E. G. (2016). Why Nonprofits Are Easier to Endorse on Social Media: The Roles of Warmth and Brand Symbolism. Journal Of Interactive Marketing, 3327-42. doi:10.1016/j.intmar.2015.10.002

Goldkind, L. (2015). Social Media and Social Service: Are Nonprofits Plugged In to the Digital Age?. Human Service Organizations: Management, Leadership & Governance, 39(4), 380-396. doi:10.1080/23303131.2015.1053585

Hootsuite. (n.d.) “Social Media Marketing & Management Dashboard – Hootsuite.com” Retrieved on April 2, 2017 from https://hootsuite.com/

Huang, Y., Lin, Y., & Saxton, G. D. (2016). Give Me a Like: How HIV/AIDS Nonprofit Organizations Can Engage Their Audience on Facebook. AIDS Education & Prevention, 28(6), 539-556. doi:10.1521/aeap.2016.28.6.539

Nwazor, T. (2016) “Faceoff: Instagram versus Facebook, For Business.” Entrepreneur. Retrieved on April 2, 2017 from https://www.entrepreneur.com/article/280833

Vincos. (2017) “World Map of Social Networks” Retrieved on April 2, 2017 from http://vincos.it/world-map-of-social-networks/

Wyllie, J., Lucas, B., Carlson, J., Kitchens, B., Kozary, B., & Zaki, M. (2016). An Examination of Not-For-Profit Stakeholder Networks for Relationship Management: A Small-Scale Analysis on Social Media. Plos ONE, 11(10), 1-20. doi:10.1371/journal.pone.0163914

Young, J. A. (2017). Facebook, Twitter, and Blogs: The Adoption and Utilization of Social Media in Nonprofit Human Service Organizations. Human Service Organizations: Management, Leadership & Governance, 41(1), 44-57. doi:10.1080/23303131.2016.1192574

Cite this article as: MacDonald, D.K., (2017), "Introduction to Social Media for Non-Profits," retrieved on July 21, 2017 from http://dustinkmacdonald.com/introduction-social-media-non-profits/.

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Introduction to Government Policy Development

Introduction

Policy development involves research, analysis and writing of government or organizational policies. Policies “refers to those plans, positions and guidelines of government which influence decisions” by governments, nonprofit agencies or other bodies. (Manitoba Office of the Auditor General, 2003)

This article focuses on government policy, rather than nonprofit policies and procedures, which will be explored in a future article.

Policies can be very broad or very specific, setting out specific plans and programs or instead suggesting the government’s commitment to development.

The 2012 US National Strategy on Suicide (Office of the Surgeon General, 2012) is an example of a specific policy, with 13 goals and 60 objectives that are laid out with clarity such as “Provide training to community and clinical service providers on the prevention of suicide and related behaviors”, while the UN Sustainble Development Goals (2015) are very broad, like “Affordable and clean energy” and “Reduced inequalities.”

Policy writing may be performed by Policy Analysts or Legislative Aides who work for government, Macro or Community Social Workers, or lobby groups who are advocating for a particular change in policy.

Policy Writing Steps

Policy analysis can be broken down into five steps:

  1. Issue Identification
  2. Issue Analysis
  3. Generating Solutions
  4. Consultation
  5. Performance Monitoring

In the first step, issue identification, the policy analyst will need to identify an issue. Issue identification may occur through many ways, such as constituents talking to their Members of Parliament (or Representatives), lobby groups focused on specific areas like Environmental Issues or Developmental Disabilities who notice concerns in their communities, or other issues.

In Issue Analysis, the Analyst gathers all available information and begins doing research to describe the problem. This can involve interviews, surveys, examining models and policies in other regions and the academic literature.

Generating Solutions involves, as the name suggests, generating a number of potential solutions, changes to policies or laws, or other ways of fixing the identified issues. There are pros and cons to all issues, so an important part of this step is figuring out what the most optimal solution is.

When the policy analyst reaches Consultation, the analyst will provide a draft of their copy to affected stakeholders and ensure that individuals have an opportunity to provide comment. This does not have to be limited to the public, but often public consultations are helpful.

Finally, after the policy is implemented, it should be monitored in order to see the desired outcomes. Outcomes measurement or evaluation is an important element of developing policies and programs.

Policy Issue Identification

The first step to policy development is to identify the issue. The important element here is to make sure that you are describing the cause of a situation, and not the symptoms of that situation. For instance, if an area does not have enough housing that is a symptom of something. That something could be lots of unoccupied, purchased houses. In that case, simply building more houses would likely not fix the problem. Instead, implementing a vacant or foreign buyers tax would help free up this real estate.

Other steps in issue identification is deciding what policymakers will actually focus on. For instance, governments may be confronted with many issues of which only some are within their control. Of those that are within their control, they must choose a smaller number to work with, so as to not exhaust limited resources.

Finally, you must decide on issues that can actually be tracked. Returning to our National Strategy on Suicide, “Provide training to community and clinical service providers on the prevention of suicide and related behaviors” is a measurable goal that can be tracked as the number of gatekeepers reported increases.

Policy Issue Analysis

Issue analysis involved collecting data in order to really deeply understand the issue at hand. There are multiple stakeholders who may see a problem in a certain way. For instance if school children are performing poorly on statewide tests, teachers, students, school administrators, academics, local and state government likely all have different angles on the problem. Those angles will need to be explored in order to get a deep dive into the issue.

Comparing your region with other regions to see if they are struggling with the same issue. If not – how come? If they are struggling with the same thing, what have they tried? This can help you rule out models that may appear to be effective but actually don’t work in your area.

Lots of data may be available at the municipal, state or federal level depending on your area. For instance, Statistics Canada in Canada and the US Census Bureau both collect a variety of data, along with many other agencies.

The expression, “Garbage in, garbage out” is useful here – if your data collection is insufficient or slanted rather than objective, you will find that you have an impaired understanding of the issues and therefore your solutions will not adequately fix the problem.

Generating Solutions for Policy

Generating solutions involves defining a number of ways of answering the problem. This should begin with identifying the assumptions that underlie your solution or opinion, and then by indicating what changes would need to occur in programs, legislation, or implementations in order to allow the solution to proceed.

Each of the available solutions is going to have positives and negatives. Negatives may affect some stakeholders or many, and may have financial impacts on the government or on the stakeholders themselves. For example, environmental regulations may improve air quality in a town (and therefore reduce the impact of asthma), but with a cost on local industry. Detailed calculations would be necessary to evaluate the net impact on the area.

Examples of implications of policy from the British Columbia Ministry of Community, Sport and Cultural Development (2012):

  • Financial
  • Legal
  • Geographic
  • Political
  • Environmental
  • Economic
  • Social

One final element in determining solutions is to identify the outcomes that will be measured and expected. In the example of children performing poorly on statewide tests, the rate of children passing the test in the region after the implementation of a new program may be one way to measure the effectiveness.

Policy Consultation

Although consultation is listed as the 5th of 6 policy analysis steps, in fact it will be throughout the entire step of developing policy. Consultation in a government setting will start with the Ministry (and often the Minister leading it) who will set the priorities for their Ministry.

As the policy takes shape, consultations will occur inside and outside of government, especially with affected stakeholders and lobby groups. The types of consultations can include distributing drafts, holding public “town halls”, private meetings, and so on. Many governments provide policies on their website and take feedback from the internet as well.

Policy Performance Monitoring

Performance monitoring begins after the policy has been implemented. Like any program implemented by a nonprofit, government programs must be evaluated as well. The reason that performance monitoring is a preferred term is that some policies may not be evaluated in the same way that programs are, especially if the subject of the policy is very broad (e.g. affordable and clean energy.)

If a policy leads to the creation of specific programs, those programs will often have evaluations attached to them that can make for fertile performance monitoring. As an example, the National Suicide Strategy goal to train gatekeepers will lead to the expansion of programs like ASIST, safeTALK and QPR (Question, Persuade, Refer). These programs can be evaluated for their effectiveness and the increase in trained individuals, in order to prove that the goal is being met.

Policy Writing Template

One example of a framework for an actual written policy is given by Young & Quinn (2002) at the Open Society Institute. Their review of common policy writing templates shows the following structure:

  • Title
  • Table of Contents
  • Abstract/Executive Summary
  • Introduction
  • Problem Description
  • Policy Options
  • Conclusion and Recommendations
  • Appendices
  • Bibliography
  • Endnotes

This final document could be between 5,000 and 20,000 depending on the depth and the amount of background information provided. Shorter policy documents are more common for those distributed to the public while longer documents are used internally in government, or with other policy analysts.

Policy Writing Training

Training in policy writing is usually on-the-job. For instance, many beginning Policy Analysts get their start doing internships for governments. Most policy analysts hold Bachelor’s degrees however it is also very common to see individuals with Master’s or PhD degrees.

Relevant courses from Athabasca University that may help an individual become a policy analyst:

  • GOVN 403 – Public Policy in a Global Era
  • HIST 328 – History of Canadian Social Policy
  • HSRV 311 – Practice and Policy in the Human Services
  • HSRV 322 – Ideology and Policy Evolution
  • MHST 605 – Demysitfying Policy Analysis and Development

A Masters in Public Administration (MPA), Masters of Social Work (MSW) or MA in Political Science may also give the student the advanced analytical and writing skills required to work as a Policy Analyst. The Office of Personnel Management (OPM) includes policy writing resources to help policy writers meet US government standards.

Policy Writing Courses

Policy writing courses are available that may help analysts build fundamental skills. Most of these are available through governments, rather than online given the limited audience for many of these organizations. Completing internships with governments or lobby groups may help aspiring policy writers gain access to this training.

References

British Columbia Ministry of Community, Sport and Cultural Development. (2012) Sharpen Your Policy Skills. Municipal Administration Training Institute (MATI) Foundations Program. Retrieved on March 31, 2017 from http://www.lgma.ca/assets/Programs~and~Events/MATI~Programs/MATI~Foundations/2013~Presentations/NICOLA-MAROTZ-Policy-Skills-Workshop-Manual-Revised-July2013.pdf

 

Manitoba Office of the Auditor General. (2003) A Guide to Policy Development. Retrieved on March 30, 2017 from http://www.oag.mb.ca/wp-content/uploads/2011/06/PolicyDevelopmentGuide.pdf

 

Office of the Surgeon General (US); National Action Alliance for Suicide Prevention (US). 2012 National Strategy for Suicide Prevention: Goals and Objectives for Action: A Report of the U.S. Surgeon General and of the National Action Alliance for Suicide Prevention. Washington (DC): US Department of Health & Human Services (US); 2012 Sep. Available from: https://www.ncbi.nlm.nih.gov/books/NBK109917/
United Nations. (2015) “Resolution adopted by the General Assembly on 25 September 2015 “. Retrieved on April 1, 2017 from http://www.un.org/ga/search/view_doc.asp?symbol=A/RES/70/1&Lang=E

Young, E. & Quinn, L. (2002) Writing Effective Public Policy Papers: A Guide for Policy Advisers in Central and Eastern Europe. Open Society Institute (OSI). Budapest, Hungary: Open Society Institute. Retrieved on April 2, 2017 from http://www.icpolicyadvocacy.org/sites/icpa/files/downloads/writing_effective_public_policy_papers_young_quinn.pdf

Cite this article as: MacDonald, D.K., (2017), "Introduction to Government Policy Development," retrieved on July 21, 2017 from http://dustinkmacdonald.com/introduction-government-policy-development/.
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Violence in the Social Services

Introduction

Nearly one-third of the 100 “fatalities in healthcare and social service settings that occurred in 2013 were due to assaults and violent acts” (OSHA, 2016) No matter what area you work in (community mental health, general or mental hospitals, working in client homes or in a centralized office like a crisis line) you may find yourself working with clients who are expressing thoughts or feelings of violence.

Risk Factors for Violence

A number of factors increase the chances that a client will be violent. Some of these include (James, 2008):

  • Substance abuse. Active intoxication increases the chances a client will be violent. (Tomlinson, Brown, & Hoaken, 2016)
  • De-institutionalization. Moving individuals into community care increases the chances they will revert to their previous state and become violent. (Torrey, 2015)
  • Mental illness. Certain mental illnesses might increase the chances a person will become violent (Stuart, 2003) although the evidence is mixed. Most people with mental illness are statistically more likely to be victims than perpretrators of violence (Desmarais, et. al., 2014)
  • Gender. Men are more likely to be violent than women and more likely to be victims of violence. (Kellermann & Mercy, 1992)
  • Gangs. Gang violence, common in some areas, can increase the chances that youth experience violence as a perpetrator and victim (Neville, et. al., 2015)
  • Elderly. As elderly clients are institutionalized, they may find themselves at increased levels of violence as perpetrators and victims. (Sandive, et. al., 2004)

Assessing Violence Risk

The Dynamic Appraisal of Situational Aggression (DASA; Ogloff & Daffern, 2006) can be used to assess the likelihood that a patient or client will become aggressive within a psychiatric inpatient environment. The DASA has 7 items that are scored 0 for absent and 1 for present within the last 24 hours.

Other useful models for assessing violence risk include the Biopsychosocial Model of Violence Risk Assessment and the Violence Risk Appraisal Guide (VRAG).

Assessing Homicide Risk

Assessing long-term homicidal risk is a task best left to clinical and forensic psychologists or social workers who have training specifically in this area. On the other hand, short-term homicide risk (such as the kind required by Tarasoff ethics) can be learned by all social service workers.

Borum & Reddy (2001) provide an article to performing these assessments, and I’ve also written an article on basic homicide risk assessment that you may refer to.

Levels of Violence Intervention

There are 3 levels of intervention related to violence, depending on the situation. These are suggested by dos Reis et al. (2013) in the youth context. Stage 1 is simple behavioural management such as listening, stage 2 involves pharmacotherapy while stage 3 involves the most significant interventions such as restraints, seclusion or antipsychotics.

A different conceptualization more useful for adult clients is as follows:

  • Stage 1: Immediate intervention to prevent further escalation.
  • Stage 2: To reduce symptoms that can lead to aggression
  • Stage 3: Maintain safety of clients and staff

Stages of Violence Intervention (James, 2008)

  • Stage 1: Education
  • Stage 2: Avoidance of Conflict
  • Stage 3: Appeasement
  • Stage 4: Deflection
  • Stage 5: Time-Out
  • Stage 6: Show of Force
  • Stage 7: Seclusion
  • Stage 8: Restraints
  • Stage 9: Sedation

Violence Intervention Training

References

Borum, R. & Reddy, M. (2001) Assessing violence risk in tarasoff situations: A fact-based model of inquiry. Behavioral Sciences and the Law. 19:375-385. doi: 10.1002/bsl.447

Desmarais, S. L., Van Dorn, R. A., Johnson, K. L., Grimm, K. J., Douglas, K. S., & Swartz, M. S. (2014). Community Violence Perpetration and Victimization Among Adults With Mental Illnesses. American Journal Of Public Health, 104(12), 2342-2349. doi:10.2105/AJPH.2013.301680

dosReis, S., Barnett, S., Love, R.C. & Riddle, M.A. (2003) A Guide for Managing Acute Aggressive
Behavior of Youths in Residential
and Inpatient Treatment Facilities. Psychiatric Services. 54(10). Retrieved on March 26, 2017 from http://ps.psychiatryonline.org/doi/pdf/10.1176/appi.ps.54.10.1357

James, R.K. (2008) Crisis Intervention Strategies. Brooks/Cole: Belmont, CA.

Kellermann, A.L. & Mercy, J.A. (1992) Men, women, and murder: gender-specific differences in rates of fatal violence and victimization. Journal of Trauma. 33(1):1-5.

Neville, F. G., Goodall, C. A., Gavine, A. J., Williams, D. J., & Donnelly, P. D. (2015). Public health, youth violence, and perpetrator well-being. Peace And Conflict: Journal Of Peace Psychology, 21(3), 322-333. doi:10.1037/pac0000081

Occupational Safety and Health Administration (OSHA). (2012). Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers. Retrieved on March 25, 2017 from https://www.osha.gov/Publications/osha3148.pdf

Ogloff, J. P., & Daffern, M. (2006). The dynamic appraisal of situational aggression: an instrument to assess risk for imminent aggression in psychiatric inpatients. Behavioral Sciences & The Law, 24(6), 799-813. doi:10.1002/bsl.741

Sandvide, Å., Åström, S., Norberg, A., Saveman, B., & RNT. (2004). Violence in institutional care for elderly people from the perspective of involved care providers. Scandinavian Journal Of Caring Sciences, 18(4), 351-357. doi:10.1111/j.1471-6712.2004.00296.x

Stuart, H. (2003). Violence and mental illness: an overview. World Psychiatry, 2(2), 121–124.

Tomlinson, M. F., Brown, M., & Hoaken, P. N. (2016). Recreational drug use and human aggressive behavior: A comprehensive review since 2003. Aggression And Violent Behavior, 279-29. doi:10.1016/j.avb.2016.02.004

Torrey, F.E. (2015). Deinstitutionalization and the rise of violence. CNS Spectrums, 20(3), 207-214. doi:10.1017/S1092852914000753

Cite this article as: MacDonald, D.K., (2017), "Violence in the Social Services," retrieved on July 21, 2017 from http://dustinkmacdonald.com/violence-social-services/.

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