 This episode was prerecorded as part of a live continuing education webinar. On-demand CEUs are still available for this presentation through all CEUs. Register at allceus.com slash counselor toolbox. I'd like to welcome you to today's presentation on the sociological approach to reducing risk and building resilience. As I was putting together this presentation, it was kind of like right in the wake of when Harvey hit and then, you know, recently we've had the shooting in Las Vegas. And some of the counselors, especially counselors in training that can't practice independently yet, that are in some of my social media groups and in my professional groups, have been talking about how frustrating it is and even some of us who are licensed, but we just can't like up and go help the Red Cross right now. How frustrating it is not to be able to help and how much we want to help. So what I usually do, because, you know, I'm generally not upwardly mobile where I can just drop everything and go to a crisis. And what I did after 9-11 was look at what things in that situation, could I positively impact and how could I do it in a way that made sense, you know, for my life. Because I can't, you know, at that point I, for 9-11, I had an infant at home and, you know, other stuff. So we're going to look at when we're talking about addressing issues like the opioid epidemic or the major problem of depression, almost, I guess, anxiety, almost one in four people has anxiety issues. And we're going to look at some of that and try to figure out what can be done, what can we do from where we are in a way that makes sense. Because, yes, we can influence politics and advocacy and, but what can we do with small chunks of time that are beneficial to helping the cause, as well as, you know, could possibly help our clients that we have currently. So we'll define the socio-ecological model, which is Broff and Brenner's model. We're going to apply it to addiction and mental health issues, and explore different variables in this model. And then discuss how this framework can be used in prevention and treatment of co-occurring or independently occurring disorders. So we're really going to talk about how it makes sense to conceptualize not only the development of addiction, but also the development of things like eating disorders and mood disorders in terms of a socio-ecological model. And even some of the things like bipolar and schizophrenia can be, a person can be genetically predisposed or whatever, but there could be certain environmental or factors that could, you know, trigger that first psychotic episode. So we want to look at what might be going on and how can we help prevent or treat. Now prevention can take the form of three different activities, if you will, preventing the problem. So helping people not get depressed at all, ever. So starting to provide those skills and tools when people are knee-high to a grasshopper, hopefully. Preventing worsening of the problem so people don't get severely clinically depressed where they can't get out of bed. So early intervention services and effective, you know, frontline resources. And preventing associated file-outs. Okay, the person gets depressed, gets clinically depressed. Well, let's see if we can help them avoid losing their job because they can't get out of bed to go to work, develop additional health problems from being depressed or developing an addiction in order to self-medicate that depression. So there are three different methods or avenues we can take in prevention. And, you know, we really want to look at them all because when you've got somebody who's becoming clinically depressed, you know, they're depressed, you know, situationally, whatever, something happened. And it starts to turn into something more than just a couple of days. It's going to start having associated file-out early. And, you know, it's not going to be huge. They're not going to lose a job right off. They're not going to start having major family problems right off. But they are going to start having little hiccups because that depression causes an imbalance in their environment. And we know environments like to maintain homeostasis. And, you know, the kids are going to be like, well, Ma, why aren't you getting up and doing these things? And what's going on? And, you know, things are going to start changing and the person will need to be able to deal with that. So the socio-ecological model explores and explains human behavior as the interaction between the individual and four environmental systems. There's actually a fifth one that is more of your longitudinal, but we're going to talk about the four main ones today. The micro, the meso, the exo, and the macro systems. The micro system involves, well, let's start before that. The individual, if you look at the model, is sort of the bullseye here. And the individual is not really considered a system, but it involves all of the things about the individual, including biology and personal learning that make people who they are. Okay, so this person exists within a micro system. And that micro system is their family, peers, school, church, synagogue, whatever, and health services. Things that they probably interface with on a really regular basis. Work should also be on that, but it's for some reason it's not on this diagram. Anyway, the meso system is the interconnection between micro systems. So how do family and peers interact? Now, I don't know about you. Thankfully, my family was very accepting of most of my peers, but I know other friends of mine who brought home peers who were not as well accepted by their family. So there was some conflict between the family and the peers, and we know how much peer pressure and peer relationships are important in an adolescent's life. So that creates conflict and consternation. How does the family interface with school? How does, how do peers, how does your peer group interact with school? And do they see it as a good thing to do? Do they see it as worthwhile? You know, etc. So when we're talking about the micro system and the meso system, we're really talking about things that people interface with on a daily basis. So I want you to think about how does the meso system, and you can feel free to chime in in the chat room if you want. How does the meso system, family, peers, school, church, you know, recreational activities, health services impact the development of mental health or illness. Now, you notice I'm trying to kind of switch gears for health because we want to promote health. And we can look at the opposite for mental illness, but you know, if you have positive family peer interactions, it's probably going to support mental health. It's probably going to support decision making in the adolescent. It's probably going to, I mean, and I'm thinking adults and adolescents here, but family and friends, you know, if you want to think about, you know, how do you get along with your significant others, peer group. And do they interface well, or is it kind of like oil and water. How does the, how does your family interface with your work, how do they deal with how many hours you have to work, whether you're getting called in at night or getting emails or text messages at eight o'clock at night or, you know, what are their expectations and how does that influence. If there's conflict, you know, if the family doesn't really like what's going on at work or the fact that, you know, your boss is emailing you at eight o'clock at night, then it can create conflict within the environment which can lead to increased anxiety and depression and yada yada yada. Now, how does mental health or illness impact the meso system. So again, thinking about how if someone is clinically depressed. How does it impact their family. How does it impact their peers and if you have a family member who has, you know, clinical depression or generalized anxiety. How does it impact how your family interfaces with everything else because you know you end up having somebody or some buddies in the family who may be caretaking for the person who has depression or anxiety or whatever the mental health issue is who's not able to do the stuff that they were able to do. So the rest of the family is kind of picking up the slack. So how does that affect how they interface, you know, the rest of the family members interface with school and work, you know, maybe they end up showing up more exhausted. So it's important to look at the meso system. The exo system involves links in a social setting in which the individual does not have a direct active role. So, for example, how would I impact my spouse's work. And again, if I am the identified patient and I've got clinical depression and I'm calling my spouse to come home because I just I can't be alone or my spouse is late to work or unproductive because he's always exhausted when he gets to work because he has so much to do since I am, you know, not able to do as much right now. Then it could negatively impact his work. And so we want to look at how that impacts how the home environment impacts work and how work impacts the home environment. The macro system describes the culture, socioeconomic status, poverty, ethnicity, etc. So what we're looking at in the macro system is really larger, you know, not just within your city, maybe, or even closer your neighborhood. We're looking at what you see in the media, what you see on national TV, your, your statewide elections, your national elections, your state laws and culture, and what's being communicated if you are a religious person, what your religious culture communicates because you know religion generally is not just in one little areas, international or national. So what types of things does that communicate to to the person and how does that influence the development or not development, if you will, of depression, anxiety or addiction. So again, think about how does the exo system, the social setting in which the individual doesn't have a directive active role, think about how how much people were influenced after the elections. I mean, yeah, we had a role if you went out and voted you had a role, but you don't decide the election. So once that happens, how does that, you know, exo system impact, you know, your, your emotions, your other community events, employment, etc. And how do those things impact the family. I know, you know, there was a lot of consternation and concern among some of my friends who are Jewish, after the last election. So their family experienced a high increase or a great increase in anxiety, development of mental health or mental illness. How does this, all this stuff that's going on in the exo system and stuff that you don't have direct control over. How does it impact the development of mental illness, you know, or mental health, and we're going to talk more specifically in a couple of minutes. Again, likewise, how does mental illness or mental health impact the exo system. If you have a healthy workforce, if you have healthy people that are active participating in work going to community activities, voting participating, then you're probably going to have a healthier outcome than if you have people who are not able. I mean they're so depressed they're not able to even get out and participate. Want to look at the reciprocal nature it's not one way the community doesn't just affect us. You know, it may affect us but then how we react affects the community. How does the attitude of the culture impact the community. So if you've got a culture that is accepting of certain ideologies they're accepting of LGBTQI they're accepting of people who are Muslim in their religion they're accepting of people who are Christian in their religion they're accepting of you know fill in the blank. If the culture is accepting of that how does that affect the community and those people within the community who might, you know, otherwise not have been accepting does it kind of pressure them in or does it cause anxiety and depression in in those people. How does the attitude of the culture, for example, about premarital sex and marriage affect the family. How does it affect the development of and again we're thinking about anxiety depression and addiction so how does it affect the development of stress which may lead to mood disorders or problems. We see family and individuals with mental health or mental illness impact the culture. You know so we have an impact on our culture we get together. We see you know we have generation X generation why but the baby boomers. They all had their own sort of, or we all have our own sort of unique cultures and things that we bring to the table and things you know that were given to us that we said no we don't want to thank you very much. So there is definitely a given take by the individuals within within the culture. And that's good, because that means we can start small, you know, start in our locale and create this positive meso system, and then build from there if you have a positive community then that's probably going to spread. Think about when a company goes and dumps fertilizer, for example, into a waterway. It doesn't just stay there over time that fertilizer bleeds out and you start having algae blooms everywhere. Things don't stay I mean in our society things don't stay in one place for very long they tend to move they tend to migrate. If a positive will migrate that's awesome. Negative can also migrate so we want to look at how can we enhance the positive migration and keep down the negative, if you will. So now let's start talking about what can we actually do how can we operationalize all of this. We realize that if we affect the individual it'll have a positive effect on the meso system which can have a positive effect on the exo system, yada yada yada. Great. We also realize that one of the only things we really have a lot of control over is the individual ourselves. So, and a lot of people come to counseling individually score. So this is where we're going to start. So what things contribute and I start out by listing risk factors for the development of mood disorders and addictions, and then we talk about capital, you know what you have in order to you need to have in order to prevent these things, and then prevention strategies so that's kind of how we're going to go. It's not going to stay depressing. Individuals with chronic pain are at higher risk of mood disorders or addiction addiction because of the pain management drugs that are out there. And, you know, once they start taking pain management drugs opiates. A lot of times the brain quits producing endogenous opioids the natural pain killers. So when they first come off the body doesn't automatically pick up so it takes a little while for the person's pain tolerance to build back up, which keeps some people from wanting to get off the medication. Among other things, but chronic pain can also be debilitating it can make people lose some abilities that they used to have or or crush some dreams if you will. You know, I think I've told you before, I have a bad shoulder and carpal tunnel. So I can't garden the way I used to, you know, I still go out and do it but I've got to pay attention and only be out there for an hour or two instead of spending six hours out on the farm. Which is frustrating to me and it's only mildly frustrating. But my grandfather when he started developing Parkinson's couldn't make his miniatures anymore, and he made gorgeous miniatures. And I know that's not chronic pain but it's kind of the same thing if you've got rheumatoid arthritis. He couldn't make his miniatures and he became devastated and became withdrawn. So understanding that pain has multiple influences that can cause depression that may trigger a grief reaction that we need to help people address. Now the things I put in bold are things that we as clinicians can easily help people prevent or and or address. So chronic pain, we can help people low self esteem. That's a no brainer if people don't feel good about themselves. And they're looking for external validation. They're going to be at a higher risk for anxiety, fear of abandonment, fear of not being good enough fear of failure and depression, a sense of hopelessness and helplessness. Substance use, especially early substance use can cause changes in the prefrontal cortex, leading to problems with impulse control and decision making, but it can also disrupt the balance of neurochemicals leading to symptoms of depression and or anxiety. So it's important to understand that, especially the earlier the substance use starts, the greater the chance that it's going to cause some sort of brain changes. And we've also found that a lot of people, not the majority, but there is a percentage a significant percentage of people that when they start using early they kind of quit developing coping skills after that they find something that works. They're like, Oh, I like this. I think I'll use that from now on. So when we start talking about talking to people who started drinking or smoking marijuana when they were, you know, nine, 10, 11, 12, you might see more mood issues and or addiction issues in those people than people who didn't start using mood altering drugs as early. A history of abuse can contribute to the development of obviously PTSD, but not everybody who is abused develops PTSD, but there can be episodes of anxiety and depression, as well as it increases the chances of the development of addiction. Genetic vulnerability. We know that mood disorders and addictions tend to run in families, and they've done studies that have shown that there is a genetic component doesn't mean it's going to happen. It just means you have this gene there that could be triggered. So we don't want, we want to make sure that clients know that they are not just doomed, you know, they can prevent triggering that, but they need to be aware that they may be more vulnerable. Inappropriate coping responses if some we're not born with coping skills. So if somebody doesn't know how to cope with life on life's terms, because either because they've always been shielded, or because they've never had anybody help them. Maybe they, they were kind of on their own from the get go. So they learned to lash out and get angry or withdraw and get depressed, but they never really learned how to deal with stuff. They're going to be at higher risk of mood and addictive disorders. We can help people develop coping responses. One of the things you want to look at when people are using seemingly unhelpful behaviors is to remember to ask what is the cause of this. So we want to look at what is the root cause, what is prompting this behavior, and what is the benefit of the current behaviors. And I'm going to keep reminding you of that as we go through this violence and aggression, you know, again, what's the cause of the violence and aggression. Did people did this person learn that's how you cope with distress in their family of origin. Is it a protective mechanism because they've experienced situations where that has helped them deal with conflict before. What prompts this and what's the benefit to it when they act out when they're violent and aggressive. What is the benefit it gives them power it pushes people away. They just enjoy hurting people. Hopefully that's the minority, but we want to ask that because we can't figure out an alternative until we know what the function is. Same thing with risk taking and impulsivity. There are certain theories that say some people need more stimulation than others they get bored easily. So they tend to be higher risk takers and maybe more impulsive. So you want to ask is this person doing this, you know, I have a friend who is an adrenaline junkie, you know, skydiving rock climbing you name it he's done it. And, you know, more power to him. I don't see a purpose of jumping out of a perfectly good airplane. But he thrives on that and when he can't get out and do those sorts of things he feels. So what is it about this risk taking and what kind of risk taking is it is it risk taking as in holding a political store, or is it risk taking as in doing something like skydiving which is theoretically safe. And what's the benefit in it makes him gives them a rush makes them feel good helps him, you know, escape or whatever. Great, that's fine. The rebelliousness, you know, again, what is and this is a key for adolescents especially. But even if you're a supervisor working with employees if they're being rebellious, you want to look and say, what's the point, what's the benefit to being rebellious what are they holding on to and refusing to let go of that you want them to let go of or what are they refusing to do that you want them to do. And what's the benefit to it. If they are being rebellious and they're staying like think again adolescents staying out all night. Okay, well what's the motivating factor. Is it to get under their parents skin probably not. Is it to conform to peer pressure. You know, oftentimes that's maybe the case, but you have to look at the individual and say okay how can you do this in a way that helps you move forward. Rejection of pro social values, if the people that espouse the pro social values are the people that the person rejects, then they're probably going to reject those values so we want to look at, you know, if you're rejecting those what values are you espousing, and why are those important to you, and why are you rejecting these over here, you know, not saying it's right or wrong I'm just trying to understand where you're coming from. And you know that's something that we've got to obviously be be sensitive to and different people are going to hold different values lack of peer refusal skills to stay out late to get into trouble to use drugs to have early sex, whatever it is. Those things a lot of times indicate poor communication skills and low self esteem need to be accepted. You know, all that stuff that's challenging during during teen and early adolescent years. Those are things we can help with being bullied. You know, that's a risk factor when people are bullied they tend to get depressed. And when they're bullied they may they turn to substances to try to make themselves feel better to numb the pain, they may self injure there's a lot of different things that might happen. We can help people develop skills to deal with being bullied since we don't really understand 100% why people bully. We need to help the victims become survivors we need to help them have the tools to be able to deal with it. And understand why it happens without letting it hurt them early and persistent problem behaviors that's just so broad. But again, look at why is the person child acting out and early sexual activity could be a history of sexual abuse could be a dysfunctional family of origin and the child is trying to get out. I worked with a 14 year old who once told me she was going to get pregnant as soon as she turned 15 because that's when she could get into housing on her own. So she was intentionally going to get pregnant at 15. And there was a reason for it she was very clear about her her logic. A lot of times it's peer pressure and acceptance but asking, what is the what is the cause, and is this cause going to keep the person from developing healthy coping skills and being happy is it potentially going to lead to depression. Peer rejection, you know, that hurts. So helping people figure out how to navigate peer rejection because you're not going to be liked by everybody. Academic failure we can help with now not necessarily as clinicians but we can advocate for the person we can help them find tutors resources, etc. Lack of information on positive health behaviors, put it out there, most of the time, youth these days have a pretty good idea of what's healthy and what's not they just aren't motivated for it, they're motivated for something else. When addictive behaviors are used to cope with stress or unpleasant feelings like I said coping skills may fail to develop. Or when they're used to enhance self confidence such as drinking before going to a party, then they may start to develop anxiety and self consciousness when they don't have a drink on board. So it may start prompting the development of some mood disorders, in addition to the fact that repeated use, especially in the young brain can cause some neurotransmitter imbalances. Using addictive behaviors also to enhance other experiences ties it to those experiences, making them person more likely to use in those and similar situations, desensitizing the brain's pleasure centers. So what am I, what do I mean, I mean, if you typically drink when you are watching football, then you're going to be more likely to drink every time you watch football is just one of those things you do when you watch football. If you're one of those people who eats when you watch TV, then when you watch TV, you're more likely to eat when you go to the movies, because that's a similar situation, you're more likely to want to have popcorn or eat. So it's important to understand that with addictive behaviors, if you have something that produces pleasure, it can be triggered, you know, the person can start thinking about it in similar situations. Using repeatedly can cause neurochemical imbalances. Genetics, you know, you can be born with a neurochemical imbalance, not enough serotonin too much, whatever. And poor health behaviors as I've talked about a bunch of times, not enough sleep, quality sleep, poor nutrition and, and high stress can also cause neurochemical imbalances. So we can educate people about some of the things that can cause depression and anxiety so they can prevent it. We can educate parents so they can start coaching their kids from the get go. So personal recovery capital in order to develop what we need to be happy, healthy human beings, we have to have certain things to help us along the way. We need to have the things to enable us for physical health. Think about Maslow's hierarchy. Bottom level is all your health and biological needs. We need to have our physical health and that includes nutrition, sleep, and you know, not being in pain all the time. Sometimes you're going to feel pain that's being human that's being alive, but we need to have our health for the most part. We need to have financial assets to get our basic needs met, you know, get that food, keep clothing on our back, transportation, roof over our head. Health insurance and access to medication. And they're two different things. Health insurance covers theoretically going to the doctor and the mental health counselor, etc. Access to medication is not covered under a lot of insurance. So remember that most pharmaceutical companies have patient assistance programs that can help clients access their medication if they can't afford it because some medication is really expensive. Safe housing conducive that's conducive to recovery and that's not just addictions. If you've got somebody who is clinically depressed or highly anxious living in a radically dysfunctional household where there's lots of yelling or arguing or other people who are similarly dysfunctional. It's probably not going to prompt those positive cognitions and mindfulness and everything that we're trying to establish doesn't mean they can move. Unfortunately, a lot of people can't. So we got to talk about how can you create an area in your housing environment that's safe. People need to have adequate clothing to stay warm to be able to dress for work and actually, you know, go to their job and be dressed appropriately and transportation to get their needs met. Most of us don't live in a city where we can just walk but walking I guess is a form of transportation. We need to be able to access the resources that are out there. Whether it be food or going to work so we can pay our light bill or whatever it is. Values awareness. People need to know what's important to them in order to figure out what they need to do to be happy. A sense of purpose helps people keep going and we can help people with this. I mean, these are easy exercises when you give them a values activity worksheet. You know, what are your top five values when you look at the sense of purpose? What is your purpose in life? And a lot of us don't really know, but we know what we want it to be. Or we can start theorizing about what is the purpose of what I do as a job on a day to day basis? What is the purpose of this activity that I'm doing? So they can start to see some meaning in the stuff they do. We can help people develop hope and optimism and we've talked about that one. People need to have a perception of their past, present and future. They need to be able to look over the past and it may suck or it may be great, but they need to be able to look back over it and go, yep, that's it. They need to be able to look at their present and realistically assess what they've got and maybe what they don't have, but realistically assess what they've got and look at their future and go, where do I want to go from here? Because you're here and you don't want to stay here forever. You can't stay here forever because time is going to move on. What next? So people need to be able to see but understand that they're not necessarily controlled by their past or stuck in the present. That they have the ability to make choices every single moment to work toward what they want for the future. Education, training and job skills. People need to be able to make a living. That's just the way it is. You need to be able to feed yourself and put a roof over your head. So we can make referrals to job training agencies. We can make referrals to social service agencies. Problem-solving skills, interpersonal skills and self-esteem. These are all things that we are super skilled at teaching. And we can teach these in chunks. They don't have to be these long groups. They don't have to be big drawn out sessions. We can provide people snippets. You can provide somebody the concept of distress tolerance and the improve acronym in a handout and have them look at that or in an email. If you email your clients once each day or on your blog, there are a lot of different ways you can just get that information out there and in front of people so they can look at it. I tell my clients it's bathroom reading. I usually give them a handout or two and I just put it on the back of the toilet and when you're in there, take a look at it. If it's useful, great. If not, ball it up and throw it in the trash can. I'm good with that. But there's no pressure and I'm not putting extra assignments on them. I'm just providing information about a skill. And then if they want to pursue it further when they come back to counseling, we can talk about it. So what can we do? We can promote positive health and wellness behaviors by educating people about why they're important and what to do and where to find more information. Because some of these things like nutrition, we can't be prescriptive, but we can point people in the direction on where to get good advice and information. And we can also model this. In our treatment plan, at least in mine, I try to make sure that people are putting an emphasis on getting enough quality sleep, eating well and maybe exercising, at least moving around if they don't want to call it exercise, but taking care of themselves and getting some relaxation and recreation in there. Bonding to a pro-social culture is difficult for us to do four people or do with people. We can talk about what are your hobbies? What are things that you enjoy doing and encourage people to try out volunteering or get involved in meetups in order to engage in activities with other people. But that's something that they're really going to have to do on their own. Participation in extracurricular activities, again, kind of the same thing. We can point them in the right direction of volunteerism, meetups, things through their church or their synagogue or whatever clubs that they're involved in. Positive relationships with adults. Now, obviously this is more important if we're working with children or teenagers. We want to help children and teenagers kind of see where adults don't really have their head that far in the ground. But we also want to help adults learn how to more effectively communicate with teenagers because a lot of adults lecture at. And I know this and you'll understand when you're older and lots of that kind of stuff. So things that we can do to enhance relationships with adults is to educate people about how to effectively communicate with teenagers, for example, who are trying to find their way and trying to assert independence and resisting some rules. How do you deal with that? How do you communicate with them? In a way, because a lot of parents have difficulty navigating that boundary between friend and parent. So we can help with that. Active workshops in the community, workshops, you can do them at churches, at libraries. Those are things you can do there. You can put them on for like an hour, once a month. It's good. It's free. But it's good promotion for your practice if you go out and do it and people come learn something from you. They're like, hey, that might be helpful. Social competence. It's another one of those things that we can do in little snippets. We can provide tips and tips and tools, whether infographics on an Instagram page, those are really useful for a lot of teenagers. They want something that's, you know, in a picture and really fast. It's a snapshot. So social competence checklists are another really good thing if you're teaching different types of skills for communication or how you're supposed to use different forks. I know the first time I went to a formal dinner, I was looking at all the silverware going, I have no idea what to do with this stuff. It's a sense of well-being and self-confidence. We can help people develop this by encouraging them to focus on what they do well. We want to make sure they have future plans. Well, that means goal setting. And since a lot of people don't know how to goal set, they don't goal set. So they're just kind of floating out there, not really looking at the future. We want to help people look at the future and figure out how they're going to get there. So they're like, wow, this is doable. This is attainable. This is another thing you can put worksheets on your website. You can do short little workshops to help people figure out how to look at how to define or learn how to define a rich and meaningful life and figure out how they're going to define their goals and actually achieve them. Knowledge about risks associated with addictive behaviors. Now, a lot of kids, you know, think back to the old dare programs. I had a lot of clients tell me that those programs only taught me how to use safely. I was like, well, that's not what they were intended for. But we do want to educate youth about, you know, still about the risks of some of those drugs. And even with adults, not just youth, educate people about how dangerous or how potentially addictive opiates, for example, can be. After three to five days, your body has already started to build up a tolerance. And that's kind of scary. So helping people understand that, but also addictive behaviors like pornography. A lot of teens don't really think about it. A lot of adults don't really think about it until they're stuck in it or online gambling. You know, those are some things that can kind of catch people unawares because they didn't think about, since it wasn't a substance, we typically think of addictions as substances. Since it's not a substance, they didn't think about the effect that the pleasure from those activities was going to have on their neurochemicals and create a situation where they didn't feel okay. They didn't feel normal. They didn't feel happy without having that in their life because their dopamine receptors had basically been blunted. Individual prevention strategies. Really, the big summary is we want to promote attitudes, beliefs and behaviors that ultimately provide the person with healthy coping skills. Whether it's through health class, whether it's through workshops, I know at organizations I've worked at before, the EAP would come in and do periodic workshops. That's a great way to connect with people and reduce utilization if you do a psychoeducational prevention group because an ounce of prevention is worth a pound of cure. I want to make sure that they're aware of positive health behaviors and how to access those resources. In Gainesville, I don't know about up here, but I know in Gainesville the mall used to open at 6 o'clock in the morning. So people could walk inside in a safe place and be out of the elements and yada yada. So just letting people know that that existed was a big step because they were like, well, I don't want to join a gym and go to the mall. Interpersonal skills. We want to make sure people know how to effectively communicate, set boundaries, all that stuff that we talk about. This can be taught. It's nice if your local news is willing to use you to do a, you know, wellness minute. And I find one of the best places to do that is either right before or right after the weather because most everybody tunes in for the weather. You might not stick around for the animal of the day or whatever. Well, I always do, but, but I'm always tuned in for the weather. So if you get either right before or right after that, you tend to get higher viewership and reach more people and a minute gives somebody a chunk of something that they can use today. Your approaches may include education and life skills training in schools, you know, as provided to the kids have them to share it with their parents through the media and community center or, or library workshops. Those are all great ways to get stuff out. I encourage you, if you want to get into providing prevention and helping to helping your community, helping people to prevent getting depressed or anxious, or developing other problems to look at doing some of these things that are very time limited because you don't want to lose a lot of billable hours, but we still want to be able to do more than we're doing. At least that's what a lot of a lot of us tend to feel like the meso system. So we've been talking about the individual so far because that's where we can have the greatest effect. The meso system examines close relationships that may increase the risk of experimenting with high risk behaviors or developing mood disorders. People's closest circle of peers, partners and family members influences their behavior and contributes to their range of experience. If you've got a child that grows up in a household where the parent or parents are clinically depressed where they're not able to model effective coping skills where they model cognitive distortions. Guess what junior is going to pick up? If you are in a household, you know, you're in college and you've got four other roommates and all of your other roommates tend to be negative and naysayers. You're either probably going to move or you may that might start wearing off on you a little bit. Likewise, if they are, you know, all kinds of go getters that can wear off on you too. So, you know, there's going to be an impact. Risk factors, peer and family reinforcement of negative or unhealthy norms and expectations. So if the, your family says, you know, people suck, they're always going to take advantage of you, what are you going to take away from that? And is that going to contribute to you probably having difficulties with trusting and maybe developing depression? Possibly. So we want to look at what kind of messages is the peer group or family sending to the individual that may contribute to the development of mood or anxiety disorders. Early sexual activity among peers could communicate that, well, this is the norm. So everybody's doing it. Ties to deviant peers and gang involvement. You know, especially at that particular group, there's a lot of pressure to conform or there's a negative consequences. Family members who don't spend much time together. And this could be because parents work a lot. This could be because everybody's, you know, involved in all kinds of other stuff. But they found that when families are disengaged, the parents tend to miss out on subtle cues. When families are disengaged, even if they don't have children in the mix, that there tends to be a weakening of those bonds, those supportive bonds. So people are at higher risk for development of depression and anxiety because they don't have that, you know, everybody's behind me sort of feeling. Parents who have trouble keeping track of youth can indicate that the youth may be at risk for developing substance or mood disorders. Lack of clear rules and consequences. Think about even just being at work when there's a lack of clear rules and consequences. You don't exactly know what you're supposed to do. I know for me that creates oodles of anxiety. I like manuals and to date pretty much every job I've ever taken, I've walked in and there hasn't been a manual and I've been like, okay, there must be a manual written and that's been my first thing. Now I'm kind of on the structured side, so I don't expect everybody to be that way. But most of us tend to experience a little bit of anxiety about failure, about acceptance. If we don't know what's expected. So it's important whether it's a family or a job situation to make sure there's clear rules and consequences. You know, what's expected and what's going to happen if you mess up or if you don't meet this expectation. There also needs to be consistent expectations and limits. You know, when people, especially children, but a lot of us tested our limits when we were kids. Even as adults, you know, I know, you know, going back to working in organizations, I would have staff who would test limits and see how long they could go without turning in a progress note before I'd be knocking on their door going paperwork. It's natural for people to kind of test limits, especially with stuff that don't want to do stuff that's not rewarding. Family conflict and abuse can cause high risk of depression and anxiety, whether it's adults or children. I mean, if there's a lot of conflict and chaos, it's exhausting and it can cause a lot of dysphoric emotions and loss of employment. That's kind of self-explanatory. Protective factors, close family relationships. So as clinicians, we can encourage people to identify who they consider their family. It may not be their blood relatives. Who's their family? Who is there for them? Who can they call it to in the morning? And how can they nurture those relationships? Encourage people to develop relationships with peers that are involved in pro-social activities like hiking or volunteering in the community. Consistency of parenting is important in terms of producing children who are stronger, healthier, more resilient. Encouraging education and parents that are actively involved can help prevent future depression because they're creating children who are able to join the workforce and have that individual capital to prevent depression and anxiety and stuff. Coping with stress in a positive way. And this is a family protective factor and a peer protective factor. Why? Because we learn from observation. So if our peers cope with stress positively by prayer or exercise or whatever it is they do, and our family has other positive ways of coping with stress, then we're going to have a greater venue of stuff to choose from. Supportive relationships with caring adults beyond the immediate family are encouraged. So we want children to grow up being able to interact with teachers, with coaches, with, you know, scout leaders, whomever, and start seeing that people outside of the nuclear family are trustworthy. Sharing and family responsibilities, including chores and decision making. And that's true for children, teenagers, or even adults. You know, if you're living in the same household, it's really important that everybody feels like they have a say in what's happening and then participates in the upkeep of the family environment. And family members are nurturing and support each other. And this is one where I tend to stop and I do a love languages little mini class to help people remember that we don't always experience nurturance in the same way. So understanding one another's love languages is really important to being able to nurture in a way that's meaningful to that other person. Peer and family interventions are designed to identify norms, goals and expectations in the family. Foster family problem solving skills. So there's not just one person always fixing it. Develop structure and consistency within the family unit. Promote healthy relationships and engage peers and family of choice in the recovery process. So somebody's already depressed. We need to be able to hopefully engage everybody that's involved in this person's immediate environment in helping them move towards recovery and, you know, preferably not dragging them back down. So we want to engage them and make sure that people have supportive others. School and work risk factors lack of clear expectations both academic or performance wise and behavioral lack of commitment or sense of belonging at school or at work. If you just kind of go and you feel like a number you punch in punch out that's may not make you feel really appreciated which can contribute to depression and you know just bad feelings. High numbers of students failing academically at school at work this translates to high amounts of turnover. If you never know who's going to get laid off, it increases stress and anxiety. And parents and community members that are not actively involved in keeping kids in school and helping make sure that the workforce workforce is strong, but we want to make sure that people have access to help when it's needed. We want to make sure that people have access to tutoring in school if they need it to prevent failing from school they have access to transportation to get to work. Now those are things those are meta concepts that are more on the community level, but it's important that as a community member, you know, we look at different things that we may be able to participate in advocacy and say, you know, it's really important to get a bus system going. I live out about 30 miles east of Nashville, and it's really important that we have the the train that goes from from my city out to into Nashville so people have access to more jobs. So that was important for us to get past the city commission protective factors school and work positive attitudes got to find a reason why you're doing this. You know, and sometimes it's hard to find a reason for algebra, but we need to help kids find a reason for that we need to help adults find a reason for why they're going to work why are they doing what they're doing. Regular attendance shows, you know, is associated with higher mood, less, less risk of mood or addictive disorders, because you're able to get up and do it and interface with people and get that social support, hopefully, from your colleagues. High expectations are communicated effectively. Goal setting and positive social development are encouraged. You know, whether it's at work or at school, there are goals, there are things you've got to accomplish there are performance objectives, but we also want to encourage morale and pop positive social bonding, whatever the setting. Having a positive instructional climate again whether at work or at school I know we learn things when we're on the job we learn things and I don't want people to feel like they're having difficulty like they're stupid. I want people to feel like anything that we teach them as a challenge and something that may be beneficial down the road. Leadership and decision making opportunities are really important again for students or employees to prevent burnout and to keep morale up reduce anxiety and increase a sense of personal empowerment and connection. Active involvement for everybody is fostered. And the school or organization is responsive to the students needs, making sure that in school in the case of school, they have access to tutoring resources. It's a safe environment for them to be in and the children that are going to that school, having a food in their bellies, you know, they can't learn if they're hungry all the time. Workplaces a little bit different but we still need to be responsive to people's needs in terms of, you know, family requirements, whether they need to, if they're going back to school, shifting schedules a little bit. We need to try to work with people instead of being completely rigid and it's my way or the highway when possible, in order to promote the best mental health. Characteristics of settings in which relationships occur are often associated with development of mood disorders and addictive behaviors. So we want to look at the characteristics of schools. Are they safe? Are they positive environments? Are they cheering squads? Or are they places where people know they're going to go and get thrown under the bus? Same thing with workplaces. You know, when you walk into a place, you get a, most of us get a sense and you're either like, oh, this is a cool place to work or, ooh, I can't wait until I can get out of here. You know, we really want to go towards the other end. And neighborhoods, when you go into a neighborhood, do people take care of their environment? Do they, or do they have trash strewn all over their lawn? All of these things communicate how people feel about their environment and generally how they feel about themselves and whether they have the energy to take care of stuff or they just feel completely disenfranchised and don't care anymore. Community risk factors, no sense of connection to the community, neighborhood disorganization, rapid changes, high unemployment, a lack of strong social institutions, lack of monitoring use activities, imbalanced media portrayals of safety, health and appropriate behavior, misleading advertising, and alcohol or drugs readily available. A lot of stuff we do, we're not going to be able to affect on the community level so much, but we're going to hit them real quick. We want to improve the climate process and policies within community, school, and workplace to make it safe and promote positive health behaviors. Prevention strategies are designed to reduce social isolation, reduce and address stigma, increase awareness of local recovery models. Who's out there that has recovered and can serve as a role model? Improve economic and housing opportunities so people have a house, a safe roof over their head, and they can earn money and feel good about themselves. Increasing the accuracy and improving the positivity of media messages and increasing physical and financial availability of recovery. So like I said, I live in a little town, so it's nice that we have a community mental health center here so people don't have to rely on going into Nashville. But also making sure that services are financially available, whether you have a free clinic once a month or, you know, make sure you take Medicaid, but there's still a lot of people who have no insurance, so where do they go? The socio-ecological model identifies how the individual impacts and is impacted by not only his own characteristics, but also those of family, peers, community, and culture. Prevention takes the form of preventing the problem, preventing worsening of the problem, and preventing associated fallout. Like I said, as clinicians, a lot of what we're going to do is target the individual, providing them resiliency skills to deal with some of this adversity that might be around them. And to help them sort through some of those media messages and go, yeah, that's not even true. You know, if I drink this vodka, I'm not suddenly going to have 14 supermodels hanging on me or whatever it is that's being communicated. So encouraging people to be informed and wily consumers. Any change in the system will have an effect on other parts of the system. So if it's a positive change, it's probably going to have positive changes. Negative has negative changes. Addressing addictive and mood disorder behaviors requires a multi-pronged approach. We need to look at the individual and provide as many skills as possible there because that's where we're going to have a lot of our impact, especially in prevention. But we also need to realize that this person resides within a family, you know, whether they live alone, which sometimes is less problematic, or they live in a household with other people. We need to make sure that where they lay their head at night, where they spend their non-working hours, feels safe and is conducive to recovery. Where they work or go to school also needs to feel safe and be conducive to recovery, and that's part of the community. So we need to kind of look at these areas, and if they aren't safe or they don't feel safe or aren't conducive to recovery, we need to help people figure out how they can fix that or address it. Like I said, they may not be able to move. So what can you do to set some boundaries to create as much safety as you can? How can you do this? And there are a lot of different techniques that I'm sure you already have that you use to help people. But it's important, again, not to just focus on the individual because they don't live in a bubble. We need to look at everything. All right. Are there any questions? Now we have, or I have, added a Wednesday class, so you don't obviously don't have to come, but if you have an unlimited membership, same time, same station, Wednesdays, so Tuesday, Wednesday and Thursday, we have a class from 12pm CST, 1pm EST for an hour. Alrighty, I will talk to you all maybe tomorrow, maybe on Thursday. Have a great day. 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