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Running Head: ASSESSMENT AND ANALYSIS ADOLESCENT SUICIDE

Community Asset Mapping Part C

Community Assessment and Analysis

Denver County Metro Area Adolescent Suicide

Cary, John, Katja, Michelle, & Kiki

University of Denver
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Theory Analysis

Contribution by various factors from a systemic framework may provide insight into the

social problem of suicide. Denver County has high rates of suicide that reflect the top ten state

ranking for national suicide rates. As suicide reports increase, research on local and national

level risk and protective factors reveal data that can inform the unique set of risk factors. As

systems require dynamic parts in the creation of a whole, micro, mezzo, and macro research can

inform risk factors and potential interventions.

Risk factors may advise related systems in how to address the prevalence of adolescent

suicide. Data collected by government reports, testimonials, case studies, and empirical research

help inform these risk factors. A meta-analysis of 365 research studies was conducted on risk and

protective factors for suicidal thoughts and behaviors (STB). From before 1985 until 2014 five

categories emerged as top risk factors alternating greatest effect at differing timeframes. From

2005-2014 internalizing psychopathology (ex. mood disorders, hopelessness), demographics (ex.

gender, ethnicity), externalizing psychopathology (ex. substance abuse, aggressive behaviors),

prior STBs, and social factors (ex. abuse history, isolation, stressful life events, family/peer

problems) ranked in order of impact. The most common predictor for suicidal ideation was prior

suicidal ideation; for suicide attempt it was prior non-suicidal self-injury (NSSI); and the top

factor for suicide death was prior psychiatric hospitalization (Franklin et al., 2017). These risk-

factors activate the rates of suicide nationally and locally in Colorado and Denver. Almost

15,000 high schoolers have seriously considered suicide and/or made a plan, and almost 11,000

attempted suicide (YRBSS, 2017). In Colorado, 1,472 high school students reported suicidal
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ideation, 1,470 made a plan, and 1,476 attempted suicide (CDC, 2017) resulting in 76 Colorado

deaths by suicide, with 8 from Denver in 2017 (Kids Count Data Center [KCDC], 2017).

Beyond those suffering with STBs, ripple effects pervade outward systemically in the

community. Cerel et al. (2017) found that 115 people are affected by one suicide. In Colorado

that is an estimated 8,760 people, and in Denver about 920 people touched by the suicides in

2017. Schools, faith based and social community programs, service providers, and the economy

are all systemically affected by suicide. Almost $70 billion per year in lifetime medical and

work-loss costs stem from STBs (CDC, 2019). Suicide creates a multitude of downstream

systemic effects.

Systems Theory

If suicide stems from more than one factor and subsequently creates post-STBs effects,

then it must be approached from a perspective that considers each system involved.

Systems Theory comprehensively looks at all the possible interconnections of at-risk high

schoolers for suicide. The theory implies a system is an entity of and to itself with distinct

boundaries, with each system effecting and being affected by one another. The theory in the

context of social work was adopted after it was introduced in the scientific community in the late

1960s (Lesser & Pope, 2011). For social workers, systems theory looks at every entity, situation,

or experience as connected to other entities, situations, or experiences. The phenomenon of

suicide is not created in a vacuum, but instead the outcome of many underlying micro and macro

factors.

Systems Theory and At-Risk Adolescent STBs

Potential influencers of suicide may be best mapped out by developing an Ecomap of

Denver County adolescents at-risk for suicide. An analysis of the systems and relevant
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biopsychosocial factors also present denotes over a dozen systems and consequent risk-factors.

Such factors as psychiatric diagnosis, stressful environments during development, internalization

with bullying and isolation, and stressful life events have the greatest impact on STBs (Health

Management Associates [HMA], 2018). A complete Ecomap can be found in Appendix A,

Image 1, and a Risk Factor Diagram is shown in Image 2. Franklins 2017's meta-analysis on

STBs denote similar predictors and broad categorical risk factors.

Colorado reports a greater than 50% increase in suicide rates in the past three years. The

HMA (2018) investigated the phenomenon and created a statewide report from the Office of the

Attorney General after interviewing citizens and collecting data in four Colorado counties: Mesa,

Pueblo, La Plata, and El Paso. The three most common risk factors cited by adolescents were

social media, perceived lack of coping skills, and exposure to adult suicide/having a family

member die by suicide (HMA, 2018). La Plata is in the same geographic region as Denver

County (Front Range) and may provide insight to address adolescent suicide locally, such as

their concern with sensationalized media coverage and the lack of available mental health

support for youth (HMA, 2018). Gathering the systemic factors compiled by various resources

could inform potential interventions for eliminating these types of risks.

A phenomenon called "the ripple effect" may also contribute to the large number of

suicides in Denver and Colorado. The ripple effect is a term used to describe 'copy-cat' behaviors

and comes from Albert Bandura's social learning theory where learning takes place by observing

other's thoughts and behaviors (Hardcastle, Powers, & Wenocur, 2014). Suicide's longstanding

high rates in Colorado may have perpetuated the current number of STBs. Pescara-Kovach &

Raleigh also call this "the contagion effect" and reference Gould (2001) and Gould, Jamieson,

and Romer (2003) in testing the "Werther Effect". The Werther Effect refers to an increase in
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suicides after mass media coverage of such events. Though there is no research to support this

imitation hypothesis for Denver County adolescent suicides, it is often suggested by residents of

the area.

Using systems to increase prevention efforts can stop STBs before they develop. Positive

youth development research and the Suicide Prevention Resource Center (n.d.) state feelings of

connection and support among peers and adults, coping skills, and awareness of accessibility to

health care as protective factors (National Academy of Sciences, 2004). The Colorado report

stated access to resources specifically targeted for youth suicide prevention, faith-based

activities, and natural outdoor resource accessibility were helpful (HMA, 2018). Franklin et al.

found most research focused on adult populations, however demographics and social factors

played a small role in total population results (2017). However, protective factors are much less

researched and limited data does not produce significant results. Much more research is needed

on protective factors of suicidal ideation, attempt, and death.

The Denver County metro area offers many resources for suicide prevention. Much of

them provide counseling or psychoeducation for the struggling individual to seek out (ie. Mental

Health Center of Denver, individual therapy) on a micro level. There are also coalitions,

nonprofits, government agencies, and independent organizations that have groups devoted to

providing assistance and organizing. Some of these are the Suicide Prevention Coalition of

Colorado, Suicide Prevention Resource Center, and the Colorado Department of Public Health &

Environment, Office of Suicide Prevention. There is a major suicide prevention campaign from

the Colorado Attorney General, mental health organizations, filmmakers, families and teenagers

that started in 2019. The purpose of the campaign is to bring awareness to and start conversations

about teen suicide. So far, no data has revealed campaign effectiveness. Regardless, this may be
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a step to a transformative model of change that the Denver County metro area, as well as the

United States desperately needs.

Model of Change Analysis

Transformative Model of Change Applied to Denver County Adolescent Suicide

Denver County metro area needs a transformative model of change to undertake the rate

of adolescent suicide. It imposes change happens when the power dynamics shift by the

community effected working together to increase knowledge and solutions from the inside out

(Hardina, 2002). A transformative model of change is the most macro-designed intervention

model and a complete transformation in systems, power, and the community.

A transformative model for Denver adolescent suicide addresses the power battle of the

main oppressor, stigma. Stigma, as defined as a mark of disgrace perceived by social

characteristics, is all-encompassing around mental health. Interviews by anonymous Denver

County community members say that their mental health makes them feel "less than", "bad", "for

weak people", and "people who can't get their shit together". They state shame, embarrassment,

and thoughts of personal failure arise as a result. These testimonies might contribute to not

seeking mental health treatment, as denying or trying to manage suffering on one's own is part of

the American cultural norms of individualism and personal responsibility. The silence gives

power to the stigma of mental health.

Systems support the power of mental health stigma and intervening where sources of

power stem from is part of the personal and political transformation. Denver County adolescent

suicide prevention efforts may benefit from addressing policy decisions, health insurance

coverage, medical costs, availability of services, efficacy of services, the system of mental

healthcare, societal norms of seeking help and reporting concerns by a loved one, and notions of
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self-blame and self-responsibility. Confronting some of the most influential factors of power is

fundamental for the change process.

Transformative Model of Change

The community may use the transformative model to lay out a structural blueprint of the

change process. Before the community intervention practice model is designed, it's imperative to

have a basic understanding of the model. The transformative model of change emphasizes power

and social structure constraints of the oppressed populations. Sometimes in extreme cases

referred to as a revolution, the objective is to change the dominant power dynamics that limit

access to resources by developing critical consciousness- the knowledge gained by dialogues of

individual values and opportunities that are shaped by social structures, and praxis- the interplay

between reflection and taking action (Hardina, 2002). Through active learning, critical

consciousness continues to grow and transforms all people, leaders and constituents working

together. They start to master their environments with awareness of their strengths that can

effect social change.

Potential downsides of using this model may be from ineffective emphasis on dialogues

and leadership. Dialogues can be time consuming and are not to be used for social crisis

situations. Values, opinions, cultures, or intersections of oppression may differ. It's important for

the intervention leadership to be well-versed in multicultural identities and acknowledge identity

differences. They should be active learners of the intersections of oppressed experiences.

(Hardina, 2002). If cultural conflict arises during intervention development, the leaders must

adopt the practice of the dominant culture to honor establishment of a new power dynamic of the

community as a whole.

Leveraging Strengths and Addressing Issues: A Hypothetical Example

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Leveraging strengths and addressing issues in Denver County will be laid out under the

umbrella of the transformative model of change for adolescent suicide, while also adopting

practices of social movements, social planning, and locality development. To start, there must be

an acknowledgement of the suicide social problem from community members, and that the

solution is directed at confronting the power dynamics of mental health and suicide stigma. A

select few community members will need to rise up as leadership. They will initially identify the

targets of change efforts and develop a strategy that organizes individuals and stakeholders,

assesses needed and available resources, and confronts anticipated adversarial cooperation from

oppressing power.

A gathering will take place to mobilize the dialogue of adolescent suicide through critical

consciousness. Members will learn the wide range of experiences surrounding adolescent

suicide. Leadership will learn from the conversations and as interventions start to develop and

are implemented, they are responsible for establishing a conducive community environment for

dialogue. Eventually, the engagement from leadership and all community members as

participating active learners will lead to personal and political transformation. From the

community will arise a power change in systems and resources.

Steps to Transformative Change of Adolescent Suicide in the Denver County Metro Area

(Hardina, 2002)

A. Following the recent campaign for suicide awareness (Teens2teensco, 2019)- leadership

may include The Attorney General, Suicide Prevention Coalition of Colorado, and family

members directly impacted by STBs.

B. The campaign's mission is to generate dialogue (Teens2teensco, 2019). This can be

brought to a largescale county forum and broken down into smaller sub-community work
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groups such as Denver High School, those directly impacted by a loved one with STBs or

death by suicide, and professionals/experts in the field of suicide.

C. Leadership develop specific interventions from work-group suggestions. These

interventions might include:

a. Social action campaign of making and wearing T-shirts of personal mental health

diagnosis, in opposition to oppressive stigma.

b. Social planning to gain expert knowledge of evidence-based interventions that

could potentially be implemented for adolescent suicide in Denver County. One

particular intervention could be modeled from Hess et. al's Transformative Learning

model to reduce mental health disparities (2014).

c. Locality development from psychoeducational support groups inviting all

community members to attend and share their personal stories.

d. Policy change at the Colorado state level by developing a bill extending the

Mental Health Parity and Addiction Equity Act (1996) and Colorado's HB20-1086.

This requires insurance companies to cover annual mental wellness assessments and

create Primary Mental Health Practitioner for all patients, reducing stigma about

mental wellness. The bill would establish a mental healthcare system task force and

overall healthcare system action group to develop and implement a model for

systemic healthcare change. Insurance companies, government officials, academics

and field experts, practitioners, and personally affected individuals and their families

would come together as part of this task force. This legislation would generate

momentum for proposing similar policy implementations at the federal level.

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e. Curriculum-based high school prevention program such as the evidence-based

curriculum by Ciffone, (2007).

B. A community-empowered active environment will hold regular meetings assessing

formative interventions through critical consciousness and amending tactics as needed.

C. The act of organizing, mobilizing, engaging in critical consciousness, participating as

active learners, and seeing systemic change in power dynamics and resources will

transform the community of the Denver County metro area. The transformative experience

will eradicate mental health stigma and provide resources needed for adolescent's at-risk

for STIs before crisis and death by suicide.

 
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Appendix A

Figure 1

Ecogram: Denver County Adolescent Suicide

Figure 2

Denver County Adolescent Suicide Risk Factors

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Colorado 72nd Generally Assembly. (2020). HB20-1086.

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