Complicating Narratives: Defining and Deconstructing Ethical Challenges in Community Psychology

In this concluding essay, we review the case studies presented in this Special Issue and examine whether community psychology has a distinctive approach to defining and resolving the core ethical canons of the Belmont Report (1979): Respect for Persons, Beneficence, and Justice. For two of these Principles—Respect for Persons and Beneficence—community psychologists elaborate upon and extend their definitions to consider their meaning in community‐based, social justice‐oriented research. The field's approach to Respect for Persons is multilevel in nature; in addition to respecting individuals and their diverse identities, we also have obligations to respect our community partnerships, the communities with whom we work, and the populations and cultures represented in our work. Similarly, for community psychologists, Beneficence is a multilevel construct that considers risks and benefits at the group, community, and cultural levels of analysis. With respect to Justice, community psychologists’ views of our ethical responsibilities are qualitatively different in meaning from the original Belmont Report and from disciplinary‐specific interpretations of this principle in ethical guidance documents from psychology, sociology, and evaluation. Our valuing of social change demands that we contribute to individual and group empowerment and liberation, and in so doing, that we avoid collusion with oppressive systems. Thus, we define our ethical responsibilities for promoting Justice as more action‐oriented than do other disciplines. The essay closes with an exploration of future directions for developing a comprehensive ethical framework for community psychology.     

自杀意念高中生的社会信息编码特征

采用两因素混合实验设计, 以日常用词为实验材料, 选取不同自杀意念得分的高中生为被试, 通过三个实验考察自杀意念高中生的社会信息编码特征。研究结果发现:(1)自杀意念高分组被试对出现在消极词位置的探测刺激的反应时显著短于出现在积极词位置的探测刺激的反应时; 自杀意念低分组被试对出现在积极词位置的探测刺激的反应时显著短于出现在消极词位置的探测刺激的反应时。(2)在知觉加工水平上, 自杀意念高分组被试对消极词、积极词及中性词的回忆量之间无显著差异; 自杀意念低分组被试对三类词的回忆量之间也不存在显著差异。(3)在语义加工水平上, 自杀意念高分组被试的消极词回忆量显著高于积极词回忆量; 自杀意念低分组被试的积极词回忆量显著高于消极词回忆量。研究结论如下：高自杀意念高中生存在对消极信息的注意偏向和语义加工偏向, 但不存在知觉加工偏向; 低自杀意念高中生存在对积极信息的注意偏向和语义加工偏向, 但不存在知觉加工偏向。     

The Complexity of Women’s Lives: Decision-making about Maternal HIV Disclosure

HIV/AIDS has reached epidemic levels in Washington, D.C. and mothers living with HIV increasingly have to make difficult decisions about whether or not to disclose their HIV status to their children. Focus groups were conducted with a sample of women (N = 15) living in Washington, D.C. to investigate maternal decision-making about HIV disclosure, the factors that influenced disclosure, challenges to disclosure, and children’s reactions to disclosure. This was a first step towards the larger goal of developing a culturally sensitive disclosure decision-making intervention. Participants were asked to identify elements to include in such an intervention. We also quantitatively examined participants’ psychosocial outcomes of depression, perceived social support, quality of life, and parenting challenges. Our preliminary findings showed that most participants experienced intense emotional distress after receiving an HIV diagnosis and this distress prevented them from disclosing their HIV status to family members and children. Several specific parenting concerns (e.g., age and gender of child, relationship to child, and number of children) influenced their decisions to disclose. All participants reported that HIV related stigma and discrimination as significant disclosure-related challenges. Health providers were not always perceived as being able to support participants in making a decision about whether or not to disclose their HIV status to their children.     

The experiences of person-centred counsellors working with suicidal clients online through the medium of text

ABSTRACT

In this study, we attempt to provide an understanding of the experiences of four UK-based person-centred counsellors working with suicidal clients online using text-based therapies and the impact of their clients’ suicidal ideation upon their “way of being”. The counsellors were selected purposively; each was working as a person-centred counsellor online, was encountering suicidal ideation in their clients, and was a member of a professional organisation. A narrative approach was taken, using unstructured interviews and a stanza format of representation. We found that participants had developed a way of being online that may be distinct from their in-person practice. Challenges included being more directive, lacking physical presence, lacking confidence in assessing risk and questions about empathic understanding. Working online with risk raises specific challenges for person-centred practitioners in line with what is indicated in the little relevant research currently already available.     

The Stories We Tell: Introduction to the Special Issue on Ethical Challenges in Community Psychology Research and Practice

This Special Issue examines ethical challenges in community psychology research and practice. The literature on ethics in community psychology has remained largely abstract and aspirational, with few concrete examples and case studies, so the goal of this Special Issue was to expand our written discourse about ethical dilemmas in our field. In these articles, researchers and practitioners share stories of specific ethical challenges they faced and how they sought to resolve them. These first‐person narratives examine how ethical challenges come about, how community psychology values inform ethical decision making, and how lessons learned from these experiences can inform an ethical framework for community psychology.     

Treating the Capability for Suicide: A Vital and Understudied Frontier in Suicide Prevention

Current efforts at suicide prevention center largely on reducing suicidal desire among individuals hospitalized for suicidality or being treated for related psychopathology. Such efforts have yielded evidence‐based treatments, and yet the national suicide rate has continued to climb. We propose that this disconnect is heavily influenced by an unmet need to consider population‐level interventions aimed at reducing the capability for suicide. Drawing on lessons learned from other public health phenomena that have seen drastic declines in frequency in recent decades (HIV, lung cancer, motor vehicle accidents), we propose that current suicidality treatment efforts trail current suicidality theories in their lack of focus on the extent to which individuals thinking about suicide are capable of transitioning from ideation to attempt. We summarize extant evidence for specific capability‐centered approaches (e.g., means safety) and propose other options for improving our ability to address this largely overlooked variable. We also note that population‐level approaches in this regard would represent an important opportunity to decrease risk in individuals who either lack access to evidence‐based care or underreport suicidal ideation, as a reduced capability for suicide would theoretically diminish the potency of suicidal desire and, in this sense, lower the odds of a transition from ideation to attempt.     

Photography and Social Media Use in Community‐Based Participatory Research with Youth: Ethical Considerations

Community‐based participatory researchers increasingly incorporate photography and social media into their work. Despite its relative infancy, social media has created a powerful network that allows individuals to convey messages quickly to a widespread audience. In addition to its potential benefits, the use of social media in research also carries risk, given the fast pace of exchanges, sharing of personal images and ideas in high accessibility, low privacy contexts and continually shifting options and upgrades. This article contributes to the literature examining ethical considerations for photography and social media use in community‐based participatory research. We describe three key ethical dilemmas that we encountered during our participatory photography project with Latina/o youth: (a) use and content of images and risk; (b) incentives and coercion; and (c) social media activity and confidentiality. We provide our responses to these challenges, contextualized in theory and practice, and share lessons learned. We raise the question of how to contend with cultural shifts in boundaries and privacy. We propose that evaluating participant vulnerability versus potential empowerment may be more fitting than the standard approach of assessing risks and benefits. Finally, we recommend upholding the principles of participatory research by co‐producing ethical practices with one's participants.     

HIV Disease Impact on Mothers: What They Miss During Their Children’s Developmental Years

Adjusting to chronic illness is very complicated for families with children, as they are already faced with the challenge of development and childrearing. In this study, qualitative interviews were conducted with HIV positive mothers on a number of issues related to being an HIV positive mother raising young children. One topic of the interview was whether or not they felt that HIV had caused them to miss activities with their children while the children were growing up, what types of activities they had missed, the age of the child for each example, and how HIV had led to missing these activities. Interviews were conducted in 2008 with a random sample of 57 mothers being followed in a longitudinal assessment study. All study participants were English or Spanish speaking. Mean age was 44.1 (SD = 5.6) years; 47% were Latina; 35% African American; 11% White; and 7% other race. About 60% of the mothers disclosed that their HIV status had caused them to miss out on activities with their children while their children were growing up, ranging from daily care activities to major school and extra-curricular activities. Some mothers missed significant amounts of time with their children due to hospitalizations. In some cases mothers felt forced into a choice between mothering ability and their own health, including adherence to medications. Implications for the mothers and the children are discussed.     

Substance Use Research with Indigenous Communities: Exploring and Extending Foundational Principles of Community Psychology

Many Indigenous communities are concerned with substance use (SU) problems and eager to advance effective solutions for their prevention and treatment. Yet these communities also are concerned about the perpetuation of colonizing, disorder‐focused, stigmatizing approaches to mental health, and social narratives related to SU problems. Foundational principles of community psychology—ecological perspectives, empowerment, sociocultural competence, community inclusion and partnership, and reflective practice—provide useful frameworks for informing ethical community‐based research pertaining to SU problems conducted with and by Indigenous communities. These principles are explored and extended for Indigenous community contexts through themes generated from seven collaborative studies focused on understanding, preventing, and treating SU problems. These studies are generated from research teams working with Indigenous communities across the United States and Canada—inclusive of urban, rural, and reservation/reserve populations as well as adult and youth participants. Shared themes indicate that Indigenous SU research reflects community psychology principles, as an outgrowth of research agendas and processes that are increasingly guided by Indigenous communities. At the same time, this research challenges these principles in important ways pertaining to Indigenous–settler relations and Indigenous‐specific considerations. We discuss these challenges and recommend greater synergy between community psychology and Indigenous research.     

Intervention Research with Youths at Elevated Risk for Suicide: Meeting the Ethical and Regulatory Challenges of Informed Consent and Assent

Intervention research with youths at elevated risk for suicidal behavior and suicide—a vulnerable and high risk population—presents investigators with numerous ethical challenges. This report specifically addresses those challenges involving the informed consent and assent process with parents/guardians and youths. The challenges are delineated in the context of pertinent laws and regulatory requirements, and guidelines are suggested for their practical resolution. These are illustrated with case examples from NIMH‐funded intervention trials. Through the sharing of such methodological information, intervention researchers can support each other in conducting ethical research in a manner that does not unduly compromise scientific rigor.     

An Examination of Disclosure of Nonsuicidal Self‐injury among University Students

Despite the widespread prevalence of nonsuicidal self‐injury (NSSI) among community‐based samples, little is known about which self‐injurers disclose their NSSI or the factors that promote disclosure among self‐injurers. To address this gap in the literature, we examined whether disclosers could be differentiated from nondisclosers on the basis of NSSI characteristics (e.g. frequency of NSSI and severity of NSSI), NSSI motivations (e.g. interpersonal and intrapersonal motivations) and psychosocial factors (e.g. suicidal ideation and self‐esteem). Participants consisted of a large sample of 268 self‐injuring undergraduate students (M_age = 19.07 years, 70.3% women) at a Canadian university. Results indicated that 57% of self‐injurers had never disclosed their NSSI to anyone. Self‐injurers were most likely to disclose to peers and romantic partners. Logistic regression analyses revealed that pain during NSSI, severity of NSSI, interpersonal motivations for engaging in NSSI, higher suicidal ideation and higher friendship quality were all associated with a greater likelihood of NSSI disclosure. Our findings suggest that individuals with severe NSSI and suicidal ideation may be more likely to disclose. Moreover, our findings underscore the importance of equipping friends and romantic partners with effective responses to NSSI disclosures to promote more formal help‐seeking behaviours among self‐injurers. Copyright © 2014 John Wiley & Sons, Ltd.     

Targeting Perceived Burdensomeness to Reduce Suicide Risk

Perceived burdensomeness (PB), defined by an intractable perception of burdening others, often reflects a false mental calculation that one’s death is worth more than one’s life and has been supported as a significant risk factor for suicide. Because PB often reflects a distorted cognition, it may serve as a corrective and promising target for the intervention of suicide. More work on PB is needed in clinically severe and in military populations. Sixty-nine (Study 1) and 181 (Study 2) military participants at high baseline suicide risk engaged in interventions targeting constructs relating to PB. Baseline and follow-up measures (at 1, 6, 12, 18, and 24 months) of suicidal ideation were administered, and various statistical approaches—including repeated-measures ANOVA, mediation analyses, and correlating standardized residuals—explored whether suicidal ideation decreased specifically by way of PB. In addition to utilizing a larger sample size, Study 2 included an active PB-intervention arm (N = 181) and a control arm (N = 121), who received robust care as usual. In both studies, participants improved considerably regarding baseline to follow-up suicidal ideation. The results of Study 2 mirrored those of Study 1, corroborating a potential mediational role for PB in treatment-related improvements in suicidal ideation in military participants. Effect sizes ranged from .07–.25. Interventions tailored at decreasing levels of perceived burdensomeness may be uniquely and significantly effective in reducing suicidal thoughts.     

Universal Prevention Exposure as a Moderator of the Community Context: Findings from the PROSPER Project

This study examined how participation in a universal family skills‐building program may interact with community risks and resources to produce youth outcomes. Prior research has noted community‐level variability in risk and protective factors, but thus far no study has examined the role that participation on a community‐wide intervention may play in moderating the effects of community risks or resources. The study included 14 communities (seven in Iowa, seven in Pennsylvania) that implemented a family focused evidence‐based program as part of the PROSPER project. Community level variables included both risk factors (percent of low income families, the availability of alcohol and tobacco, norms regarding adolescent substance use, incidence of drug‐related crimes) and community resources (proactive school leadership, availability of youth‐serving organizations, and student involvement in youth activities). The proximal youth and family outcomes included youth perceptions of their parents’ management skills, parent–child activities, and family cohesion. Results indicated that the Strengthening Families Program:10–14 may have moderated the impact of the community risks and resources on community‐level youth outcomes; risk levels meaningfully associated with community‐level change in program participants, though these results varied somewhat by outcome. Generally, higher levels of resources also meaningfully associated with more positive change after participating in the family‐focused intervention. These results suggest that the effect of some evidence‐based programs may be even stronger in some communities than others; more research in this area is needed.     

A comparison of Estonian,Swedish, and Finnish mothers' controlling attitudes and behaviour

The current study examined maternal control of children across families with early adolescents from different sociocultural backgrounds. The intention was to find out whether belonging to the same ethnic group/language community (i.e., Estonian or Finnish) is more important for determination of child‐rearing attitudes and practices than sharing the immediate sociocultural context (i.e., Swedish society). In addition, attention was paid to the relationship between attitudes and behaviour. The results were obtained from three monocultural samples of Estonian, Swedish, and Finnish families living in their country of origin; two bicultural samples consisted of Estonian and Finnish families residing in Sweden. Two types of data—mothers' reported attitudes towards the importance of control over children's behaviour (the Control Scale) and video‐recorded real‐life verbal behaviour—were used to determine how the mothers' attitudes towards control relate to the behavioural control exhibited in their real‐life interactions. The study showed that the Finno‐Ugric mothers living in their countries of origin controlled their children's behaviour significantly more frequently than those Finno‐Ugric mothers who live in Sweden, but both Estonian samples outperformed Finns in their reported control attitudes. The Swedish mothers were the least directive among monocultural mothers both in maternal beliefs and in real‐life behaviour, but they differed from Estonian and Finnish mothers residing in Sweden only in their lower scores on the Control Scale. The study revealed that mothers' real‐life control behaviour corresponded rather modestly to their reported attitudes toward the importance of controlling children. Analyses of actual mother—child interaction showed that only the Estonian mothers living in Estonia actually put their relatively high scores on the Control Scale into practice in real‐life interactions with their children. Finally, some characteristics of Estonian, Finnish, and Swedish languages and cultures are discussed that might determine the cultural differences in child rearing that emerged.     

Latina Mothers’ Involvement in an HIV/STI and Substance Use Prevention Program for Adolescents: A Parallel Intervention Curriculum

As part of a larger HIV/STI/Substance Abuse Prevention intervention targeted to middle school students, we offered students’ parents an opportunity to participate in an adult education class. The same curricular materials were used for students enrolled in the intervention and for their parents. In the current study, mothers who had completed the adult education class participated in a focus group. The focus group explored what components of the intervention were perceived by mothers as particularly useful to them or to their child. Three core themes emerged from interpretive analyses of the focus group: (1) positive relationships with intervention staff and school personnel enticed students to participate in the intervention and facilitated parents’ involvement; (2) both students and parents felt respected and empowered by the intervention’s cornerstone values and curricular philosophy of cultural richness and pride in Hispanic/Latino heritage; and (3) mothers perceived their mastery of the course content—materially wholly dedicated to the health and wellness of their children—benefitted them in terms of both understanding the material and potentially allowing mothers to discuss health-oriented behavior with their young adolescent child.     

Enhancing the care of children with chronic diseases through the narratives of patient,physician, nurse and carer

We tested the hypothesis that a narrative approach may enhance a bio‐psycho‐social model (BPS) in caring for chronically ill children. Forty‐eight narratives were collected from 12 children with six different medical conditions, their mothers, physicians, and nurses. By a textual analysis, narratives were classified on their predominant focus as disease (biological focus), illness (psychologic focus), or sickness (social focus). Sixty‐one percent of narrative’ text were classified as illness, 28% as disease and 11% as sickness. All narratives had a degree of illness focus. Narratives by patients and physicians on the one hand, and nurses’ and mothers’ on the other were disease focused. Narratives were also evaluated with respect to the type of medical condition: Illness was largely prevalent in all but Crohn’s disease and HIV infection, the latter having a predominance of sickness most probably related to stigma. Narrative exploration proved a valuable tool for understanding and addressing the needs of children with complex conditions. Narrative approaches allow identification of the major needs of different patients according to health conditions and story tellers. In the narratives, we found a greater illness and disease focus and surprisingly a low sickness focus, except with HIV stories. Narrative medicine provides a tool to strengthen the BPS model in health care.     

Dating and Sexual Violence Research in the Schools: Balancing Protection of Confidentiality with Supporting the Welfare of Survivors

Rigorous research and program evaluation are needed to understand the experience of dating and sexual violence among youth and the impact of prevention and intervention efforts. Our dilemma in doing this work occurred when youth disclosed dating and sexual violence on a research survey. What responsibility do researchers have to protect survivors’ confidentiality as a research participant versus taking steps to ensure the student has the opportunity to access help? In our evaluation of a pilot dating violence prevention program, our protocols employed widely used procedures for providing resources to participants upon their completion of the survey and de‐identifying survey data. Upon reviewing preliminary survey results, we became concerned that these established procedures were not sufficient to support research participants who were adolescent survivors of dating and sexual violence. We followed a structured ethical decision‐making process to examine legal and ethical considerations, consult with colleagues, consider impacts and alternative solutions, and ultimately find a solution. Through this process, we developed procedures that balance participant confidentiality and the desire to support the welfare of survivors, which other researchers may want to employ when conducting youth sexual and dating violence research in school and community settings.     

Trajectories of Suicidal Ideation from Sixth through Tenth Grades in Predicting Suicide Attempts in Young Adulthood in an Urban African American Cohort

The trajectory of suicidal ideation across early adolescence may inform the timing of suicide prevention program implementation. This study aimed to identify developmental trajectories of suicidal ideation among an urban cohort of community‐residing African Americans (AA) longitudinally followed from middle school through early adulthood (ages 11–19 years). Subtypes based on the developmental course of suicidal ideation from late childhood through mid‐adolescence were identified using longitudinal latent class analysis (LLCA) with 581 AA adolescents (52.7% male; 71.1% free or reduced school meals). The developmental trajectories of suicidal ideation were then used to predict suicide attempts in young adulthood. Our LLCA indicated two subtypes (i.e., ideators and nonideators), with 8% of the sample in the ideator class. This trajectory class shows a peak of suicidal ideation in seventh grade and a steady decline in ideation in subsequent grades. Additionally, suicidal ideation trajectories significantly predicted suicide attempt. Results of these analyses suggest the need for suicide prevention approaches prior to high school for AA youth.     

Emotion Dysregulation and Military Suicidality Since 2001: A Review of the Literature

Policy makers and researchers have worked to explain the perplexing rise in U.S. military suicides since 2001, with little progress in explaining this widespread phenomenon. This article synthesizes several literatures to highlight the role of emotion dysregulation in military suicidality. After considering advances in suicidal ideation‐to‐action frameworks and the factors that contribute to the prevalence of emotion dysregulation in the modern U.S. military, it explores how military service provides for two distinct circumstances in which such emotion dysregulation may facilitate the transition from suicidal ideation to behavior. The first circumstance is high distress tolerance, wherein the effects of disproportionately high rates of adverse childhood experiences (ACEs) among service‐members may increase vulnerability to suicidal behavior. The second circumstance is preexisting acquired capability with lethal means paired with executive functioning degradation. Empirically associated with military environments, such degradation may undermine the effectiveness of top‐down emotion regulation strategies—thereby allowing acquired familiarity with lethal means to assist the transition from suicidal ideation to action. Thus, emotion dysregulation’s unique relationship with the U.S. military may help to explain the powerful correlation between service and suicide since 2001—suggesting that enhancing emotion regulation skills may present a key leverage point for effectively addressing the issue.