Date of Award
Doctor of Social Work (DSW)
Allison Werner-Lin, PhD, AM, EdM, LCSW
Carolina Vélez-Grau, PhD, LCSW
Objective: This qualitative study explores the experiences of social workers who work with Latina adolescents with suicidal behaviors. Specifically, this work explores social workers’ knowledge and utilization of sociocultural risk and protective factors (e.g., level of acculturation) when engaging Latina adolescents in suicide risk assessments and safety planning. “Latinx/Latine” will be used throughout the dissertation to reference the entire Latinx/Latine community as well as for gender non-conforming adolescents, and where gender is not relevant, unknown, or nonspecific, whereas “Latina” will designate Latina cisgender females. Research over the past two decades has shown that Latina female adolescents have higher rates of suicidal ideation and attempts over time compared to non-Hispanic White, Black, and African American adolescent females (CDC, 2017, 2011; Price & Khubchandani, 2017; Romero et al., 2014; Silva & Van Orden, 2018) and are twice as likely to report suicidal ideation, prior suicidal plans, and suicide attempts compared to Latino male adolescents (Kann et al., 2018). Given the significance of suicidality among Latina adolescents, the study explores the understudied therapeutic relationship between Latina adolescents and their social workers to understand the facets that support therapeutic trust and risk assessments from the therapists’ perspectives when engaging in treatment to mitigate suicide risk.
Method: This study employed grounded theory methodology. The researcher used purposive, targeted, convenience, and snowball sampling to recruit 20 licensed social workers from outpatient mental health agencies in New York City. Participants each completed a single, in-depth, semi-structured interview about their therapeutic work engaging Latina adolescents and their parents in treatment for suicidality. The interview guide included questions and prompts addressing the following topics: social workers’ experiences treating Latina adolescents with suicidal behaviors; the understanding and use of Latinx/e sociocultural factors when assessing for suicide risk and safety planning including familismo, perceived as a factor that encourages keeping problems and concerns within the family (Steidel Lugo & Contreras, 2003); immigration and generational challenges; language barriers; perspectives on the significance of the therapeutic relationship; and training intervention needs. Interviews were transcribed verbatim for analysis. Using the constant comparative method, the researcher completed open coding to develop an iterative codebook, in addition to deductive coding using concepts from literature on suicidal behaviors for Latinx/e individuals and theoretical constructs surrounding Latinx/e beliefs and experiences regarding mental health and mental health care. The researcher worked with a qualitative methods expert and a content expert to analyze and synthesize data into findings.
Findings: Interview data supported the importance of social workers’ understanding of sociocultural factors in suicide treatment with Latina adolescents and their families. Specific factors identified by participants included the following: large acculturation gaps between the parent and adolescent; challenges acquiring independence and individual identity away from their family systems while balancing how autonomy looks for the family and the girls; pressure to embody the Latina female gender role; burden to create a better life than their immigrant parents; immigration status and discrimination; cultural and religious traditions values as protection; and family cohesion. Implicit biases were evident in all interviews and were not dependent on the participant’s self-identified race or ethnicity. These biases are highlighted by the researcher to increase contextual awareness viewpoints held in therapeutic care with Latina adolescents and their families. The primary importance of the social worker’s relationship with the adolescent, their parents or other family members, and the collective relationships with outside community members/providers involved in the adolescents’ lives contributed to effective treatment from the social worker’s point of view. The trusting, therapeutic role that bilingual and bicultural social workers hold due to their ability to grasp a deeper understanding of sociocultural factors was emphasized throughout the interviews as well. Engagement and effective care for Latina adolescent clients and their family members were aided by the following: utilizing relational growth strategies, including building trust and transparency around multiple identities in treatment; providing concrete therapeutic tools to both the adolescents and their family members such as teaching perspective-taking and increasing psychoeducation around suicide risk and safety planning; and social workers’ engagement in identity work outside of the therapeutic relationship.
Discussion: Sufficient trainings and a comprehensive understanding of Latinx/Latine sociocultural risk and protective impacts are necessary to effectively provide suicide treatment for Latina adolescents and to support their families. Findings speak to a significant gap in theoretical understandings of the clinical relationship in this context. Specifically, findings suggest elements that may flesh out the Ecodevelopmental Model including mental health treatment, the relationship with the social worker, and their knowledge of sociocultural factors to broaden a trajectory away from the Latina adolescent’s suicide attempt. Dominant cultural messaging about Latinx/e families and White-centered mental health practices that inform provider bias and approaches require ongoing analysis and discussions in order to increase engagement in growth-fostering therapeutic care for suicide risk.
Conclusion: This research finds several essential clinical needs for working with Latina adolescents exhibiting suicidal behaviors. These needs include the following: building a comprehensive sociocultural understanding of Latina adolescents that reduces biased assumptions of the girls and their families, the contexts they live in, and their immigration statuses; integrating family values and members into care; and building trust with cultural humility. It is essential to add to the knowledge base and minimize ongoing explicit and implicit bias of the mental health providers who serve this high-risk population in order to help Latina adolescents navigate and thrive in their complex multicultural worlds.
Schindelheim, Samantha G., "Apoyar El Baile Multicultural (Supporting the Multicultural Dance): A Qualitative Study of Social Workers Treating Latina Adolescents with Suicidal Ideation and Behaviors" (2022). Doctorate in Social Work (DSW) Dissertations. 168.