Sociological Approach to Prevention | Addressing Risk and Enhancing Protective Factors

I'd like to welcome everybody to today's presentation on the sociological approach to reducing risk and building resilience. I'm your host, Dr. Donnelly Snipes. In this video we're going to define the socioecological model which was posited by Brofenbrenner, gosh, many, many years ago. We'll apply the model to the prevention of mental health, addictive and stress related disorders. We'll explore different variables in a socioecological model and discuss how this framework can be used in prevention and even treatment of co occurring or multi occurring disorders. So if you remember from the last video, prevention can take the form of preventing the problem from ever occurring, preventing somebody from ever developing an addiction or ever developing diabetes, preventing worsening the prop of the problem. So you're pro. They have the issue addiction, diabetes, depression. And we're trying to keep it from getting worse than it already is and hopefully get better and then preventing associated fallout problems that happen as a result of the condition. So for example, if you've got depression, developing anxiety, developing difficulty with maintaining stable housing because you're so depressed you can't go to work. So all of these are different forms of prevention. Some will call them early intervention. We're not going to get too hung up on semantics here, but basically we want to prevent people from being blocked from living the richest and most meaningful life that they can. So what is the socioecological model? That's a really fancy term, or you know, whatever clinical term if you will. But basically it explores and explains human behavior as the interaction between the person, the individual and all of their characteristics and experiences. And five environmental systems, the microsystem, the mesosystem, the exosystem, macrosystem and chronosystem. And we're going to go through each one of those. I don't expect you to know what they are yet. So let's first think about the ripple effect. When we talk about being part of a system and these systems interacting, I want you to think about the ripple effect. I remember when I was a kid I used to go and I'd skip stones on, on lakes and ponds and stuff. I think kids still do that today. I don't know. But when you throw a rock into the water, it makes ripples. You see the ripples on the surface of the water and that's true. But what else happens? So what effects? What are the effects when you throw a rock into a pond? Now I put this together the best I could. Forgive me, I'm not a Super good artist. But when you throw a rock into the pond, yes, you have those ripples on the surface. So you disrupt what's going on up here with, you know, the little spiders that are walking on the surface of the water and the little gnats and maybe even the frogs and, and things that are up on the, on the surface. And it makes a splash. Okay. So there's a noise. Well, that noise also carries down and you see the rocks spiral downwards. Well, that's not where it ends. Even though you can't see it from where you stand on the, on the bank, there are all kinds of other effects of that rock. It comes down and it hits the. It hits the sand, it hits the. The ground underneath, and it stirs up all that sediment. Well, Mr. Crab used to live in that sediment. He's going, hey, you just destroyed my house. What the heck? And all the fish, because of the sound and because of this, just all the sediment going around, the fish start taking off. And then this big fish over here, he's like, where'd all my food go? Because he would eat the little fish, but now there's no little fish for him to eat. So as morbid as this analogy is, I want you to recognize as we go through this, any change you make is going to have potentially some very obvious changes right there in front of you. But there are also probably a lot of underlying changes that you may not even recognize. Now, the good news is, and this is a bad news example, if you will, you don't really want to have a rock come in and destroy your home. But the good news is it goes the same way for prevention, for positive things. When we start doing positive things for the environment, then the fish can flourish and the big fish have food to eat, and Mr. Crab has plenty of places to live because he's not fighting with rocks and trash and debris and all that kind of stuff. So things can go positively as well as negatively in a ripple fashion. So exploring the model, there are, as I mentioned, a lot of systems, and it's less important to understand. Remember all the names of all of the systems. And it's more important just to really think. Think about yourself. Where do you fit? And it's easier to apply this to yourself than try to apply it sort of abstractly. So think about yourself as an individual. Your physical and your genetic characteristics, what make. What are you more vulnerable to? What are you more resistant to? What does your. Your physical characteristics make you more able or less able to do? Your psychological and temperamental characteristics you know, if you are somebody who tends to be high strung or anxious or compulsive or have, quote, an addictive personality which doesn't really exist, but that is going to impact how you interact with your environment, how you interact with other people. People who've been exposed to trauma as children often have a stress response system and HPA axis that's dysregulated. So they may respond to threats and stress with a much stronger reaction than people who haven't had that experience. And that's the result of changes in their nervous system. So their individual characteristics and their individual experiences and their personal history is going to affect how they react and interact with the environment and how the environment reacts to and interacts with them. It's also going to affect their schema or the way they remember things, the memories they form. If they have traumatic memories, then they're more likely going to be hyper vigilant. They're more likely going to be interpreting things from a threat based lens. If they don't have traumatic memories, then they may not. So this is the individual. So think about yourself, your experiences, your characteristics, your uniqueness. And how does that impact how you interact with your microsystem? And the microsystem is institutions and groups that most directly impact the person, including your family, your peers, your school, your church or your synagogue, your health services, those things that you interact with on a regular, maybe not daily, but on a very regular basis. And the people in those organizations or people in those places, like your family members, how, how do you interact with them? And if you grew up in a big family, you may realize that you interact differently with one person than you do with another person. And you know, you interact differently with everybody. And that is based on their, guess what, their individual characteristics. So understanding that and then looking at peers, you're going to react, interact and react differently to your peers and they're going to interact and react differently to you based on your characteristics. Your friends are not going to treat you exactly the same as they treat all their other friends. Okay. You know, there's, that's not necessarily a bad thing. We'll just do school, church and health services all in one. And when I say church, let's talk community organizations. Brof and Brenner put church. But I know there's a lot of other things like community centers and after school programs and those sorts of things. That's what we're talking about here and the people in those places. So a person with a history of trauma who is, who has impulsive characteristics, emotional disregulation, attention problems, how are they going to interact with the school, and how is the school going to interact with them compared to somebody who doesn't have those characteristics? And the answer I hope we get to by the end of this is that it's individualized, but it is responsive and respectful of both individuals. Recognizing that behavior is communication and behavior was developed for a reason. Instead of looking at behavior as bad and being critical and punishing, we try to understand it and support the person in making healthier choices in the future. Now, the mesosystem is kind of interesting because that's the interconnection between your microsystems. So how your family interacts with the school, how the school interacts with your family, how your family interacts with the neighborhood, for example, and the HOA and, and how all of those things interact with one another. So nothing is in a vacuum, nothing can change without indirectly at least impacting most other things. So I think that's cool. And in a lot of my videos I talk about trying to create safety, trying to create a sense of contentment and security in your corner of the world. And what I'm talking about is after the individual, after you feel safe in your own skin, creating that in your microsystem, start with your, your family, however you define that, that does not have to be blood relatives, whoever you consider family, and then your peers. And as you feel safe and supported and encouraged among your family and your peers, and then you can start making or trying to make positive changes in your school, in your workplace and, you know, maybe even health services so that it starts broadening. As you have health in one neighborhood and then you have health in another neighborhood, then those two neighborhoods can work together. Likewise, if you have dysfunction and crime and disarray in one neighborhood, it's going to spill over and impact the surrounding neighborhoods as well. So we want to work in the, ideally in the positive work towards the. The pro protective factors today. So think about the MESA system, your part of the pond, your little area of sediment and plants and whatever else. How does your MESA system impact the development of mental health in yourself? Your family members, the people that are in that MESA system, the people that are in that school, in that community center, in that neighborhood. Think about Maslow's hierarchy. And for those of you who are unfamiliar, Maslow created this pyramid on the bottom of the pyramid, which, you know, you look at and go, makes total sense on the bottom of the pyramid. People need to have their biological needs met first. If you're hungry, if you're thirsty, if you're in pain, if you're sick, you're not going to be able to function and, and, and try to alleviate your depression. You know, you need to get your physiological needs met first and then the next level is safety. If you don't have safety again in your own skin, but as well as in your environment, then it's going to be really hard to work on creating nurturing relationships and building self esteem. You're just worried about survival. Once you have your biological needs met and your safety needs met, then comes creating love and belonging and secure attachment and self esteem and all that other stuff that we need. We really need those things. So think about how mental health in the individual impacts the MESA system. So if you have a child that has a trauma history, maybe it was aces, maybe it was something else, but the child has a trauma history and they have some traumatic stress behaviors that developed. Well, how does that impact a parent who has a trauma history? Oh, that might trigger their, the parents trauma and make it harder for them to be present for their child or cause them to overreact to their child. How does that child impact their teacher who has a trauma history? Their teacher may also. And, and same thing with the counselor. The child's trauma history may trigger the trauma history in their caregivers, in the people in that meso system, which may keep them from being able to effectively and appropriately respond to that child's needs. But it also may impact those people, the parent, the teacher, the counselor, and cause them to experience distress and cause them to be less able to be present not only for that child but for everything else. Same thing when we think about a child whose parents have addictions, for example. And if the child has a parent who has addictions and the parent has, has parents who have addictions, you know, that can trigger that, those memories of growing up in an addicted household and can trigger intergenerational trauma. The child again, interacting with a teacher or counselor who grew up in a family where there were addictions that may trigger memories for them. So we want to look at what's going on and how does this person that you're interacting with, what do they bring out in you? What memories do they bring up? How do they impact you? And likewise how do you impact them? Maybe somebody reacts strongly to you for some reason and you're like I don't know. What I did may not be about you. It could be that you remind them of something from their past and it, it's triggering to them so their individual characteristics, their individ experiences affect how they interact with you. When I was working in community, community behavioral health, we used to go out and do prevention programs and we had a pitiful poor attendance at some of them. And one of the things we realized when we did a focus group was that a lot of the people we were trying to reach had had really bad experiences at school. The last thing in the world they wanted to do was go to that place, go back to school. Even though it wasn't their school anymore, it was their kids school. There was just so much associated when they walked in that building that it made it really unpleasant for them to go. So they didn't. We need to recognize that. Now let's talk, talk about the exosystem really quick. This is industry, social services, mass media, local politics. And he puts neighbors out here, but this would be people that are in your community, not your, the people that are living like right next door, but more the people that are you encounter at, at the grocery store. The exosystem involves links between a social setting in which the individual does not have a direct active role and the individual's immediate context. So how does what's going on in your community impact your family, impact you? How does what's going on with you impact your community? And, and maybe you impact your family and your family impacts the community. But again you've got that ripple effect. So we want to look at the connections that are there. Likewise, you can ask what can you do as an individual? What can I do as an individual to impact industry, social services and stuff in my community? And there's a lot we can do grassroots efforts to provide more of a support network for people within communities. But a lot of times people don't think about it. And that is sort of the heart and soul of today's presentation. We need to create a, what they call a recovery oriented system of care. We need to create a network within every community that ensures that people can get their basic needs met, that people can feel safe and respected for, you know, in their skin, in their environment. Not everybody's going to agree with them, but they can feel safe that their boundaries are not going to be demolished or that they are going to be somehow canceled or ridiculed in some way. And the macro system describes the culture in general. You know, thinking larger than your local community thinking the state, the country, the culture. The macrosystem describes the culture including socioeconomic status, poverty and ethnicity. People, homes and individual workplaces are always a part of a Larger cultural context. For example, you know, we think of culture, A lot of people default to ethnicity. And that's not just, that's not the only part of culture. There is culture that's associated with your age group. For example, we have boomers and Gen X's. There are cultures associated with where you live. You, people who live here in semi rural Tennessee have a much different culture than people who live in New York City. That's a culture that, you know, I, I wouldn't even know where to begin to fit in there because I've never been there. But it's a different culture. And, and so we need to recognize that what is what works in one place like Nashville may not work in another place like New York. So we need to recognize how those groups, how those families, how that system impacts the larger, impacts the larger whole. So think about how the exosystem, the social setting in which the individual does not have a direct and active role, impact the family. So how does mass media impact the family? What you see on social media, what you see on television, what you hear on podcasts, how does that impact the family? How does that impact individual? How does that contribute to the development of, and we'll stay with positive mental health? How can mass media help us improve our health and mental health? How do community events help improve health and mental health of the family, of the individual? And when the families and the individuals are healthy, how does that impact the schools and the workplaces? Well, guess what, it has a positive effect. People are showing up to work, showing up to school. There's less distress, there's less illness, you know, it's a good thing. And then think about how different cultures impact the community, the family, and the development of mental health. So thinking from big to smaller, think about how your age, you know, again, whether you're a boomer, Gen X, a millennial, a zoomer, whatever you identify as, or your occupation or your socioeconomic status, or your religion or your ethnicity or your geography, how does that impact your you as an individual? How does that impact your family and the development of mental health? And then finally the chronosystem, these are events and transitions, chrono chronological over the life course as well as socio historical. So you think the chronosystem, you think back, you have the prehistoric age and, you know, the dinosaurs, and my son could tell you all of those different things in correct order. I cannot but think evolution, chronic system, think chronosystem, the seasons, summer, winter, fall, spring, not in that order. But recognizing that all of these things impact the individual. Marriage, birth, death, moves. All of these things are normal life events that happen chronologically as somebody gets older. And how does that impact them and how does that impact how they impact everything else? How they interact with other systems? When I was younger, I didn't use health services nearly as much as I do today. So that's one of those things. As we get older, we tend to need to go to the doctor more. So we do want to think about those things. Now let's get down to those risk and protective factors that you really wanted to learn about today. Risk factors for mental or physical illness. Much of the physical illnesses out there, many of the physical illnesses out there are caused by or contributed to by stress. The number of stress related physical illnesses are just astronomical. So we need to consider individual risk factors. Genetics. Some people are more prone to develop autoimmune issues. Some people are more prone to develop certain types of cancer. Some people, you know, you get the point. Okay, so that's a risk factor. Some people are more genetically have genetically genetic predispositions for mood disorders. We see that mood disorders and addiction does have a genetic component. We need to recognize that it doesn't mean they're going to develop an addiction or a mood disorder. It means they are at risk. So it's important for us to address those things and, you know, help those people who are at risk take steps in order to protect themselves. Hypertension, obesity, chronic pain, these are all or can all be stress related issues. And they can all contribute to stress and distress, emotional and mental distress. We need to look at that. More than 45% of adults develop hypertension. Wow, that's a big number. So we want to look at the impact that that has. We want to educate people. And one of the best, best tools for prevention is health literacy. And I have a video on health literacy. It was staggering when I did the research on that, that less than 20% of people in the United States are what we consider health literate. So that also means that there's a lot of clinicians and teachers and people out there that are supposedly in the know that would not be deemed as, or would not deem themselves as health literate. That's terrifying. So one of the first steps in prevention as well as treatment is to help people understand what do they need to be healthy and what are these different things? What is depression? You know, what is it really? What causes it? You know, we know that depression can be caused by environmental factors, by physiological changes like hypothyroid we know there's a lot of different things that can cause depressive symptoms. So understanding what depression is and what a risk factor may be can help people screen themselves and ideally prevent it from happening. But if they start developing these symptoms, then they can say, okay, here's depression, here are the symptoms of depression. Which one of these, which ones of these apply to me and what might be causing these symptoms for me in this context at this time. And that health literacy is so important for, for people to be able to basically problem solve and have an understanding. Now they may not be able to say, all right, well I've got depression and just out of the blue go, well, I'm probably hypothyroid, I may have this going on. And that, that is going to be where you consult with your medical providers and other people who can help you differentially diagnose what's causing the condition. But understanding that there are treatments out there, if you have hypothyroid, that is pretty easily treatable in most cases. So hey, that's hope. When you know that there may be tools that you can use to feel better, may not make it go away completely, but it's going to make it feel a lot better. Sleep disorders are associated with a lot of different mental health as well as well as physical health issues and trauma. So we need to recognize that people with sleep disorders may have developed it as a result of mental health trauma, physical health issues. And if they have sleep disorders or if they have sleep disorders, it makes, puts them at greater risk for if they don't already have them developing those things. We need to screen. We need to again educate people about the importance of good quality sleep. The majority of Americans do not get sufficient quality sleep most nights. It's just, there's no other way to say it. There's no other way around it. We don't, we stay up too late, binge watching television or playing on the Internet or doing whatever or maybe in, in the case of a lot of students, they stay up until, you know, 9, 10, 11 o' clock doing homework and then they need to be up at 5:30 the next morning to go to school. Again, that is not enough sleep. So we need to help people recognize the importance nutritional deficiencies. This is another one. Many people's diet is abysmal. Helping people recognize that deficiencies and things like iron and calcium and potassium and vitamin D and omegas can contribute to pain and mood disorders. Likewise, you know, we're not going to be screening for these, but they can get an app on their phone, they can track the foods they eat to see, hey, am I getting the nutrition I need? If your body doesn't have those nutrients, it can't make the hormones and the neurotransmitters and everything else you need to feel happy and healthy. And we need to screen for abuse and neglect because that certainly puts people at risk of developing other issues. If you've been abused or neglected, you probably have some element of trauma related stress and trauma related behaviors. Even if it doesn't rise to the level of meeting diagnostic criteria, in my mind, that doesn't matter. If you have behaviors that are keeping you from achieving your highest quality of life, that's what matters. Environmentally, sensory gating issues can be a risk factor for developing mental illnesses. And we can't prevent this. This is something that's genetic. But people with schizophrenia, with depression, with ADHD, have more difficulty filtering out unnecessary stimuli from necessary stimuli. And they may be more sensitive or less sensitive to stimuli than other people. So something that feels lukewarm to you may feel way too hot to somebody else. As an infant in autism is another one that has sensory gating issues. As an infant who has sensory gating issues, they may get overwhelmed really easily. Things that they, you think feel fine, they think are way too hot, but they just come off as fussy. We don't understand, you know, the caregiver often doesn't understand why, and that's traumatic, that's scary for the child because they can't ask for help and they're not getting relief. So we want to recognize sensory gating issues and educate people about them. If child is fussy, whenever you do this, instead of getting angry or ignoring it, get curious, think about what is it that is causing this child to react in this way to this thing? Being bullied or other victimization is also an environmental risk factor for the individual if they don't feel safe, whether they're infants or children or adults. If they don't feel safe, that is exhausting. That can be traumatizing relationally or interpersonally. Adverse childhood experiences, abandonment and just generally chaos can be a risk factor for mental or physical illness and low self esteem. And these are not all of the risk factors, but I'm hitting some of the big ones. And I want us to realize that we need to look at ourselves and say, what unique characteristics or experiences have I had that might make me more prone to develop a mental illness or physical illness and how can I prevent it? How can I safeguard myself so I don't go there affective or cognitive risk factors in the individual. I already talked about trauma, abuse and neglect on the last slide. But it's important to recognize that emotional abuse is also abuse and it can have lasting impacts. Pre existing mental illness is another risk factor. It's not uncommon for people to have multiple mental health diagnoses. Inappropriate coping responses is something else that's a risk factor. If somebody doesn't have emotional intelligence, if somebody doesn't have skills and tools to tolerate distress and to cope with it and modulate their emotions, then the world is going to feel very scary and very overwhelming. So from a protective standpoint, we want to help people identify any mental illnesses they may have early. We want to prevent trauma, abuse and neglect as much as possible, but also educate people about the impact of that if they experienced it, so they can figure out, all right, well it happened. Now what, what do I do? And educating people about effective, healthy coping tools. Distress tolerance skills, mindfulness, problem solving. There are lots of tools out there that can be super helpful. But the key is to help people learn them. I mean they're, they're great, but if you have a bunch of tools and you have them in a toolbox that's in the basement, that ain't going to do you any good. We need to get those tools out of the basement and get them out to everybody so they can use them to build this happier, healthier universe. Addiction, smoking, violence and aggression, risk taking and impulsivity. Academic failure. These are other individual risk factors. And I do want to note on academic failure that can be for a lot of reasons. Many times, most times it's not because the child's IQ is too low. It's because the child is malnourished, is not rest well, rested enough, has experienced trauma, has adhd, there's, there's, may have a learning disability that hasn't yet been diagnosed. There's a whole list of reasons, things that contribute to academic failure. Maybe they don't have good study skills. So we need to get curious. What is it that's going on with this individual that is contributing to their academic failure? Because we don't want academic failure to contribute to low self esteem, to contribute to depression and then the development of addiction. I know that's catastrophic thinking, but it can happen again. Lack of information on positive health behaviors. We need to help people from the time they are, as I've said before, knee high to a grasshopper. We need to help people understand what it takes to be healthy. It doesn't mean you've got to Be radically healthy. You can have a life where you enjoy, you know, things in moderation. You can enjoy a chocolate bar here and there, or pizza. Those are mine. But helping people understand why excess is bad, helping people understand what they can do to protect themselves against free radicals and those sorts of things. Rebelliousness in a child or in a person actually is also a risk factor for mental illness. We want to ask ourselves what? Why is this person being rebellious? What is the benefit to them to be rebellious? And how did it protect them in the past? In what way is it serving them now? And you know, in what way is it not serving them? And then we can use motivational interviewing techniques in order to help them decide whether they want to change the way they approach things. Rejection of pro social values. This can be because somebody falls in with a crowd that rejects pro social values. But a lot of times at the crux of all of that is people rejecting pro social values because society has rejected them. Society hasn't been there to help them. Society has not supported or cared or loved for them. So why should they embrace pro social values? Why should they care about anybody else if nobody else cared about them? There are things that we can do to help people. But again, when we talk about prevention, we want to prevent people from feeling rejected, prevent people from feeling unsafe in the environment, and help people develop empathy and compassion for others as well as themselves. Lack of peer refusal skills. This is one that's hard. It's one that's hard to develop. And youth who have attachment issues, youth who are desperate for approval from somewhere, especially youth with low self esteem, often have poor peer refusal skills. Early and persistent problem behaviors. Early sexual activity and peer rejection are also risk factors that we want to consider. And this isn't just when the person is a child. This is as an adult. We want to look back and say, did you experience these things? Oh, well, if you did, then let's look at how that might be contributing to your behaviors, your feelings, your reactions in the present, and what can we do about it? What can we do to help you cope in the present with how your past is impacting you? In terms of productive factors helping people learn those positive wellness behaviors, including exercise, nutrition, diabetes and blood sugar control and sleep. I already mentioned those. Help them bond to pro social culture. But that means getting to know them as an individual, not saying, okay, you need to like everything we do, we need, you need to agree with everything we do. No, pro social culture means respecting people's individual differences and synergizing with them and getting Curious and wanting to know more. So helping people find a place that is pro social and where they feel like they belong. Participation in extracurricular activities can be one of those places. Helping people develop a sense of social competence. And this is such a big deal these days. As people have become more attached to their digital devices and texting and that stuff, they've become much more comfortable in face to face settings and actual IRL interactions. So helping people develop a sense of social confidence in in IRL interactions is really important. Encouraging the development of a sense of well being and self confidence. Life is not going to be perfect, probably ever. However, there is often a lot that is going well in addition to the things that aren't going well. So helping people develop what we call hardiness skills can be super helpful to instilling a sense of well being so they can see the good with the bad and they can embrace them both and go, well, this over here sucks, but I also have these things that are going well. Helping people develop positive future plans is also important as a protective factor. If they don't know which direction direction they're going, then they can get caught up with any wind that comes and pushes them by. That's not exactly the metaphor, but you know what I mean. So if we help people identify where do you want to be a month from now, six months from now, five years from now? And I have videos on the channel that talk about helping people define their rich and meaningful life, what it, what is it that would make your life rich and meaningful? What people, places, activities, things would make your life rich and meaningful. That's what you're working towards. That's where you want to use your energy to move toward that. So once they have a vision of what they're moving toward, it can be very helpful and helping them develop negative or at least cautious attitudes towards substances and substance use. The environment the person interacts with on a regular basis, their family, peers, school, church, neighborhood and health services may increase the risk of experimenting with high risk behaviors or developing mood disorders, or decrease the risk depending on the health of those microsystems. A person's closest social circle, including peers, partners and family members, influence their behavior and contribute to their range of experience. So always start at home. Health starts at home. Start in your little corner of the universe and figure out what can I do in order to feel safe, empowered, and as happy as possible in the moment. In terms of peer and family risk factors, if peers and family reinforce unhealthy norms, everybody's doing it or do as I Say not as I do. So if caregivers are saying you shouldn't drink and they are polishing off a bottle of wine every night, that's a mixed message. So it's important that we model what we, we teach, we practice what we preach. Early sexual activity among peers has been found to be a risk factor. We want to educate youth. Youth we know are going to do what they are going to do. However, we want to make sure that they have the information they need to make an informed decision. Ties to peers who lack appropriate coping and emotion regulation skills and who embrace antisocial norms. We already talked about this a little bit, but it's important. We can start from kindergarten or preschool or even before that teaching coping and emotion regulation skills, teaching empathy and compassion and those pro social norms. Family members who don't spend much time together. Parents who have trouble keeping track of youth and families that have a lack of clear and consistent rules, limits and, and consequences or if there is conflict and abuse and, or these are all risk factors. There is a lot of chaos here when you, when you see this, when you talk about families not spending much time together and you know, 6, 7, 10 year olds having to make their own meals because their caregivers are at work or you know, are passed out drunk or whatever if it's a family. And right now, unfortunately, the way societies are, there are a lot of people who have to work two jobs. I grew up as a latchkey kid. I'm not, you know, I'm not dissing the parents by any means, but I am saying that when they're, when that situation does exist, that there is a higher risk. So we need to take steps to make sure that those latchkey kids, for example, have the resources they need in order to prevent problems in the future. In terms of protective factors, one of the strongest protective factors is developing secure attachment. Even if caregivers aren't there, you know, in body and mind 24, 7, which is not realistic. If children know that their family or if people know as they grow up they know their family will be there for them, they can trust that their family will be there for them. It provides a sense of safety and empowerment. Again, other videos talked about how to develop secure attachment, but basically I use the mnemonic craves consistent awareness or mindfulness of your own feelings, thoughts, wants and needs. But also in your family, those around you, their feelings, thoughts, wants and needs. Now that doesn't mean get all up in everybody's business, but that means noticing instead of being completely like obsessed in your phone or watching TV and oblivious to everything else that's going on. Noticing, being cognizant of what's going on around you. Responsiveness that's sensitive and timely. If a person in your family or a child is in distress, responding by going, hey, what's wrong? Or would you like to talk? Or do you need a hug? Or whatever's appropriate. But responding in a sensitive manner to help that person feel safe, heard and respected. Helping them if necessary. And this is more true for children, helping them identify what emotion they're feeling and use distress tolerance skills so they can get into their wise mind and figure out how to solve the problem. This is important, and this is key in that initial attachment relationship where caregivers help children learn how to identify what this feeling is. And okay, now, how do I get it under control? Not necessarily make it go away, but how do I tolerate it and how do I get it under control? Positive attention. And this is spending time with your family, with your peers in a positive way. Not just when there's a problem, but because you actually enjoy spending time with them. Imagine that. Validation and empathy. Empathizing with people, you know, recognizing how they're feeling and validating how they're feeling. You don't have to agree with them. If they're scared and you're like, what's to be scared of? That doesn't mean they don't have a right to be scared. You know, I think of roller coasters. I'm terrified of those things. My cousin thought they were the greatest thing in the world. So validating that I'm terrified of them. He's a, okay, you know, you can be terrified. I'm not. I'm gonna go do my thing. So he didn't tell me I was wrong for being terrified of roller coasters. He didn't understand it and he told me that, but he didn't tell me I was wrong or I was stupid. He just said, I disagree. So validation doesn't mean co signing on it. It just means I see from. From your experiences, from your point of view, this is how you're saying you feel. Encouragement for using coping and problem solving skills and learning from experiences and growing from them. Instead of feeling like you have to be perfect. That whole progress, not perfection. So encouragement comes from family and peers. They love you for you even when you make mistakes. And they want you to learn from those mistakes. So it does you don't hurt in the future. And then providing safety and un. Which through unconditional positive regard, again, they love you. For you love the person, dislike the behavior and assertiveness. Why does assertiveness under safety? Because when we communicate aggressively, we are invading someone else's boundaries. We're telling them how they should feel or think or whatever. That's not okay. So with assertiveness, we're saying my thoughts, wants and needs are equally as valid as your thoughts, wants and needs and I will respect yours. I may not agree with them, but I, I will respect your right to have yours. And that creates what we call cognitive safety. This secure attachment helps people feel safe, helps people feel connected, and helps them have a sense of love and belonging. And going back to Maslow's hierarchy, that's the third level we have biological needs. Safety, then love and belonging. In terms of protective factors, close family relationships are super helpful. Where people know that they've got one or more family members or friends that they can go to. When they've got a problem, they know they can count on somebody. Relationships involve pro social activities, whether it. And that doesn't mean volunteering all the time. It means doing things that are positive. Not going out and, you know, spray painting buildings or stealing cars or something. Going out and playing golf or playing tennis or hiking in nature. Things that are positive and promote social bonding between two individuals in a way that is beneficial and not harmful to anyone else. Consistency of parenting, of course that is helpful goes back to that Secure attachment. Education is encouraged and parents are actively involved. Obviously this is more for children, but it is important to recognize in our society, whether you like it or not, there is still definitely a an emphasis placed on higher education. The person copes with stress in a positive way, is aware of clear expectations and limits within the family. You don't expect mind reading. You know what you're supposed to do. You know what the consequences are if you don't do what you're supposed to do. You don't have to guess like ooh, maybe I was supposed to do this today and they're mad at me because oh gosh, that just adds stress. Assertiveness with clear expectations and limits supportive relationships with caring adults beyond the immediate family are also encouraged and developed. And this is true in for, for children as well as for adults. Because the immediate family, the immediate caregivers may not always be able to be there. So who else can you know, the child go to? Sharing and family responsibilities, including chores and decision making that the part, the belonging part, the you're loved and you belong. People want to hear what you have to say. You actually impact the environment. You impact the family and family members nurture and support each other. In terms of school risk factors, there's a lack of clear expectations, both academic and behavioral, for a lot of students. What am I supposed to do? How do I get an A? What do I need to do? And I think a lot of us struggled with that in school where it was like, you know, I'll write the report and I'll do my very best, but I really don't know. Rubrics are super helpful. If the teacher says, this is how you're going to be graded, then the child or person in older schools in college can look at it and go, okay, now I know what I need to do. Students lack of a commit, lack of commitment or sense of belonging at school. Too often school is just kind of a warehouse for children during the day. We want them to feel like they belong, feel like they matter, feel like they have a say, feel like the school, get this, the school is, is interested in them. They actually contribute in some way. But that means we've got to have opportunities that are diverse and meet the needs of the different people. High numbers of students fail academically because of learning disabilities, trauma, adverse childhood experiences, misdiagnoses. So maybe they've got trauma, but they're diagnosed with adhd. That's going to be a problem. Lack of adequate nutrition and sleep deficiencies. We need to address these. We need to make sure we're screening for these. We need to make sure that students have, and families have access to proper nutrition and theoretically can get enough sleep at night. And parents and community members need to be actively involved. We don't know what the gaps are in the community if the caregivers aren't involved. We can't, you know, help improve some of these school risk factors unless we know what's causing them. What is causing a lack of nutrition at home. You know, how can we address that from a community standpoint? Positive attitudes towards school, you know, they can happen. Regular school attendance is important. So we need to make sure that people are getting there and, and they're awake. High academic and behavioral expectations are communicated. That's another protective factor. And goal setting, academic achievement, and positive social development are taught and encouraged. People are not born knowing how to set goals. Heck, I've worked with clinicians who are in graduate school who can't write a treatment plan because they still haven't figured out how to effectively articulate goals. We need to teach people goal setting and study skills and all that stuff. There's a positive instructional climate. It's not one of it's all about grades. It's about encouraging curiosity and encouraging learning. There are leadership and decision making opportunities for students, their active involvement of students, parents and community members. And the school is responsive to students needs, including making sure that there is adequate opportunity for students to access tutoring, that the environment is safe and that everybody's belly is full. They need to have food in order to be able to have blood glucose in order to be able to learn. In terms of community risk factors, the characteristics of settings in which social relationships occur which are associated with developing mood disorders and addictive behaviors such as schools, workplaces and neighborhoods. So we need to look in the community and go, what might be contributing to anxiety, depression, trauma, a sense of unsafeness and, and it's not just, you know, on the street. We need to look in our own workplaces. There are some really hostile work environments. We need to look in our neighborhoods and we need to say, what can we do to make this environment nurturing and supportive and safe. We want to help encourage neighborhood stabilization so people aren't constantly moving in and out because they're trying to find a job or they, you know, can't afford the rent anymore. In communities, we want to encourage people to have connection, to actually know their neighbors. Maybe they're not best buds, but they know their neighbors. I know in the neighborhoods that I have lived in, people know the different cars that are supposed to be going in and out. We don't get together for neighborhood bar, neighborhood barbecues or anything. We're not that, you know, warm and fuzzy, but we're aware of who's supposed to be here and who's not. High unemployment and a lack of affordable housing is another are two more community risk factors. If people can't keep a roof over their head, they're going to be really hard pressed to stay healthy and happy and, you know, not anxious and depressed. There are strong social institutions. We need to make sure that people have that safety net to provide, you know, food banks and counseling and dental care and medical care even to people who don't have insurance. Because there's a lot of people out there who don't have insurance and they don't have Medicaid. Now granted, they can usually get on the, whatever it is, the plan, the, the government plan. But I digress. It is important to make sure that people know that they can access services. Lack of monitoring of youth's activities and alcohol or other drugs are relative readily available. Youth need to be supervised. They don't want to be especially older Youth. But there does need to be some level of supervision of what's going on with youth. And figuring out how to do that, you know, can be a challenge. Some communities have decided, like churches, synagogues, community centers have created after school activities and weekend activities where youth have the opportunity to go and play board games or video games or just hang out in a place that is welcoming to them and is not the street or some parking lot or somewhere else where they might be getting in trouble. The goals of prevention are to promote attitudes, beliefs and behaviors that ultimately provide all people, regardless of age, ethnicity, gender, anything, all people with safety and the ability to meet their basic needs. So how can you do that for yourself in your family, in your neighborhood, in your community? Love and belonging, secure attachment and reduced isolation? Again, how can you do that for yourself and then for your family, for your neighborhood, for your community? How can you develop self esteem in yourself and others? How can you develop emotional intelligence in yourself where you can identify, okay, this is what I'm feeling and why I'm feeling it, managing it. This is how I had tolerate the distress and response and coping. All right, this is unpleasant and this, these are my response options. These are the choices I have for how I can cope with this. You know, we need to develop that in ourselves and teach it to our children and develop it in our communities. Awareness of individual needs. These are your vulnerabilities. What do you need to be happy and healthy? Providing that health, literacy and motivation to engage in positive health behaviors and teaching as well as modeling effective interpersonal skills education and life skills training is also important. This can be integrated into curriculum for, you know, books that children read in school, health classes, fitness classes on the Internet, on social media. There are a lot of places where we can get information out and it's better to, to get it out in these little chunks so people can hear it and digest it than to try to provide them 100 page book that they may never read. Schools, as I mentioned, can have the curriculum that teaches a lot of these things. We schools can be a partner in ensuring that everybody has access to adequate nutrition counseling, screening and for the children, tutoring media, as I mentioned before, public service announcements by influencers on social media and the providing trustworthy educational content can go a long way to helping people live happier and healthier. Community centers, libraries and religious organizations can offer workshops, wellness fairs, camps, after school activities, tutoring and even volunteer case management. I have a whole series on that on the YouTube video, on the YouTube channel in the community. Encourage community leaders to Try to figure out how to fund available and affordable counseling, nutrition, medical and dental care. There are a lot of providers out there who are more than willing to donate one weekend a month or one Saturday a month. But it's up to the community leaders to provide them a place to do that and help get the word out. And finally, law enforcement. Ensuring that law enforcement is trauma aware, they understand the impact of trauma and how their presence may actually elicit strong reactions from people and community oriented policing. If people start to get to know the law enforcement and law enforcement gets to know the people, then you're going to start to have that connection, that bond. And finally, we need to improve the climate, processes and policies within the community, school and workplace to be sensitive to individual needs and responsive or aware of the impact of trauma on individuals so we can create environments that are safe and empowering instead of re traumatizing, stigmatizing and illness causing. The socioecological model identifies how the individual impacts and is impacted by not only their own characteristics, but also those of family, peers, community and culture. Any change in the system will have an effect on all other parts of the system. So we want to make sure it's a positive change. Addressing physical and mental illnesses, trauma and addictive and disordered behaviors requires a multi pronged approach in the individual and the family and the community in order to make sure that that person is nurtured in their recovery process and then that recovery process can be sustained.