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Peter Franz: Welcome everyone. Thank you so much for being here today. This is a presentation on multicultural suicide risk assessment presented by Dr. Sherry, Mullick, and hosted by the American Psychological Association Division, 20 nine's early career professionals, domain.

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Peter Franz: the early career professionals domain is dedicated to supporting career development of mental health professionals, and fostering a diverse community to generate and share evidence-based clinical practice.

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Peter Franz: The Apa is offering continuing education credits for registered attendees of this webinar, who are also registered members of Apa Division 29. Please refer to the invitation email for instructions for registering for the division 29 in addition, we'd also like for attendees of today's webinar to complete a brief quiz which will be linked during the meeting in the chat by Dr. Zach.

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Peter Franz: and with that I I also then just want to introduce our speaker today. Dr. Sherry Molak, who's an associate professor of clinical Psychology at George Washington University in Washington, DC. Dr. Mollock's program of research focuses on better understanding risk and protective factors for suicidal thoughts and behaviors in African American adolescents and college students, focusing especially on cultural factors that play a role in suicide risk.

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Peter Franz: In these populations.

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Peter Franz: Her published research has been cited extensively over 3,000 times, according to Google Scholar and Dr. Mullick is also an ordained minister who studied the protective role of religiosity, and she has developed suicide prevention programs for youth in face faith based communities.

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Peter Franz: So today's presentation will be focused on the assessment of suicide risk in minoritized groups using culturally attuned assessments.

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Peter Franz: I also wanna thank the division 29 for hosting this as well as the Division 29 s. Early career professionals domain for supporting this work that we hope will enhance the clinical training of a number of young professionals.

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Peter Franz: Thank you so much for being here, Dr. Mullick. I'll get the those tones muted in the background. But if you'd like you could share screen and get started.

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Sherry Molock: Alright. Thank you guys so much for inviting me. It's an honor to be here.

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Sherry Molock: and I'm going to go ahead and share my screen. I'm going to apologize in advance.

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Sherry Molock: I have my 2 furry babies in the room with me. They are typically quieter when I'm in there with me, but there's no guarantee of that.

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Sherry Molock: So if you hear barking, that's who that is

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Sherry Molock: on the background.

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Sherry Molock: Okay, can everyone see my slides?

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Sherry Molock: You're good. Okay? Great. Okay. So we're gonna talk today about multicultural suicide risk assessment. And we're gonna be focusing a lot on the importance of context

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Sherry Molock: and in the in the spirit of context and then practicing what I preach. We showed this slide when I start a presentation which is my context.

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Sherry Molock: And so you'll see, these are pictures of my family, including my 97, almost 98 year old Dad.

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Sherry Molock: who's still living alone and independently, is still driving by himself. And it's doing quite well is my young adult children

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Sherry Molock: and my grandchildren and just things I like to do. Some of that's my work, and I'm gonna encourage you to create your own collage, because I think sometimes we act as though we live in a vacuum where we just do research, and we just do clinical work, and that's not all that there is to us. But, in fact, we're very multifaceted individuals.

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Sherry Molock: plus. It's a fun way to show pictures of your family. So this is my context.

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Sherry Molock: So I wanna also acknowledge my colleagues in the youth suicide research consortium. The talk I'm gonna be doing today is based on a article which I hope I think I sent for you guys to read this in the American psychologist, but I did not write that alone.

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Sherry Molock: and in fact, we consider ourselves to be Co. Equal authors on the paper. And so I just wanna give a shout out to my colleagues and the youth. Suicide, resource, construction, which I must admit is the best group

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Sherry Molock: of researchers and suicide have ever ever worked within my life. It's such a joy for me to work with like minded people, and to really not just meet to get and talk or produce reports that we actually do meaningful things, including a conference in June, and we've had several publications that have come out of working in this group already. So I encourage you. If you are interested in suicide, youth, suicide research to consider joining the consortium.

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Sherry Molock: This is just a copy of that article which I'll be talking about today. You can see again, there are multiple authors and everyone contributed equally.

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Sherry Molock: So we're gonna talk about identifying risk and protective factors for suicide, for youth and communities of color discuss approaches to suicide risk assessment for youth from communities of color. And I'm gonna really encourage you to consider using more non-traditional suicide risk assessment tools, particularly for this community.

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Sherry Molock: So I like to start with definitions, because

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Sherry Molock: labor, not in suicide. Research is not consensus on definitions

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Sherry Molock: and part of the problem with equivocal findings in the research

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Sherry Molock: on suicide in particular, youth is that we don't always agree or not operationalizing terms in the same way. So suicidal ideation, our thoughts of harming or killing oneself.

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Sherry Molock: And they, you can assess the severity of suicide ideation by looking at frequency, intensity, and duration. And that's actually very important, because it's not uncommon for young people to have fleeting and very big diffuse spots of suicide. But it's when those thoughts become more intense, more frequent, and more specific that we become more concerned.

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Sherry Molock: A suicide attempt is a potentially injuries behavior that is directed towards the cell. Really, importantly, the intention has to be to die. And typically, when we talk about this.

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Sherry Molock: we talk about this as being imminent

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Sherry Molock: and a suicide Champ may or may not result in injury, and then suicide is death caused by self, directed injuries, behavior where the intent was to desire to die as a result of that behavior.

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Sherry Molock: And we typically don't use the term commit suicide because suicide used to be a considered to be a commission of a crime. In most States. I think it's a few States is still true, and so we don't want to infer the people who are

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Sherry Molock: caught in the throes of depression. Other mental health challenges are committing a crime as well. There's already enough stigma associated. So we typically say things like suicide die by suicide, suicide, fatality, fatal or fatal death.

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Sherry Molock: The words or terms that we typically use.

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Sherry Molock: This is based on the

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Sherry Molock: wire. Bs data. The most recent one that's available is 2021.

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Sherry Molock: And there's lots of different indices about suicide. I just wanted to point out this one for youth. And you look at about 10% of you.

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Sherry Molock: tried to attempt suicide in the past year

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Sherry Molock: typical pattern that you see is that females are more likely to attempt the males, which is pretty common. Also want you to look at the when you look at racial differences that Alaskan, in American Indian Alaskan natives have the highest attempt rate, followed by black youth, the black youth is significantly increasing.

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Sherry Molock: The other thing to notice about this in this, in part points to why we need to do suicide risk assessment with the cultural lens is when you look at the the data that says black youth are feeling sad or just, or

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Sherry Molock: I'm depressed.

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Sherry Molock: The rates are actually lower in black youth. It's not much higher when you look at Temps. And so it lets us know that there's some issue with the way we're asking questions of black youth about attempts or about.

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Sherry Molock: I'm suicidal thoughts and suicidal planning, because their rates are actually lower at them. And so oftentimes we say that black youth under report. I don't like that term, because it implies that they're doing something wrong as opposed to. I mean, they were not asking the right question. So we will say we're not capturing something with some of the risk factors earlier that occur or tend to be frillless of suicide attempts, particularly in black youth.

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Sherry Molock: And so you look at this also. Multiracial youth have elevated rates as well. When you look at sexual identity and sexual orientation, Lgbtq plus users significantly more likely to feel depressed to have so cell thoughts have suicide intent, have a specific plan.

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Sherry Molock: and to make an attempt compared to their heterosexual counterparts. And when you look at this question another way, which is the sex of sexual contacts?

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Sherry Molock: Any same sex

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Sherry Molock: also always outpaces those who use have opposite sex partners only.

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Sherry Molock: So now wants to talk a little bit about risk and protective factors for suicide.

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Sherry Molock: So risk factors out. And I'm I'm gonna apologize in advance. I use the common denominator that you know nothing about this, and you might know a lot about this. Some of this may seem a little elementary to you, but wanna make sure we're all on the same page. And more importantly, that we when we use these terms, we're talking about the same thing. So risk factors are characteristics that increase of likelihood

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Sherry Molock: that a person will develop a problematic behavior. Risk. Factors can change over time, risk factors for suicide include family history of suicide.

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Sherry Molock: a history of depression or other mental health challenges.

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Sherry Molock: Unfortunately particularly for youth of color, the school to prison pipeline is alive and well, and young people are at high risk for suicide attempts at every point that they interface with the system. So from the time kids are picked up to the times that they make an entree into the system, the time that they are adjudicated. If they go home in between

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Sherry Molock: being charged with the with a crime, and having to go into trial and trials can. The time it takes to go to trial can be one or 2 years. So if you think about these are young people who are in limbo for that time period, and not really sure of their future outcomes, and where they're going to be with the disposition, for the case is going to be

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Sherry Molock: kids who have been multiple repeaters into the system. Sometimes lose family support along the way because family run family run out of goodwill. Sometimes they run out of resources. And so all of those things place these kids at risk having easy access to lead domains. We know that the number one cause or method that's used for

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Sherry Molock: for youth, particularly males as firearms.

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Sherry Molock: and the more leaf of a mean, the more likely there an attempt is going to lead to a death.

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Sherry Molock: The easier the access. So rule of thumb for here is that you want to put time and distance between

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Sherry Molock: the method that that young people or anyone actually is using. Etoa stands for alcohol. So alcohol and drug uses particularly problematic and youth about 50%. All youth who attempt to assign are intoxicated on some kind of substance at the time of their their attempt

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Sherry Molock: exposure to suicidal behavior of others more than any other age group youth are more likely to engage in modeling. And so it's not uncommon

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Sherry Molock: to see clusters of suicide amongst youth, and particularly if those suicide attempts or deaths are romanticized or glamorized. And what we mean by that is, when when the media paints this picture is sort of

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Sherry Molock: a lost soul who's gone onto a better place. That kind of imagery can be dangerous, and for young people who are vulnerable it can seem, make suicide seem more appealing. So it's not that we are encouraging Media not to talk about suicide, but not to talk about in a way that romanticizes it.

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Sherry Molock: Residential mobility is important, because the more stable your community and your involvement in it, the more likely you are to feel socially connected, and that reduces risk for suicide. As I said earlier, being a member of a sexual minority group is a risk factor. Stigma and any sort of source loss.

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Sherry Molock: Protective factors are characteristics that help people adapt to different levels of hardship. And I think there's a lot of confusion, particularly in research between promotive factors and protective factors. So promotive factors also help people adapt. But there is, regardless of context. Protective factors always occur in the context of adversity.

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Sherry Molock: Protective factors can be grouped into 5 categories, strong family relationships, religious and spiritual engagement, which is the fact that I tend to focus the most with my research along with community support

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Sherry Molock: personal factors which we all tend to focus on in our clinical work, particularly self-esteem, emotional well-being

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Sherry Molock: and factor. Such a stable housing.

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Sherry Molock: income and employment. So oftentimes, when I talk about this, what I share is that if we could stabilize everyone's housing.

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Sherry Molock: have affordable living in terms of a livable wage.

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Sherry Molock: and can stabilize people's employment. And along with that food security a lot of the risk factors for suicide would dissipate.

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Sherry Molock: So I wanna talk a little bit about the myth of John Henryism. And I wanna talk about that because a lot of our clinical efforts and research efforts at the individual level tend to focus a lot on promoting resilience and resilience obviously is very important protective factor for suicide and other mental health challenges. But the the problem with only focusing on resilience

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Sherry Molock: is, you're only focusing on the individual. And you're not addressing systemic issues. So Brody and colleagues found the average American youth who are from high risk low ses, backgrounds

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Sherry Molock: with high levels of social and academic competence. In other words, they were really resilient when you follow those kids over time as they be going mature into adulthood and particularly middle adulthood. They have higher biological indicators for physiological stress, so they may be resilient and they may be functioning well. But there's a cost to that.

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Sherry Molock: and when they're older they are more likely to be at risk for developing hypertension diabetes. And so when we do our work, we can't just focus on making the person stronger.

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Sherry Molock: And I call that the

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Sherry Molock: challenge or promoting resilience lilies versus dandelions. So you know anything about flowers, and I love lilies. Lilies are very beautiful, but they're also very sensitive, and they need to grow in the right light and have the right water and really enrich soil.

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Sherry Molock: And when we talk about resilience for young people, we really talk about dandelions, and you may have even heard of this metaphor where we talk about. You know, these these are kids who can

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Sherry Molock: thrive in any environment, including brusting through concrete.

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Sherry Molock: And the the issue with that is, why should they have to.

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Sherry Molock: So yes, we want kids to be strong and sturdy, and to be able to bounce back from lots of adversity. But why don't we also address the things that make their environments and adverse. In the first place.

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Sherry Molock: so, continuing with protective factors, a lot of what those protective factors we talked about earlier have in common is they help people

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Sherry Molock: feel socially connected. And we really saw that where this mattered during covid, the covid 19 pandemic right? So many of the factors

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Sherry Molock: that are talking about social connectedness. You can think about that at the individual level which is looking at social connections within family and friends, but also at the community level, which is, does the person live in a socially cohesive community?

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Sherry Molock: So I like to share the story that when I was growing up

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Sherry Molock: millions of years ago in Baltimore, I lived about

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Sherry Molock: within a one and a half, 2 mile radius of my entire extended family

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Sherry Molock: and my mom's family. She was one of 14,

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Sherry Molock: and I had 6 aunts and 8 uncles.

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Sherry Molock: and so everyone knew me, either through them or through my brother, and then we also had neighbors who literally sat on their front porch to sometimes looked out for their second story window and watched all of us come home from school.

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Sherry Molock: so that if something were going on in my community, there were almost like checkpoints every every 3 or 4 houses of people who were watching out for you. They also sent new if you were doing something wrong. So if I was doing something I wasn't supposed to be doing. By the time I got home my mom was literally waiting on the porch, and I would go no so and so.

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Sherry Molock: So, you know, sort of snitch dot me the other thing in my family, because there are 14 of my mom siblings or brothers, 13 brothers and sister. There are 32 grandchildren in my generation. I'm in the older group. And so the older kids always babysat the younger kids. And so I, babysat, from the age of 12 to about 12, went to college 18, and never was I paid.

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Sherry Molock: So that was also a rule of thumb. You couldn't get paid because it's family, and literally I have cousins who are in their fifties now, who still look at me as this big cousin who's gonna take care of things for them. So we have such a strong knit, cohesive net of community, because there was always someone you could turn to. If you didn't feel comfortable. Turning to your parents, you could turn to aunts and uncles could turn to cousins. And so that's that social net of fabric that's really really important.

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Sherry Molock: The other concept that's really important is mattering

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Sherry Molock: and mattering is something particularly in faith communities that is so rich.

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Sherry Molock: And it's people who notice when you're there. But they also notice when you're not there, and they check up on you. People care about what you think, they care about what you say, how you feel about things. These are the groups of people who celebrate when things are going well for you, but they also lament with you when things are not going as well, and they rely and depend on you, and the degree to which you feel don't matter is the degree to which you will feel marginalized.

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Sherry Molock: So now I want to talk about the use of existing. So suicide, risk assessment measures on youth of color.

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Sherry Molock: Unfortunately, there is very little research on formal validation of existing evidence based suicide, risk, assessment measures for youth of color.

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Sherry Molock: A lot of that is, we tend to use tools. And I'm not gonna name any. But they're commonly used tools, for example, for depression, and because they are used a lot with African, American, or Latin, or Asian, American or native American youth, we assume that they're culturally valid without actually doing the research to actually demonstrate that so just having large groups of youth from communities of color in a sample does not mean that the measure is validated.

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Sherry Molock: Establishing

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Sherry Molock: reliability and validity and assessment tools doesn't mean that they should function equally across racial ethnic groups. And we call that the problem of non-equivalence of measures. I just want to give a couple examples.

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Sherry Molock: So one of the questions that people sometimes ask. I hope you don't ask this question.

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Sherry Molock: Who's the better athlete so known? Bowels are you saying both?

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Sherry Molock: And if you're like me and I love, I love track and field. Mike. All 3 of my kids did participate in track and field, and I love gymnastics just to watch it. So there, this, this seems like a ludicrous question, right? Because they're different athletes, cries, different training, different skill sets. And so we do the same thing, though when we conduct research in different cultures, we compare across cultures without recognizing that there are differences in language.

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Sherry Molock: norms, shared meetings and values. And so that question may become difficult to answer when we're comparing people across different cultural communities.

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Sherry Molock: Similarly.

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Sherry Molock: who's the better athlete, Mark Spitz or Michael Phelps? And so it's hard to answer that question, because, even though it's true that both of these people were excellent swimmers and Olympic gold medalists.

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Sherry Molock: The training that was required now, the way that athletes train

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Sherry Molock: the way people approach the sport is so different. And these athletes are almost 3 decades apart. So it's really hard to do that. And so if you think about some of the concepts that we measure that we assume occur the same way over time, for example, would be exposure to racial discrimination and prejudice.

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Sherry Molock: And so sometimes people will think well. Racism and discrimination has decreased, not necessarily the form, and that it takes may have also changed. So, for example, youth from communities of color, have more exposure to racism online is that reflected in our risk assessment questions.

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Sherry Molock: we currently don't consider victim, precipitate victim, precipitated homicide, or some people call it suicide by cop as a form of suicide. But should we?

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Sherry Molock: And I know the people that I have seen clinically, I'm a child psychologist by training. I've had young people who will put themselves in really dangerous situations. They're not actively pulling a trigger, but they also will say to you, I don't want to kill myself, but I'm gonna let someone else do it.

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Sherry Molock: And so yet, right now, on our current definitions, we don't consider that

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Sherry Molock: a form of suicide. And so we need to think about. Maybe we need to change the way we operationalize what it means to take, make a suicide attempt.

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Sherry Molock: There is one suicide risk assessment that specifically looks at culture to date that I'm aware of. It is called the cultural assessment of risk for suicide. The cars

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Sherry Molock: it's specifically designed to integrate cultural factors related to suicide risk and evaluate the psychometric properties of the tools, particularly with ethno racial minority populations.

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Sherry Molock: So it has captured culturally salient factors, including cultural acceptability of suicide.

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Sherry Molock: verbal and nonverbal expressions of suicidal thoughts and behaviors.

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Sherry Molock: social identity stressors

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Sherry Molock: and the alienation of conflict.

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Sherry Molock: So this measure is really wonderful. There's a new shortened version that has only 14 items on it, but it has not been widely used with minority youth.

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Sherry Molock: So now we're going to talk about the consideration of nontraditional factors in suicide, risk, assessment, and youth from communities of color.

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Sherry Molock: So most of you probably have seen a chart like this. This is a sociocultural or ecological model. That's used by a lot of people who do community-based participatory research.

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Sherry Molock: But it looks at wh, when you do your risk assessment, you can look at it at different levels, at the individual level, which is what we typically do. We can look at the inner personal level, which is family friends and social networks

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Sherry Molock: looking at institutional levels.

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Sherry Molock: community levels. And then policy. And the question, I'm going to the challenge I'm going to bring to you today is, do you do risk assessment at these multiple levels

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Sherry Molock: and to see what difference it makes. And secondly, when you're doing risk assessment? Are you only assessing risk? Or are you also assessing protective factors? Because in in trying to address someone's suicidal behavior and thoughts, we want to decrease risk factors. But we also want to use protective factors as a mechanism for intervention.

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Sherry Molock: So this is from the article in the American psychologist. And this is us looking at or making suggestions about doing suicide, risk assessment at the societal level, the institutional level neighborhood context and the family context. We don't have time to go over all these in detail. I just want to talk about a few of them, and please feel free to put questions in the chat, and we'll have some time for questions as well at the end.

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Sherry Molock: So the societal level we can look at stigma

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Sherry Molock: and stigma made

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Sherry Molock: be self, stigma or courtesy, stigmas, courtesy, stigma is what happens when stigma is extended to people who are close to you. So it's kind of that, old added what goes on in our family stays in our family. So the stigma then associates with the family members, and so there it strongly it. It puts a strong emphasis on not sharing information about mental health challenges.

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Sherry Molock: So youth may find self disclosure and help seeking challenging because of self stigma. And that's one of the theories about why black youth may not be as disclosing, even in the context of a suicide, risk.

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Sherry Molock: or suicide attempt. I had a former client who, made an attempt by swallowing class.

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Sherry Molock: went to the emergency room, denied that it was an attempt, and was sent home the same day.

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Sherry Molock: So that's my one of my horror stories about that. The the strength of stigma and her mother was with her, and her mother didn't

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Sherry Molock: contradict her story, or deny or

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Sherry Molock: note that this was, in fact, a suicide attempt.

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Sherry Molock: Okay, so one of the ways that we can make a small change is when we do our suicide risk assessment to ask the suicide risk assessment questions later in the assessment process, to give yourself in the client a chance to maximize, rapport

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Sherry Molock: and increase the likelihood of disclosure. So we don't need to start off with, you know. Have you made an attempt to tart yourself or kill yourself, because that's an off putting question, and also the person may not feel comfortable answering it when they've just met. You

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Sherry Molock: could also look at the societal level at acculturation, which is a very complex process, and its role in suicide risk is unclear.

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Sherry Molock: Part of that is because we have to respect that this heterogeneity within racial ethnic groups, Latinx group Asian, Americans.

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Sherry Molock: native American groups.

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Sherry Molock: and that also suicide risk factors may have different presentations.

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Sherry Molock: So we know that in, for example, in African, American and Asian American communities there's less emphasis placed on internalizing symptoms, and most of our suicide risk assessments assume

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Sherry Molock: that people are struggling with depression. So we tend to talk about internalizing symptoms first, and say very little about externalizing. So symptoms. And so we miss an opportunity to do a more accurate risk assessment

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Sherry Molock: concerns about losing face, or particularly

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Sherry Molock: common in Asian American communities. And again, are, have you? Have you? Do you ask questions about that

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Sherry Molock: and then exposure to racism and discrimination, but particularly in multiple contexts.

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Sherry Molock: not just personally, but in the community school and social media. One of our former graduate students at George Washington did a really wonderful dissertation, a qualitative study

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Sherry Molock: on the exposure of racial discrimination for young African American men who were high schoolists, and one of the most depressing and sad findings from that

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Sherry Molock: setting was the amount of exposure that these young men have to racism and discrimination on social media. I was, I mean, they were just giving examples of things. And what was really

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Sherry Molock: heartbreaking was how desensitized they were to it.

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Sherry Molock: So when the asking questions about you know racial epithets that are said while playing gaming with an anonymous person the racial epithets that are, and prejudice prejudicial comments that are in the games themselves.

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Sherry Molock: And so I thought to myself, you know, is there any space that young people can go into where they can get away from these racial discriminizer racially charged events.

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Sherry Molock: My one of my graduate students is actually working for her dissertation on developing a measure of looking at racial discrimination for black females.

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Sherry Molock: And again, when you look at the data, there are no, there's a lot of issues around, particularly standards of beauty. There are no instruments or measures that look at that. And so we need to make sure that we do a really comprehensive examination

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Sherry Molock: and a Mo. A more contextualized contemporary contextualized situation. When we're assessing racism and discrimination.

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Sherry Molock: Looking at healthcare infrastructure, we know that black youth and youth from communities of color are less likely to have access to treatment.

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Sherry Molock: Is that due to poor economic resources, housing and security, food, insecurity

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Sherry Molock: increased access to lethal suicide means those who live in rural communities where firearms are rarely accessible, or who live in communities where it's a cultural norm for people to carry firearms

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Sherry Molock: much higher risk.

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Sherry Molock: And then also those in same communities, particularly rural communities. They may have less access to healthcare professionals, the mental health specialists.

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Sherry Molock: So we might need to broaden our understanding of the healthcare infrastructure. So one of the things I share with my graduate students is when I was in graduate school.

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Sherry Molock: about 3% of people in the United States had a Phd in any discipline.

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Sherry Molock: not county psychology. And when you look at psychologists from communities of color, I believe the the percentage is point 3%

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Sherry Molock: that I graduated in 1985. This is 2024. So almost 40 years later, that percentage is still the same number.

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Sherry Molock: So if we plan to to

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Sherry Molock: intervene.

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Sherry Molock: make sure that we can meaningfully

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Sherry Molock: fulfill that promise of the 0 suicide campaign.

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Sherry Molock: we won't do it by by encouraging people to go to clinicians because they just aren't enough.

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Sherry Molock: And there aren't going to be enough in our lifetime. Probably.

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Sherry Molock: So we need a plan. B, and we need a plan. B, really quickly. And we need a plan. B, that shores up protective factors for you

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Sherry Molock: rather than completely rely on formal healthcare systems because it just won't happen.

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Sherry Molock: So we need to look at what are the organizations in the community schools, faith institutions, local government agencies, community gate based programs that can help connect youth to services, but really, importantly or equally importantly, help to enhance protective factors. And that gets back to what we talked about earlier social connectedness

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Sherry Molock: and mattering.

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Sherry Molock: I use church communities because in the black community black people go to church more than any other racial ethnic group in the United States.

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Sherry Molock: they're more likely to belong to a predominantly black church. About 60% of youth go to church, black youth, go to church regularly, and so this is not saying it replaces

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Sherry Molock: you know how services. But we need something and adjunctive. And we also need something that's gonna helps young people in between sessions, because most of us see kids once a week. Well, what happens? The other 5 days, 6 days of the week. And so we need to have these resources. And we need, in my opinion, we need to develop partnerships.

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Sherry Molock: So the assessment of systems that can buffer the bird to access traditional clinical resources. You can use trained lay helpers, which is the program we're doing right now in New York State. We're developing suicide protection

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Sherry Molock: protective factors.

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Sherry Molock: Programs. Excuse me. And black churches.

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Sherry Molock: And part of that is we're using church members who are trained helpers, who are adults who who normally interact with kids. And they're being trained to enhance protective factors for these youth. You can train the trainer programs. You can develop assessment tools that examine how to maximize the use of available resources.

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Sherry Molock: This is gonna be something as basic. For many years now, 20 years now I have helped churches develop mental health resources. Directories.

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Sherry Molock: is go in at. Talk to people about mental health concerns. One of the major concerns that they're having, whether they where they located you can get undergraduates or even high school students to do this for community service hours. What are the major carriers or providers or clinics in that area? Develop a resource directory, update it once a month.

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Sherry Molock: I know I'm making it sound simple, but it is that simple so particularly involving high school students who are very good at accessing different medium to look up these resources.

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Sherry Molock: this assessment of continuity of cares. Particularly important when particularly kids who run to the er the ed, or who are in or inpatient facility was to step down care once they are returned to the community.

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Sherry Molock: Traditionally trained clinicians may have to be flexible regarding your role as a provider

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Sherry Molock: in our doctoral program. When students do their comprehensive exams, they do comprehensive exams and assessment.

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Sherry Molock: and they do a comprehensive exam and therapy.

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Sherry Molock: and in both of those those exams, they have to do an ecological study of the client.

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Sherry Molock: So they're not. Part of their competency has to be, what's the socio cultural context for this client? Given that context, what resources are available. One of these we're focusing on is don't make recommendations for services that don't exist in their community. And what can we do instead of those services? Because if they're not there, there's no need. There's no point in creating a need that cannot be addressed.

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Sherry Molock: You may have to run suicide prevention programs. You need to develop partnerships with community leaders. We have developed several. We have a a 2 semester community psychology class as required. And so the students have to develop a partnership with a community organization and develop an intervention with that organization.

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Sherry Molock: And our students have done beautiful jobs. With this, we every possible organization you can think of. They have developed partnerships with. We also have a partnership with local high schools where we do stress management for teens. So those are kinds of things that you can do and make it a part of your training

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Sherry Molock: that the neighborhood context, looking at community violence which can be experienced multiple ways, direct victimization. But also what kids hear about in their community, right. And when that's not just living in a violent neighborhood, but also what's going on at school.

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Sherry Molock: and most kids are more aware of what's going on at the school than they are in their own community.

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Sherry Molock: We do know that black and Latin youth are more likely to be exposed to community violence.

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Sherry Molock: So one of the things that you can do is assess the frequency and the degree of exposure to community violence, not just at the individual perception level, because, as I said earlier, some youth are not aware of what happened 3 blocks over. But you can get crime statistics on any level district, because that that information is public.

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Sherry Molock: and you can look at the exposure that when also the information about public acts or behavior, violent behavior in schools is also

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Sherry Molock: public information. So you can get that as well. But also look at what are the protective factors in the community, what? How Co. Socially cohesive or connected to kids, feel to their community are there safe indoor and outdoor spaces. I live in the Washington DC. Area. They have really great boys and girls clubs

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Sherry Molock: for every sport you can imagine and guess what it's free.

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Sherry Molock: And so that's a good avenue for kids to feel connected and safe.

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Sherry Molock: What are the trusted organizations and institutions in the community. And again facilitating the development of partnerships with those organizations.

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Sherry Molock: the family context.

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Sherry Molock: what kind of risk and protective factors are occurring there.

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Sherry Molock: Look at culturally relevant parenting practices, the racial socialization. So

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Sherry Molock: unfortunately, a lot of parents from communities of color have to do what's called the talk you've seen, probably commercials about this.

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Sherry Molock: and asking asking parents if they had to talk with their kids, how they've had it. And what kinds of how is that talk

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Sherry Molock: changed or shape based on the developmental stage of the child that's giving you're giving the talk to.

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Sherry Molock: So I think, in conclusion, we need a contextualized approach to suicide risk assessment.

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Sherry Molock: Don't forget that for risk assessment is often the first step to treatment

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Sherry Molock: that culturally informed risk assessment can lead to the development of more culturally salient treatments.

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Sherry Molock: Our recommendations are assessed structural level concerns. I wanna really stress this because, for example, we know for research that when

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Sherry Molock: the community that that youth from the Lgbtq plus community

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Sherry Molock: past policies

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Sherry Molock: that are really antithetical to positive mental health for these young people, their anxiety levels and their depression levels go up. And so we need to be paying attention to not just the national level, but the local level, what kind of policies are being passed? And what role can we play as experts.

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Sherry Molock: as experts? What role can we play in shaping policy? And so one of the things I share at my church community is, vote.

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Sherry Molock: vote for people who pass policies that you believe in, that you think advocate for the welfare and the wellbeing of youth, and don't vote for people who you don't think do that.

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Sherry Molock: I think when they have these community town halls, you can be there as a as a citizen at the Town Hall meeting and talk about and share information about research, because a lot of these these policies are passed without being informed by research or clinical practices. And so you can be that voice in the wilderness.

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Sherry Molock: In my community. My church, we're very known for environmental justice. And so anytime someone's trying to put it up

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Sherry Molock: trash, place, or or dump, or whatever after they know us. Even there were a small chart. They know we are, because we're at all these meetings. And so that's a a really good place where you can affect change. Try to identify the structural factors that may increase protective factors.

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Sherry Molock: so affirming historically underrepresented groups and curriculum policies.

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Sherry Molock: explicitly addressing homophobia and transphobia in school policies and having access to resources, to meet basic needs.

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Sherry Molock: train current and future mental health professionals to identify culturally salient factors that should be considered a suicide risk assessment.

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Sherry Molock: particularly looking at intersectional identities increase the diversity of researchers, clinicians, administrators, and policy makers increase diversity of research samples

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Sherry Molock: address what my colleagues call the cycle of exclusion, having unfair burden, so that the only people who do research in communities of color are people from communities of color. Everybody needs to be involved in this

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Sherry Molock: use, a ground 0 approach. So I I know I love mixed methods, approaches, and that's all we do. So I think

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Sherry Molock: quantitative methods are very important, but particularly in a in a field where, on the area of research, where we don't know a lot about a qualitative research can be very rich and can give you a better understanding of the aniseed thoughts and behavior.

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Sherry Molock: And then, when developing suicide, risk assessment tools, take steps to mitigate the historical harms caused by psychological assessments really appreciate and understand that people may be reluctant to engage in assessments because of the historical context

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Sherry Molock: and the racist outcomes that have come from those assessment tools

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Sherry Molock: and be sensitive to that.

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Sherry Molock: So want to thank you all for the invitation.

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Sherry Molock: This is my contact information.

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Sherry Molock: and I'll stop there.

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Sherry Molock: And there are questions we can take questions.

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Peter Franz: Thank you. Thank you so much for that lovely presentation. I especially appreciate all the actionable items that I that I hope will be helpful to clinicians in our audience and thinking through this content, and how we can employ these strategies for enacting effective and culturally sensitive risk assessment. We'd love to do. QA. And I see that we have a couple of questions already in the QA. Please feel free to continue adding.

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Peter Franz: adding them but I'll turn it over to Dr. Mullick. Are you able to? Should I read the question aloud, or are you able to take a look. How how would you like to do that?

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Sherry Molock: If you could read it, it'd probably be faster.

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Peter Franz: Yeah, that sounds good. Okay? So I'm happy to do that. So Tiago Saras puts in the QA. Could you encourage pastors to reduce their prejudice with mental disorders. If church is used as a way to build a healthy social systems to prevent suicide, ideation.

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Sherry Molock: That's a great question, and the answer to that is, yes.

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Sherry Molock: What one of the things I've been pleasantly surprised, I I almost would say, shocked by

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Sherry Molock: is the number of churches that

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Sherry Molock: reached out for help during Covid.

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Sherry Molock: I think Covid is a game changer, and I also think, Covid, I don't think we've seen the complete aftermath

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Sherry Molock: or consequences of code either.

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Sherry Molock: So I think during Covid, partially because the tools that churches typically use

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Sherry Molock: to help people which is gathering together in the community was gone, people were much more isolated.

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Sherry Molock: and so a lot of mental health challenges were

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Sherry Molock: on on steroids. And so we had, I think, during that 2021 year. In particular.

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Sherry Molock: we were literally doing workshops, going to churches, doing stuff on Zoom almost every week.

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Sherry Molock: and it was. It was. It was just, it was overwhelming and amazing.

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Sherry Molock: So

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Sherry Molock: and I hope I don't offend anyone. Does anyone know what Koji is? The Church of God in Christ.

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Sherry Molock: It's their Pentecostals, much more traditional and more conservative in our study. Half of the churches are cojic. I thought I would never see that in my I'm serious. Never in my lifetime, when I see cojic churches address mental health openly.

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Sherry Molock: and there has been no hesitation at all. I think, because people realize that while church is a very important resource, it's not the only resource.

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Sherry Molock: and that we really have to work together. And surprisingly, even when we have differences about how we understand. Mental health was common. And I think, and I do think this is somewhat use unique to you. People want to help. Young people have good, well, being period.

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Sherry Molock: And if we have to use tools that we're not as familiar with.

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Sherry Molock: people are much more willing to trust. Now.

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Sherry Molock: I will also say that I think one thing that works well in our program

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Sherry Molock: is that we don't ask people to change their theology.

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Sherry Molock: We? What we ask people to do is in given your theology, how can we help these young people? So it's not asking anyone to change anything. It's but it's really saying we respect that we might have some differences. And this is particularly true of the Lgbtq youth. Right? So we have part of our curriculum. We have a curriculum that we give the pastors to develop a sermon in that curriculum. Our statistics about Lgbtq.

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Sherry Molock: So many of them are shocked by the statistics. And then I say, well, you know some of your messaging is harmful.

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Sherry Molock: We're not telling you to change the messaging, but we are telling you what it does.

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Sherry Molock: And so it's up to you to decide what to do about that, to put it in the sermon. Not put in sermon, but we are sharing. We're not gonna we're not gonna shoot a code. Then we're not gonna not tell the truth about it, either.

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Sherry Molock: The other thing.

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Sherry Molock: there are churches that are open and affirming, which are gay for me. My church is is one of those churches, but interestingly, so far, none of the open and attorney, Nope. Open and affirming churches have participated. That doesn't mean they won't. But it's been the more traditional churches, and it may be that those churches are

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Sherry Molock: seeing more difficulties with youth or more concern. I'm not sure what that is about, but it is definitely the more conservative charges that are participating in the study.

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Sherry Molock: and we're trying to. So.

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Mahdi Goli: So Charlotte.

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Sherry Molock: I'm sorry.

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Peter Franz: So chad will also ask an another question that. I I'd love to put out there because I think it's a fascinating one ask me if you could talk a little bit more about how social media plays a role in suicidal thoughts and what the role of risk assessment might be in the context of suicide risk that may be related to social media.

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Sherry Molock: That's a great question, too. So there's a couple of issues there. One is

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Sherry Molock: we've up for a while. Now we've been concerned that social media could lend itself to clustering

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Sherry Molock: because

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Sherry Molock: kids who are advocating suicide, and particularly kids who split specific details about the way to complete a suicide.

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Sherry Molock: Always worries us.

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Sherry Molock: The major social media platforms, Instagram, Facebook.

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Sherry Molock: Snapchat. Do you have monitors

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Sherry Molock: who monitor the chats?

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Sherry Molock: And if they feel that the

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Sherry Molock: chat is encouraging suicide behavior. They have mechanisms to intervene with, that. Some of that comes out of the work by the National Action Alliance for suicide prevention. So that part is really cool.

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Sherry Molock: but suicide. The the thing that I worry about is

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Sherry Molock: A lot of bullying can go on in on in social media. A lot of racism, discrimination, transphobia, homophobia can also occur on these platforms.

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Sherry Molock: and while

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Sherry Molock: they are monitoring it, I'm not sure

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Sherry Molock: how well they can stop that. That's I guess. So. The web they can prevent it from happening, I think, is what worries me.

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Sherry Molock: On the other hand.

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Sherry Molock: you can also use it for good, right? So there's good evil. But there's also good, because you can take that same platform

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Sherry Molock: and talk about prevention and connect kids to services. So one of the things that one of our students is doing is trying to figure out

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Sherry Molock: how you can sort of use that platform in a really positive way.

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Sherry Molock: I think for me, what was very disconcerting was

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Sherry Molock: the amount of racism even in gaming. I I for me it just feels like there's no place or space. It's safe for young people away from that kind of vitriol. And I also think it's a good example of where what's going on in adult social media

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Sherry Molock: isn't influences, what? How kids perceive all this. So the way the rhetoric that goes on in the politics right now, locally and nationally young people, I think we forget. See that, and expose to that.

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Sherry Molock: And I'm feeling very

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Sherry Molock: unwelcome and unloved in that context.

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Sherry Molock: Does that? I hope? I answered your question.

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Sherry Molock: Did I answer your question? Yeah.

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Sherry Molock: So for me, that's disheartening. I have a 10 year, almost 11 year old, granddaughter.

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Sherry Molock: and you know the way I think we I monitor her grandfather or mother, my her mother's partner. Everyone's monitoring her to the point where she's probably over monitored. But but it's like we can't keep up.

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Sherry Molock: you know, like, whenever we think we've we've gotten

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Sherry Molock: something covered

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Sherry Molock: we just took her off a tiktok completely, just because we couldn't. It's too hard.

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Sherry Molock: and I like Tiktok, and she said she's in cheer, so they do these routines on there. But.

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Sherry Molock: you know, one of the things that kept coming up. They got blocked several times because

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Sherry Molock: cheerleader uniforms are kind of skimpy, and they're just 10, but they get blocked for child porn every time. So we were like to stop. Just don't do it, you know, and it's so. It's it's it's hard. She's also had some stuff on her site that even though we have parental blocks on there, it pops through, anyway. So it's just, you know. It's you feel like you're you just can't win.

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Peter Franz: We've got another question in the context of spirituality from Odessia Brown. How does religious holidays or extended periods of spiritual disciplines, such as Ramadan or lent impact suicidality.

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Sherry Molock: Great question. So there is no evidence that I'm aware of that.

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Sherry Molock: They have a negative impact.

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Sherry Molock: I think, Ramadan went, is has the potential to strengthen social cohesiveness

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Sherry Molock: and a sense of mattering

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Sherry Molock: because it's a collective. And you're coming together for one purpose. I think. So. That's good. And the Christian community. We just finished letting Easter

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Sherry Molock: also those

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Sherry Molock: those celebrations focus a lot on community gathering together and families gathering together. So I think that to me they could be very protected. But I'm not aware of them being associated with any risk. Factors.

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Peter Franz: Lillian comas. Diaz asks next, have you considered approaching a famous person of color or celebrity, who has a history of depression or suicide as a spokesperson for suicide, prevention.

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Sherry Molock: Great question. And Hi, Lillian, so?

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Sherry Molock: yes and no. So the the in the past, when people have have used celebrities.

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Sherry Molock: It's hard to. How can I put those?

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Sherry Molock: It can work really well if the Celebrity is willing to be honest and not glamorize their own mental health issues? That's the tricky part.

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Sherry Molock: I know. I don't know if you all know the actress, Regina King. She recently lost her son to suicide.

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Sherry Molock: and so we have thought about that often not, but we also want to respect her privacy.

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Sherry Molock: Taraji P. Henson has been a really strong advocate for mental health

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Sherry Molock: and well being, and we have worked with her in the past.

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Sherry Molock: the American foundation for Suicide prevention has a program called Soul Shop, which is an intervention for black churches. She's been very active in that. When we did the task force for the the working group, for the task force for

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Sherry Molock: suicide prevention at the Congressional Black caucus. She was very instrument on that, so it can work really well, I think what

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Sherry Molock: you have to be careful of is helping them tailor their message so that it's not sensationalized.

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Sherry Molock: And it's really talking more about protective factors and also positive messaging about help seeking. So I I'm not even gonna tell you who this was. But I work with church

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Sherry Molock: famous church people who have

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Sherry Molock: even though we've talked in advance before the talk or the show, whether you know that whatever we're doing about making sure we promote mental health and mental health care that people get up and say you don't need that. If you just created juice you got. And you know you're just looking at going. What happened to that? All those meetings we had.

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Sherry Molock: and I think sometimes people get caught up in the moment. I've also seen this with the military right where we talk about the importance of not being punitive. If people disclose that they're having mental challenges.

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Sherry Molock: then a general will get up and say something that undoes all of that. So I think celebrities and people who are who are

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Sherry Molock: influential can be good. But I think it's also important that you worked closely together about messaging.

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Peter Franz: I also, Robertson asked, can you elaborate more about partnerships with schools? Does that involve a school counselor or outside volunteers? Slash experts.

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Sherry Molock: So I've seen it done a couple of ways, a lot of school districts, particularly in urban settings. You're gonna have to unfortunately go top down. So you need to go to the superintendent of schools and get agreement to work with schools.

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Sherry Molock: We've.

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Sherry Molock: I think, schools work really well, because if you think about it, school is a relatively closed system.

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Sherry Molock: you can get everyone to do the same thing at the same time.

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Sherry Molock: You can also get a really good diffusion of your messaging.

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Sherry Molock: And you're in position of stranging cultural norms and values about help seeking. So there's a

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Sherry Molock: evidence based program called sources of strength. They do that on schools. A component of our program is called youth Connect. They are also doing that in schools. And those programs work really well. I think the hardest thing about working in schools be honest with you is entree into the school. But I think if you have a good relationship, and you can get into the school system.

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Sherry Molock: I think it's it's yes. I think school partnering with schools is great, I think, for communities of color. The reason why we go to faith communities and not schools is part of the realities for students from communities of color tend to get negative evaluations in school.

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Sherry Molock: and there's more concern around stigma. So we're not saying the schools are not good. But we're saying, I think, in suicide prevention research in general, we have to get over. There's going to be one solution to this. I think it's going to take multiple approaches for some kids. Schools is going to be great, but for some kids

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Sherry Molock: and also parents, they don't trust school systems. And so we started doing churches because parents, black parents were saying, if my child just faced in this program like, who knows about this?

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Sherry Molock: And what does this mean for future references.

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Sherry Molock: or

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Sherry Molock: Is my child going to be evaluated in a negative light, and they've already had experience with that.

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Sherry Molock: So they don't trust the school system, whereas they do trust their faith, community

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Sherry Molock: and also faith communities. There's no evaluative component right? You don't go to church to be graded on something. You just go to church or mosque or temple because you're going.

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Peter Franz: Well, thank you, Dr. Mark, this was a a wonderful presentation. I thought the QA. Was excellent. I appreciate all the thoughtful questions. I'm sorry we couldn't get to all the others. We appreciate your participation for joining us. We hope that you'll consider joining Apa Division 29. We'd like to let you know that if you're interested in continuing education credits that Dr. Ellison has posted a link for the quiz

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Peter Franz: in the chat. Please also know that a video recording of this presentation will be posted to the Apa

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Peter Franz: 29 Division 29 website. That can be shared with others. Thank you all. I I appreciate your attendance here. This is an incredibly important topic. And and I just wanna one last time, thank Dr. Monic for such a wonderful and engaging presentation.

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Sherry Molock: Thank you so much for inviting me. Take care and enjoy your weekend.