Taylor Vacca

1 Forgetting Our Founding Fathers: “Advocacy(۸5) [for Awareness, Acceptance, Authenticity, Adaptability & Altruism]” Outreach, and Prevention—Needs Assessment/Program Development Paper COUN 480-8 Methods 3: Skills for Social Justice Advocacy, Outreach and Prevention Northwestern University Taylor Vacca ADVOCACY, THE POWER OF FIVE & THE EVOLVING COUNSELOR-PROFESSION 2 Forgetting Our Founding Fathers: “Advocacy(۸5) [for Awareness, Acceptance, Authenticity, Adaptability & Altruism]” Outreach, and Prevention—Needs Assessment/Program Development Paper Dedication: I must begin by acknowledging the pure, true, and tenacious teachings still taught today by the many brilliant professionals, professors, and providers who have served before me. What was once considered trailblazing theory and practice within the newly emerging field of mental health and wellness, has now, unfortunately, become a tantalizing way of conducting such treatment. As we have come to see the ever-evolving nature of our realm of study, we must continue to grow alongside the ground-breaking research and revolutions we’ve been subjected to and/or became stagnanted by. Advocacy has always been an art, yet an art seen and served as severely undervalued. When coming to understanding our ethical commitment to honor competency within our capabilities as counseling professionals, I feel that a few of our founders foraged forward, forgetting our most foundational frameworks and lens’ of which to focus. I think it is time we bring back advocacy, advocacy as it was intended, advocacy as it is defined to be, advocacy as it is destined to become. The definition of advocacy I wish to propose and permeate would encompass five of the following virtues: Awareness, Acceptance, Authenticity, Adaptability, and Altruism. Below I will be exploring, evolving, and enlightening the ever-emerging existence of advocacy, both in and outside of the therapist’s office, and how ‘The Power of Five’ will not only break the barriers that continue to bury and burden us, but according to numerology, they just may bring about its’ symbolisms blessings of cultivating freedom, curiosity, and change. ADVOCACY, THE POWER OF FIVE & THE EVOLVING COUNSELOR-PROFESSION 3 Dream Exploration: The ever-evolving counseling-profession has failed to uphold its ethical responsibility of advocating for policies that ensure the most empirically-driven practices into place. The more I learn about the process and procurement of discovering our clinical-voices to further enlighten our field, the more I find myself seeking to scream. As this may seem extreme, we must continue to challenge ourselves, as professionals, in aspiration to end ‘old-age operationally-oppressive ways,’ reconcile our field of studies historically-inhumane assessment and approach to mental health concerns, and further integrate ‘new-age collaborative-culturally competent conceptualizations and cares.’ So, what is the wait? Let’s begin this journey of revolutionizing the realm of science we study, we practice, we breathe. I will now embrace this assignment as a means of catalyzing the changes I’ve come to conceptualize considering the critical gaps I’ve grappled throughout my practicum-experience with Lorenz Clinic. Before we rewrite this narrative, let me start by introducing my site’s mission, setting, services, outreach interests, etc: ❖ Lorenz Clinic Mission: The Lorenz Clinic’s Mission is based on the principles and values of promoting the common good through ensuring clinical excellence of compatable care to clients of all ages. ❖ Lorenz Clinic Setting Type: The Lorenz Clinic provides services as an outpatient clinic, primarily focusing on the assessment and treatment of the most common mental health presentations via weekly-services. ❖ Lorenz Clinic Services Rendered: The Lorenz Clinic provides services ranging from selecting effective treatments, triaging client needs, as well as collaborating with community resources and higher levels of care to achieve the attunement of collaborative goals in complex cases. ADVOCACY, THE POWER OF FIVE & THE EVOLVING COUNSELOR-PROFESSION 4 ❖ Lorenz Clinic Compatible Clientele: The Lorenz Clinic has adopted a multi-disciplinary psychotherapeutic-approach to serve the mental health needs of adults, couples, children, families, and groups. ❖ Lorenz Clinic Compatible Staff: The Lorenz Clinic endorses a diverse blend of professions from family therapists and adult psychologists to child specialists and couples counselors, as well as practicum- and internship-level students who embody passions of upholding competence, professionalism, and dedication to the common good. ❖ Lorenz Clinic Outreach Interests: The Lorenz Clinic takes pride in cultivating a socially-tolerant clinical standard of individuals who are able to intervene interpersonally and conceptualize contextually. The Lorenz Clinic utilizes practicum- and internship-level students to provide client’s access to quality services, to increase community impact, to increase capacity for services, as well as benefit the training program and clinic by learning more from the brightest minds currently studying within the mental health and wellness field (https://lorenzclinic.com/). As The Lorenz Clinic secures and supports a healthy and admirable mission, vision, as well has adopted a set of progressive core values; there is much more growth to guide and give rise to. I have come to notice areas where care has been unjustly-compromised during the client-clinician placement process of assigning client-presentations of trauma using unsuitable practices of procurement, principles of policy, and professionalism. Dream Analysis (Manifest Content vs Latent Content): While having had my own first-hand experience of being coerced into completing a same-day Diagnostic Assessment (DA) for a client presenting to therapy for recent exposures to trauma. ADVOCACY, THE POWER OF FIVE & THE EVOLVING COUNSELOR-PROFESSION 5 Not only was this client incorrectly placed upon my capacitated practicum-caseload, but upon my immediate attempt to communicate such confusion, as well as advocate for culturally-competent consistent care for the client by ensuring a safe, secure, and confidently-collaborated placement, my efforts were ignored, invalidated, and insecurely integrated. These injustices, inadequacies, and incompetencies have inspired an integral-piece of ingrained-practices, to be incorporated into both their endorsed clinical-physical- and psychological-processess, that has been missing. “What is missing,” did you ask? Let’s go ahead and take a look at the proper points of interest that must be considered: ❖ Lorenz Clinic’s Manifest (Background) Content: The Lorenz Clinic operates off of the standard practice of delivering therapeutic services “dedicated to affecting the common good through clinical excellence.” ❖ Lorenz Clinic’s Latent (Rationale) Content: In order to uphold the Lorenz Clinic’s mission statement of their commitment to provide clinical excellence “across all ages and walks of life,” they must instill and enforce new values and procedural-policy reform regarding clientele seeking trauma-related therapeutic services. ❖ The State of Minnesota’s Manifest (Background) Content: As the Lorenz Clinic operates and is dedicated to providing therapeutic services within the Southern and Western Twin Cities Suburbs, the research I will be referencing and defining my community needs from is the State of Minnesota’s Mental Health and Wellness accumulated statistical data from the year 2020. The State of Minnesota’s community needs have emerged from not only the arrival of the COVID-19 Global Pandemic on March 6th, 2020, but also the subjective-exposure to the monumental death of George Floyd on May 25th, 2020. ADVOCACY, THE POWER OF FIVE & THE EVOLVING COUNSELOR-PROFESSION 6 ❖ The State of Minnesota’s Latent (Rationale) Content: The perspective through-which considering the microcosm-of-trauma the State of Minnesota was and has continued to endure, would leave all mental health-professional’s obligated and required to practice through a trauma-informed lens and adhere to trauma-informed policy and procedure. Dream Interpretation: Needs Assessment: ❖ Identified Stakeholders: The identified stakeholders within this proposed Needs Assessment/Program Development established for the sake of integrating and implementing trauma-informed practices within trauma-exposed communities are as follows: The Lorenz Clinic’s CEO, COO, Training Director, Director of Operations, Practicing Providers, & Clinical Assistants (CA’s); potential clientele, community needs, and the State of Minnesota. ❖ Strategy Development: My vision is to extinguish compromised-community care and services for individuals impacted by trauma. ❖ Community Demographics: The Lorenz Clinic operates in the following locations: Victoria, Chaska, Prior Lake, Rosemount, Wayzata, & newly employed (COVID-19 Pandemic-Induced) Tele-Mental Health services across the State of Minnesota. These communities are representative of an upper-middle class socio-economic status, however, due to the COVID-19 Pandemic-induced required Tele-Mental Health accessibility platform, the Lorenz Clinic’s clinical-reach now extends the entirety of Minnesota's state boundaries. ADVOCACY, THE POWER OF FIVE & THE EVOLVING COUNSELOR-PROFESSION 7 ❖ Questing (Questioning) for Truth: Considering the “trauma avalanche” to come throughout the State of Minnesota, we must confront ourselves (as mental-health care providers and advocates) and ask the following questions (Gary Norman, MSW, LICSW, March 23rd, 2021): ➢ What is the State of Minnesota’s current mental health (child/adult) prevalence? ➢ How accessible are mental health and wellness services in the State of Minnesota? ➢ What is the most effective treatment-theory and -approach to initiating and incorporating psychotherapy into the lives of those affected by trauma? ➢ What are the most optimal clinical-conditions to enter and explore a subjective-trauma? ➢ What policies need to be put into place to ensure a safe, secure, and hopeful environment for those subjected to trauma to procure the most promising therapeutic-outcomes? ❖ Data Collection Methods: The data collection methods I put into practice to comprehensively and competently compose this Needs Assessment/Program Development proposal included: observations (my clinical-practicum experience), interviews, and databases. ❖ SWOT Analysis: ➢ Site SWOT Analysis: Strengths: Increases initial access and opportunity (subjectively viewed as either a worthy or unworthy dedication) to mental health and wellness services. ADVOCACY, THE POWER OF FIVE & THE EVOLVING COUNSELOR-PROFESSION 8 Weaknesses: Reinforces history of oppressive-operationally driven practices and policies to compromised-vulnerable clientele. Opportunities: Increases initial access to mental health and wellness services and increases employment and experiential opportunities for experienced and upcoming mental health and wellness professionals. Threats: Potential loss and declination of clientele- retention due to lack of repeatability, potential loss of established-revenue, and compromised reputability. ➢ State SWOT Analysis: Strengths: The State of Minnesota exhibits a lower prevalence of mental illness and higher rates of access to mental health care for adults. The State of Minnesota exhibits an average prevalence of mental illness as well as an average rate of access to care for children. Weaknesses: The State of Minnesota has encapsulated a microcosm-of-trauma induced by the arrival of the COVID-19 Global Pandemic on March 6th, 2020, as well as the subjective-exposure to the monumental death of George Floyd on May 25th, 2020. Opportunities: The proposed undertaking of revolutizing therapeutic services, obligations, and advocacies to potentially transcend trauma-informed teachings and tailoring of treatments could prosper and ADVOCACY, THE POWER OF FIVE & THE EVOLVING COUNSELOR-PROFESSION 9 promote existential re-embodiment, empowering the sense of evolution within the inevitable, and emerge clientele-enlightenment. Threats: Due to the existential-crisis evident and further evolving within the State of Minnesota, not instilling and enforcing trauma-informed practices could result in catastrophic and developmentally-detrimental deterioration of the population's capacity to sustain mental health and wellness. ❖ Data Rating: When rating the data collection process for this Needs Assessment/Program Development proposal, the steps taken to procure and produce the integration of the data consolidation and summarization are representative of high internal, external, ecological, and statistical conclusion validity. The data collection process also identifies with low content, construct, and criterion-validity due to the historical- and present- lack of awareness and overwhelmingly deficient cultural-emphasis of the importance and impact of providing adequate- and authentically-approached trauma-based therapeutic services to those seeking such care. ❖ Data Consolidation & Summarization: The research compiled, to validate and authenticate my aspired-approach of requiring mental health and wellness facilities and professionals to adopt and adhere to a trauma-informed lens, comprised of exploring and examining the epidemiology of trauma-related clientele-presentations, as well as provided a glimpse into the existential-need and emergence of a new-age nuanced form of trauma-informed therapeutic treatment. Let’s start our quest for the truth: ➢ What is the State of Minnesota’s current mental health (child/adult) prevalence? ADVOCACY, THE POWER OF FIVE & THE EVOLVING COUNSELOR-PROFESSION 10 ■ The State of Minnesota’s overall mental health-ranking is 7th across the nation, representative within the highest ranking by ensuring our community needs meet lower prevalence of mental illness (https://www.mhanational.org/issues/2020/ranking-states#overall-ranking) ➢ How accessible are mental health and wellness services in the State of Minnesota? ■ The State of Minnesota’s overall mental health-ranking is 7th across the nation, representative within the highest ranking by ensuring our community needs meet higher access to care (https://www.mhanational. org/issues/2020/ranking-states#overall-ranking). ➢ What is the most effective treatment-theory and -approach to initiating and incorporating psychotherapy into the lives of those affected by trauma? ■ According to Carson et al. (2021), a therapeutic-environment that encourages practices that allow for intentional versus elicited trauma-related disclosures are representative of providing a critical-factor in enhancing the potential prognosis throughout the trauma-related recovery process. By dissecting the nature of an individual’s need and desire to intentionally-reach out regarding trauma-related exposures, we must never condone a clinically-coerced second- “first encounter” requiring retraumatization. Higher client-clinician working alliances are associated with lower post-traumatic-stress-disorder symptoms and better working-alliances at the beginning of the therapeutic-process predict treatment outcomes (Ehlers, et al., 2021). Lorenz Clinic’s first-impression must not be their final-impression for those seeking trauma-related ADVOCACY, THE POWER OF FIVE & THE EVOLVING COUNSELOR-PROFESSION 11 services. Trauma-related-exposures induce an attachment-focused-emotional-detachment that requires acute and authentic therapeutic-intervention that relies upon the trust and rapport collaboratively-created between the client-clinician dyad. When initialtherapeutic services are sought, if they are not met with maternal-inclinations, and are as well met with immediate separation of their subjectively-intended security and attachment-to-safety, they will most likely result in continued symptomatology throughout their entire developmental life-span presenting with increased anxiety, depression, and hypervigilance (Duckworth & Follette, 2012). ➢ What are the most optimal clinical-conditions to enter and explore a subjective-trauma? ■ When considering the unique and nurturing-needs of those impacted by trauma, especially existential-trauma, the therapeutic-journey, from start to finish, must embody the envision and evolution of establishing the therapeutic-alliance off of values ingrained in trust, rapport, and transparency of the treatment procurement, plan, and process. Where traumatized clients may be (entering) suspicious of authorities, it is essential that therapeutic trust and rapport is established early throughout the entrance- and engagement/explorative- phase of the therapeutic journey (Hassan, 2021). Trauma-focused CBT interventions have been found to accelerate recovery from Acute Stress Disorder, solidifying the ADVOCACY, THE POWER OF FIVE & THE EVOLVING COUNSELOR-PROFESSION 12 need for immediate and integrative- policy and reform to promote the mental health and wellness of those affected by trauma (Lomax, 2020). ➢ What policies need to be put into place to ensure a safe, secure, and hopeful environment for those subjected to trauma to procure the most promising therapeutic-outcomes? ■ The field of mental health and wellness systemically strives to de-stigmatize the nature of differing-psychological presentations, however, mental health professionals seem to remain under the impression that Distress Intolerance is an expected symptom required of rendering a trauma-related-diagnosis. According to Albanese (2021), Distress Intolerance does not predict the trajectory of naturalistic intrusions during a week-follow-up period post-witnessing a film depicting life-threatening car accidents (trauma-related-exposure). Therefore, confirming the need to presumptively procure and perform utilizing a trauma-informed-lens. ❖ Community Plan Development: Considering the proposed conclusions conceptualized from the data-driven development of the Needs Assessment intended to promote and advocate for the tailored-therapeutic needs of the people residing in the State of Minnesota, the systematic-implemental and incorporation of trauma-informed practices (from telephone to DA, therapy and ongoing treatment) must be adhered-to and accepted-from all identified stakeholders. A Peek Into The Window (of Tolerance) of Wishes: ❖ Lorenz Clinic Site Program Development Proposal ADVOCACY, THE POWER OF FIVE & THE EVOLVING COUNSELOR-PROFESSION 13 ➢ Plan: My plan proposes to extinguish compromised-community care and services for individuals impacted by trauma through providing services that engage the epidemiology of the condition’s change-process to ensure and implement a conducive- trauma-informed therapeutic-journey, from start to finish. The Lorenz Clinic’s outreach and procurement philosophies must evolve to embody the envision and emergence of protecting the power and sanctity of starting, securing, and honoring the therapeutic-alliance initiated and ingrained by trust, rapport, and transparency of the treatment procurement, plan, and process. ➢ Implementation: Who: The proposal of eliminating the current procurement-process in place at the Lorenz Clinic begins by replacing their practicing-philosophy of “transferring” trauma-related-presentations to practicum students secondary to the client’s initial-DA conducted by licensed-providers for clientele needing sliding scale services, requires the review and systematic-reconciliation (from The Lorenz Clinic’s CEO, COO, Training Director, Director of Operations & Clinical Assistants) of how therapeutic-services are rationalized and rendered to those impacted by trauma (Suarez, B., August 30th, 2021, 14:00). What: The revised procedural and procurement-guidelines informed by trauma-tailored philosophies, to ensure a consistently-available clinician for the purpose of eliminating compromised-care principles, need to be replaced, trained, and upheld by the Lorenz Clinic Clinical Assistants during the client’s initial contact and scheduling sought. ADVOCACY, THE POWER OF FIVE & THE EVOLVING COUNSELOR-PROFESSION 14 Where: This revised client-clinician-procedurement training process would take place onsite across all-five physical locations. When: I would advocate for this revised client-clinician-procedurement training process to be implemented and culturally-ingrained as soon as possible considering the ease of the training-task at hand. How: This Needs Assessment/Program Development proposal would need to be instigated and integrated by the Lorenz Clinic’s Training Director, as well as adopted by their CEO, COO, and the Director of Operations. ➢ Evaluation: Process: The evaluation process of assessing the potential-beneficence of trauma-informed client-clinician procurement-practices would consist of monitoring client-retention rates. Impact: The intended-impact of the new trauma-informed policies in place would be best evaluated and determined through the use of initiating direct-client feedback of their therapeutic experiences. Outcome: The optimistically desired outcome would be encompassed by the State of Minnesota’s overall mental health and wellness rankings, as well as the ratings of resiliency reported by individual’s subjected to trauma-exposed communities seeking therapeutic-services. ❖ The Power of Five ADVOCACY, THE POWER OF FIVE & THE EVOLVING COUNSELOR-PROFESSION 15 ➢ Advocacy: Considering the all-too-real evolutions of existential crises’ that have emerged and continue to endanger the livelihood of the State of Minnesota's mental health and wellness’s capacity for resilience. ➢ Prevention: Advocacy for the mandated-practice of providing trauma-informed therapeutic interventions within endangered and at-risk communities, has been unjustly silenced and incompetently ignored. In an attempt to restore compromised-care practices that have historically-permeated and unethically persist across the overarching field of mental health and wellness, we must redefine the concept of advocacy. As I alluded to in my Dedication, The Power of Five’s integration (i.e. the instillation of Awareness, Acceptance, Authenticity, Adaptability & Altruism) within the way in which we conceptualize advocacy, has the possibility to foster competently-considered practices, culturally-sound care, and catalyzing client-change. ➢ Wellness: The preservation and prosperity of the mental health field’s professional-passion and proper-policy serving to protect client’s exposed to trauma, has the potential if psychologically presented with polished-practices that promote, enrich, and enlighten experiences despite the inevitable interactions with environmental-detriments. Debriefing: To honor the beauty of embracing and authenticating advocacy in session, I will now leave you with these inspirational words incited by my Site Supervisor following the discussion of how I personally envision, embody, and empathetically-evoke the evolution of trauma-informed case conceptualization and care: ADVOCACY, THE POWER OF FIVE & THE EVOLVING COUNSELOR-PROFESSION 16 "We're not in this work to win. An art is not a contest, it's a continual growing. Whenever the artist thinks she's mastered the craft, she's stopped growing and so has stopped being an artist. True art is only to be found on the edge of what is known - a dangerous place to be, an exciting place to work, a continuously unsettling place to live subjectively ("The Art of the Psychotherapist" by James Bugental, 1987).” I am calling out to all to put the art back into advocacy. ADVOCACY, THE POWER OF FIVE & THE EVOLVING COUNSELOR-PROFESSION 17 References Albanese. (2021). Distress Intolerance Prospectively Predicts Traumatic Intrusions Following an Experimental Trauma in a Non-clinical Sample. Cognitive Therapy and Research., 45(6),-. https://doi.org/10.1007/s- Carson, K. W., Babad, S., Brown, E. J., & Nikulina, V. (2021). Why Do Women Talk About It? Reasons for Disclosure of Sexual Victimization and Associated Symptomology. Violence Against Women, 27(15/16),-. https://doi-org.turing.library.northwestern.edu/10.1177/- Duckworth, M. P., & Follette, V. M. (Eds.). (2012). Retraumatization: Assessment, treatment, and prevention. Routledge. Ehlers, A., Wiedemann, M., Murray, H., Beierl, E., & Clark, D. M. (2021). Processes of change in trauma-focused CBT. European Journal of Psychotraumatology, 12(sup1),-. https://doi.org/10.1080/- Hassan. (2021). (Mis)recognition in the Therapeutic Alliance: The Experience of Mental Health Interpreters Working With Refugees in U.K. Clinical Settings. Qualitative Health Research., 31(2), 399–410. https://doi.org/10.1177/- Lomax. (2020). Systematic Review: Effectiveness of psychosocial interventions on wellbeing outcomes for adolescent or adult victim/survivors of recent rape or ADVOCACY, THE POWER OF FIVE & THE EVOLVING COUNSELOR-PROFESSION 18 sexual assault. Journal of Health Psychology. https://doi.org/10.1177/-