Knowledge For Practice Final 1

Knowledge For Practice Final

Samantha Fleifel, Leah Hicks, Kamryn Mattison, and Zayda Swick
University of South Carolina
College of Social Work
April 24, 2023
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Knowledge For Practice

A major issue we want to focus on concerns the homeless population. We will be

researching mental health and access to treatment and resources for individuals experiencing

homelessness.

Problem Statement

Mental health resources are not easily accessible for young adult [ages 18-26] men and

women of all races who are living in homelessness in Columbia, South Carolina. This is an

increasing issue that is detrimental to the well-being of young men and women on the streets in

Columbia. Mental health issues and homelessness go hand in hand; bad or untreated mental

health can increase the amount of time homelessness is experienced. Financial status, family

systems, education, and race are some factors that can affect how long someone experiences

homelessness (SAMHSA). Young adults who are experiencing homelessness are unable to meet

their basic needs and reach a sustainable way of life. This should be a public concern because of

the rising numbers of depression. The purpose of our research is to assess the access that young

adults experiencing homelessness in Columbia have to mental health resources and how this may

vary from individual to individual. We will be identifying factors that lead to depression and how

to prevent homeless youth from increasing depressive symptoms.

Hypothesis

When assessing homeless young adults' ability to access mental health services, several

identifying factors improve or limit an individual's accessibility. Would individual therapy or

group play therapy be most effective in assessing and treating depression in homeless adults? In
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an effort to address how to bring about intervention most effectively, it is important to consider

different individual factors that impact available resources such as transportation, location, and

education level. For our intervention, we will focus on homeless adults located at several

different shelters in the Columbia area.

There is a multitude of interventions designed to help bring assistance to those who are

homeless and facing mental illnesses, specifically depression. According to Bhatt, 75% of people

dealing with depression are not able to receive medical treatment even though effective treatment

is available. Furthermore, according to AHAR and NSHAPC reports from 1996 to 2010 show

that 26.2% of all sheltered homeless people have struggled with mental illnesses such as

depression. Furthermore, almost 35% of those who are sheltered and homeless also struggle with

substance abuse. The possible interventions for our target population will include individual

therapy and group play therapy. Both interventions will be given through in-person CBT at

designated shelters.

Pros and Cons of Intervention

The two possible interventions both have pros and cons. With individual therapy, the

possible cons for the homeless adult population would be difficulty receiving and making

appointment plans. It could be difficult to stay consistent with each client receiving therapy for

their depression. Another con for individual therapy would be the educational levels of everyone.

A con for the group play therapy intervention can also be on how we keep track of those at the

transitions homeless center. Tracking the progress of therapy also can be difficult if contact is

lost within the year. The pros of group play therapy are the community given to others who are

struggling. A specific pro with play therapy will allow people to open up and feel comfortable

that is not in a strict therapy session environment

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Methods

According to Olfson, the number of people seeking mental health treatment is increasing

each year. People becoming aware of mental health and the effects it has could be the reason

people are seeking help. People are becoming more comfortable with talking about it. Years ago,

depression and anything having to do with mental health were looked at as negative and were

often hidden and not talked about. There are traditional and non-traditional intervention methods

for helping reduce depression. First, we will give people a BDI, or Beck Depression Inventory,

which measures aspects of depression. This test includes questions on areas related to depression

symptoms such as (a) agitation; (b) irritability; (c) pessimism; (d) sadness; (e) guilt; (f) suicidal

ideation; (g) sleep disturbance; (h) loss of appetite (Groth-Marnat, 2009). This is a self-

assessment that only requires a 5th-grade reading level to complete. We will administer this as

our primary measurement because it can be understood for different education levels and

ethnicities. This will be administered before and after each intervention to see their impact on

homelessness and depression. Our traditional intervention includes individual therapy, and our

nontraditional intervention will be play therapy.

Two methods of data collection will be used. The use of the BDI test to distinguish levels

of depression in those participating. Data will be stored anonymously; no identifying names or

factors will be placed on the data, but a number will be assigned to each patient. A survey with

10 questions will be administered at the end of the intervention to collect data on symptoms. Will

have sections to comment not multiple choice. The BDI test and survey will then be administered

again a year after the intervention was started. By tracking the test and survey over a year will

show whether the methods were efficient in helping the population and show places needing to

be reformed. The participants would be tracked on an excel and follow up through email from

transitions homeless center. This will be where the participants will meet up in an open space for

group therapy and or one on one therapy.

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Traditional Intervention

The traditional intervention method we believe would work would be individual

therapy. All participants would take the BDI screening before and after attending all the

designated appointments. There was a case study done on a 26-year-old nurse who suffers from

depression (Spelman 2021). This study examined the effectiveness of individual cognitive

based therapy on depressed individuals. In the duration of the study, the private therapy clinic

found that over the span of 12 sessions, depression symptoms were decreasing, proving

individual CBT has a positive effect.

In a study by Pepperdine University, 43 homeless individuals with diverse

races/ethnicities and medical backgrounds were engaged in 50-minute psychotherapy sessions

for 6 weeks to assess changes in depressive symptoms. It was hypothesized that after each male

went through all six therapy appointments their BDI scores would decrease. The BDI posttest

scores were able to show that homeless men when paired with psychological treatment had a

reduction of depressive symptoms. However, there are many outlying factors that could have

contributed to their post-test scores in this case. The biggest error with this posttest was that the

second BDI was not given to this group until 70 days (about 2 and a half months) after the first

test. A second randomized group of 43 homeless individuals with diverse races/ethnicities and

medical backgrounds was put through the same process and therapy. This retest was able to

support the conclusion that when depressed adults are paired with psychological intervention

for a period of 6 weeks their BDI scores will reduce, and their overall mood will improve. The

BDI for this was given approximately 40 days (about 1 and a half months) after the first BDI

test. Each participant in this study after taking the BDI for the second time scored in the middle

range for depression regardless of how high it was before (Adam Joy 2013). Traditional therapy
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intervention can help to reduce the symptoms of depression; however, it may not be the most

effective.

Non-Traditional Intervention
Group therapy is a common nontraditional intervention method used to treat depression.

In a study facilitated by Thimm and Antonsen (2014) at the Helgeland Hospital in the psychiatric

center unit, 124 patients of diverse backgrounds and demographics were chosen to participate; to

measure its effectiveness, each participant would take the BDI test to measure their symptoms

and level of depression before, during, and after group therapy. The study consisted of 15 group

therapy sessions lasting 2 hours each (with a 15-minute break). Mental health professionals

administered the sessions using multiple different CBT (cognitive behavioral treatment)

manuals, which caused variations in the subject matter of the session. However, the central

topics of CBT were prevalent in all sessions (Thimm and Antonsen, 2014). Participants were

provided with a workbook to use during the sessions, and a set meeting structure was in place. At

the end of the 15 sessions, there was a drop-out rate of 17.5%, which was 25 participants, most

of whom were female, and there were a variety of reasons for not continuing group therapy

treatment (Thimm and Antonsen, 2014). At the post-treatment point, 2 patients’ symptoms

deteriorated, 32 were unchanged, 9 improved, and 18 recovered; at the follow-up point, 1

deteriorated, 26 did not change, 11 improved, and 25 recovered. Average BDI scores were

reduced by 10 points from the start of the study to the end; these scores stayed the same when

patients took the BDI at a 3-month follow-up before the sessions (Thimm and Antonsen, 2014).

These results show a large effect of group therapy sessions on depression symptoms;

furthermore, anxiety levels also decreased moderately (Thimm and Antonsen, 2014).

At the beginning of this nontraditional intervention, each participant will take a BDI test
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to diagnose whether someone has depression and type. Once all participants are accounted for

and their diagnoses. Once done, the participants would be enrolled in an intervention with two

options. The first would be traditional therapy and the second intervention would be group play

therapy. For this intervention, 86 individuals will be receiving BDI tests. 43 of the individuals

will undergo individual therapy while the other 43 will undergo group play therapy. These

individuals will be randomly selected by homeless individuals volunteering. The Probability

Systematic sampling design works the best for us because the selection of the population

undergoing the intervention is done on a broad scope with few controls.

For this intervention, A group of at least 50 participants would be added to a patient

system specific to the intervention. Each participant of sheltered homeless adults will take the

BDI test to indicate if they have depression. The participants will then be seen twice a month

by a licensed therapist volunteering from a local hospital. The therapist would come around to

homeless centers in a bus and see patients within a medical bus. This is to get through the

obstacle of transportation that participants may not have access to. Around 47% of those who

are homeless are diagnosed with a depressive disorder. With these numbers being so high,

interventions are needed to help secure professional help and decrease the numbers. In 2000 a

mobile crisis program was launched. Though not specific to homelessness the program aided

in mental crisis calls and helped offer efficient care that was more affordable. This program

was used in 39 states and had a high success rate. In past studies therapy has shown to improve

side effects of depression and help through episodes. There are multiple types of therapy that

can be more independent or supportive that matches best with patients.

Social Work Values and Ethics

There are many social work values and ethics that could be related to this issue. The
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most pressing values displayed in this topic would be the importance of service and dignity

and worth of a person. For service, the ethical principle is to serve those in need. To serve a

certain population, we must be aware of an issue and have a desire to aid in solving social

problems. Through the dignity and worth of a person lense, we must serve those individuals in

need with respect. When dealing with the homeless population with depression, while

employing these two values, we are to be aware of the homelessness issue and aid in solving

the symptoms of depression all while showing respect for the person.

Conclusion

It is safe to say depression in on the rise, especially in Columbia within the young

adult age range. Luckily, there have been interventions that can be proven successful in the

treatment or management of depression symptoms. A traditional method we researched was

the individual CBT and we found that it is effective when the goal is reducing depressive

symptoms. However, we have found a nontraditional intervention of play therapy, although

not popular for this age range, can be more effective than the traditional method of CBT.

According to our research, both interventions had decreased DBI screening scores during their

posttest after receiving treatment. After comparing all the different possible interventions, we

concluded that the nontraditional method of play therapy will help to reduce depression in

homeless young adults in the United States.

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Works Cited

Allison , B. A. M. (2005, July 20). Case study of a client diagnosed with major depressive
disorder. rowanuniversity.edu. Retrieved April 4, 2023, from
https://rdw.rowan.edu/cgi/viewcontent.cgi?article=1958&context=etd
Bhatt, S. (2022, October 14). Targeting inflammation: A potential approach for the treatment of
depression. Metabolic brain disease. Retrieved April 3, 2023, from
https://pubmed.ncbi.nlm.nih.gov/36239867/
Current statistics on the prevalence and characteristics of ... - Samhsa. (n.d.). Retrieved April
24, 2023, from
https://www.samhsa.gov/sites/default/files/programs_campaigns/homelessness_programs_
resources/hrc-factsheet-current-statistics-prevalence-characteristics-homelessness.pdf
Homelessness Resources: Youth. SAMHSA. (n.d.). Retrieved April 24, 2023, from
https://www.samhsa.gov/homelessness-programs-resources/hpr-resources/youth
Joy, Adam. “ProQuest | THE RELATIONSHIP OF INDIVIDUAL THERAPY TO
DEPRESSIVE SYMPTOMS AMONG TREATMENT-SEEKING HOMELESS
MEN. Better Research, Better Learning, Better Insights.” Proquest, June 2013,
https://media.proquest.com/media/hms/ORIG/2/NjzhI?_s=Nfb9ro%2BKBPzSeIywQKTS
KOMWhZc%3D
National Patterns in Antidepressant Medication Treatment. Retrieved April 3, 2023, from
https://jamanetwork.com/journals/jamapsychiatry/articlepdf/483159/yoa90007_848_856.
pdf
PMC, Europe. Europe PMC, https://europepmc.org/article/med/22244723.
Pop-Jordanova, Nada. “BDI in the Assessment of Depression in Different Medical Conditions.”
PRILOZI, 1 Mar. 2017, https://sciendo.com/article/10.1515/prilozi-2017-0014.
Psychiatry Online | DSM Library.
https://dsm.psychiatryonline.org/doi/full/10.1176/appi.books.9781585629992.mf02.
Spelman, D. B. (2021, December 31). Using CBT in the treatment of depression. Private

Therapy Clinic. Retrieved April 18, 2023, from

https://theprivatetherapyclinic.co.uk/blog/treatment-of-depression/

Thimm, J. C., & Antonsen, L. (2014). Effectiveness of cognitive behavioral group therapy for

depression in routine practice. BMC psychiatry, 14(1), 1-9.

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Appendix

While conducting the research, Google Scholar was used for finding peer-reviewed

articles and studies. Furthermore, the sources were found by using a combination of the words

“depression and whichever intervention method we were looking for.” For example, “depression

and group therapy.” While doing this research, there were no limitations used, and finding the

articles was easy because depression is a widely known and important topic. Google Scholar was

the most helpful because it provided all peer-reviewed articles with easy access to view them.

The only problem that occurred while looking for literature in this research was finding articles

that did not use studies. When this happened, we just moved on and found sources that gave

studies done on Depression and treatment methods.