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Girls Got Issues: The Importance of Gender-Responsive Treatment in Working with Girls

Girls Got Issues: The Importance of Gender-Responsive Treatment in Working with Girls. Dr. Tyffani Monford Dent Falisa Asberry , MS. Objectives. Gain understanding of the prevalence of mental health issues in girls Learn how mental illness presents differently in girls vs. boys

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Girls Got Issues: The Importance of Gender-Responsive Treatment in Working with Girls

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  1. Girls Got Issues:The Importance of Gender-Responsive Treatment in Working with Girls Dr. TyffaniMonford Dent FalisaAsberry, MS

  2. Objectives • Gain understanding of the prevalence of mental health issues in girls • Learn how mental illness presents differently in girls vs. boys • Gain understanding of the components of gender-responsive treatment

  3. Why Gender-Specific Treatment?

  4. Why Girls Need Gender-Competent Programs • Girls develop in unique & powerful ways that require specialized focus • Programs designed for boys do not address unique & complex needs of girls • Programs for are more successful when:

  5. Note: • Primary focus of Gender-Responsive Treatment has come from Adult and Juvenile Corrections

  6. Mental Illness and Girls

  7. Women and girls with mental health and/or substance use conditions/disorders are at higher risk for associated physical health and medical problems.

  8. Mental Health by Gender • Boys are more likely than girls to have a mental health need • BUT • Girls are more prone to anxiety and depression • Girls are more likely to come to the emergency department having attempted suicide

  9. Girls have higher prevalence rates of PTSD, eating, sleeping, somatization and borderline personality disorders and features. • Girls have higher rates of co-occurring mental health and substance use rates. • Gender differences in aggression narrow beginning in adolescence

  10. Interpersonal stress is higher in adolescence, especially with girls---and more related to depression in girls than boys • Girls more likely to ruminate than boys

  11. Issues in working with girls

  12. SAMHSA Assertions about working with girls • Women and girls are different from men and boys in • Physiology • Cognition • Emotions • social development • communication patterns • roles, socialization • Risks • resiliency.

  13. Biological/physiological • Adolescence, pregnancy, perimenopause, and menopause are distinct periods in a woman’s life, each accompanied by a range of physiological, psychological, and developmental changes, with changing risks, opportunities, and support needs.

  14. Societal gender-role expectations • That stereotypes about sexuality in the media and community, and the unrealistic portrayal of their bodies • Gender influences communication, life priorities, responsibilities, and expectations. • Recognition of resiliency

  15. Societal expectations and messages regarding women’s sexuality can deter healthy sexual development and decision-making.

  16. Experience with trauma • Being female means there is an increased likelihood of violence and trauma • trauma can have a strong and long-lasting effect on development and on the experiences of women and girls. • Societal and cultural interpretations and contexts shape how the trauma experiences are • defined • accepted, • prevented,

  17. Women and girls are more frequently vulnerable to violence and trauma, and this vulnerability must be addressed in prevention efforts as well as other mental health and substance abuse services.

  18. Prevalence Rates Boys & Girls • Girls are 3-4 times more likely to be victims of sexual abuse than boys. • Girls are more likely to be victimized physically, and sexually by a family member. • Victimized girls are more likely to present serious mental health symptoms.

  19. Boys and girls respond differently to abuse. Boys generally become aggressive. • Girls tend to internalize the injury, sometimes becoming aggressive and other times becoming depressed, or both at the same time. • Boys tend to minimize their negative emotions.

  20. Relationships are critical to the emotional development of women and girls and also play a significant role in both the development of, and recovery from, mental health and substance use conditions/disorders.

  21. shame and personal guilt feelings • That women and girls who are trauma survivors may have “triggers” of traumatic memories that can cause them to re-experience the trauma. • Of the developmental impact of violence and trauma on girls in childhood and adolescence, and how it can influence their transition to adulthood. • Of the increased vulnerability to violence and trauma for girls and women with disabilities • Of the concept and potential impact of historical-cultural and intergenerational trauma

  22. Special Populations • As many studies and reports have indicated, differences in cultural beliefs and values are important to consider in mental health service delivery, as they affect treatment preferences and outcomes. • Culture impacts how individuals receiving mental health services • • identify and express or present distress • • explain the causes of mental illnesses • • regard mental health providers • • utilize and respond to treatment Hogg Foundation for Mental Health (2006)

  23. SAMHSA • Although women and girls may share many biopsychosocial and spiritual characteristics as a gender group, women and girls are heterogeneous. Culture, age, socioeconomic status, religion, disability, and racial and sexual identity all influence women’s gender roles. It is critical that staff understand how sociocultural identities differ among women and girls and may lead to different health outcomes.

  24. Cultural identity and impact on girlhood • May identify more with race/ethnicity than girlhood • Cultural beliefs about girlhood (marianismo, being black first and girl second)

  25. Areas of competency needed (SAMHSA) • Sex and Gender Differences •  Relational Approaches in Working with Women and Girls •  Understanding Trauma in Women and Girls •  Family-Centered Needs of Women and Girls •  Special Considerations During Pregnancy •  Women’s Health and Health Care •  Collaboration and Interdisciplinary Skills

  26. What is Gender-Responsive Treatment • Treatment that addresses the unique needs of girls and women • Trauma-informed, integrated treatment approach

  27. What does GRT do? • “Create environment in which program development, content, and material reflects understanding of the realities of the lives of women and girls…that addresses and responds to their strengths and challenges” (Covington & Bloom)

  28. Theory underlying GRT • Strengths-based • Relational Centrality • Holistic • Safe • Evidence-Based

  29. Strengths-Based • Promote empowerment and activate social supports • Understand their relational capacities as assets and manage relational aggression

  30. Resiliency • innate capacity that when facilitated and nurtured empowers to successfully meet life’s challenges with a sense of self-determination, mastery and hope.

  31. Identify strengths and build upon them • Know about Protective Factors • Religion • Family • Self-esteem • Educational achievements • Independence

  32. Clear expectations • More intensive reserved for those who are the most vulnerable • Avoid referring to girls as “high-risk” • Rise Sister Rise language “Girls At-Promise”

  33. Increasing strengths-based • Engage the girls in being active participants—give a voice • Develop natural supports/bonds • Teach new skills based on strengthsProvide equitable academic & vocational experiences • Support leadership skill development

  34. Relational

  35. Agreement among researchers that girls’ friendships are critical in the development of adolescent identity, behaviors, and overall health

  36. Relational-Cultural Theory(Jean Baker Miller) • People grow through and toward relationships throughout the lifespan, and that culture powerfully impacts relationship. • Impacts cognitive, emotional, physical, and spiritual health

  37. Gilligan & Mikel Brown • Critical need for girls to experience relationships in which their voices are heard without being alienated

  38. Building healthy alliance • Girls socialized to listen to others • Girls value the emotional exchange that takes place in relationships

  39. Need to • Agreement on • Goals of intervention • Collaboration on tasks required to achieve goals • Trustng and respectful relationship that is safe • Female staff may have the advantage in this

  40. Demonstrate • Respect women and girls. • Value connection with others and recognize women’s and girls’ need for connection as a legitimate objective. • Value and express compassion, warmth, support, empathy, authenticity, humility, and sensitivity toward women and girls. • Value women and girls as active participants in their health and wellness, and recognize that they are capable of setting their own priorities and identifying steps toward change. • Recognize sexual stereotypes and sexualizing messages regarding women and how these messages can affect one’s attitudes, expectations, and treatment of women and girls.

  41. Promote healthy connections • Emphasize positive connections with family, peers, school, and community • Expose to positive role models • Promote healthy relationships among girls • Social competency techniques • Cognitive interventions that decrease negative self-view

  42. Safety • Physical Safety • Emotional Safety • Surroundings that Value Females • Single-gender programming – in small groups, free from attention of adolescent males

  43. Evidence-Based • Test measures • YLS/CMI • Early Assessment Risk List for Girls (EARL-21G) • BDI • Massachusetts Youth Screening Instrument (MAYSI-II) • Child and Adolescent Needs and Strengths-Juvenile Justice (CANS-II)

  44. Promising Curricula(Per OJJDP) • Girls Circle • Girls 9-18—Aggression, violence, family problems, AOD, trauma • Project Chrysalis • Girls 14-18 who have been abused. • MovimientoAscendencia (Upward Movement) was established in Pueblo, Colorado • Girls 8-19, Hispanic—delinquency, gang prevention • Girls, Inc. Friendly PEERsuasion • Ages 11-14, primarily AOD, conflict resolution

  45. Other Options • VOICES: A Gender-Responsive Curriculum for Girls • Growing Beyond: A Workbook for Girls • Growing Great Girls A Gender Responsive Life Skills Curriculum • Project Girl (Media and body image) • Creating Resiliency in Girls • Michigan Department of Human Services

  46. BUT… • women and girls are heterogeneous.

  47. Remember • Their presentation and needs often differ from boys • Programs/interventions designed for boys may not meet their needs

  48. Must • Individualized Assessment • Helping Alliance • Gender-responsive programs/resources • Healthy connections • And Again, Recognize their differences • Value the FEMALE PERSPECTIVE • Celebrate & honor the FEMALE EXPERIENCE • Respect & take into account FEMALE DEVELOPMENT • EMPOWER young women to reach their full potential

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