Introduction
The public approach to problem-solving and prevention of disease or other adverse phenomena is comprehensive and powerful because it allows the simultaneous examination of an issue from multiple perspectives including health, physical, social, legal, and psychological areas. The population-based approach, as well as public policy development and implementation, can bring substantial changes to the social environment and improve the quality of life.
Therefore, the evaluation of regulations and strategies and the factors that contribute to the positive outcomes in the administrative process is essential to the achievement of better policy effectiveness. Based on this, the given health policy research (HPR) aims to investigate current policies on the prevention of teenage suicide. Nowadays, intentional self-harm is one of the most common causes of death worldwide, and some studies reveal that suicide is especially common among people of 15-30 years old (Kutcher & Szumilas, 2008). It means that suicide is a significant public problem that can be solved only through a comprehensive approach.
Key Elements of the Research Process
Conceptualization
Problem statement
According to the Centers for Disease Control and Prevention (CDC) (2015), one-fifth of the U.S. teenagers think of suicide each year. Nearly 8 percent of adolescents (about 1 million people) attempt suicide, and approximately 1,700 die by suicide annually (CDC, 2015). The present-day suicide prevention programs, as well as national and state policies, primarily aim to provide mental health specialists, educators, and community leaders with appropriate resources to identify teenagers who are at risk and refer them to competent care (Pennsylvania Department of Education [PDE], 2015).
But even though suicide intervention and postvention are essential to dealing with this issue, most researchers claim that youth suicide is preventable (Kutcher & Szumilas, 2008; CDC, 2016; White, 2016). Therefore, teenage suicide prevention efforts should be core to the effective public health policies that focus on decreasing teenage suicide rates at the local and national levels. Therefore, it is important to analyze what aspects of public policies and national strategies better affect the reduction of youth suicide rates.
Research questions
- What is the major focus of the current preventive strategies and policies?
- What are the prerequisites for the success of the national teenage suicide prevention strategies?
- Are they responsive to the needs of the target population?
- How and under what conditions can public policy improve mental health outcomes contribute to the decline in teenage suicide rates?
Knowledge paradigm
The given HPR project is constructed according to the principles of critical realism. From this theoretical perspective, social reality is independent of various social actors but, at the same time, it influences and is influenced by them (Gilson, 2012). It means that individual behavior is affected by micro and macro-social processes and structures. Based on this, the study put in the critical realist framework aims to determine the causes of the social phenomenon, i.e. health policies and teenage suicide. Moreover, the relationships between causes and effects are regarded as non-linear, dynamic, and complex as they are linked to both social actors and contexts (Gilson, 2012).
Thus, the application of the critical realism paradigm allows the multilateral explanation of health policies and helps to identify the processes which explain the results of strategic interventions.
Groundwork: HPR Data
The study evaluates the sample of twelve randomly collected resources including five health policy research papers, four qualitative peer-reviewed articles, and three quantitative research located through MEDLINE and NCBI databases. The selected data derives from the highly credible academic and professional resources, including the Ministry of Children and Family Development and the CDC, and, therefore, it serves as high-quality evidence.
Methods: Literature Review
The review of literature related to teenage suicide and relevant public health policies is conducted at the early stage of the HPR. The literature review includes the systematic search, location, and evaluation of materials on preventive health policies and the published HPR information. This research method allows the analysis of underlying assumptions behind the formulated research questions and facilitates the interpretation of the HPR findings.
Research Design
Qualitative research
Qualitative methodology is selected because it allows researchers to fulfill the gaps in knowledge through the description of data. The main strength of the qualitative research methodology is its focus on comprehension, explanation, and interpretation of evidence rather than statistical estimations.
Validity threats
Interpretative research is always characterized by a high level of subjectivity, and the validity of qualitative cannot be proved according to the traditional scientific criteria. However, it is considered that knowledge in itself is always interpretative, and it always depends on the individual perspective (Lessor, 2000). Moreover, it is possible to increase the objectivity of data interpretation by adequate research structuring and integration of supportive evidence.
Sampling
The non-probability sampling technique is applied during the selection of academic studies and published HPR. The non-random selection of sample studies was primarily influenced by the character of the investigation and the overall orientation to the topic and formulated research questions. The convenience sampling is employed because it is characterized by simplicity and a high level of access to the objects of evaluation and, at the same time, by using convenience sampling, it is possible to include all available and suitable materials as part of the sample.
Measurement: Validity and Reliability
Validation of qualitative research determines whether other professionals in the field of study will be able to accept the author’s view, understand the initial data provided in the paper, and comprehend the offered suggestions and conclusions (Whittemore, Chase, & Mandle, 2001). To achieve a high level of HPR validity, the strategy of analytical induction is applied. This method implies the reassessment of the working hypotheses by the introduction of new data on different stages of the research process. The additional information sharpened data interpretation and conclusions and facilitated the achievement of the maximal level of generalization.
Data Collection
Secondary data collection is performed in the study. The secondary data is characterized by accessibility and availability. Moreover, it allows the comprehensive evaluation of the problem and refinement of research objectives. However, the main disadvantage of this method is the reduced control over the research process in terms of setting study aims and limitations, as well as a high level of dependability on the boundaries and frameworks identified in the published materials.
Data Processing
Data editing, classification, and tabulation were carried out in this project. The first step helped to clean the information from potential biases and eliminate inconsistency in different research findings. The following classification and tabulation of both qualitative and quantitative evidence by themes and attributes largely facilitated the comparison of data and increased their readability.
Data Analysis
Grounded theory is used as a method of evidence analysis and synthesis. This approach implies the development of theory on the basis of systematic collection and analysis of data related to the subject. In this case, the phases of data collection, data analysis, and generation of the theory are interrelated (Lessor, 2000).
By following this principle, the inductive method of analysis is selected. It means that the analytical models, themes, and categories are developed as the outcomes in the process of evidence evaluation – they are introduced merely after data collection and analysis. In the given theoretical framework, the emphasis is made on the natural variations in data derived from the previous literature findings which were categorized and systemized to support and generate new theoretic ideas.
Application
Communication of the HPR evidence is important as it may contribute to the improvement of the rulemaking and policy operation processes. The publication of a manuscript in a professional or scholarly resource significantly increases its value because publishing verifies the credibility of evidence and data validity. However, in order to achieve this objective, it is important to comply with high standards of writing: ethics, proficient language use, styling, etc. A published work serves to inform decisions about practices, planning, and policymaking.
Ethical Considerations
The main requirements of the Health Insurance Portability and Accountability Act (HIPAA) and Institutional Review Board (IRB) regarding research conduction is the protection of participants’ well-being and rights. The protection of privacy is the central point of the HIPAA and IRB regulations. It is important to use personal information of study participants confidentially and avoid its disclosure without their permission.
The given HPR paper is written according to the principles of ethical research conduct by selecting only those research resources which showed the compliance with the mentioned standards, i.e. did not disclose personal information of study participants outlining only the necessary information about their demographic backgrounds, used only harmless methods of data collection, implemented the principle of informed consent, and minimized the risk of data misinterpretation.
Literature Review
Factors Defining Policy Inefficiency
According to Knox, Conwell, and Caine (2004), the current endeavors towards youth suicide prevention are still focused on identifying and intervening individual cases “just before or during suicidal events” (p. 40). Prevention of suicide in teenagers is primarily based on clinically-focused or community-focused approaches rather than the population-based ones. The primary cause of it is rooted in the fact that, in the recent past, the U.S. mental health specialists suggested to consider each suicide attempt as an individual or interpersonal act.
Although, since then, the transition from the individual-oriented approach to school, family, and community-based approaches was made, the preventive efforts are still localized. The researchers suggest that it is the lack of evidence on the effects and significance of suicide prevention that creates the barriers to the implementation of teenage suicide prevention strategies at the nation-wide level (Knox et al., 2004).
Policy Focus
As stated by Kutcher and Szumilas (2008), national suicide prevention efforts often focus on risk factors including the onset of major psychiatric disorders, social disadvantages, childhood abuse, distress, dysfunctional family relationships, etc. It is considered that the best effect can be achieved if the policies address causal and, at the same time, modifiable risk factors. The evidence for the impacts of preventive policies and interventions is still insufficient, but the research findings obtained by Gould, Greenberg, Velting, and Shaffer (2013) reveal that school-based skill training, development of suicide awareness in teenagers, education of health care specialists, media education, and restrictions on the acquisition of lethal means may be considered promising prevention strategies.
Core Components of the National Youth Suicide Prevention Policy
According to White (2016), a comprehensive strategy for teenage suicide prevention will target both welfare promotion and risk reduction. The specific objectives of national public policies thus should include community strengthening, reduction of social disparities, and promotion of social justice, improvement of social support, as well as youth and family education. However, it is important to consider the fact that when preventive measures implemented independently of each other, their positive effect may be reduced. Therefore, it is important to develop an integrated approach to improving the situation by targeting many areas of concern simultaneously.
Resilience promotion
First of all, researchers suggest increasing the accessibility of support resources to all social strata, provide them with information about available helping resources, and improve community members’ skills of navigating them (White, 2016). According to the CDC (2016), better connectedness of youth and families to social and community organizations benefits them. However, nowadays, there are many barriers to enhance family-organization connectedness including the limited capacity of locally rendered service, excess costs, insufficient quality, and many others. Since the promotion of resilience is a potentially effective measure in suicide prevention, the policy should make efforts towards removing the existing material or social barriers to support seeking.
Youth education
Teenage skill-building is regarded as an essential part of suicide prevention efforts by most health policy researchers. The core skills that should be developed are coping skills, problem-solving, goal setting, stress management, interpersonal communication, cultural sensitivity, self-awareness, and many others (White, 2016). The given approach is mostly school-based and implies personnel training and the creation of a response team and staff development (PDE, 2015).
Family support and parent interventions
Interpersonal connectedness is associated with a reduced risk of suicidal behavior. Social integration and the lack of social isolation protect individuals from thinking of suicide. For example, one of the cross-sectional studies on the U.S. youth behavior revealed that improved relationships between teenagers and their family members, as well as a higher level of perceived family care, decreases the risks of suicide (CDC, 2016).
It is considered that empowerment-based parent education and skill development may have a positive effect on youth suicide reduction rates (White, 2005). By learning how to deal with family conflicts and identify early signs of suicidal behavior in children, parents may become more engaged in the improvement of the situation and bring a positive change into the community.
Addressing the Needs of Vulnerable Subpopulations
There are a few significant differences associated with suicidal behavior among various demographic subgroups. For instance, the data shows that suicide in males is more frequent than in females while, at the same time, women tend to have suicidal thoughts more often than men (CDC, 2016). Moreover, suicides are especially common among minor racial and demographic subgroups, e.g. American Indians (CDC, 2016) or same-sex orientation youths (Russell & Joyner, 2001).
It is also observed that bullying and exposure to aggressive peer behavior trigger the development of psychological problems and social isolation in teenagers and increase the probability of suicidal ideation in them (Borowsky, Taliaferro, & McMorris, 2013).
The findings indicate the importance of the development of the school-based and community-based interpersonal connectedness as they are core to the prevention of suicide in youth. The policy thus should focus on the promotion of positive attitudes to diversity and the creation of a favorable environment by reducing social and structural oppression of minority youth, providing equal opportunities, and eradicating violence among peers (White, 2016).
Impacts of Substance Use Policies on Youth Suicide Rates
Substance intake and particularly alcohol drinking is one of the risk factors that provoke suicidal behavior. According to Markowitz, Chatterji, and Kaestner (2003), nearly one-third of teenage suicide victims suffer from various substance abuse disorders. Based on this, the researchers suggest that state and national alcohol policies on the establishment of legal drinking age, alcohol taxation, and availability may play a big role in the prevention of suicide among youth (Markowitz et al., 2003). Therefore, by including the alcohol policy tools into the teenage suicide prevention strategy, it will be possible to make it more efficient.
Impact of Suicide Research Evidence on Suicide Rates Decrease
Widespread adoption of evidence-based practices is a prerequisite for successful policy enforcement (U.S. Department of Health and Human Services, 2008). Research advancement is thus one of the ways to improve policy formulation and implementation. The development of adequate data and case report systems, improvement of analytical tools, conduction of participatory action research, and enhancement of collaboration between researchers and stakeholders foster the positive practical results in suicide prevention (Little et al., 2016).
Policy Implementation
Rulemaking
The accuracy of policy formulation and the selection of the right language is essential to its successful implementation. At this stage, it is important to take into account evidence and use it for the formulation of clear objectives, and the creation of well-balanced rules and regulations which will not be too specific or too vague (WHO, 2012). Additionally, the interaction of executive branch representatives with multiple stakeholders, legislators, etc. may allow the amendment of policy statements and significantly facilitate their implementation.
Operation
At this phase, the design and conduction of administration procedures are performed. And since the quality of the policy itself is as important as the skilfulness of the administrative personnel, it is important to integrate operation activities with the rulemaking process. Any inconsistency and contradictions between policy objectives will be especially evident in the operational phase and will result in policy implementation failure. Thus, when planning policy operation activities, it is important to make sure that all policy characteristics are well combined and will not lead to conflicting outcomes.
Conclusion
The HPR has outlined some key elements of the population-based approach to preventing suicide in teenagers. The findings reveal that a comprehensive strategy should target multiple suicide-related issues at the individual, community, and national levels simultaneously. The major youth suicide prevention operations include the promotion of competencies, awareness development, risk reduction, improvement of protective factors, and enhancement of early detection practices. It is important to strategically combine these actions and efforts in various settings: hospitals, schools, social organizations, etc.
The most promising policy regulations should target both individuals and their social environments by supporting connectedness, compliance with human rights, and minimizing the exposure to negative influences. Additionally, it is important to improve research design and methods to generate new evidence on youth suicide and use it for the improvement of policy implementation and policy administration outcomes.
References
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