Friday, January 23, 2015

#WeAreAllWorthy: A Critique and Response to StopBullying- Paola Peynetti

Bullying is a major problem in schools and workplaces all over the world. It is a “multifaceted form of mistreatment, characterized by the repeated exposure of one person to physical and/or emotional aggression including teasing, name calling, mockery, threats, harassment, taunting, hazing, social exclusion or rumors” (17). The World Health Organization has documented a wide range of bullying prevalence worldwide. As all public health and societal problems, bullying is the consequence of a complex network of socially constructed image and personality stereotypes and ‘labels’ promoted and fueled by mass media, interconnected discriminatory behaviors and actions against people from with different race/ethnicity, gender, sexual orientation, body image, and even hobbies and interests. In the realm of public health, bullying is an enormous problem—it is the emotional and/or physical abuse that has detrimental effects not only in the physical and mental health of the victim—even mortality, but also on their academic/professional performance, self-esteem, continuous systematic and interpersonal discrimination of ethnic/sexual minorities, and future of the victim as possible victimizer.
The U.S. government’s campaign is failing to protect victims and prevent further victimization of individuals in schools, as most of its proposals are innately misled from individual health behavior models, such as the Health Behavior Model, the Transtheoretical Model, and the Theory of Planned Behavior—as analyzed below, the approach towards bullied students fuels victim-blaming and helplessness, the response towards bullies fails to address the roots of the abuse, and the advice for parents and teachers is not strong enough to change their behavior in a progressive, understanding, way, maybe only their attitudes—then they become an authoritative figure nobody wants to listen to. Today’s Western value system emphasizes the ability of the individual to control his or her own personal fate. However, this focus on the connection of social conditions to single diseases via single mechanisms at single points in time neglects the multifaceted and dynamic processes through which social factors may affect health and, consequently, may result in an incomplete understanding and an underestimation of the influence of social factors on health (11).
Social epidemiologists and psychologists have continuously concluded “multidisciplinary efforts are needed at a community level to provide effective interventions” (13). There is also an urgent need to reframe the issue (22) in the social construct of how bullies, victims, and bystanders react. fails to acknowledge and respond to the intersectionality of other oppressive systems that facilitate bullying, such as racism, discrimination, sexism, homophobia, stigma, domestic violence, mass media reach and patriarchy. We urgently need a “reconceptualization of lifestyle” (7) in collective action instead of individual, self-interested competition. The intervention #WeAreAllWorthy is a multidimensional movement using social networks, allyship, the urge for safe spaces, good citizenship, and the prevention, protection, and respect of basic human rights for all to defeat bullying.

Critique Argument 1: Victim Blaming Is Counterproductive and Fuels Stigma
The Federal Government’s campaign’s advice to victims is, “If speaking up seems too hard or not safe, walk away and stay away. Don’t fight back. Find an adult” (19). This advice is innately flawed because of three reasons, all connected to individual health models with wrong assumptions or to a wrong approach to social health models.
First, asking children to walk away and not fight back automatically gives more power and control to the bully. Control is a crucial core value that people want in their lives, and by giving it to the bully, the victim feels even more dependent on and further victimized by the system.
Second, this continued “victim-blaming” of the campaign, through further Labeling, saying not to provoke or go near the bully, not to fight back or speak back at them, only strengthens the victim’s hopelessness: if he/she’s the victim and the system is telling him/her that it’s impossible to fight back and one must only stay away, it’s turning the blame on the victim for being in the same space as the bully. It’s like blaming a rape victim for what she’s wearing or what party she was in instead of blaming the rapist or the bully for the abuse.
Third, the campaign tells students to report to the school, but often this reporting is not anonymous and the victim sufferes further abuse—this point thus assumes that the victim is in a vacuum and that the environment is receptive to reports. Social Cognitive Theory (15) is the least restrictive of the individual models, but it still assumes a dynamic, ongoing process in which personal factors, environmental factors, and human behavior exert influence upon each other” (14). The intervention is asking too much of the victims- if the environment is abusive, violent, and full of stigma, its influence on the individual’s thoughts and actions will be negative and victims will not feel comfortable or safe reporting to a school that continues to fail them.

Critique Argument 2: Punishing the Bullies Fails to Address the Roots of Abuse
The campaign follows a traditional approach towards the bullies, or abusers, punishing them in the same way that other students are punished for completely different reasons. Bullying is thus treated in school rules as just one more behavior that is forbidden, yes, but not adequately handled. Bullying is a much more complicated problem than smoking, or eating in class, or speaking during a test—this abuse permanently scars the emotional and physical health of another human being. Following are three reasons why this privation of freedom is counterproductive and also fails to address the roots of the abuse.
First, bullies are punished through not being able to go outside during recess, or an extra study period, etc. and also sometimes through forced instructions on how to stop bullying other students. This is based on the Transtheoretical Model (9), which concludes that a model where change takes place in stages is best (Pre-contemplationà contemplationà preparationà actionà maintenance). Unfortunately, it not only fails to find incentives for good behavior and maintenance of that good behavior, but it also doesn’t even consider the roots of the abuse. Bullies aren’t going to sit during lunch break on Monday contemplating how their abuse might be hurting their victim, and by Thursday they’re Most Compassionate Student. Any trigger, such as being abused themselves, can absolutely take them to an unpredictable jump, backwards or forwards in this model. Furthermore, the alternative model of Psychological Reactance (18) states that whenever an individual feels that its freedom is being threatened, it will do whatever it takes to restore that anxiety and get that freedom back. This means that anytime a student is punished at school for bullying or breaking any other rule, they’ll react to that threat or that punishment by exerting their power and control over other students even more than before. The bully wants to maintain his/her position of power and autonomy to call others names or beat others up, so maybe
Second—and maybe the most important failure of this campaign, is that it doesn’t directly address the psychological causes of bullying. Teachers recognize that the abuse may be a consequence for past or parallel victimization of the abuser, but in the context of school rules and action steps, the bully is not a victim, but a rule-breaker. Studies have continuously shown that the victim-bully cycle is fueled by the Social Learning Theory (the most comprehensive of the individual theories). Studies of violence and abuse have discussed the role of social learning theory in the victim-offender cycle of abuse, finding that “victims of abuse are often more likely to be disruptive, aggressive, and violent than their non-abused counterparts” (12, 15).
Third, the campaign explicitly tells kids to “be nice” (which again touches on Psychological Reactance), but it fails to consider the social norms of schools and of mass media telling kids that abuse and name-calling increases the social status of the bully within their individual social networks. The campaign is advocating for the Theory of Planned Behavior (9), where individuals should go through a rational, cognitive decision-making process. However, this model fails to consider subjective norms associated with that behavior. Even if the bully considered decreasing or stopping the aggression, peer pressure of more bullies or of the popular or ‘cool’ kids in the school would encourage him to act irrationally and continue the violence.  Some bullies are bullied to bully, and individual models fail to recognize the social network where students face this stigma, abuse, and norms.

Critique Argument 3: How Adults Are Promoting the Wrong Values also has an unrealistic and incomprehensive approach towards teachers and parents in the community. The campaign fails to understand the unrealistic optimism of parents who don’t believe in bullying and teachers who choose to ignore the problem; it also stresses the adults’ attention on victim-blaming again; lastly, it fails to recognize the social norms of reinforced prejudice and stigma that kids mimic from adults around them.
            First, it is worth mentioning again the Health Behavior Model’s (9) assumption that it’s the victim’s fault that he or she is being bullied. The model states that each individual considers his/her perceived susceptibility, severity, benefits of action, and barriers of action—meaning the costs and benefits of particular actions, which should result in rational decision-making.  This theory then rationalizes that a situation of youth violence is a consequence of a victim not measuring the costs and benefits of their behavior correctly and ending up in the wrong place at the wrong time.
            Second, this campaign fails to acknowledge the predictable irrationality (1) of the parents and teachers who are supposed to be role models and examples for their students and children. As the adults in the community, these individuals are responsible for not only advocating for kindness, respect, and equality, but also for showing these behaviors and actions by example. The campaign fails to address the normalized and institutionalized racism, sexism, prejudice, homophobia, and abuse within families, communities, and workspaces also. If students are being told not to bully but they’re being shown violence, discrimination, and injustice, they’re going to mimic the behaviors and silence the advice. (15)
            Third, the campaign is unaware of the Theory of Optimistic Bias and of the Law of Small Numbers, therefore, parents and teachers choose to ignore signs of abuse rationalizing it as unlikely to happen to their students or their children. These theories have shown how that people tend to think they’re invulnerable, but they expect others to be victims of misfortune, not themselves. Studies have repeatedly confirmed that “cognitive and motivational considerations lead to predictions that degree of desirability, perceived probability, personal experience, perceived controllability, and stereotype salience would influence the amount of optimistic bias evoked by different events” (21). Therefore, just as police departments and administrators of universities deny sexual assault prevalence in their schools because it must be sure happening somewhere else, but not here, teachers and parents rationalize that because they didn’t suffer bullying or because they’ve never seen it—because they know only a few kids who aren’t bullied they assume nobody is, especially their kids (Law of Small Numbers), they don’t assume the problem with all of its complex causes and connections to other forms of violence, aggression, and bad parenting or teaching.

Intervention idea: #WeAreAllWorthy
The campaign is failing to recognize the importance of social health behavior models. It isn’t acknowledging the negative impacts of victim blaming, the strong propaganda-like effects of violent, disrespectful, competitive behavior of celebrities and TV stars in their shows and movies and in real life. The campaign also fails to recognize the victim-bully cycle and the psychological causes of youth abuse. It doesn’t create safe spaces where victims, allies, and victimizers can safely learn about stigma, about community values, or about taking control of their own safety and actions through a collective effort of everyone remotely involved. Most importantly, the campaign fails to identify the real cause behind bullying, discrimination, and physical and mental health consequences of the abuse: the real cause is the socially constructed culture and space of competition, individuality, injustice, racism, patriarchy, sexism, homophobia, and corporate control of people’s (including children) identity and desires. The World Health Organization states “enacted legislation has placed the responsibility of prevention on the shoulders of organizational (educational or workplace) management with no apparent input expected from the public health sector” (17).  This must stop as we re-think the role of public health professionals and public health frameworks for public policy and social norms. The intervention #WeAreAllWorthy is a multidimensional campaign and movement the crucial function of understanding social networks, allyship, the urge for safe spaces, good citizenship, and the prevention, protection, and respect of basic human rights for all (freedom of expression, freedom of speech, freedom from persecution and violence, etc.) in the fight against bullying.
Intervention Defense 1: #TakingControl
First and most essential, the campaign must be understanding and appealing. For victims and allies, the intervention should not just be a policy or a new rule or a new punishment for against their bullies and only in the classroom. The intervention should be a movement that gives the victims of bullying the control and autonomy that they lost from the abuse. It’s important to note that in order for this movement to be appealing, it must be as inclusive as possible. Using the Diffusion of Innovation Theory (16), it will start with victims and their friends/siblings, but as soon as enough people consume the product (or join the movement), then everybody will join as well. This movement will be called  #WeAreAllWorthy,  #TakingControl. It would be not only a social media campaign and also a very comprehensive, well-developed curriculum in schools. The program would be branded (using Advertisement and Marketing Theories) with a positive message, nothing about victims but about survivors, not about bystanders but about allies, not about individuals but about a team. The curriculum would have an extra class with discussions on different mental health and community development topics, collective reflection, safe space discussions, and conversations on diversity, acceptance, respect, body image, stereotypes, etc. It would also have an anonymous confidential section where students could speak to a peer ally and also a counselor about their experience with youth violence or abuse.
Another key point of this intervention is that the leaders of this movement will be older peers who stand as allies to the younger student survivors. Malcom Gladwell’s The Tipping Point (10) explains that “all epidemics have tipping points,” as soon as a specific number of students join the movement and become part of the campaign, everybody else will also join. Studies have shown that in schools with severe bullying problems, students believe and are committed to peer support systems, and teachers have a mostly positive view of the intervention (3). Furthermore, Maslow’s Hierarchy of Needs explains that unless students have their basic needs met—including safety, community, belonging, love, etc., then asking them for personal development and understanding of others is not realistic or reasonable. This is why the campaign would have to address basic needs: after water, housing, food, there’s family, community, security—these are the most important requirements for children to develop as community members and leaders: belonging and love.

Intervention Defense 2: #AllyForSafeSpace
The most critical point to address when including the bullies and victimizers into the campaign above is to acknowledge the high probability that they have of having been victims themselves, and of understanding the social norms and also social community, environmental, psychological causes of their actions and behavior. The victimizers would also be part of this campaign and group counseling sessions—and it is essential that these conversations foster core values of love, security, equality, role models, safety, and belonging. Older kids will be trained and serve as the leaders of these groups along with mental health professionals and teachers—however, these older “cool” or more popular kids will be the ones passing the message on, with the theme and title #AllyForSafeSpace, as Social Expectations Theory (2) has shown that people are social beings, they depend on and follow those who they deem more fit, more popular, more able, more attractive, more intelligent, etc. If this campaign has as leaders, trained and educated older kids who will serve as mentors for younger peers and talks to them about the above-mentioned topics, then it is more likely to be attractive to young victimizers instead of a campaign where the teacher reprimands all students who participate in aggression.
There’s another important point to mention: discrimination and aggression against sexual minority though is significantly higher than among heterosexual populations. Homophobic bullying is pervasive among children and adolescents in schools- as well as in workplaces:
 “Students who frequently experience homophobic bullying are at an elevated risk of several negative outcomes, including depression anxiety, hostility, mental health symptoms, health problems poor school functioning school absenteeism, substance use risky sexual behaviors post-traumatic stress disorder self-harm and suicidal behavior…. Researchers and practitioners have recognized the importance of a framework that considers assessment of risk and protective factors beyond the individual-level, as emerging evidence suggests that certain environmental factors have a profound effect on homophobic bullying in school… There’s been some initiatives for interventions in an ecological system of individual, micro, exo, and macro actions and campaigns.”  (17, 20)

Intervention Defense 3: #PassItOn
The last point of this intervention would be a mass media campaign with celebrities and personal stories aimed not only at changing kids behavior but also parents and teachers’ behavior and attitudes with regards to their everyday lives. These adults are examples/role models for their kids, and because of the intersectionality of this problem—with racism, homophobia, discrimination, individualism, etc. Parents and teachers thus will therefore learn from celebrities about bullying, good citizenship, the extra class, and the vulnerability of their kids to any form of mental and physical aggression by other kids (because of Optimism Bias, they didn’t think their kids would be bullied…). The message for teachers will also talk about the damage of bullying and of allowing for a normalized level of youth violence in schools, because studies have proven that “Teachers with stronger beliefs that bullying is normative were less likely to intervene to stop bullying, and lack of intervention was in turn related to higher levels of peer victimization in their school” (8).
The most important part of this campaign is that the message is not shooting statistics and blaming adults of bad-parenting, but it’s going to show them, with subliminal but well-structured messages, how to act in front of their kids to be more consciencious about their words, behavior, and actions with regards to race, gender, respect, violence, and conflict resolution. This campaign will appeal to strong core values of family, equality, and safety, and it’ll be successful due to Agenda Setting Theory (22) and also to Advertisement and Marketing theories (mentioned above).

It’s important to change the framing of this issue of bullying and stop blaming the victim, punishing the victimizers with no rehabilitation or dialogue, and start including parents, older kids, friends, and teachers alike in the movement to end stigma, end discrimination, and end youth violence. “The scientific literature suggests that preventative interventions should include whole community awareness campaigns about the nature of bullying and its dangers. Efforts should also be made to enhance the emotional and organizational environments in school and work settings by promoting sensitivity, mutual respect and tolerance to diversity while prohibiting bullying” (17). It is also important to remember that referral to appropriate health services will be required to alleviate the physical and emotional consequences of bullying. This campaign is branded; it’s a movement that people want to join, belong to, and share stories in. Through social  and behavioral science theories that aim to change the community’s behavior, through marketing and branding, and through understanding the multisectorial aspect of the problem, the #WeAreAllWorthy campaign will end all the failures of the initiative. Let’s #JoinTheMovement!


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The California Dream of Justice & Terror of Mental Illness: A Behavioral Indictment Of The “Three Strikes and You’re Out” Policy – Ryan Manganelli

Justice is not served best with a singular solution. For the United States, the path to justice is undeniably intertwined with incarceration. Compared to all other nations of the world, with a staggering 2.2 million inmates, the United States possesses the largest imprisoned population in the world (1). America’s most populated state (2), the Golden State, California played a major role in augmenting the nation’s incarcerated population over the last twenty years. Enacted in 1994, California’s Proposition 184, or as the infamous piece of legislation is also titled, the “Three Strikes and You’re Out” policy was crafted with the intent of deferring repeat criminal offenses. As the title denotes, under the “Three Strikes” policy, Californian criminals are punished relative to the amount of felony offenses they have committed. Repeat offenders receive twice the sentencing length otherwise mandated by law for their second offense and a third offense leads to a life imprisonment with the minimum term being 25 years (3). The law catalyzed a tremendous influx of jailed prisoners in California since its enactment. Beyond the ethical and legal dilemmas posed by the Proposition 184, the law offers profound implications for the public health sector of California. In particular, the incarceration of criminals suffering from severe mental illness creates a need for systematic reform.
Examining the “Three Strikes” policy through the lens of behavioral science provides a medium to address the disenfranchisement of mentally ill prisoners in the state of California. One of the nation’s most prestigious academic institutions, Stanford Law School has launched the discussion regarding Proposition 184’s role in the imprisonment of the mentally ill with their publication “When Did Prisons Become Acceptable Mental Health Care Facilities?” According to Stanford’s extensive report, approximately 45 percent of Californian inmates are suffering from a mental illness. The most alarming disparity highlighted in the report is the disproportionate number of inmates sentenced to life in prison under the “Three Strikes” law. Prisoners sentenced under the “Three Strikes” law are nearly twice as likely to be mentally ill compared to other California prisoners (4). Rather than establishing public institutions that assist the mentally ill prisoners combat their diseases, the state of California is shackled by its inadequate criminal justice legislation, the “Three Strikes” policy. Stemming from such inadequate policies, a vicious cycle plagues people who are mentally ill not only in California, but also the entire nation. In the fractured mental health care system of the United States, people diagnosed with severe mental illnesses face tremendous barriers to receive the necessary medical care to manage their illness. When severely ill patients are left untreated, the unfortunate reality of their illness manifests in the form of erratic and illegal behavior (5). With a policy such as the “Three Strikes” rule, mentally ill criminals are relegated to serving as cogs in the vicious cycle of repeated imprisonment and neglected treatment. Indicting Proposition 184 with several evidence-based social and behavioral science theories can bring the Golden State closer to justice.
 Issues of Stigma
            Consider the trajectory of a prototypical civil rights movement. Each civil rights trajectory can be placed in the confines of a narrative with heroes and villains. With each civil rights narrative, the villain is continually embodied by an ominous social phenomenon – stigma. Ervin Goffman, one of the most influential sociologists of the 20th century, was a founding scholar in the examination of stigma as a social concept.  By Goffman’s foundational account, stigma is a reference to a social attribute (race, occupation, religion, sexual orientation, educational status etc.) that is labeled as “deeply discrediting” by the “normals,” or exclusive factions in a society (6). Stigma plagues the socially discredited in a cyclical fashion. As Patrick Corrigan outlines, stigma unfolds in a three-part act: signals, stereotypes, and discrimination. Physical characteristics and language exuded by the stigmatized provide signals for exclusive members of society to construct stereotypes about discredited factions. With the stereotypes on the conscious of the elite, the discredited faction is subject to confront discrimination in various arenas of social life (7). As investigative journalism published in the New York Times reveals, the “Three Strikes” policy has created a medium for California to stigmatize the mentally ill.
Dale Curtis’ confrontation with the “Three Strikes” policy exemplifies the villainous nature of stigma. Curtis is a 55 year-old, Californian male who suffers from mental retardation and schizophrenia. Multiple non-violent, robberies of negligible monetary values committed by Curtis earned him three strikes in the California court of law. The tragedy of stigma ultimately confronted Dale Curtis in the courtroom. Although Curtis displayed severe episodes of mental impairment during questioning and with the negligence of his public defense attorney to mention his extensive record of illness, Curtis was awarded the status quo, life sentence for his third strike (8). Corrigan’s three-part act of stigma was exemplified in the case of Dale Curtis. Through his actions in the courtroom, Curtis provided the surrounding audience signals to justify stereotypes and discriminatory sentencing. Despite the clearly visible signs and records available to validate Curtis’ illness, the court opted to discredit his illness and ignore mental health care treatment options. Addressing issues of stigma can alter the tragic course of mental illness in California to form a story of triumph & redemption. 
The Role of Social Norms
            Before detrimental stigmas around mental illness can be resolved, there is a pressing social issue underlying the phenomena of stigmatization. Perceived social norms of mental illness are at the foundation of the injustice perpetuated by the “Three Strikes” policy.  Social norms are beliefs shared within a social environment (school, occupational setting, church, city, etc.) regarding a set of behaviors or “customary codes.” The theory of planned behavior explains the potential for social norms to impact communities. Before an individual can reach an intention to facilitate a certain behavior, the attitude that individual holds toward the particular behavior is influenced by the prevalent social norms in an environment (9). The perceptions individuals share of one another and the nature of social interactions are tremendously impacted by the prevalent social norms shared in an environment. Social norms have the potential to influence the manner that human beings treat one another. Stigmatizing and discrediting social norms regarding mental illness can further complicate disparities of mental health among individuals in a social setting.
One recent study featuring a cohort of undergraduate students demonstrates the role perceived social norms have in the stigmatization of mental illness. In the study’s primary experiment, the students were asked to describe their level of comfort to interact with individuals who display symptoms of schizophrenia and depression, as designated by the Diagnostic and Statistical Manual of Mental Disorders. Before the investigators assessed the subjects’ comfort in the hypothetical scenarios, they assessed the subjects’ perceived social norms of behaviors and personal beliefs related to mental illness using questionnaire instruments. Ultimately, the analysis revealed an association between subjects reporting less comfort with interaction among mentally ill people and perceived normative expectations about general behavior (10). The study validates the role of social norms in the stigmatization of mental illness. If people approach those battling a mental illness with discrediting preconceived notions, the ill are subject to face discrimination and stigma. Dale Curtis’ story mirrors the conclusion of the social norms study. Curtis’ symptoms and history of illness were subsequently discredited and approached with tremendous social distance, or an ambivalent interaction based on a set of collectively recognized norms in a social group (11). Perhaps, discrediting institutional norms regarding mental illness were at the foundation of Dale Curtis’ stigmatized experience.
Frames that Make the Mentally Ill Invisible
            Perspectives surrounding the implementation of the “Three Strikes” policy and subsequently proposed amendments completely ignore the role played by California’s criminal justice system in the manifestation of mental illness. With the aid of framing theory, California’s ignorance toward the mental health of its inmates can be brought to the forefront.  Framing is the manner in which information is packaged and arranged to convey an intended connotation, or message is framing (12). Polarizing issues, such as policies surrounding incarceration and the treatment of mental illness, evoke a vast spectrum of frames in the media and political forums. In the construction of public policies, framing creates a significant impact on the perspective of voters and politicians in their consideration of issues debated in legislative arenas. One of the fundamental tasks in frame analysis is identifying the core values, or the “appeal to principle” offered by a frame presented in the media. Core values are terms that link the underlying position of the frame and its attempt to resonate with an ideal that is ubiquitously valued in society (13). With the use of core values, frames have the power to influence which values and beliefs are instilled within a society. In the case of the “Three Strikes” policy, the frames surrounding the policy neglect to include health as a core value.
Proposition 36 is the most recent proposal on behalf of California’s legislature to mend the oversight embedded within the “Three Strikes” policy. Established in 2012, Proposition 36 raised the valid concerns of revising the “Three Strikes” policy to save the state money and continue to ensure the safety of its citizens. One glaring piece was missing in the frames constructed to support Proposition 36 – an emphasis on the mentally ill prisoners who are marginalized by the “Three Strikes” policy. Safety, justice, and economics are core values disseminated throughout Proposition 36’s website Fix Three Strikes. The highlighted potential benefits of the proposition include: “saves California over $70-100 million annually,” “restores the original intent of the Three Strikes law,” and “no rapists, murders, or child molesters will benefit from Prop. 36”(14). While public safety, resurrecting California’s budget, and incarcerating legitimate felons are valid concerns built upon core values that resonate with the public, there are no statues in Proposition 36 that speak to the mental health burden of inmates. As the Stanford report examines, the lack of attention devoted to the mentally ill that are incarcerated under “Three Strikes” sentencing has consequences. While nearly 1800 prisoners reaped the benefit of gaining a revised sentence following the Proposition 36 approval, 75 percent of the inmates denied a revised sentence after the proposition was passed were mentally ill (4). Proposition 36 was an opportunity to leverage the influence of framing theory to afford the mentally ill who are imprisoned by the “Three Strikes” a path to seeking treatment. The unfortunate reality is that frames in support of Proposition 36 neglected health as a core value and the negligence continues to haunt prisoners struggling with illness. Frames provide an outlet to bring an issue, not unlike prisoners battling mental illness, from subterranean media and advocacy circles to the center of mass media. With the use of health and equality focused frames, citizens imprisoned by mental illness will be granted a previously absent voice and platform in the conscious of the public.
Campaign to Address Social Norms & Stigmatization
            Mental health is gaining momentum in reaching the center of public health interventions and awareness campaigns. On the other hand, outreach and campaign efforts specific to mental illness within the criminal justice system are incredibly scarce. Invisible social issues, like the oppression of the mentally ill through imprisonment, require drastic social measures to foster legitimate social change. In the plight of the mentally ill who are imprisoned, establishing a campaign to raise awareness of Proposition 184’s role as an oppressor is the necessary social measure. Marketing principles can lend the necessary tactics to construct an effective campaign aimed at debunking stigma and reframing social norms of mental illness among the incarcerated. Social marketing, in particular, is a theoretical model pertinent to what would best assist the design of a mental illness social norm campaign. The ultimate goal of social marketing is to garner effective campaigns by utilizing principles of commercial marketing (product planning, pricing, communication, and marketing research) to leverage influence on the acceptability of social ideas and norms. To achieve significant social change, the principles of commercial marketing must address historical, cultural, political, and social environments surrounding an issue (15). Each component, or tool offered by social marketing can be applied to the predicament of the mentally ill affected by the “Three Strikes” law to design an effective social norms campaign.
Historically, California has struggled with transitioning from the deinstitutionalization of mental illness in the 1960’ s-1970 and subsequent  “emptying” of the ill released from closed state hospitals to prisons during the proceeding decades (4).  While California legislature has offered several policies to address mental health, such as the Mental Health Services Act in 2004, politically the state has been silent on issues of mental illness among the incarcerated. Considering the stigma encountered by Dale Curtis in the courtroom, the social environment in California surrounding mentally ill criminals is not one of reconciliation. With the historical, political, environmental, and social factors surrounding the “Three Strikes” law in mind, social marketing tools can be leveraged to design an effective campaign aimed at changing the social norms regarding mentally ill prisoners.
Building a social norms campaign with a product, price, place, promotion, and partnership as the pillars of intervention is paramount in the design phase. In particular, considering the product disseminated in social media, television, and print campaign materials will foster the most relevant campaign to a 21st century audience. The product, or an immediate benefit (15) to be acquired by the audience (the state of California) in the case of the norms campaign is an abstract commodity – social purpose. For instance, in promotional material, the issue of incarcerating the mentally ill can be framed as the current generation’s marquee civil rights issue. To illustrate the campaign’s product, compiling images of mentally ill persons in hospital gowns behind prison bars with images of the 1960’s civil rights movement, or the AIDS movement of the 1980’s will add historical relevance to the campaign. Like previous generations, the current generation can acquire social purpose by participating in a social movement. Politically, the campaign can engage the audience by instituting a pledge for Californians to call on their representatives and senators to craft legislative action that aids the mentally ill whom the “Three Strikes” law repeatedly oppresses.  If the historical and political components are successful, the goal of systematic social change will follow. With social marketing, a social issue can be afforded a social resolution and newfound visibility.

Establish Multi-Dimensional Care Options
            Mental illness is an immensely complex issue that requires multi-faceted solutions. Combine the difficulty of managing a mental illness with confronting the criminal justice system on a regular basis, and the issue becomes even more baffling. Maslow’s “Hierarchy of Needs” is a behavioral model that resonates with the complex and multi-dimensional nature of mental illness. Utilizing Maslow’s hierarchical model as a platform to design treatment programs for mentally ill and legally troubled populous, such as those affected by the “Three Strikes” policy, provides an outlet to compartmentalize a densely faceted issue. Abraham Maslow devised his theory to identify the most fundamental human needs, which when fulfilled, can lead to the achievement of “self actualization.” The diverse array of human needs highlighted by Maslow includes: physiological, safety, love and belongingness, esteem, and self-actualization. If all of the fundamental needs are met, individuals theoretically reach an empowered state of being that spawns the development of critical thinking and problem-solving abilities (16). Addressing the “Hierarchy of Needs” for the mentally ill poses a valid model to provide coordinated care to mental health patients and assist those who frequently confront the law assimilate into society, rather than prison.
            On a national scope, there are examples of health care facilities that provide treatment options to assist mentally ill patients meet their “hierarchy of needs.” Bridgeview Manor is an adult care home in Ashtabula, Ohio that provides mental health treatment to patients suffering from severe mental illnesses who have also served prison sentences. The facility was featured in PBS’ Frontline documentary series, “The Released,” which depicts the plight of mentally ill prisoners in the United States. In Frontline’s interview with the Bridgeview Manor director, Sherri Sullivan, she acknowledges the mentally ill patient’s unique need for assistance with routine tasks (physiological needs), such as practicing daily hygiene and preparing meals. Regaining connection with family members (love and belongingness), access Social Security and Medicaid Benefits (safety), and motivational interventions (esteem) are other services that Bridgeview Manor offers to patients.  Sullivan also noted about the patients at Bridgeview, “they need a lot of additional help that's not available particularly in an outpatient community setting” (5). Although operating a facility like Bridgeview Manor poses significant funding and administrative challenges, the facility offers an outstanding example of how mental health patients leaving prison should be treated. If California allocated more resources in community settings to address the unique “hierarchy of needs” for the mentally ill, versus imprisoning the ill as a substitute for treatment, self-actualization for the mentally ill can be realized.
Enhance Public Defense & Police Mental Health Training
            Modifying the norms of an institution is approachable through the use of individualized behavioral models. To prevent future instances of stigma within legal forums, such as the case of Dale Curtis, bolstering mental health training programs for criminal justice authorities in California is a viable solution. For the design of such training programs, social cognitive theory provides a behavioral framework to assist legal authorities transcend prejudice thought regarding mental illness and embrace social differences in their line of work. Social cognitive theory (SCT) is a dynamic behavioral model that focuses on the relationship between individual factors, environmental variables, and subsequent human behavior. At the core of SCT, is the classic nature-versus-nurture debate – are individuals a product of their environment, or is the environment a product of the individuals? According to SCT, the adoption of new behavior causes both the onset of social modifications that alter the individual and the environment (17). In the plight of the mentally ill affected by the “Three Strikes” law, the previously suggested interventions are aimed at creating environmental, or macro-level social changes. California’s individual, or micro-level solution: adopt SCT-modeled training programs for figures in the state’s criminal justice system. Through the use of a SCT model, law enforcement, judicial, and correctional professionals can develop the self-mastery to constructively interact with mentally ill persons, to recognize symptoms of illness, and to identify safe and ethical methods to coerce untreated individuals experiencing heightened states of illness.
            Patrick Corrigan also presents thought provoking literature regarding the dynamic between social-cognition, institutional stigma, and life-chances for the oppressed. Corrigan expresses the dynamic in a formulaic manner. As a product of social cognitive function, authoritative individuals exercise institutional stigma, which pressures society to undermine access to care (18). Because of pressures in the courtroom (environment) and the negligence of the judicial and legal professionals (individuals), Dale Curtis did not receive equal due process (discrimination and stigma). Expanding mental health training programs for California’s criminal justice system will reconcile the environmental and individual elements in Dale Curtis’ narrative. The National Alliance for Mental Illness (NAMI) offers one of the most comprehensive law enforcement mental health training programs in the country – Crisis Intervention Training (CIT). With a bi-dimensional program design, CIT combines an individual component: “training for law enforcement to improve response to people experiencing a mental health crisis;” and an environmental component: “a forum for partner organizations to coordinate diversion from jails to mental health services” (19). CIT focuses on social cognition by intervening the approach of individual police officers and the approach of communities, or larger social environments to treating mental illness. By addressing the individual and environmental components of the SCT model, the CIT program is a shining example of an alternative approach to incarceration of the mentally ill.
             Managing mental illness is an immense challenge for both individuals and societies. The complexity of addressing the issue is beyond daunting. In the world of criminal justice, the complexities of mental health serve as an excuse to perpetuate the oppression of the mentally ill through imprisonment. Embracing social differences will allow societies to mitigate the consequences of inadequate and antiquated policies, such as the “Three Strikes” policy. Campaigns to address social norms, establishing more multi-dimensional community mental health care facilities, and funding criminal justice mental health training programs, are viable interventions to address the systematic disenfranchisement of the mentally ill in California. Social endeavors are a balance of exercising patience and urgency. Profound societal change does not transpire instantaneously, yet the consequences of injustice do not rest.
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  14. Three Strikes Reform. About Proposition 36. NAACP Legal Defense and Educational Fund, Inc.
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Enriching The Lifestyles Of Children With Down Syndrome With The Use Of Behavioral Theories - Hurain Khan

            Children with special needs receive various responses from families and communities all over the nation. There have been many attempts to reduce the discrimination and improve these children’s quality of life. Trisomy 21, or Down syndrome, in particular has experienced discrimination fueled by ignorance that needs to be reversed. A general approach that is taken to improve these children’s lives is the use of individualized therapy sessions, separated classroom settings, and distinctive learning goals (1). There is only so much that these interventions can accomplish in the physical, mental, and social growth of a child with Down syndrome. Here, we will examine flaws with these types of programs and how to improve the details to reach a more favorable outcome in developmental abilities and learning outcomes.
Current Approach
            There are numerous programs throughout the U.S and the world that are dedicated to the wellbeing and health of children with Down syndrome (1)(2). It is very important to ensure their overall health is assessed and that they are not at risk for heart and growth complications. Clinical and classroom settings that set these individuals apart from those without developmental delays are not beneficial after a certain age. Separated facilities should not be the lifelong focus for individuals and families with Down syndrome. As they grow older and remain healthy, they develop social and interpersonal needs as well. These are clearly represented in Maslow’s Hierarchy of Needs and it is completely logical that this would also apply to individuals with Down syndrome (3). Many approaches that are in place today focus only on the physiological and safety levels, which are helpful, but severely restrictive in lifestyle. The focus now, especially for adolescence, should be the belonging, the self-esteem, and the self-actualization levels. This really is just as important, if not more important to children with Down syndrome in order to feel like they are capable of the same things that anyone else is. Here are a few ways that many current approaches do not support these long-term needs.
Argument 1
            When a parent discovers that their child has Down syndrome, whether it be prenatally or at the time of birth, they often feel like this is their personal problem and that they have to do something about it right away. Fortunately, the option of termination is becoming much less popular, but it does still exist (4). Parents and families make assumptions about what their child’s lifestyle and even their own lifestyles will be like throughout the child’s life. There are aspects of Leon Festinger’s theory of Cognitive Dissonance playing a role here. This theory states that an event that brings about a feeling of discomfort causes someone to want to take action in order to bring back a sense of comfort and balance (5). Parents may feel that the presence of Down syndrome is something that has disturbed their idea of consistency and that they need to adjust it to make it go back to normal. It is perfectly reasonable for a parent to want to take action to improve their child’s life, but sometimes over-action or over-care can be just as detrimental to the child’s future. However, parents and families often receive skewed messages of how to handle and work with a child with Down syndrome and that it should be particular and distinctive from a child without a developmental delay. This pre-conceived notion that special care is needed is often exaggerated and does not give enough credit to the child. When children are given too much extra attention and special care that other children their age do not receive, it creates something of a barrier between them and their peers. This is not the goal; we want children with Down syndrome to feel as if they are not treated differently and that they can accomplish what anyone else can. This presence of support and motivation is helpful, but it must come with appropriate motives. There are definitely benefits that come from these programs, but they are only part of what should be going on.
Argument 2
            Another flaw with these approaches is the pressure that is put on parents to fix things. Health care professionals and other organizations are using some seemingly inspirational techniques from the Theory of Planned Behavior. These ideas include enforcing certain attitudes upon people about a behavior to change and what the perceived norms are of doing that behavior. These are combined with intention and self-efficacy, and it assumes that behavior change will automatically be made (6). The idea of treating the growth of a child as the behavior to change is not appropriate. Parents often feel like they can fix this problem and lessen the negative effects that it has, or even use the technique to aspire to be in the norm. A few flaws with this theory are that it is encouraging parents to make a change in their child’s life with the wrong purpose, and it is not very useful for long-term behaviors or actions. This is precisely the case with children with Down syndrome. For a parent to want to “fix” their child based on perceived norms about what their child should be like is having a skewed intention of what is best for them. The intention behind the use of this theory is admirable, but the information being put across is not what we want parents to hear and relate to. This would involve parents being adamant about sending their eight-year-old child to a specialized classroom that is separate from everyone else and that only includes other students with developmental delays. The intention is present and there is self-efficacy for doing the right thing, but the deprivation of being around other children is definitely disadvantageous. The individualization of this approach is what constricts the mental and developmental growth of these children.
Argument 3
            Finally, those who implement these programs and health plans for parents with Down syndrome realize that taking action and continuing to take action throughout their child’s life is a way of being in control over something that happened against their will. Down syndrome is not a desired outcome, so this allows for them to be able to take some action and feel good about it. The programs and systematic interventions intended for children with special needs to undergo are restrictive of long-term goals and benefits. Being able to make a difference in how one’s child is raised and treated may give the illusion of control. This is a proposed theory by Ellen Langer that explains how people tend to prefer feeling like they have control over a situation even when that may not be the case (7). However, by doing so and trying to control and mediate the experiences a child growing up with Down syndrome has, it really ends up taking away from the more positive practices and skills that they could learn on their own with less interference. As with the majority of parents, having control over teenagers is desirable but quite difficult. Adolescents with Down syndrome should be able to experience freedom to explore and be able to learn from these same environments. Not only will this improve their social skills and self-esteem, but they will thrive in the situations they are put in because they will be able to work and solve problems more efficiently, thus boosting their self-esteem.
            All in all, individualized programs have good intentions and they are appropriate to ensure the health of a child with Down syndrome early on. However, there comes a point when these programs are restrictive and do not help children advance as far as they could if they were in more typical settings. By using influential explanations of behavior change, the skills that these children learn are constrained rather than allowed to flourish. Shifting these kinds of program to using more social models will allow more growth among adolescents with Down syndrome and their peers.
New Intervention
            As a typical child grows older, he or she ideally develops friendships and experiences that serve as pivotal social situations to growth and learning. Preventing a child from experiencing these necessary components of childhood is a great disservice to their social skills, particularly in a child with Down syndrome. Christopher Kliewer helps explain that there are so many factors that can change the way they experience the world and the opportunities that they are given (8). One way to do this would be to ensure that children with Down syndrome and other special needs are able to socialize and relate with other children that can help advance their development. Our new intervention will be based primarily in classrooms of elementary schools, middle schools, and even high schools. In order for them to flourish socially and psychologically, inclusion is key. Students with Down syndrome will have some individualized attention to assist with their academic success, such as reading, writing, and mathematics, but they will spend a large portion of their day with the same schedules and classroom time as everyone else. This integration will not only help them learn better and adapt to their environment, but their classmates will be able to collaborate and work with them in order to provide a stronger, more close-knit environment. In addition, it is really important for adolescents with Down syndrome to not feel cast aside or alienated from their classmates. Setting all the children on a more socially balanced level will allow them to feel as if they have equal opportunities to succeed and participate. This intervention of inclusion and integration will help these individuals to feel assisted based on their needs, but with the freedom to explore and expand their limits and goals.
Defense 1
            The first flaw in current approaches was about the message being given to parents to do the right thing and take steps to fix the problem that they have been presented with. The parents care very much, but we need to redirect this energy in the proper direction for something more positive. Individuals with Down syndrome are capable of many things, so long as they are given the chance. Our intervention will have an effective way of showing parents a different perspective on what their child’s life can be like and how Down syndrome does not have to obstruct their dreams. This message will be particularly effective when it comes from someone who means it and understands what a parent’s role is. It should also be someone that parents can connect with and look up to for comforting guidelines and encouragement. For this, we would use Down syndrome advocates Eva Longoria, with her own organization, Eva’s Heroes, Jamie Foxx, who is a stakeholder at the Global Down Syndrome Foundation, and Lauren Potter, the Glee actress with Down syndrome (9). Longoria and Foxx both have sisters with Down syndrome and they have had personal experiences with being told to take the assumption that their respective sisters would not live fulfilling lives, but they were given countless opportunities anyway and they have accomplished great things and lead happy lives (10)(11). This is the message we want to portray to encourage parents who may not know what Down syndrome entails and how to best “fix” it. Potter can go further to explain what her lifestyle is like and the opportunities she received throughout childhood that help her thrive. With these messages, we are employing Robert Craig’s Communication Theory, which simply shows that if an audience feels connected with the communicator, they will be much more likely to take the information to heart and understand it better (12). Seeing these celebrity advocates will have a familiarity factor and parents will be better persuaded to enrich the opportunities for their own child. 
Defense 2
            The next step we want to take is to fix the issue that stands regarding making a change to improve their child’s life. Instead of using an individual-centered intervention based on the Theory of Planned Behavior, we need to look at society and the environment and adjust how they function in those situations. We will use the Social Expectations Theory founded by Joseph Berger, which helps our goal by showing that a behavior is best formed by being done in large groups that can be imitated (13). By spreading our campaign advertisements, billboards, and posters all over the nation, we will be able to inform many people and transform the idea of inclusion of all people with special needs. Down syndrome will be better known and there will likely be much less discrimination. Changing the norm is really going to speak to parents and families and help them feel more comfortable with the idea of raising a child with Down syndrome. It will also improve the ways that current approaches attempt to solve the problem of having to take action right away. This campaign will help change people’s mindsets, which will change their behavior, which will spread very quickly. This process will take a snowball effect and it will be so rewarding for parents to feel secure about the ambitious lifestyles their children can have and that they do not have to be limited in any way.
Defense 3
            Finally, we want to completely reverse the meaning of control. Parents should definitely be able to experience control, but so should their children. As they grow older, they are already aware that they are different from other people, so this should not be reinforced by the system. The environment needs to be welcoming and accepting of everything they want to do. The control that was dubbed an illusion will now become more concrete with the implementation of our campaign and there will be confidence in what they can accomplish. The idea of this control will duplicate that of the progress Down syndrome has made in the nation in the last 50 years. Michelle Sie Whitten, the Executive Director of the Global Down Syndrome Foundation, illuminates this timeline and how things have changed. Prior to the 1980’s, individuals with special needs in general were often institutionalized just for being different and this brought about the assumption that they were not capable of living like “normal” humans. It was assumed that it was impossible for them to carry out regular activities like eating, dressing, communicating, and living past 28 years of age. After these practices were considered inhumane and the focus shifted, individuals with Down syndrome were living at home, attending schools, and living in everyday society. This dramatically increased the IQs of people with Down syndrome, life expectancy to about 60, and many are educated and employed (14). This is outstanding progress that serves as a more extreme example of what is being done today; these children and adolescents should no longer be limited to confined classrooms and other settings where they are not integrated with the rest of society. There is clearly vast potential among these individuals that we need to expose and share with families and communities everywhere. This will be the real control that not only we should have, but that we can give to those with Down syndrome who have goals and desires of their own.
            It is clear that individualized methods alone are not helping children with Down syndrome reach their full potentials, and that viewing them as having a developmental disability will only hinder their abilities. This group-based intervention will help change that stigma and make the population realize that they can be integrated into normal school systems and be treated with the same amount of respect and knowledge. The initial push is beneficial for them when they are younger, but parents and families must feel more optimistic about their lives. Integration and acceptance into society will provide that guidance for all individuals with Down syndrome to reach new limits and accomplish more than anyone thought they could.
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            Understanding of Possibility. New York, NY: Columbia University, 1998.
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            Gala. The Denver Post. 2014.
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            Disability. Mail Online. Associated Newspapers, 2009.
(11) Jamie Foxx: Global Down Syndrome Foundation 2012 Quincy Jones Exceptional
            Advocacy Award Recipient. Global Down Syndrome Foundation. 2012.
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Siegel, M. (Professor) Social and Behavioral Sciences: Challenging Dogma. Lecture

            conducted from Boston University School of Public Health, Boston, MA, 2014.