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Nursing Professors' Article Gives Advice on Counseling Troubled Goth Teens

What's a school nurse to do when the patient who has been referred for treatment is a black-garbed teenager who has purple-streaked hair, dozens of body piercings and tattoos, a surfeit of dark sarcasm and a raging infection of a self-inflicted cut on the arm? Two Old Dominion University nursing faculty members and a former police detective provide answers in their journal article, "Vulnerable Goth Teens: The Role of Schools in This Psychosocial High-Risk Culture."

Carolyn Rutledge, associate professor of nursing, and Micah Scott, a senior nursing lecturer and coordinator of ODU's nurse practitioner program, teamed up with former Virginia Beach police detective Don Rimer to write the article for the September 2008 issue of the Journal of School Health.

The purposes of the article, according to the authors, are to describe characteristics of Goth teens, identify psychosocial risks for these teens and describe actions that school personnel can take to minimize the risks.

For Rutledge, the focus on Goth teens emerged from a series of grants-totaling more than $3 million-that ODU nursing faculty members have received to help medical professionals and nursing educators understand the ways cultural diversity can affect health care. These projects, most of which have been funded by the U.S. Health Resources and Services Administration, have established ODU's School of Nursing as a leading designer of training programs that address potential clashes and miscommunication between health-care professionals and certain types of patients.

The cultural awareness projects have been led by Rutledge, as well as Richardean Benjamin, chair of the School of Nursing, and Laurel Garzon, associate professor of nursing.

The researchers insist on a broad definition for culture. "I have a problem being too narrow with the definition," Rutledge said. "It involves a lot more than ethnicity." In fact, she often refers to "subcultures" and "people of similar orientation" in order to describe groups-teenage Goths, overweight older women and gay people, for example-who often report unsatisfactory health-care experiences.

During their research, the faculty members recognized that nursing students found it difficult to build rapport with a "patient" who played the role of a young Goth who looked and acted like a social misfit. Rutledge said this experience persuaded her to look more closely into the interaction between Goth youths and the health-care system.

When he was a police detective, Rimer earned a reputation as an expert investigator of, as The Virginian-Pilot put it in a 1996 article, "vampires, grave robbers, the occult, black magic, Satanism and all things bizarre." Now retired, he is a frequent speaker around the country on ways parents, schools and police can deal with youths who have chosen alternative lifestyles. The subcultures that he studies typically challenge traditional values and are seen as threats to the community, as well as to the health and even the lives of some subculture members.

The article in the Journal of School Health states, "In recent years, a number of tragedies have been linked to the Goth culture. Most alarming has been the acts of violence, suicide and self-harm found among teens. Teachers, parents, administrators and fellow students are at a loss on how to relate to such students."

Goth subcultures, according to the article, attract teens who are depressed, feel persecuted, distrust society, and, sometimes, have suffered abuse or persistent ridicule. "They surround themselves with people, music, Web sites and activities that foster angry or depressed feelings. They have a higher prevalence of depression, self-harm, suicide and violence than non-Goth teens."

The article makes a specific point about the range of diversity within the Goth subculture, and advises that nurses and other school personnel such as counselors should not confuse students who are mainly interested in the theatricality and artistic expression of the culture with more alienated youths who practice behaviors that pose dangers to themselves or to others.

For school nurses and counselors, the focus must be on how to identify at-risk teen Goths and how to decide what interventions are appropriate, the authors state. A critical mission for the school personnel is to assess the likelihood of self-harm, suicide or other types of violent behavior.

Research cited in the article shows that teens associated with the Goth subculture are five times more likely than others of their age to participate in self-harming activities, and that boys are more likely to do so than girls. School personnel are advised that the cutting, scratching, scoring and burning often is done on the arm opposite the hand with which the teen writes, and that Goths may wear long sleeves to hide festering lesions. But even more important than identifying and treating an infected cut would be the observation by a teacher, counselor or nurse that a student's self-harming activities indicate he or she is drifting deeper into depression or toward more violent actions.

Telltale signs of a troubled Goth teen are best detected by "school nurses and counselors (who) develop a rapport that shows concern and a true desire to help," according to the authors. "They must approach the student from a nonthreatening manner that is free from judgment. School nurses and counselors should provide for confidentiality based on ground rules that state that the information will be kept confidential unless there is a risk of harm for the student or others."

Lines of questioning for informal assessments are offered by the authors, as well as a list of formal assessment tools, such as the Children's Depression Scale and the Suicidal Ideation Questionnaire, that can be employed. Some of the formal instruments are completed not only by the teen, but also by his or her parents and teachers.

The authors also suggest that school nurses and counselors may want to become acquainted with therapists, health-care providers and law enforcement personnel in their communities who can provide support services for troubled Goth teens. Conversely, the same school personnel can be a community services resource themselves by gathering "sound, empirically based information" about the Goth subculture and, thereby, helping to separate fact from the fiction that can create subculture legends.

When school nurses and counselors develop a network of helpers in the community, they can serve as liaisons between a student, the student's parents, teachers and health-care personnel, according to the article. This may lead to school personnel helping to organize community programs, perhaps involving conflict resolution, that address teen issues and problems. "Programs that work best include the family, peers and the community," the authors state.

Finally, the authors suggest an important role for school nurses or counselors in the aftermath of a student committing suicide or another act of violence. "As other students learn of the activities of a classmate, those who have a tendency toward similar actions are more likely to follow through on their plans. It is vital that the school nurse or counselor has providers available to help the students deal with their thoughts surrounding such issues."

This article was posted on: November 12, 2008

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