Narrative Description of Activities

501(c)3 Nonprofit Application for J2SYL
Part IV: Narrative Description of Journal To Save Your Life Activities

Overview

It is the mission, duty, and purpose of Journal To Save Your Life (J2SYL) to help address America’s dearth of mental health resources. There is a $12 billion dollar annual need to provide mental health services for adolescents, but only $3 billion dollars of this is met.[i] For every 300-850 middle and high school students, there is only one school counselor. This one counselor is given the task of addressing issues ranging from current academic performance and college entry to classic mental health problems such as anxiety, depression, and familial stressors. Clearly one person cannot effectively address the mental health needs of 300-850 children in one year, or ten.

The World Health Organization reports that: a) worldwide, up to 20% of children and adolescents suffer from a disabling mental illness; b) worldwide, suicide is the third leading cause of death among adolescents; c) major depressive disorder often has its onset in adolescence, across diverse countries, and is associated with substantial psychosocial impairment and risk of suicide; d) conduct disorders tend to persist into adolescence and adult life and are frequently associated with delinquency, adult crime and dissocial behavior, marital problems, unemployment and poor physical health.[ii] The good news is that in tandem with this tendency toward depression and other mental illnesses, teenagers are “particularly receptive to the positive influences of youth development strategies, social and emotional learning, and behavioral modeling.”[iii] Adolescence thus represents a key point of brain development in which self-destructive psychological patterns can be identified and addressed.

In terms of dissemination of our treatment program, we have decided that an exclusively online approach is necessary to make the biggest impact on our youth. This decision is based on the research shared by seven scholarly commissions that make up the Adolescent Mental Health Initiative, an Annenberg Foundation Trust project led by leading psychiatrists and psychologists nationwide. [iv]  According to this significant research agenda for improving the mental health of our youth, there are systemic barriers to implementing evidence-based treatments in our existing mental health delivery system. One primary barrier is service fragmentation — that is, the fact that treatment of adolescents is performed by at least six separate systems: specialty mental health, primary health care, child welfare, education, juvenile justice, and substance abuse. Other barriers include poor access and use of services among minorities, lack of sustained family involvement, and fiscal disincentives under managed care.  These authors argue that increasing the availability/accessibility and quality of school-based services for the treatment and prevention of adolescent mental health problems is therefore a central component of any plan for improving the lives of adolescents. Building on this, J2SYL will help supplement the actions and efforts of school counselors, social workers, parents, mental health workers, communities, and nonprofits — for free in perpetuity. J2SYL will also connect directly with girls who find us online; girls that may or may not have any mental health support in their own environments.

Additional scholarship shows that self-expressive, journal-based interventions provide a unique opportunity to assist youth with the often times difficult transition through adolescence. The Internet has introduced a dynamic platform by which such interventions can be effectively implemented. The anonymity and invisibility experienced by an adolescent Internet user has been shown to induce the therapeutic process of venting emotions and releasing pressure. Through psychologically relevant processes such as personal reflection, such expression can enhance a writer’s feelings of well being. Researchers have found “online therapy” explores the “therapeutic value of writing” and “can act as a legitimate alternative or a complementary procedure to traditional, face to face approaches”.[v]

The J2SYL program integrates rational emotional behavioral therapy (a form of cognitive behavioral therapy), narrative psychiatry, education research, and the transformational learning model.[vi] Through education, research, and a free mental health program disseminated via a website, we aim to alleviate the devastating intra and interpersonal effects experienced as a result of anxiety and depression. Fundamentally, we intend to teach mental resiliency and confidence to effectively support the mental health our next generation of women.

The Journal To Save Your Life Program

J2SYL disseminates a free, online mental health program for at-risk, adolescent females aged 13-17. The one-year J2SYL pilot program launches in the spring of 2012.  The efficacy of the J2SYL program is being professionally evaluated.

J2SYL is offered exclusively online via a secure website. The J2SYL program is made up of 52 weekly, therapeutic installments. J2SYL is available to individual girls, therapists, nonprofits, and families for free in perpetuity.

Program Components

Through a synthesis of cognitive behavioral therapy (CBT), stories relevant to the lives of adolescent females, social skills training, and multi-media ‘prompts’ (video, audio, written, photography, dance, spoken word, news items that will prompt self-expression by the participants), J2SYL addresses the debilitating effects of anxiety and depression and shows girls how to work through, challenge, and alter these negative mental states.[vii]

Weekly Installments

Succinctly, over the course of 52 weeks, girls will receive a weekly “J2Gift” inviting them to visit J2SYL. Once the girl logs into J2SYL, she will have access to her week’s “J2Gift” which will include three distinct parts:

1. Social Skills Training
2. Cognitive Behavioral Therapy (CBT)
3. Expression (Art Therapy)

Social skills training includes an inside look at a variety of topics, including, but not limited to, defining distorted thinking, identifying dysfunctional relationships, and building a sense of self worth. Cognitive Behavioral Therapy is a specific approach to empowering a person to change their thoughts in order to change their lives. The cognitive-behavioral approaches for youth depression and anxiety focus on identifying and modifying negative thought patterns and improving distributed behavioral self-and social-regulation skills thought to underlie the etiology of depression and anxiety.[viii] Evidence suggests that CBT techniques overall have a highly beneficial effect on depression and anxiety in youth.[ix] In youth depression and anxiety treatments, these have been addressed through the application of cognitive and behavioral techniques such as:

1. Mood monitoring
2. Cognitive restructuring
3. Behavioral activation, pleasant activity scheduling, and goal-setting strategies
4. Relaxation and stress management
5. Social skills and conflict resolution training
6. Training in general problem-solving skills[x]

The CBT used in J2SYL has been taken from several CBT programs for youth developed and then published in the Journal of the American Medical Association (JAMA) by Gary Clarke. Educator Dr. Susan Werstein developed additional social skills training.[xi]

In the third step, Expression, girls are invited to express themselves in response to the weekly J2SYL prompt installments through the creative medium of their choice: by writing in a private journal, scripting a play, choreographing a hip-hop dance, or creating audacious YouTube videos, original songs, finger puppet skits, and/or spoken word poems. Research shows that such guided, artistic expression can alleviate the effects of mental health stress. The media used for this section was collected and collated by J2SYL founder and psychiatric nurse practitioner student, Jasper Faolan, and edited by J2SYL Board member and Women and Gender Studies professor Dr. Keira Williams, and Dr. Werstein.[xii]

Issues Addressed

Specific issues addressed throughout the three areas of the “J2SYL Package” include, but are not limited to: difficulties with parents, negative body image, grief, crisis management, bullying, stressful environments, violence, cutting, questions about sexuality, and autonomous identity formation. We take into account that anxiety and depression are caused by a plethora of experiences, and without using ‘triggering’ language, we allow each girl to process the events that are relevant to her.

Safety

Girls are first educated on how to generate a mental health ‘safety plan’ so that they can address these difficult issues safely. We also provide direct links to 24/7 online and telephone-based crisis hotlines to ensure that every girl has immediate access to mental health professionals and support, as needed. For our pilot program we are only recruiting girls to participate in J2SYL through established middle and high school counselor networks. This way every girl will be directly connected to a mental health professional throughout the program. We are also working with professional evaluators to provide J2SYL with a software program that “crawls” all of the text generated by the girls for specific, high-risk language. For example, if a girl writes “I want to kill myself,” this software will pick up this phrase and then send both the girl’s school counselor, the J2SYL staff, and an emergency service a red flag notice. The emergency service can respond immediately, the school counselor can check in with the girl directly, and the J2SYL Team will follow up via email.  School counselors will also communicate with J2SYL any significant changes. Overall we emphasize the importance of developing a mental health safety plan, a flexible mind, of learning how to interpret the world in a productive way, how to connect with people healthfully, and how to become happy and resilient in the face of inevitable change.

Openness

The hope of this program is that we provide girls with the tools and structure to claim their own version of mental health. We present a variety of information and encourage critical thinking skills. We do not impart a biased perspective of ‘one right way’ of attaining mental health; J2SYL is intentionally dynamic and the girls direct their own experiences. By offering this free service, we help support girls that might otherwise be minimized by their own lack of education on how important the mind is in determining their own life trajectories and personal happiness, and we empower them to choose their own paths towards mental health.

Incentives

The J2SYL online program has also been ‘gamified’ by designers, meaning the girls gain points for completing the various components of their program. Incentives and rewards for points will be offered throughout the program, such as art supplies, personal letters of encouragement from the J2SYL team, and private videos from bands or other artists whose work resonates with the participants.

Research Results for the Public

After the J2SYL pilot year, we will review qualitative feedback from the girls as well as the quantitative (survey based) research we are doing on J2SYL to determine the efficacy of the program. We will integrate all feedback into J2SYL 2013.  We will also share our research with the public through articles (academic and/or trade publications) and on our website as a way of furthering the public’s knowledge of innovative, exclusively online mental health programs. It is our hope that with this contribution J2SYL will continue to meet the needs of at-risk youth, and that other such programs are developed to address the billion dollar disparity that exists between need and resources.

Future Aspirations

In 2014, we will address the needs of boys as well as girls by designing a similar mental health program for this demographic. We intend to remain focused on adolescents for the foreseeable future.

Programs for Volunteers

At times, per the discretion of the board of directors, we may provide internships or volunteer opportunities which will provide opportunities for involvement in outreach activities and programs in order to have a greater impact for change. Such activities shall always be free of charge to participants and will not include compensation to the volunteers.

Multimedia

We intend to broaden our outreach by documenting and reporting our efforts. It is our goal to bring awareness from every medium possible, including documentaries and photographs of our activities, projects, programs and expeditions. These multimedia features will be recorded by our volunteers during the aforementioned activities and will be available to the public.

Please Note:

As an organization, Journal to Save Your Life complies with the following sections of the Income Tax Regulations that address eligibility for tax-exempt status:

Section 1.501(c)(3)-1(d)(2) of the Income Tax Regulations states that the term “charitable” is used in section 501(c)(3) of the Code in its generally accepted legal sense and includes the advancement of education.

Section 1.501(c)(3)-1(d)(2)(ii) of the regulations states that the term “charitable” is used in section 501(c)(3) of the Code in its generally accepted legal sense and to eliminate prejudice and discrimination.

Section 1.501(c)(3)-1(d)(2)(iv) of the regulations states that the term “charitable” is used in section 501(c)(3) of the Code in its generally accepted legal sense and to combat community deterioration and juvenile delinquency.

Section 1.501(c)(3)-1(d)(3)(i)(a) of the regulations states that the term “educational”, as used in IRC 501(c)(3), relates to the instruction or training of the individual for the purpose of improving or developing her capabilities or the instruction of the public on subjects useful to the individual and beneficial to the community.

Section 1.501(c)(3)-1(d)(3)(i)(a) of the regulations states that the term “educational”, as used in IRC 501(c)(3), states that an organization may be educational even though it advocates a particular position or viewpoint so long as it presents a sufficiently full and fair exposition of the pertinent facts as to permit an individual or the public to form an independent opinion or conclusion.

Example 2 in Section 1.501(c)(3)-1(d) Exempt purposes (3) Educational (ii) of the regulations, makes it clear that “An organization whose activities consist of presenting public discussion groups, forums, panels, lectures, or other similar programs,” is educational.

Section 1.501(c)(3)-1(d)(5)(i) of the regulations states that a “scientific” organization may meet the requirements of section 501(c)(3) only if it serves a public rather than a private interest; a scientific organization must be organized and operated in the public interest.

Section 1.501(c)(3)-1(d)(5)(i)(a)(2) of the regulations states that “scientific” research carried on for the purpose of obtaining scientific information, which is published in a treatise, thesis, trade publication, or in any other form that is available to the interested public.

Section 501(c)(3) of the Internal Revenue Code provides tax exemption for organizations organized and operated exclusively for charitable, educational, and/or scientific purposes.

Financial Information

The sources of the corporation’s income derive from personal resources and public donations, as well as grants, sponsorship and public fundraising.  The corporation disposes its income through the decisions made by its board of directors or through the decisions of the duly elected treasurer, whose power to pay expenses is set out by the board or the corporation’s bylaws in accordance to the corporation’s purpose.  Expenses paid by the corporation include, but are not limited to: equipment purchases and rentals, ambassador’s salary and boarding, insurance premiums, internet web site fees, publications, advertising, and miscellaneous board expenses.

References

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[i] Rand Corporation, “Mental Health Care for Youth Who Gets It? How Much Does It Cost? Who Pays? Where Does the Money Go?” (www.rand.org/pubs/research_briefs/RB4541/index1.html, accessed June 28, 2012).

[ii] World Health Organization, “Caring for Children and Adolescents with Mental Disorders” (Geneva: World Health Organization; 2003); World Health Organization, “World health report” (Geneva: World Health Organization, 2000); World Health Organization, “World Health Report” (Geneva: World Health Organization; 2001); M.M. Weissman, S. Wolk, R.B. Goldstein RB, D. Moreau, P. Adams, S. Greenwald, C.M. Klier, N.D. Ryan, R.E. Dahl, P. Wickramaratne, “Depressed Adolescents Grown Up,” Journal of the American Medical Association, v. 281, no. 19(May 12, 1999): 1707–1713; G.R. Patterson, B.D. DeBaryshe, E.A. Ramsey, “Developmental Perspective on Antisocial Behavior,” American Psychology, v. 44, no. 2 (February 1989): 329–335.

[iii] S.W. Schwarz, “Adolescent Mental Health in the United States: Facts for Policy Makers,” National Center for Children in Poverty, June 2009 (http://nccp.org/publications/pub_878.html, accessed June 28, 2012).

[iv] D.L. Evans, E.B. Foa, R.E. Gur, H. Hendin, C.P. O’Brien, M.E.P. Seligman, B.T. Walsh, “Treating and Preventing Adolescent Mental Health Disorders,” Annenberg Public Policy Center, 2005 (http://amhi-treatingpreventing.oup.com/anbrg/public/content/mentalhealth/9780195173642/toc.html, accessed June 28, 2012).

[v] M. Boniel-Nissim and A. Barak, “The Therapeutic Value of Adolescents’Blogging About Social–Emotional Difficulties,” Psychological Services (December 12, 2011); J.  Suler. CyberPsychology & Behavior. June 2004, 7(3): 321-326; H-C. Ko and F-Y. Kuo, (2009). “Can Blogging Enhance Subjective Well-being Through Self-disclosure? CyberPsychology & Behavior, v. 12, no. 1 (2009): 75-79; K. Anthony, D. Nagel, and S. Goss, The Use of Technology in Mental Health: Applications, Ethics, and Practice (Springfield, IL: Charles Thomas Publisher, Ltd., 2010); A. Barak, L. Hen, M. Boniel-Nissim, and N.Shapira, “A Comprehensive Review and a Meta-Analysis of the Effectiveness of Internet-Based Psychotherapeutic Interventions,” Journal of Technology in Human Services, v. 26, no. 2/4 (2008): 109-160; Barak, Proudfoot, and Klein (2009), as quoted in Boniel-Nissim and Barak (2011), p. 2.

[vi] Windy Dryden, Rational Emotive Behavioral Therapy: Theoretical Developments (New York, NY: Brunner-Routledge, 2003; G. N. Clarke, P. Rohde, P.M. Lewinsohn, H. Hops, and J.R. Seeley, “Cognitive-behavioral Treatment of Adolescent Depression,” Journal of the American Academy of Child and Adolescent Psychiatry, v. 38 (1999): 272-279; P.M. Lewinsohn, G.N. Clarke, H. Hops, and J. Andrews, “Cognitive-behavioral Group Treatment of Depression in Adolescents,” Behavior Therapy, v. 21 (1990): 385-401; G.N. Clarke, M.C. Hornbrook, F.L. Lynch, M.R. Polen, J. Gale, E. O’Connor, J.R. Seeley, and L.L. DeBar, “Group Cognitive Behavioral Treatment for Depressed Adolescent Offspring of Depressed Parents in a HMO,” Journal of the American Academy of Child and Adolescent Psychiatry, v. 41 (2002): 305-313; J. Garber, G.N. Clarke, V.R. Weersing, W.R. Beardslee, D.A. Brent, T.R.G. Gladstone, L. L. DeBar, F.L. Lynch, E. D’Angelo, S.D. Hollon, W. Shamseddeen, and S, Iyengar, “Prevention of Depression in At-Risk Adolescents,” Journal of the American Medical Association, v. 301, no. 21(June 3, 2009): 2215-2224; National Center for Educations Research; M. G. Lodico, D.T. Spaulding, and K.H. Voegtle, Methods in Educational Research: From Theory to Practice (San Francisco, CA: John T. Wiley & Sons, 2010); M. Smith, An Emotional Intelligence Intervention Program for Academic At-risk High School Students (Unpublished doctoral dissertation, Texas A&M University-CorpusChristi, 2004).

[vii] For a detailed explanation of cognitive behavioral therapy (CBT), see Clarke et al., 2001, and Garber et al., 2009.

[viii] Evans et al., 2005.

[ix] In two meta-analyses of such treatment of adolescent depression and anxiety, mean effect sizes for comparisons of CBT to a control group were estimated to be quite large: 1.02 and 1.27 post treatment respectively; on average, youth made a 56-73% improvements on scales such as suicidality, depressive symptoms, self-esteem, self-efficacy, and general psychosocial adjustment (L. Kroll, R. Harrington, D. Jayson, J. Fraser, and S. Gowers, “Pilot Study of Continuation Cognitive-behavioral Therapy for Major Depression in Adolescent Psychiatric Patients,” Journal of the American Academy of Child and Adolescent Psychiatry, v. 35, no. 9 (September1996): 1156-1161).

[x] N.J. Kaslow  and M.P. Thompson, “Applying the Criteria for Empirically Supported Treatments to Studies of Psychosocial Interventions for Child and Adolescent Depression,” Journal of Clinical Child Psychology, v. 27, no. 2 (June 1998): 146-155; A.E. Kazdin and J.R. Weisz, Evidence-Based Psychotherapies for Children and Adolescents (New York, NY: Guilford Press, 2003).

[xi] Clarke’s programs are open source and found on this website: http://www.kpchr.org/research/public/acwd/acwd.html. Dr. Werstein’s academic profile is available on http://www.JournalToSaveYourLife.com.

[xii] Brief biographies of each of the J2SYL team members can be found on our website, www.JournalToSaveYourLife.com.