Running Head: POPULATIONS AT RISK

National Council on Alcoholism and Drug Dependence Greater Detroit Area Field
Placement:
A Population at Risk
Angela Bell
Wayne State University

POPULATIONS AT RISK

Abstract
The term at risk population refers to any group or sub group that is more subject
to oppression than the general population. At risk populations include but are not limited
to women, ethnic minority groups, children, the elderly, members of the LGBT
community, etc. Being a member of an at risk population takes on a presence in every
aspect of an individuals life. Various studies have shown that members of these
oppressed groups are less likely to take advantage of the health care system, more
likely to abuse drugs and alcohol and that there is a lack of social services available to
them. With so many groups being considered a population at risk, cultural competence
is essential across the board.

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National Council on Alcoholism and Drug Dependence-Greater Detroit Area Field

Placement:
A Population at Risk
National Council on Alcoholism and Drug Dependence Greater Detroit Area
(NCADD-GDA) has been operating in the Southeastern Michigan area for over 60 years
(Our History: NCADD-GDA, 2015). It is the mission of NCADD-GDA to raise public
awareness of alcoholism and drug dependence issues across the state, while working
to ensure those affected by the disease of addiction have the resources necessary
when accessing treatment and sustaining recovery (Our History: NCADD-GDA, 2015).
Consumers of the agency are primarily African American individuals ages 18 years and
older. The agency offers outpatient therapy in three different varieties. Individuals can
see a counselor for one on one sessions one day a week, attend outpatient group
therapy one day a week and for individuals that need a little more assistance they
attend intensive outpatient therapy four days a week.
The consumers of this agency are either mandated or voluntary with the majority
of the clientele being mandated. Individuals can be mandated from several different
avenues including employment or the court system. For the individuals that are
mandated, he/she has to have a progress note sent to the individual or organization that
required the client to seek treatment. Voluntary clients have decided to seek treatment
on their own or with the suggestion of family, friends, etc. Being voluntary also means
that the client does not have a progress note sent to anyone unless they elect to have
one sent.

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The organization has a close relationship with the community that it is located in,
the staff and its clientele. The organization operates on more of an open door policy
allowing clients an opportunity to build genuine relationships with the staff and each
other. The counselors at NCADD-GDA come from all walks of life. Some have faced
addiction themselves and are more relatable to the clients as they can speak from
personal experience. Not all of the counselors have a degree in social work. There are
a mix of degrees such as BSW, MSW, psychology, sociology, etc. The variety of
educational backgrounds make for an interesting spectrum of therapy styles.
When reflecting on the clientele at NCADD-GDA in relation to being a member of
an at risk population one case in particular case stands out. This particular case
involves a 27 year old African American transgender female dealing with an addiction to
alcohol. For the purpose of confidentiality this client will be referred to as Jackie Smith.
Jackie has been a client at NCADD-GDA for six weeks. She has received three DUIs
over the course of two years. Due to her DUIs she is on probation for two consecutive
years and has to attend a treatment program as a condition of her probation. As a client
she is subjected to a random drug screen at the discretion of her counselor and/or
group leader. Progress notes are sent weekly to Jackies probation officer. In several of
the group sessions Jackie has mentioned that she feels her problem with alcohol is
directly related to the trials and tribulations she faces as an African American
transgendered female.
Being an African American transgendered female places her in an at risk
population. The term at risk population refers to a specific group or subgroup that is
more subject to oppression than the general population. With this description in mind

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there are several at risk populations that exist. Some examples of those populations
would be ethnic minorities, women, the elderly, mentally and/or physically challenged
individuals, members of the LGBT community, etc. Jackie is considered to belong in at
least two of those at risk populations. One of the populations being her membership in
an ethnic minority group of color as a woman and the second being her membership in
the LGBT community.
The great majority of clients are members of populations whose diversity places
them at risk of experiencing prejudice, discrimination and oppression (Stephen J.
Yanca, 2008). As a social worker, most of the clients at any particular agency will be a
member of one at risk population or another. Being a member of a population at risk
adds another layer to the issue that the client is seeking service for. In Jackies situation
not only is she seeking treatment for substance abuse, but also skills to deal with her
underlying issue which directly affects her abuse of alcohol. Jackies underlying issue is
the pressure she faces for being an African American transgendered female. Belonging
to more than one of the vulnerable populations essentially creates more difficulty for the
client. It can attribute to an identity crisis within the client.
According to Generalist Social Work Practice with Families, many of the
difficulties faced by populations at risk of discrimination are a result of their interactions
with the environment or with the surrounding systems rather than with in the clients
themselves (Stephen J. Yanca, 2008). So it is not that the client is uncomfortable with
their identity, it is the outside environment that puts pressure on the individual to
conform. If the individual resists societies call to conform, they are ridiculed and
overtime this can lead to the creation or expansion of a vulnerable or at risk population.

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Being an African American transgendered female Jackie is subjected to triple

victimization because she is African American, a woman and living off of a meager
income (Copeland, 1982). This puts Jackie into one of the largest oppressed or at risk
poulations. According the Copeland, victims of racism, sexism, and restricted in their
ability to obtain adequate economic resources, low-income black females may be
required to function in a physical environment that is not conducive to positive mental
health (Copeland, 1982). Being required to function in that type of environment causes
stress and puts a strain on the relationships in the individuals life and her ability to
function normaly. This causes an increase in the need for services to address the
various stresses and strains in the life of an African American woman, however there is
a lack in those services. Research examining emotional stress in black women is
sorely lacking, some writers maintain that black women in general are plagued by the
negative perceptions that society has (Copeland, 1982).
In the article The Queering of Medicine, the authors mentions that the results of
a study performed in Canada shows that members of the LGBT community use the
health care system differently than non members (Derek Puddester, 2008). The article
goes on to mention that lesbian women are less likely to access regular pap tests, have
mammograms and see a family physician when compared to heterosexual women
(Derek Puddester, 2008). With lesbian women being less likey to access the health care
system than heterosexual women, this increases their risk for various types of diseases
due to lack of preventive care. Which in turn can play a role in the rising cost of health
care. This goes to show that placing people into groups and then oppressing the group
does not only have a negative effect on the group, but on society as a whole.

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This unbalace in use of the healthcare system does not only exist between
lesbian women and heterosexual women. Puddester goes on to mention that, gay men
are particularly vulnerable to body image and eating disorders, and sexually transmitted
diseases, and have increased rates of death from prostrate, testicular, and colon
cancer. Lesbian women are particularly vulnerable to breast cancer, poor heart health,
gynecological cancers and osteoporosis. Transgendered persons underutilize health
care services, are vulnerable to complications arising from supervised and
unsupervised hormone use and are less likely to share their full health history with care
providers (Derek Puddester, 2008). No person should be shamed into not seeking
health care services or not being truthful to their physicians. This can lead to the spread
of diseases that could have been prevented. A spread of disease does not stay within
the borders of a particular group. This can effect anyone.
Being that the LGBT community is an oppressed population, there is a stigma
placed on membership in the community by non members. This stigma causes conflict
in the lives of the oppressed members. Lesbigay people are more likely to access
mental health services than heterosexuals, and bisexual people are 2 to 3 times more
likely to perceive their mental health as fair to poor. Disturbingly, all sexual minorities
had unmet health care needs at rates much higher than heterosexuals (Derek
Puddester, 2008). Not only does being a member of an at risk population have a
negative effect on a persons physical health, but his or her mental health as well. In
general, lesbigay and transgendered people are described as having higher rates of
mental health concerns, tobacco use and substance dependence and abuse. These
things are critical issues that we must address with culturally sensitive professionalism

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(Derek Puddester, 2008). It is essential that all individuals working with populations at
risk be culturally competent in the areas specific to their clients. This should be a goal
across all professions, not just social work.
When working with the LGBT community, ethical dilemmas are more than
likely related to the social workers personal values clashing with the profession. With
the client Jackie Smith an ethical dilemma occurred between her and a male intern. The
intern was responsible for completing the intake process with Jackie and would then
take her on as a client. During the intake process Jackie revealed that she is a
transgender female. The intern was uncomfortable working Jackie because he felt he
was not competent in the LGBT community. He presented his concerns to his
supervisor after he finished the intake process. After assuring that the only reason he
was uncomfortable working with Jackie was because of incompetence, the supervisor
agreed to have a social worker who is more familiar with Jackies background shadow
him. It is the policy of the agency for staff to seek competence in areas where they are
unfamiliar instead of passing the client on to a coworker.
At risk populations and cultural competence should go hand in hand. For every
profession that comes across one of these groups should receive training that pertains
to that particular population. Gaining an understanding of the double and often times
triple victimization of an African American female will allow for service providers to tailor
services around that particular population. Instead of a program for African Americans, a
program for the poor and a program for women there needs to be an increase in
programs for poor African American females. If more health care professionals were to
become culturally competent on the LGBT community, the gap between the number of

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heterosexual individuals and members of the community who take advantage of the
healthcare system could move closer together. Cultural competence is the key to a
better understanding of populations across the board and a decrease in what is now
known as at risk or vulnerable populations.

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10

References
Copeland, E. J. (1982). Oppressed Conditions And The Mental Health Needs Of LowIncome Black Women: Barriers To Services, Strategies For Change. Women
and Therapy, 13.
Derek Puddester, M. (2008). Queering of Medicine. Canadian Medical Association
Journal, 1624.
Our History: NCADD-GDA. (2015, Februrary). Retrieved from NCADD-GDA:
http://www.ncadd-detroit.org
Stephen J. Yanca, L. C. (2008). Generalist Social Work Practice with Families.
Pearson.