Name of Program: Screaming in the Silence: Mental Health in Asian-American Young Adults

Target Population: Second-Generation Asian American Children of Immigrant Parents (young

adults)

Name: Angelica Arriola

Section 1: Program Rationale
A Rationale for a Comprehensive Mental Health Program for Second Generation Asian
Americans

Mental health is a growing issue found among ethnic minorities in America. This holds

true for Asian Americans, especially for the second-generation children of immigrant parents

(American Psychological Association, 2006). There is a cultural difference many of them face

because of their parents. Growing up in a different country is very different and difficult to adapt

to. Many Asian parents struggle with the cultural change when raising their children in America.

However, each Asian American family will have different family dynamics depending on their

personalities, the meanings behind behaviors, what psychological behaviors mean to them, their

values, and their perspectives (Uba, 2003). There are exponentially huge differences in American

and Asian culture, ethics, and values, which confuses both Asian parents and their American-

born children (Cauce, et al., 2002).

According to WebMD, among all ethnic groups, Asian Americans are the least likely to

try to find mental health services. Asian families dont even have a language for even

understanding what mental health is (Kam, K., 2016). They never spoke about it or how to get

treatment or help. Many were taught that there was nothing wrong with them unless it could be

physically seen, which is an underlying problem in itself (Nguyen and Bornheimer, 2014). In

2014, 5.4% of the population in the United States identified as Asian American or Pacific

Islander. Of those, over 13% had a diagnosable mental illness that past year (Mental Health

America, 2014). There is a social stigma they struggle with, and there needs to be a movement to

help them realize that it is okay to seek help. A unique element to the Asian ethnic group facing

different issues based upon culture is their feelings of guilt over that of depression. Studies have
shown that it is a hidden problem since second generation Asian American are most likely to hide

the fact that they are depressed or suicidal (Mental Health America, 2014). Talking about the

issue was often seen as weak and shameful. They were taught to keep silent on the subject.

Mental health was never an addressed issue in Asian families, which is one of the roots of the

problem.

According to the Centers for Disease Control and Prevention, Asian Americans report

fewer mental health concerns than whites, but statistics show that suicide death rates are higher

for Asian American females than white females by 30% (Mental Health America, 2014).

Although suicide and depression are highly prevalent, the proportion of use of mental health

services was low (Augsberger, A., Yeung, A., Dougher, M., Hahm, H.C., 2015). A common issue

that arises out of cultural differences between American and Asian culture is that Asian culture

creates a strong sense of repayment towards their family. Instead of feeling depressed as most

would under this scenario (relates to Indian culture), Asian Americans experience a strong sense

of guilt (Mental Health America, 2014). This may prevent them from pursuing opportunities to

better themselves as they put their families first. After school clubs, activities, and relationships

may be limited as they place family first. This burden is strongest on the eldest child. The eldest

child takes on the most responsibility, in some cases acting as another parent. Their role in the

family life is to fill in gaps where the parents are not able to in raising children. An example

would be, the eldest child making sure all their siblings are taken care of and are ready for the

next day, while the parents pursue opportunities to better their own lives. While the parents are

enriching themselves, the eldest child typically takes over basic household needs, along with

babysitting. In the college setting, this scenario hinders the ability of the student to perform up

to their parents expectations.

 Coming from an Asian culture, students are expected to study hard and receive high

marks in their classes. The college atmosphere in Asian culture differs from that of American

higher education in various ways. In Asian culture, higher education begins at a younger age,

with the average graduate being between 18-20 years old (Cauce, A. M., et. al, 2002). During

their education, students can study as a group with the support of their family, because of the

established cultural norms. In American culture, study groups are not held in the traditional

Asian way which prevents them from taking advantage of this useful study tool. Studying alone

becomes difficult, with the extra responsibility of taking care of their siblings. The needs of the

siblings take precedence over the responsibility that Asian American teens should over

themselves.

Curfews also limit the opportunities that Asian Americans have. It is common for Asian

Americans to have a designated time in which they need to be at home. Parents will contact the

student if they are not home, which leads to feelings of guilt for not being at home to help the

family. This idea may be hypocritical when looked at from an outside perspective, as the parents

may not be home to address the issues that they brought up to their child.

Family always comes first, and seeking out self outside of the family is discouraged

(Kramer, J., Kwong, K., Lee, E., Chung, H., 2002). This leads to confusing messages when the

second-generation children of immigrants have grown up and gone to college, for finding self

and individuality is encouraged in American culture. As Asian American young adults get more

exposure to Western culture, many start to feel conflicted between what their friends want and

what their families want. These years are even more confusing, because they were taught to

follow Asian cultural norms at home, but see differently outside of home. This often leads to

Asian American young adults having one identity when out with friends and another when with
their family. The confusion and identity crisis contributes to mental issues that many Asian

American young adults share.

References

Augsberger, A., Yeung, A., Dougher, M., Hahm, H.C. (2015). Factors Influencing The
Underutilization Of Mental Health Services Among Asian American Women With A
History Of Depression And Suicide. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4673784/
Cauce, A. M., Domenech-Rodrguez, M., Paradise, M., Cochran, B. N., Shea, J. M., Srebnik, D.,
& Baydar, N. (2002). Cultural and contextual influences in mental health help seeking: A
focus on ethnic minority youth. Journal of Consulting and Clinical Psychology, 70(1),
44-55. Retrieved from
http://ry7wh7fe2u.scholar.serialssolutions.com.ezproxy.emich.edu/?
sid=google&auinit=AM&aulast=Cauce&atitle=Cultural+and+contextual+influences+in+
mental+health+help+seeking:
+a+focus+on+ethnic+minority+youth.&id=doi:10.1037/0022-
006X.70.1.44&title=Journal+of+consulting+and+clinical+psychology&volume=70&issu
e=1&date=2002&spage=44&issn=0022-006X
Kam, K. (2015). Asian-Americans Tackle Mental Health Stigma. WebMD. Retrieved from
http://www.webmd.com/mental-health/news/20150212/asian-americans-mental-health
Kramer, E. J., Kwong, K., Lee, E., Chung, H. (2002). Cultural Factors Influencing The Mental
Health Of Asian Americans. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1071736/
Mental Health America (2014). Asian American/Pacific Islander Communities And Mental
Health. Retrieved from http://www.mentalhealthamerica.net/issues/asian-
americanpacific-islander-communities-and-mental-health
Nguyen, D. & Bornheimer, L.A.(2014). Mental Health Service Use Types Among Asian
Americans With A Psychiatric Disorder: Considerations Of Culture And Need. The
Journal of Behavioral Health Services & Research, 41(4), 520-528.
doi:10.1007/s11414-013-9383-6
Uba, Laura. (2003). Asian Americans: Personality Patterns, Identity, and Mental Health.
Retrieved from https://books.google.com/books?
hl=en&lr=&id=1ZV1zIFxadIC&oi=fnd&pg=PA1&dq=Uba,+Laura.+(2003).
+Asian+Americans:+Personality+Patterns,+Identity,+and+Mental+Health.
+Guilford+Press+doi&ots=K-
lr3v3h5Q&sig=Ja1uoi7Ll48gAJGteU561sJRzPQ#v=onepage&q&f=false
Section 2: Goals, Introduction to the Program and Program Objectives
Screaming in the Silence: Mental Health in Asian-American young adults, is a program

that is geared to make mental health resources more known around Asian American family

communities. This program is meant to help second-generation Asian American children of

immigrants come to terms with mental health problems they may have been suffering but have

not yet addressed. Studies have shown that suicide and depression are at very high rates in Asian

American young adults, yet use of mental health services are very low (Augsberger, A., Yeung,

A., Dougher, M., Hahm, H.C., 2015). The implementation of this program will attempt to reduce

the number of those suffering from mental health problems due to cultural differences.

GOALS:

o To increase the awareness of mental health services available to second-generation Asian

Americans through religious groups.

o To increase the amount of second-generation Asian Americans who seek mental help

professionally
o To improve the mental health of Asian American youth
o To reduce the amount of Asian American teens who suffer from mental health issues

LEARNING OBJECTIVES

o To increase the knowledge and understanding of the importance of mental health in

second-generation Asian Americans

o Attain and maintain an attitude that enables them to cope and deal with the mental health

problems they go through

o Practice skills necessary to engage in enhancing their means of communicating their

thoughts and feelings

ACTION/BEHAVIORAL OBJECTIVES:
 o Second generation Asian Americans will be able to identify and express their mental

health concerns
o Will recognize personal mental health issues and initiate contact with a professional
o Practice activities that will help participants feel more comfortable with themselves and

talking to someone about their mental health

OUTCOME OBJECTIVES

o Decrease the number of Asian American young adults who suffer from mental health

issues
o Improve the outlook of second-generation Asian Americans on mental health issues
o Recognize the signs and symptoms of mental health problems
o Overall improvement of quality of life through treating mental illness

Section 3: Program Activities (Interventions)

ACTIVITY 1

Test Your Knowledge (survey)

Time: 7-10 minutes

Materials: laptops/tablets, link: http://www.mentalhealthamerica.net/mental-health-screening-

tools

Procedure: Link to website will be projected onto screen for all to see. Participants will use

laptops or tablets to follow link to take mental health screenings for depression or anxiety online.

Tell them the surveys are completely anonymous. This will help show the needs of the group.

ACTIVITY 2

What Is Mental Health? (lecture)

Time: 7-10 minutes

Materials: projector, laptop, handouts, pens

Procedure: Pass out handouts of lecture to participants. Set up laptop to projector and project

lecture onto screen. Instruct participants to take notes and write down any questions they may

have. Lecture will consist of definitions of different mental health problems, diseases, and

statistics.

ACTIVITY 3

Crossing the Line (activity)

Time: 30-45 minutes

Materials: Crossing the Line activity sheet

Procedure: Facilitator will read from Crossing the Line activity sheet. Tell participants to stand

in the middle of the room. Instruct them to walk silently to each category on the wall as it applies
to them while they hear the statements being read off. The whole exercise is to be silent among

participants. Read statements aloud, giving time for participants to walk to their destination.

Once everyone has chosen a place, go on to the next statement, and so on. Debrief afterwards.

(worksheet in Section 4). Counselors should be available outside the room if participants feel the

need to talk to someone after or during the activity.

ACTIVITY 4

Start a Conversation (video)

Time: 1:05

Materials: laptop, projector, link: https://www.youtube.com/watch?v=FQcAAfCj4bQ

Procedure: Play video on screen. This video acts as a tool to get a message across: start a

conversation. If participants have every felt anxiety, depression, thoughts of suicide, etc., this

video goads them on to speak to someone about it.

ACTIVITY 5

Youre Not Alone

Time: 5-7 minutes

Materials: pens, paper, envelopes

Procedure: Pass out a pen, paper, and envelope to each participant. The participants will write

an anonymous letter about a struggle they currently face but do not openly discuss. Afterwards,

they will fold up their letters and put them in the envelopes. Shuffle the envelopes then randomly

pass them back out to the participants. Prompt them that no one will know whose letter they get,
even if it is their own. Participants will read their letters one by one. A discussion should follow

in which participants will converse about their thoughts.

ACTIVITY 6

Help is Right Around the Corner!

Time: 4-6 minutes

Materials: Handouts/brochures advertising nearby mental health services, laptop, projector

Procedure: Pass out handouts/brochures to participants. Ask if they have heard of any of the

services on the handouts/brochures. Explain each one and their locations.

LOGIC MODEL

INPUTS
- Local religious facilities/religious groups
ACTIVITES
- Counter-marketing
- Community mobilization
OUTPUTS
- Population is exposed to information about mental health problems
- Recognizes the signs and symptoms of mental health problems
- Mental health resources around the area more widely known/advertised
OUTCOMES
SHORT-TERM
- Increase awareness of rising mental health concerns
- Increased knowledge, awareness, and skills
- Increase understanding of those that face similar life circumstances
INTERMEDIATE
- Increased attempts to seek professional help
- Increased use of resources available
LONG-TERM
- Increase amount of second-generation Asian Americans born of immigrant parents who
seek mental help
- Decrease the number of Asian American young adults who suffer from mental health
issues
Section 4: Collection of Materials and Resources

o Mental Health Screenings by Mental Health America

http://www.mentalhealthamerica.net/mental-health-screening-tools
o Laptop
o 2-3 tablets
o Projector
o 30-50 Pens
o Asian American Mental Health video https://www.youtube.com/watch?v=FQcAAfCj4bQ
o 30 Envelopes

o Lecture:
Crossing the Line
INTRODUCTION: When facilitated right, "Crossing the Line" is a powerful,
interactive, and effective activity that builds diversity awareness within a group.
The goals of this activity include helping participants learn about themselves;
give participants an opportunity to reflect upon their self- and cultural identity;
allowing the community involved to appreciate its own diversity more and learn
to treat each other like the diverse human beings we all are, instead of as
homogenized, singular, cultureless beings.
POINT TO PONDER: "Education should not be the filling of a pail, but the
lighting of a fire." - William Butler Yeats
DIRECTIONS: The following is a list of recommended instructions for Crossing
the Line. This activity requires thorough facilitation, and should not be conducted
carelessly or lightly. Read over the directions closely, and email any questions
you have to info [at] freechild.org.
Time needed
About 35 minutes for the activity. About 45 minutes for discussion.
Room set-up
Plenty of open space (All chairs to the side or out of the room)
Note on the door (Workshop in Progress, DO NOT DISTURB!)
Dim the lights a bit if possible.
Facilitator should be off to the side so he is not the center of attention.
Publicity
Keep it vague. It seems fair to describe it as a workshop where we find ways in which we are
both different from and similar to each other. Be careful about over billing the workshop.
Content
Introduction of the facilitator
Be careful not to draw too much attention to the facilitator; the focus should be on the exercise
and the group.
Statement of Purpose
"This is a diverse organization and we have spent the last couple days exploring that diversity.
In this exercise we continue exploring that diversity. Much of our earlier exercises addressed
diversity that was obvious.
We want to acknowledge and address those differences but also bring to the surface other
differences that we may not have recognized. This process might prove difficult at first, or a bit
awkward. This afternoon we want
to break down stereotypes and make it easier to know one another as full human beings."
Description of the Process
"I would like everyone to gather on one side of the room and face towards its center." (Wait for
everyone to move.)
"I will call out specific categories/labels/descriptions. I will ask that all those who fit this
description walk to the other side of the room and turn around, facing the rest of the group."
(As an example, the facilitator names a category that only he or she would fit, and then walks
to the other side of the room, and turns around.)
"After several seconds I will ask you to return to the group.
Guidelines
"Over the next half hour or so, we will share some of our experiences and vulnerabilities with
one another. This will demand a safe atmosphere. To insure that we remain sensitive to one
another's feelings, we need to follow two critical guidelines."
"The first involves LISTENING. Let's have silence throughout the exercise--no talking,
snickering, giggling, etc. Silence will allow all of us to participate fully. Silence will also enable
us to experience our personal thoughts and feelings more clearly.
"The second guideline is RESPECT. It is imperative that we respect the dignity of each person
who is here this evening. Everything that is shared should remain confidential. Nothing that is
offered should leave this room. However, if--having gone through the workshop--you truly need
to talk to a particular individual about something he or she has shared, be sure you ask that
person's permission."
I need a nod of the head to indicate that you understand the importance of our keeping an
atmosphere both silent and respectful..."
"Before we begin there are several other guidelines that we need to consider."
NO PRESSURE. "No one here is under any pressure to respond in any particular way to any of
the questions. If you have any doubts about sharing some part of yourself, you should feel
perfectly comfortable with your decision not to walk across the room."
"One final point. Each of the categories I use will have some GRAY AREAS. If you find yourself
stuck in a gray area, simply define the words from your own point of view. In other words,
define the terms as you yourself understand them when thinking of yourself. For example,
suppose the question asks everyone who is religious to walk across the room. If you think of
yourself as religious, then the word fits, regardless of whether or not someone else would use
the word "religious in the same way, and regardless of other meanings the word might have. If
you have serious reservations about the clarity or meaningfulness of any particular category,
then the best things to do is to not cross to the other side of the room."
Suggestions to Facilitator
Speak clearly. If the group is large, people may have trouble hearing you,
and their questions will cause an interruption.
Don't rush the process. Allow time for reflection. Don't ask the next
question too soon.
Beginning
"So that's it for the format and the guidelines to he followed. Any
questions?"
"If you cannot stay for the entire exercise, don't feel comfortable with the guidelines, or simply
don't believe like the workshop is going to he beneficial for you, it's OK to wait outside the room
during the exercise."
"To start, let's try a simply category. It will help me clarify the process."
"CROSS TO THE OTHER SIDE OF THE ROOM IF YOU WEAR GLASSES OR CONTACT
LENSES.
THANK YOU.
Once we begin, please, no interruptions.
ONCE WE BEGIN, PLEASE DO NOT ASK ANY QUESTIONS.
Often during the process you may feel like you want to say something. There will be plenty of
time at the end for discussion about the process."
The Questions
Cross to the other side of the room if you are not from ___________.
Cross to the other side of the room if you feel your home is ________.
REMINDER ABOUT GRAYNESS
REMEMBER, all the legal and philosophical questions about "home" don't matter. What matters
is what the word "home" means to you. If you are confused or uncomfortable, the best policy is
NOT to cross to the other side of the room.
You are male
You are female
Since joining (this program), you have broken off a serious relationship.
REMINDER
No talking... (Consider issuing this and other reminders as an ounce of prevention, even if a
problem isn't coming up at the moment.)
In the past year you have been in a relationship and been hurt.
You feel that you have not formed a close friendship in national service.
You take pride in your work in national service.
 You are Catholic
You are Protestant
You are Jewish
You are another religion other than those three major U.S. religions.
You are an atheist or agnostic.
You are a person of color.
You know little about you cultural heritage
You wish you had more money
You consider your family as working class
You consider your family as middle class
You consider your family as upper class (VERY FEW WILL GO, BECAUSE THAT NOT
HOW THEY THINK OF THEMSELVES, BUT THAT'S OK)
You have felt embarrassed about the economic class your family is in
REMINDER
Walk across the room only when you feel comfortable identifying yourself in this way.
You come from a family of four or more children you are an only child
You live independently of your parents
You have taken primary responsibility either for raising another member of
your family or caring for an elderly member of your family
You have low self-esteem
You would like to lose ten or more pounds
You feel lonely (ALWAYS AN IMPORTANT QUESTION)
You have been to college or plan to go to college
You have not graduated from high school
You have had serious thoughts about leaving national service
You feel physically unattractive
Note
As the workshop is structured it makes one dip into the personal with the previous question.
Then we back up to what is easier before making a deeper trip.
You consider yourself a Democrat
 You consider yourself a Republican
You consider yourself a socialist
You consider yourself a feminist
Your parents have either divorced, separated, or never married
At least one of your parents have died
You feel estranged or unconnected
There have been times when you have seriously felt that, if you could choose, you
would not choose
the ethnicity into which you were born
You find yourself thinking about food considerably more often than you want
You have medical problem
You have a learning disability
You have a physical disability
You have questioned your sexual orientation
You have experienced the effects of alcoholism in your family
You have experienced the effects of drug addiction in your family
You have had a sexual experience that you regretted
You have experienced suicidal thoughts at some point in your life
You have cried at least once this year
You have cried at least once this year for someone or something other than yourself
Since you joined _____________, you have laughed at yourself at least once
Cross the room if you could use a hug right now. (People generally begin hugging each
other during this time.)
Discussion Afterwards
REMINDER OF GUIDELINES
"I want to remind the group again of the guidelines. During this discussion we must have the
utmost respect. Again, no talking while others speak, no side comments, giggling, etc.
"I also want to remind people that everything spoken in this room stays in the room."
DEBRIEF OF DISCUSSION
(The discussion should feel a bit confessional. If the exercise has run well, people will be very
introspective and quiet. FOCUS THE DISCUSSION ON TWO QUESTIONS:
"How are you feeling right now?"
"Is there anything you want to say to your fellow participants about why you crossed the room
on a particular questions?"
(Use the discussion to allow people to EXPLAIN, SHARE, AND TELL STORIES about any of the
statements. Use the discussion to allow people to talk about HOW THEY FEEL right now and
how
the feel about the exercise.)
WARNINGS
BE CAREFUL ABOUT THE DISCUSSION CENTERING THE MERITS OF THE WORKSHOP.
One person says they did not like how we had only two choices, crossing the room or not.
Another defends the workshop and the workshop becomes the center of the discussion. (If
someone makes a comment about the workshop, thank them for their comment and refocus the
discussion towards people's feelings and stories.)
BE CAREFUL ABOUT COMMENTS THAT FOCUS ON OTHERS RATHER THAN
THEMSELVES.
(The discussion can become a group of people questioning other people why they crossed. Try
to gently steer the discussion to give space for those who really feel the need to explain and tell
the group something about themselves.)
Closure
End the discussion by thanking everyone for participating. You may want to describe how this
workshop has affected you.
REMINDER
Remind everyone again that whatever was said in the room stays in the room. It is a serious
breach of respect and trust if you share any of this with anyone outside this room. If you feel
like you need to speak with an individual about something he or she said, please ask them first.
Suggested Citation
Fletcher, A. (2002). FireStarter Youth Power Curriculum: Participant Guidebook. Olympia, WA:
Freechild Project.
Workshop Designers: This workshop originally came from presentations done at Stanford
University around 1985 by Isoki Femi and Linda Gonzales csp). This is a modified version based
on an outline from Dennis Matthies, Center for Teaching and Learning, Stanford University.

Section 5: Description of Implementation Process

Phase 1: Adoption of Program

o To get this program rolling, a street team will be formed. People who are passionate

about the subject and have had experience with the topic of Asian American mental

health will be the main target. They will hand out fliers about the program at public

events, such as religious gatherings and fundraisers held at their facilities. Fliers will also

be hung at the facilities with contact information.

 TIMELINE
Soft Start: Reserve a room at the facility big enough for activities to be held in. Check to see if there are computers
available and if building has working internet. Hire counselors from local mental health clinics to help with facilitating
activities and for participants to speak to when needed.
0 minutes 10 minutes 20 minutes 30 minutes 40 minutes
50 minutes 60 minutes

--Activity 1------
Test Your Knowledge
------Activity 2-------
What Is Mental Health?
---------Activity 3------------------------------
Crossing the Line
Activity 4
Start A Conversation
---Activity 5-------
Youre Not Alone
----Activity 6--
Help is Right Around the
Corner!
Narrative:
10 minutes
Link to website will be projected onto screen for all to see. Participants will use laptops
or tablets to follow link to take mental health screenings for depression or anxiety online. Tell
them the surveys are completely anonymous. This will help show the needs of the group.
20 minutes
Pass out handouts of lecture to participants. Set up laptop to projector and project lecture
onto screen. Instruct participants to take notes and write down any questions they may have.
Lecture will consist of definitions of different mental health problems, diseases, and statistics.
30 45 minutes
Facilitator will read from Crossing the Line activity sheet. Tell participants to stand in the
middle of the room. Instruct them to walk silently to each category on the wall as it applies to
them while they hear the statements being read off. The whole exercise is to be silent among
participants. Read statements aloud, giving time for participants to walk to their destination.
Once everyone has chosen a place, go on to the next statement, and so on. Debrief afterwards.
(worksheet in Section 4). Counselors should be available outside the room if participants feel the
need to talk to someone after or during the activity.
45 minutes
Play video on screen. This video acts as a tool to get a message across: start a
conversation. If participants have every felt anxiety, depression, thoughts of suicide, etc., this
video goads them on to speak to someone about it.
46 minutes
Pass out a pen, paper, and envelope to each participant. The participants will write an
anonymous letter about a struggle they currently face but do not openly discuss. Afterwards, they
will fold up their letters and put them in the envelopes. Shuffle the envelopes then randomly pass
them back out to the participants. Prompt them that no one will know whose letter they get, even
if it is their own. Participants will read their letters one by one. A discussion should follow in
which participants will converse about their thoughts.
53 minutes
Pass out handouts/brochures to participants. Ask if they have heard of any of the services
on the handouts/brochures. Explain each one and their locations.
BUDGET
PERSONNEL
Counselors x 3 per program session: ($300 each) $900
SPACE
Rent a room in facility- $60
MATERIALS
Paper- $7
Pens x 50 - $13
Tablets x 3- $210
Envelopes- $10
Laptop- $500
EQUIPMENT
Portable projector- $150
TRAVEL
Transportation- $20
MISCELLANEOUS
Flyers- $100

Total: $1,970