By Iris Smith, Ph.D.

Social network analysis (SNA) is a research paradigm used to examine the pattern of relationships within a social structure or system to understand how individual components interact and influence each other.  For example, SNA can be used to examine communication patterns within a community to identify opinion leaders, patterns of knowledge diffusion, linkages between individuals, groups or organizations, and how these linkages influence a desired outcome.  This information can be helpful during prevention planning, implementation, and evaluation. 

There are two types of analytic methods used in network analysis: visualization and mathematical analysis.  Visualization analysis involves the construction of a graphical summary of interactions within a network.  For example, in the visualization below (Figure 1), each circle represents an individual within a social network.  The lines connecting the circles (called vertices) represent interactions or communication between individuals in the network.  In this visualization, the individual (or organization) represented by the orange circle is central to the communication within this network.  In social network analysis this is defined as “betweenness” and illustrates how individuals in this network interact and communicate with one another.  It also shows that while the group of blue individuals on the left appear to be interconnected, the two blue individuals on the right and the yellow individual on the left seem to be isolated and are only connected to the network through a single individual.  You might conclude that the individual represented by the orange circle would be an important person to influence since she or he is connected to all the other individuals in the network and may even be considered an opinion leader.

Figure 1

The length, thickness, or directionality of the lines can also be used to represent proximity, frequency of communication, or other characteristics of the network. Network graphs can be generated using several statistical programs such as R, SPSS, and SAS. While mathematical computer-generated models can be quite complex, simple visualizations can also be created manually.

A  2019 scoping review identified 27 published studies that used SNA to examine networks involving health professionals to determine how knowledge was transferred and how the knowledge transfer influenced outcomes related to health behaviors, attitudes, or innovations  The studies included in the review used SNA in a variety of ways including examinations of patterns and efficiency of information sharing among health professionals, identifying positions of influence, similarity of attributes among system components, and determining the effectiveness of interventions.¹ SNA has been used extensively to study adolescent health behaviors including substance use.  A 2022 systematic review identified 201 studies that used SNA to study adolescent health behaviors such as peer influence, substance use, and the spatial context in which social relationships take place.  These researchers developed a 5-step decision tree to guide researchers interested in applying SNA methods (https://ars.els-cdn.com/content/image/1-s2.0-S0277953622008255-gr3_lrg.jpg).²

Resources

Burgette, J. M., Rankine, J., Culyba, A. J., Chu, K. H., & Carley, K. M. (2021). Best Practices for Modeling Egocentric Social Network Data and Health Outcomes. HERD, 14(4), 18–34. https://doi.org/10.1177/19375867211013772

Collonnaz, M., Riglea, T., Kalubi, J., O'Loughlin, J., Naud, A., Kestens, Y., Agrinier, N., & Minary, L. (2022). Social network analysis to study health behaviours in adolescents: A systematic review of methods. Social science & medicine (1982), 315, 115519. https://doi.org/10.1016/j.socscimed.2022.115519

Glegg S,JenkinsE, Kathari A (2019) How the Study of Networks Informs Knowledge Translation and Implementation: A Scoping Review.  Implementation Science 14; pg 34. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6437864/#CR54  

Saqr, M., López-Pernas, S., Conde-González, M.Á., Hernández-García, Á. (2024). Social Network Analysis: A Primer, a Guide and a Tutorial in R. In: Saqr, M., López-Pernas, S. (eds) Learning Analytics Method and Tutorials.  Springer, Cham.  https://rdcu.be/dMk1I

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¹ Glegg S,JenkinsE, Kathari A (2019)  How the Study of Networks Informs Knowledge Translation and Implementation:  A Scoping Review.  Implementation Science 14; pg 34. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6437864/#CR54

² Collonnaz, M., Riglea, T., Kalubi, J., O'Loughlin, J., Naud, A., Kestens, Y., Agrinier, N., & Minary, L. (2022). Social network analysis to study health behaviours in adolescents: A systematic review of methods. Social science & medicine (1982), 315, 115519. https://doi.org/10.1016/j.socscimed.2022.115519

Social network
analysis (SNA) is a research paradigm used to examine the pattern of
relationships within a social structure or system to understand how individual
components interact and influence each other. 
For example, SNA can be used to examine communication patterns within a
community to identify opinion leaders, patterns of knowledge diffusion,
linkages between individuals, groups or organizations, and how these linkages
influence a desired outcome.  This
information can be helpful during prevention planning, implementation, and
evaluation.  There are two types of
analytic methods used in network analysis: visualization and mathematical
analysis.  Visualization analysis
involves the construction of a graphical summary of interactions within a
network.  For example, in the
visualization below (Figure 1), each circle represents an individual within a
social network.  The lines connecting the
circles (called vertices) represent interactions or communication between
individuals in the network.  In this
visualization, the individual (or organization) represented by the orange
circle is central to the communication within this network.  In social network analysis this is defined as
“betweenness” and illustrates how individuals in this network interact and
communicate with one another.  It also
shows that while the group of blue individuals on the left appear to be
interconnected, the two blue individuals on the right and the yellow individual
on the left seem to be isolated and are only connected to the network through a
single individual.  You might conclude
that the individual represented by the orange circle would be an important
person to influence since she or he is connected to all the other individuals
in the network and may even be considered an opinion leader.

 

 

 

 

 

Figure 1

 

 

 

 

 

 

 

 

The length,
thickness, or directionality of the lines can also be used to represent
proximity, frequency of communication, or other characteristics of the network.
Network graphs can be generated using several statistical programs such as R,
SPSS, and SAS. While mathematical computer-generated models can be quite
complex, simple visualizations can also be created manually.

 

A  2019 scoping review identified 27 published
studies that used SNA to examine networks involving health professionals to
determine how knowledge was transferred and how the knowledge transfer
influenced outcomes related to health behaviors, attitudes, or innovations  The studies included in the review used SNA
in a variety of ways including examinations of patterns and efficiency of
information sharing among health professionals, identifying positions of
influence, similarity of attributes among system components, and determining
the effectiveness of interventions.^[1]
SNA has been used extensively to study adolescent health behaviors including
substance use.  A 2022 systematic review
identified 201 studies that used SNA to study adolescent health behaviors such
as peer influence, substance use, and the spatial context in which social
relationships take place.  These
researchers developed a 5-step decision tree to guide researchers interested in
applying SNA methods (https://ars.els-cdn.com/content/image/1-s2.0-S0277953622008255-gr3_lrg.jpg).^[2]

 

Resources

 

Burgette,
J. M., Rankine, J., Culyba, A. J., Chu, K. H., & Carley, K. M. (2021). Best
Practices for Modeling Egocentric Social Network Data and Health
Outcomes. HERD, 14(4), 18–34.
https://doi.org/10.1177/19375867211013772

Collonnaz, M., Riglea, T., Kalubi, J., O'Loughlin, J.,
Naud, A., Kestens, Y., Agrinier, N., & Minary, L. (2022). Social
network analysis to study health behaviours in adolescents: A systematic review
of methods. Social science & medicine (1982), 315,
115519. https://doi.org/10.1016/j.socscimed.2022.115519

Glegg S,JenkinsE, Kathari A (2019) How
the Study of Networks Informs Knowledge Translation and Implementation: A
Scoping Review.  Implementation
Science 14; pg 34. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6437864/#CR54  

 

Saqr, M., López-Pernas, S., Conde-González, M.Á.,
Hernández-García, Á. (2024). Social Network Analysis: A Primer, a Guide and
a Tutorial in R. In: Saqr, M., López-Pernas, S. (eds) Learning Analytics Method
and Tutorials.  Springer, Cham.  https://rdcu.be/dMk1I

By Rachel Karch, Instructional Design and Accessibility Manager, Suicide Prevention Resource Center

Accessibility is crucial for creating an inclusive environment where everyone, regardless of ability, can access and benefit from information and resources. Here’s why accessibility matters:

• Everyone feels included and valued.
• It benefits all users, including those with temporary disabilities and non-native English speakers.
• It helps meet legal requirements and avoid issues.
• Accessible content reaches a wider audience.
• It shows commitment to equity and social responsibility.

Here are five ways to make your content more accessible:

1. Use Clear and Simple Language

Avoid jargon and technical terms. Use plain language that is easy to understand for everyone.

2. Provide Alternative Text for Images

Always add descriptive alt text to images. This helps individuals using screen readers to understand what the images represent.

3. Ensure Text is Readable

Use high-contrast colors and easy-to-read fonts. Make sure the text is large enough for those with visual impairments.

4. Caption Videos and Provide Transcripts

Include captions in videos for the deaf or hard of hearing. Provide transcripts for all video and audio content to ensure everyone can access the information.

5. Make Documents Accessible

Organize content with headings, bullet points, and lists. Use accessible formats like tagged PDFs, which are easier for assistive technologies to read.

By following these simple steps, you can make your content more accessible and inclusive

By Iris Smith, Ph.D.

Substance use within a family is considered a risk for adverse childhood experiences (ACEs). In addition to the association with child abuse or neglect, the death of a parent due to overdose can have significant impact on a young child or adolescent.

A cross-sectional study of the U.S. population estimated that between 1999 and 2020 over one million youth lost a parent to a drug overdose.  Most of the parental deaths were among individuals between the ages of 15 and 54. Black, American Indian and Alaskan Native youth are disproportionately affected, with Black youth more likely to experience the death of a father.¹  

A 7-year prospective study of children who lost a parent to sudden death (suicide, accident, or sudden natural death) found higher rates of psychiatric disorders such as post-traumatic stress disorder (PTSD) and functional impairment. Depression was more likely in the first two years following the parental death and was more prevalent in youth whose parents died when they were less than 12 years old. Adults who lost a parent during childhood report increased depressive symptoms, diminished self-confidence, educational attainment, and dissatisfaction with interpersonal relationships. This study also found that predeath risk factors, post bereavement child disorder, disruption or loss of social support, and negative life events contributed to severity and duration of impairment.² Another study of children who experienced parental loss because of opioid-related overdoses between 2002 and 2017 found that within 3 months following the parent’s death, nearly 1 in 10 (11.1%) of the Medicaid-enrolled children had used mental health services. With 5 years this had increased to 1 in 5 (24.8%) and 19.8% had been involved in the child welfare system.³

Families of individuals with substance disorders often face challenges that can affect their physical, emotional, and even financial well being. Children of substance-using parents often grow up in chaotic and sometimes abusive family environments which put them at risk for developing social and emotional problems. Children who reside in marginalized and under-resourced communities are also more likely to be exposed to community level drug-related violence.  

At present there are few interventions focused on this growing population of children.  Development of evidence-based interventions that address parental loss and bereavement in collaboration with mental health providers are needed to prevent negative developmental outcomes in these children.

Resources

Aguirre, L. V. C., Jaramillo, A. K., Saucedo Victoria, T. E., & Botero Carvajal, A. (2024). Mental health consequences of parental death and its prevalence in children: A Systematic Literature Review. Heliyon, 10(2), e24999. https://doi.org/10.1016/j.heliyon.2024.e24999

Hulsey EG, Li Y, Hacker K, Williams K, Collins K, Dalton E. Potential Emerging Risks Among Children Following Parental Opioid-Related Overdose Death. JAMA Pediatr. 2020;174(5):503–504. doi:10.1001/jamapediatrics.2020.0613

Jones CM, Zhang K, Han B, et al. Estimated Number of Children Who Lost a Parent to Drug Overdose in the US From 2011 to 2021. JAMA Psychiatry. Published online May 08, 2024. doi:10.1001/jamapsychiatry.2024.0810

Kentor, R. A., & Kaplow, J. B. (2020). Supporting Children and Adolescents Following Parental Bereavement: Guidance for Health-Care Professionals. The Lancet. Child & Adolescent Health, 4(12): pp. 889–898. https://doi.org/10.1016/S2352-4642(20)30184-X

Schlüter B, Alburez-Gutierrez D, Bibbins-Domingo K, Alexander MJ, Kiang MV. Youth (2024). Experiencing Parental Death Due to Drug Poisoning and Firearm Violence in the US, 1999-2020. JAMA. 2024;331(20): pp. 1741–1747. doi:10.1001/jama.2024.839

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¹ Schlüter B, Alburez-Gutierrez D, Bibbins-Domingo K, Alexander MJ, Kiang MV. Youth Experiencing Parental Death Due to Drug Poisoning and Firearm Violence in the US, 1999-2020. JAMA. 2024;331(20):1741–1747. doi:10.1001/jama.2024.8391

² Pham, S., Porta, G., Biernesser, C., Walker Payne, M., Iyengar, S., Melhem, N., & Brent, D. A. (2018). The Burden of Bereavement: Early-Onset Depression and Impairment in Youths Bereaved by Sudden Parental Death in a 7-Year Prospective Study. The American journal of psychiatry, 175(9), 887–896. https://doi.org/10.1176/appi.ajp.2018.17070792

³ Hulsey EG, Li Y, Hacker K, Williams K, Collins K, Dalton E. (2020). Potential Emerging Risks Among Children Following Parental Opioid Related Overdose Death. JAMA Pediatr. 174(5); pp. 503-504.

By Sarah Davis, MNM

Our world is made up of intersecting and interconnected systems. The work of prevention takes place within the context of these systems (think: education system, healthcare, or judicial system). As prevention professionals work to make changes – at the individual, interpersonal, community, and societal levels¹ –it is important to understand how systems work, so that we can influence them to ensure everyone can achieve their greatest level of health and wellbeing.

Schools are an example of a system. A school system could be viewed as a single school, a school district, or the U.S. educational system. Defining the “boundaries” of the system helps you to identify the components within the system, and, most importantly, identify leverage points for change.

In this case, let’s take school districts in our community as the system in question. Within the school district, we identify the following:

1. Roles: we have the teachers, staff and administrators within the schools. We also have the students and their parents or guardians. We have our school board members, and we know that policymakers at the state and federal levels have influence on our school district. 
2. Rules: there are a myriad of policies and laws that impact our system. There are human resource policies about hiring, compensation, days off, and much more. There are requirements about certification for teachers, and curriculum and graduation requirements for students. There are laws that govern how the schools in our district are funded, and how that funding is allocated. The school district has safety protocols, wellness policies and discipline practices, and much more.

Gathering an understanding of the Relationships between the people and the policies within the school district provide prevention professionals the opportunity to see how a system functions (i.e., who has influence over what and how policies impact the system’s functioning). Having a systems perspective enables us to see which parts of a system may be supporting health and wellness, and which parts may be inhibiting it. We can identify and prioritize opportunities for change – and see the people who need to be involved and the policies that need to change.

Systems thinking is the art of seeing and leveraging the connections between components within a system. When prevention professionals build their skills in understanding systems, they expand their opportunities to create lasting and meaningful changes that positively impact health and wellness. For example, if behavioral health in schools has been identified as a need, prevention professionals could ask themselves questions such as:

• Who currently plays a role in supporting students’ behavioral health in schools? (Ex: school nurses? Social workers or counselors?) Which schools in our district have these staff?
  • What rules or laws influence the number and availability of these staff in our schools?
  • What rules or policies impact the services these professionals can provide?
• Who makes the decisions about the amount of allocated funding for behavioral health professionals or services within our schools?
  • What relationships exist between these decision makers and: School administrators? Behavioral health professionals? Parents of students needing behavioral health supports?
  • Who has influence with those in decision-making positions?
• Who is involved in the implementation of social-emotional learning (SEL)³ principles that has been shown to support behavioral health in young people within our school district?
  • What rules or requirements govern a school’s implementation of SEL principles?Who sets these rules?
  • What is the relationship between schools and community-based organizations with expertise in SEL principles?

This is just a sampling of questions, but hopefully give you, a prevention professional, an idea of how taking a systems approach to prevention offers the opportunity to make impactful change based on an understanding of the roles, rules, and relationships that exist within a system.

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¹ To learn more about the Socio-Ecological Framework for Prevention, check out this planning tool from the Great Lakes PTTC: https://pttcnetwork.org/wp-content/uploads/2022/03/Socio-Ecological-Approach-Worksheet_PTTC_Harm-Red._508_kms-FINAL2.pdf

² This framework of looking at a system is influenced by USAID’s “The 5Rs Framework in the Program Cycle”: https://usaidlearninglab.org/resources/5rs-framework-program-cycle

³ Learn more about Social Emotional Learning from SAMHSA’s Evidence-Based Practices: https://www.samhsa.gov/resource/ebp/casel-guide-schoolwide-sel-essentials