ttwud - dream a world cultural therapy - frederick hickling

DREAM-A-WORLD CULTURAL THERAPY

Frederick W. Hickling CD, DM, FRSM, FRCPsych, DLFAPA Caribbean Institute of Mental Health & Substance Abuse (CARIMENSA), University of the West Indies. Mona, Jamaica.

Turning The World Upside Down, London , November 27, 2013

DREAM-A-WORLD CULTURAL THERAPY

Frederick W. Hickling CD, DM, FRSM, FRCPsych, DLFAPA Caribbean Institute of Mental Health & Substance Abuse (CARIMENSA), University of the West Indies. Mona, Jamaica.

Turning The World Upside Down, London , November 27, 2013

Cultural therapy, was pioneered at Bellevue Hospital in 1978

“Madnificent Irations” A historical pageant of madness in Jamaica

Psychiatry in Jamaica has been assimilated into Primary & Secondary public health care

Jamaican society – Little Economic growth or development in 50 years

RESILIENT PRODUCTIVE 60% ADULTS

TRANSGRESSIVE UNPRODUCTIVE

40% ADULTS

HEALTHY PRODUCTIVE

ADOLESCENTS

Healthy resilient reading by age 8Disruptive, underperforming NOT

reading by age 8

MENTALLY UNHEALTHY DISRUPTIVE ADOLESCENTS

CHILDREN 0-3: - Economic & social inequality; high viability, high risk

DREAM-A-WORLD CULTURAL THERAPY

?

HOWEVER THE TRANSGRESSIVE

BEHAVIORAL UNDERBELLY OF THE SOCIETY HAS BEEN

EXPOSED:

The third highest murder rate in the world

Krause, K., et al (2011).

The third lowest suicide rate in the worldAbel, W., et al (2007)

Jamaican children are suffering

• High physical abuse and neglect• High rates of sexual molestation

Jamaican children are suffering

• 40% pregnancies under 16 years old • 50% school dropout rates & illiteracy

Jamaican children are suffering

• High rates of youth aggression & criminality

MENTAL HEALTH CHALLENGES FOR THE NEW MILLENNIUM

• A shift from curative to preventative mental health care

MENTAL HEALTH CHALLENGES FOR THE NEW MILLENNIUM

• Creation of antidotes for conduct and impulsivity disorders

MENTAL HEALTH CHALLENGES FOR THE NEW MILLENNIUM

• Creation of antidotes for anti social behavior

MENTAL HEALTH CHALLENGES FOR THE NEW MILLENNIUM

• Promotion of self-esteem and self-confidence

A bold new University of the West Indies

initiative in primary mental health

prevention

Caribbean Institute of Mental health & Substance Abuse

(CARIMENSA)

GOVERNMENTAL ORGANIZATIONS

(Health, Education,

Security etc)NGO’S TRANSITION TO

SCALE

SCALE UPSERVICES

EVIDENCED BASED OUTCOMES

CARIBBEAN INSTITUTE OF MENTAL HEALTH AND

SUBSTANCE ABUSE (CARIMENSA)

PROOF OF CONCEPT TRAINING

UNIVERSITY OF THE WEST INDIES

Recent international studies have demonstrated that children who cannot read by age 8 are most likely to become involved in high risk behaviors.

Huesmann LR, Eron LD, & Yarmel PW, 1987

ACHIEVEMENT GAP OF CHILDREN IN UK

Carimensa & Allman Town Primary Dream A World Cultural Therapy

‘Proof of Concept’ 2006

The Dream-A-World Process

• 30 who had failed Grade 3 Test, 30 controls

The Dream-A-World Process

• 40 hour 3-week workshops in summer vacation

The Dream-A-World Process

• 60 hours ‘top-up’ sessions during the term

The Dream-A-World Process

• 240 hours over 2½ years

The Dream-A-World Process

• Annual ‘Show and Tell’ performance

IDENTITY

Laminated photo-ID’s boosted self esteem

The Dream-A-World Workshop

• Breakfast and lunch• Daily literacy & numeracy

The Dream-A-World Workshop

• Psychotherapy ‘small groups’• Identify things they like in their world

The Dream-A-World Workshop

• Invent a new Planet comprising things they like - ‘Dream-A-World’

The Dream-A-World Show & Tell Pageant

• Created a play of their new World• Created songs about their new planet

The Dream-A-World Show & Tell Pageant

• Created costumes and masks• Performed to their community family

The Dream-A World Cultural Therapy process:

• Catalyzes the creative imagination

The Dream-A World Cultural Therapy process:

• Focuses on the drum and homemade instruments

The Dream-A World Cultural Therapy process:

•Creates music, songs, dances, skits and artwork

We took the children on field trips

We taught them to hug

PILOT PROJECT PROOF OF CONCEPT RESEARCH ARTICLE.

Promoting Resilience in High-risk Children in Jamaica:

A Pilot Study of a Multimodal Intervention

Jaswant Guzder MD, FRSPC; Vanessa Paisley MSc; Hilary Robertson-Hickling

PhD; Frederick W. Hickling DM, FRCPsych (UK), DLFAPA

Abstract

Objective: To assess the effectiveness of a multimodal afterschool and summer

intervention called the Dream-A-World (DAW) Project for a cohort of school-aged

Jamaican children from an impoverished, disadvantaged inner-city community in

Kingston, Jamaica. Children were selected by their teachers based on severe

disruptive disorders and academic underachievement and compared with a

matched control group. The pilot was a child focused therapeutic modality

without parental intervention for disruptive conduct and academic failure.

Method: A group psychotherapeutic intervention of creative arts therapies and

remedial academic support adapted for the Jamaican context was implemented

with 30 children from an inner-city primary school. The intervention was

implemented over 21⁄2 years spanning grade three to six with evaluation of

outcomes using the ASEBA Teacher Report Form (TRF) and end of term grades for

the intervention group versus matched controls who were offered usual school

supports. Results: The intervention group made significant improvements in

school social and behavior adjustment measured by the TRF, with more

successful outcome amongst boys for behavioral gains. No significant

improvements were made by the girls. Limitations of cohort size, lack of parent

data and questions of gender disparities in outcome were unresolved

interpretative issues. Conclusion: This multi-modal mental health and academic

intervention for high-risk children living in an impoverished, violent

neighbourhood, improved global functioning of boys more than girls, and raised

questions for design of further preventive planning.

Jaswant Guzder

H Robertson-Hickling

Vanessa Paisley

Fred Hickling

PILOT PROOF OF CONCEPT RESEARCH

ARTICLE

Journal of the Canadian Academy of Child and Adolescent Psychiatry, May 2013

CHANGES IN ASEBA BEHAVIOR RATINGS OVER THE STUDY PERIOD

Significant improvements in school social and behaviour adjustment

compared with controls

CHANGES IN ASEBA BEHAVIOR RATINGS OVER THE STUDY PERIOD

Boys received significantly improved teacher ratings in school social and emotional adjustment

than the girls.

Dream-A-World Cultural Therapy ‘Scale-up’

intervention for school-aged high-risk primary

school Jamaican children July 2013

THE ‘SCALE UP’ - TASK SHARING 4 Primary Schools in Seaview Gardens

Dr. Hilary Robertson-Hickling, Principal Mrs. Elaine Jones, Dr. Duncan Pedersen

(Teacher) “… these children they can’t sit still… they can’t socialize well…they have very short attention span, they are

underdeveloped…they are not alert...”

Performers from 4 Primary Schools at final “Show & Tell” of the 2013 ‘Dream-A-

World Scale Up’ in inner-city Kingston

(Teacher): “…some of them could not spell things as simple as their names…but then at the end of the program they

were writing the names of their school, and their own names clearly… in 3 weeks…”

(Psychologist): “…we are now at the 4 scale up but … we have to go to 400. What are the lessons learned …when you now have the

expansion from 1 to 40 or 400... There is still a lot to learn and we are going to have to learn it quickly …”

Scale up & transition to scale

“…Emancipate ourselves from mental slavery…” Bob Marley

Teaching self control & self-confidence

Shelly Ann Fraser-Pryce

Shelly-Ann Fraser-Pryce Jamaica University of Technology Graduation 2013

One love, brothers and sisters, one heart, one

destiny