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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