Dream-a-World Cultural Therapy for Primary School Children

Innovation summary

High-risk primary school children with severe disruptive disorders and academic underachievement are identified by primary school teachers in disadvantaged, inner-city communities of Kingston. The original Dream-a-World (DAW) Cultural Therapy model was a child-focused therapeutic model addressing disruptive conduct and academic failure without parental intervention. Group psychotherapeutic interventions have now been combined with homework supervision and remedial sessions in literacy, arts, information technology, audio-visual technology, sports and games.²

Dream-a-World Cultural Therapy aims to do the following for high-risk children:

Promote resilience
Improve academic performance
Increase self-control and modify mal-adaptive behaviors
Improve self-esteem and wholesome identity formation
Increase creativity and productivity

The community-level goal is to bring about behavior change that will seed communities with young people who eschew violence, substance abuse and dangerous sexual behavior, instead prioritizing achievement and gainful employment.

Impact summary

The initial pilot project involved 30 children in a single inner-city primary school and cost $50,000 USD over 36 months
A scale-up project involving 100 children has been initiated in four inner-city primary schools and is estimated to cost $300,000 USD over 26 months

"Everything that was incorporated in it [the DAW program] was tremendous during those three weeks. I think the children need it; because [with] a lot of kids, a teachers is not going to see. I see where health, education, culture comes together and if this is there [present], very consistent, we are going to have a well-balanced individual."

- Primary school teacher

Innovation details

All 30 children from the initial ‘proof of concept’ pilot project (2006) were students who had failed the Grade 3 Primary School Test and exhibited severe disruptive disorders. They all went on to pass the Grade Six Achievement Test 36 months later, and have now entered accredited High Schools in Jamaica.

This intervention group made significant improvements in school social and behavior adjustment, as measured by the Achenbach System of Empirically Based Assessment (Teacher Report Form) (ASEBA TRF), with particularly successful outcomes for behavioral gains among boys.

Significant academic improvements were made in overall average language arts (p = 0.0028), science (p < 0.001), mathematics (p < 0.001), and social studies (p = 0.0018) scores across the four assessments during the period of study. The intervention group also made significant improvements in artistic, musical and dramatic performance, resulting in measurable artistic performances by the group during the study period.2

In July 2013, the project was successfully scaled up into four primary schools in inner-city Kingston. This venture involved two teachers, four cultural therapists and a community mental health nurse practitioner in each of the four schools. The ‘Scale-Up’ DAW activity performed baseline psychological assessments; including ASEBA evaluations for 100 DAW participants and 100 control students.

Each child involved in the three-week summer ‘Scale-Up’ produced artistic creations such as paintings, papier-mache masks and costumes. Each participating school also produced a ten minute drama reflecting original music, songs and performances from all DAW students. These productions mirrored the thematic concept of a Dream-A-World activity in which students are asked to imagine a new planet, reflecting particularly on which aspects of life they wished to keep and which they wished to discard.

Some of the projects key outcomes are:

Fostering creative and visionary leadership in resource challenged, overcrowded inner-city primary schools
Transforming disruptive, fractious and under-performing eight-year-old children in the remarkably short period of three weeks, and sustaining this behavioral improvement for the ensuing three years
Triggering improvements in academic achievement – mathematics and reading – in three weeks and sustaining this improvement over three years
Catalyzing teacher task-sharing and task-shifting skills in the management of mental disorders in the children in their schools
Practical demonstrations to primary school teachers of this method of producing and sustaining significant academic achievement in the children in their schools
Significantly increasing parental engagement in the development of their children
Providing continuity and support to consolidate social skill development

Key drivers

Strong foundation

Creating and developing a mental health primary prevention institution – the Caribbean Institute of Mental Health and Substance Abuse (CARIMENSA) – to link with governmental and national training institutions for the delivery of evidence-based therapeutic and health promotion techniques
Conducting evidenced-based therapeutic and health promotion research projects, which provide scalable approaches for workable national outcomes
Generating theories of change to catalyze national and regional development from evidence-based deliverables
Training psychiatrists and other mental health professionals in psychohistoriography, cultural therapy and other indigenous therapeutic activities developed in Jamaica

Collaboration

Integrating trained mental health professionals with teachers and cultural therapists in schools
Catalyzing task-sharing and task-shifting models between mental health professionals and other community workers and professionals
Encouraging private-public collaboration in mental health and the development of private community mental health care facilities, organizations and associations
Facilitating the development and growth of child mental health research and publication
Incorporating mental health promotion as a sine qua non of clinical and administrative practice

Challenges

Evidence

Establishing academic and clinical ‘proof of concept’ evidence-based parameters

Resistance

Hesitancy to change on the part of clinicians and public policy administrators

Funding

Resource acquisition and allocation

Continuation

The process is proving to be effective, sustainable, viable, scalable and inexpensive, generating interest and excitement from schools and organizations both across the island and in other countries.

The Ministry of Education has incorporated the innovation in a total of 70 schools over a two year period following the initial project. The Government has also committed to carry on the program on an annual basis, including an additional 20 schools proposed for 2017.

Partners

Primary partners:

Government of Jamaica
University of the West Indies, Jamaica
NGOs and the Jamaican private sector

International organizations who have played important supportive roles in the development process:

Funders

The Jamaican people
Private and international contributors

Evaluation methods

The proof of concept intervention was implemented with 30 children from an inner-city primary school in Kingston in 2006, over 2½ years spanning grade three to six with evaluation of outcomes using The ASEBA (Achenbach System of Empirically Based Assessment) Teacher Report Form and end of term grades for the intervention group versus matched controls who were offered usual school supports.^2,3

Cost of implementation

The initial pilot project involved 30 children in a single inner-city primary school and cost $50,000 USD over 36 months
A scale-up project involving 100 children has been initiated in 4 inner-city primary schools and is estimated to cost $300,000 USD over 26 months

Impact details

All 30 children from the initial ‘proof of concept’ pilot project were students who had failed the Grade 3 Primary School Test and exhibited severe disruptive disorders. They all went on to pass the Grade Six Achievement Test 36 months later, and have now entered accredited High Schools in Jamaica.

This group made significant improvements in school social and behavior adjustment, as measured by the Achenbach System of Empirically Based Assessment (Teacher Report Form) (ASEBA TRF), with particularly successful outcomes for behavioral gains among boys.

Significant academic improvements were made in language arts, science, mathematics, and social studies scores across the four assessments during the period of study. The intervention group also made significant improvements in artistic, musical and dramatic performance, resulting in measurable artistic performances by the group.

In July 2013, the project was successfully scaled up to four primary schools in inner-city Kingston. This venture involved two teachers, four cultural therapists and a community mental health nurse practitioner in each of the schools. The ‘Scale-Up’ DAW activity performed baseline psychological assessments; including ASEBA evaluations for 100 DAW participants and 100 control students.

Each child involved in the three-week summer ‘Scale-Up’ produced artistic creations such as paintings, papier-mâché masks and costumes. Each school also produced a ten-minute drama reflecting original music, songs and performances from all DAW students. These productions mirrored the thematic concept of a Dream-A-World activity in which students are asked to imagine a new planet, reflecting particularly on which aspects of life they wished to keep and which they wished to discard.

The intervention group at baseline was performing significantly below the control group in literacy and mathematics. After one year of intervention they showed significant improvements in literacy. For mathematics, the intervention group was performing at the same level as the control group, but both groups showed a significant decline in their scores over the period. This was an unexpected result, but part of a national issue at the time.

The ASEBA assessment revealed that the intervention group was performing better than the control group over the 18 months of the study. The intervention group also showed a significant reduction in mental and physical distress symptoms, such as somatization and thought disturbance. This decrease, however, was not statistically significant when compared to the control group.

Some of the project’s key outcomes are:

Fostering creative and visionary leadership in resource challenged, overcrowded inner-city primary schools
Transforming disruptive, under-performing eight-year-old children in the remarkably short period of three weeks, and sustaining this behavioral improvement for the ensuing three years
Triggering improvements in academic achievement – mathematics and reading – in three weeks and sustaining this improvement over three years
Catalysing teacher task-sharing and task-shifting skills in the management of mental disorders in the children in their schools
Practical demonstrations to primary school teachers of this method of producing and sustaining significant academic achievement in the children in their schools
Significantly increasing parental engagement in the development of their children
Providing continuity and support to consolidate social skill development

References

Guzder J et al. (2013) Promoting resilience and competencies in high risk school aged children in Jamaica: a pilot study of a cultural therapy multimodal intervention. Canadian Journal of Child and Adolescent Psychiatry, 22(2):125-130
Robertson-Hickling H et al. (2009) Fostering resilience in children at risk through a cultural therapy intervention in Kingston, Jamaica. Journal of Health Care for the Poor and Underserved, 20:31–35.
Achenbach T M & Rescorla LA (2001) Manual for the ASEBA School-Age Forms & Profiles. Burlington, VT: University of Vermont Research Center for Children, Youth & Families.
Graham S et al. (2007) Dream A World: A Cultural Therapy Risk Reduction Programme for Nine-Year-Olds in Allman Town, Jamaica. In Hickling FW (Ed.) Dream A World : Carimensa and the Development of Cultural Therapy in Jamaica. Carimensa, Jamaica.

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Country

Jamaica