Liz Mullinar & Tanya Fox presentation

Evaluation of a community-based, peer-support, trauma recovery program using a replicable model, showing significant improvement in the mental health of program participants

CHILDHOOD TRAUMA
More emotion than a person can handle.
Perceived as life threatening.
Emotional shock that creates substantial lasting damage to an individuals psychological development. (James)
A potentially traumatizing event is any event that overwhelms the infant or child’s capacity to cope. This can be a one off event or ongoing in nature (Nijenhuis )
Trauma corresponds with abuse

HEAL FOR LIFE - RESIDENTIAL PROGRAMSfor those seeking to heal from childhood trauma and abuse
NSW ● QLD ● SA ● VIC ● WA ● UK

HEAL FOR LIFE - RESIDENTIAL PROGRAMS
5-day residential programs for:
7 – 11 years ─ mixed
12-17 years ― girls
boys
18+ years – mixed
25+ years – mixed private retreat
3 week programs for:
16 – 25 years ─ young women
young men

HEAL FOR LIFE - RESIDENTIAL PROGRAMS
Facilitators are trained in mental health and trauma-recovery
Peer-support volunteers (carers) are trained in our trauma-recovery model
All program participants (facilitators, carers and guests) have a lived experience of childhood trauma
The healing program operates on a non-hierarchical basis and all participants take part in the program schedule

Evaluation conducted by
Dr Chris Edwards
Central Coast Research & Evaluation
Impact Evaluation of the Heal For Life Program

Background to the impact evaluation
HFL has collected self report pre & post healing week data since inception
2005 – 2009 longitudinal evaluation by CC R&E conducted pre, 6 month-post and 4 year-post follow ups
Follow ups consistently showed significant decreases in participants depression, improvements in self reported physical & mental health, employment & relationships with partners & children, after 6 months
2009 4 yr follow up showed improvements sustained and in some cases participants continued to improve

Issues with the self report longitudinal evaluation
Self report questions not validated
HFL staff collecting and entering data
311 guests participated in a HFL program during 2005, 245 agreed to be followed up. 51 guests completed all questionnaires over the 4 year period. Response rate of 20%.
Transient nature of traumatised peoples lives
Were the characteristics of those that responded different from those who didn’t?

2008 -2009 Impact Evaluation
simple pre and 6 month-post design to measure the effect of HFL program on a cohort of adult guests attending between July and December 2008
Validated, reliable measures used to measure changes in psychological wellbeing of participants
NSCCAHS Ethics approval gained & informed consent gained from (139) 84% program participants
Pre measures administered during the healing week by facilitators trained by evaluator
6 month follow up measures sent by email or prepaid post and returned directly to evaluator

The Measures
The number of guests suffering from mental health problems as identified by the Kessler Psychological Distress Scale - 10 (K10)
The number of guests suffering from ill health according to the Short Form (36) Health Survey (SF36)
The number of guests with drug, alcohol and/or gambling problems as identified by self report and the Alcohol Use Disorders Identification Test Screening Instrument (AUDIT)

The Measures- continued
The number of guests in dysfunctional relationships according to the Abbreviated Dyadic Adjustment Scale (ADAS)
The number of guests (who were parents) who report dysfunctional parenting behaviour according to The Parenting Scale (Arnold)
The level of self reported guest satisfaction with their experience of the Healing Week

Findings
Response Rate

166 individual guests completed HFL program
139 agreed to be followed up
98 returned completed 6 month-post follow-up surveys.
Providing a follow-up response rate of 71%

Respondent history

Differences in the measures 6 months post-program

K10 scores
Mean psychological distress scores reduced significantly from 32.4 to 25.7 (t=32.25,df=93,p<.0001).
79% of respondents reducing their psychological distress at follow up as measured by the K10.
The percentage of respondents who were likely to have a severe mental health disorder reduced significantly from 63.8% to 35.1% after attending the Healing Week (x2=15.51,df=1,p<.0001).

SF-36
respondents improved their SF36 mean scores on every dimension, 6 months after completing the Healing Week.
Respondents pain index, vitality, social functioning, emotional functioning, and mental health scores all showed statistically significant improvements.

Comparison of respondents' baseline and post Healing Week SF-36 means scores with Australian Norms
100
Aust Norms
Post group
90
Pre group
80
70
60
50
40
30
20
10
PF
RP
BP
GH
VT
SF
RE
MH
PCS
MCS
Dimensions

Addiction problems
29% of respondents reported having an addiction problem in the 6 months pre-program. At 6 months post-program there was a statistically significant reduction, with 16% of respondents reporting an addiction problem (x2=4.22,df=1,p=.04).
AUDIT results showed 31.9% of respondents drinking at dependent, hazardous or harmful levels pre-program. A non- statistically significant reduction to 27.7% was recorded 6 months post-program.

Relationship satisfaction
37 guests had the same partners pre and post program. Their mean ADAS score improved from 19.8 at baseline to 20.27. This increase was not statistically significant.

Dysfunctional Parenting skills
Statistically significant reduction in the mean dysfunctional parenting scores of the 37 participants completing the Parenting scale pre and post
3.5 reduced to 3.21 (t=2.42,df=37,p=.02)
Arnold’s Parenting Scale was validated using a sample of 168 mothers, 65 of which were attending a clinic because of extreme difficulties in handling their children. The mean Parenting score for these mothers was 3.1 compared to 2.6 for the non-clinical group.

Satisfaction with the Heal For Life program

Strengths & Weaknesses
simple pre- and post- test analyses usually insufficient to accurately determine causation because there is no control group
Sourcing a control group for this type of study is challenging as:
HFL has an ethical stance to not refuse access to the program for those who request to come
HFL does not keep waiting lists
The HFL program is quite unique and sourcing a comparison program is also quite difficult

The National Child Protection Clearinghouse states:
“Another alternative to the adoption of a classic experimental approach (that is, the use of control or comparison groups) is
the use of multiple methods or triangulation – in essence the
comparison of data from multiple perspectives.”
HFL triangulated evaluation:
2005-2009 Longitudinal Study
2008-2009 Impact Evaluation
Survey exploring efficacy of the program from the perspective of board members, staff and carers.
Comparison of data from the 3 studies provides compelling evidence that the Heal For Life program is effective in assisting people to recover from the effects of childhood trauma.

T.R.E.E.
This innovative model has evolved from 12 years of work with over 4500 guests.
It is informed from the latest understandings in the neurobiology of trauma, its impact on the brain, human development, behavioural outcomes and effective therapeutic intervention.
The outcomes are achieved from weaving neuroscience and psychological understandings with experiential knowledge of people the using and working with the model for their own healing.

TRUST
Safety
Emotional, physical and spiritual safety is required for a person begin healing.
It is an imperative that an atmosphere of safety and trust is created prior to the processing of trauma. (Meares, 2005).
Special care and safety ethics are needed when working with trauma.
Boundaries are particularly understood and emphasisedin training of HFL carers

TRUST
Power-sharing
The model is implemented in a non-authoritarian way, countering the power imbalance often experienced in abuse.
Special care and safety ethics are needed when working with trauma.
Boundaries are particularly understood and emphasised in training of HFL carers

TRUST
Therapeutic Relationship
Programs are staffed by peer-support volunteers
All facilitators and carers are actively engaged in their own recovery and healing
Authentic empathy demonstrates emotional attunement in support of healing
The emphasis is on guidance in the therapeutic relationship rather than advice giving.

TRUST
Setting
modeling of a functional setting with healthy boundaries and safe containment.
A sense of community – sharing of meals, tasks, reflections and feelings
Encourage functional relationships – honest, open and accepting
Healing does not occur in isolation

RELEASE
Grounding
De-triggering and grounding tools stabilise the autonomic nervous system
Techniques may include relaxation, mindfulness, drumming and yoga
Allows access to the feeling centre – right hemisphere of the brain
Assists in maintaining dual consciousness – awareness of here & now and past trauma state

RELEASE
Access the trauma
The most difficult and traumatic memories are stored in non verbal memory, bodily memory. Creating words for these emotions is a fundamentally important activity. For the words to be found, the feelings have to be endured. (Seikkula & Trimble, 2005)
Right brain activities such as visualisation, music, creativity, movement and non-dominant hand drawing and writing are used to engage the inner child self
This allows access to the unconscious memory of the trauma held in right brain amygdala

Access the trauma continued…
Remembering the trauma unlocks the beliefs imposed at the time of trauma allowing changes in neuronal pathways
Art therapy and writing allows symbolic expression of the trauma and communication between right and left brain

RELEASE
Emotional Release
Feeling the emotions arising in relation to the trauma is the first step of release and provides validation of emotional experience
Emotions are energy in motion and are often suppressed at the time of trauma
Releasing the stored energy of trauma in a method relevant to the individual activates the healing mechanism of the body/mind system.

Emotional Release continued…
Integration of left/right brain hemispheres and implicit/explicit memory is initiated
Integration leads to reduction of traumatic triggering
Discourage repetition of story
After integration further repetition of abuse/trauma content can be re-traumatising for self or others, and is discouraged

EMPOWER
Self-empowerment
Changes perception of trauma into a conscious and completed event
Abuse and trauma generally create a sense of powerlessness
Symbolic re-empowerment of the “child” state helps to reclaim a sense of agency and decreases identity with a victim state

EMPOWER
Left and Right Brain Integration
Early childhood trauma impairs left and right hemisphere integration
Integration corresponds to ego strength, mature defenses, and mental health
Neuroplasticity research shows that neural connections can transform towards integration through processing trauma
Cozolino, 2002

EDUCATE
Understanding trauma and its impact helps to view adaptive responses in childhood without shame
Understanding that adaptive childhood responses can be maladaptive to adult well-being and can be changed supports a recovery-oriented perspective
Psycho-education in the principles of transactional analysis and attachment theory provides further understanding on how adaptive mechanisms are formed in childhood.

QUESTIONS?
www.healforlife.com.au

Liz Mullinar & Tanya Fox presentation

by mhcc on Jul 27, 2011

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