Frederick W. Hickling pioneered a cultural therapy called Dream-A-World for at-risk children in Jamaica that focuses on creative arts, academics, and developing self-esteem. A pilot study showed boys who received the therapy improved behavior and academics more than girls or controls. The therapy is now being scaled up to reach more children across primary schools in Jamaica to promote resilience. Lessons from scaling up smaller programs will help expand it to hundreds more children.

1. 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

2. 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

3. Cultural therapy, was pioneered at Bellevue
Hospital in 1978
“Madnificent Irations”
A historical pageant of madness in Jamaica

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

5. Jamaican society – Little Economic growth or development in 50 years
TRANSGRESSIVE
UNPRODUCTIVE
40% ADULTS
RESILIENT PRODUCTIVE
60% ADULTS
?
HEALTHY
PRODUCTIVE
ADOLESCENTS
MENTALLY UNHEALTHY
DISRUPTIVE ADOLESCENTS
DREAM-A-WORLD
CULTURAL THERAPY
Healthy resilient reading by age 8
Disruptive, underperforming NOT
reading by age 8
CHILDREN 0-3: - Economic & social inequality; high viability, high risk

7. 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 world
Abel, W., et al (2007)

8. Jamaican children are suffering
• High physical abuse and neglect
• High rates of sexual molestation

9. Jamaican children are suffering
• 40% pregnancies under 16 years old
• 50% school dropout rates & illiteracy

10. Jamaican children are suffering
• High rates of youth aggression &
criminality

11. MENTAL HEALTH
CHALLENGES FOR THE NEW
MILLENNIUM
• A shift from curative to preventative
mental health care

12. MENTAL HEALTH
CHALLENGES FOR THE NEW
MILLENNIUM
• Creation of antidotes for conduct and
impulsivity disorders

13. MENTAL HEALTH
CHALLENGES FOR THE NEW
MILLENNIUM
• Creation of antidotes for anti social
behavior

14. MENTAL HEALTH
CHALLENGES FOR THE NEW
MILLENNIUM
• Promotion of self-esteem and selfconfidence

15. A bold new
University of the
West Indies
initiative in
primary mental
health prevention
Caribbean Institute of
Mental health &
Substance Abuse
(CARIMENSA)

16. UNIVERSITY OF THE WEST INDIES
CARIBBEAN INSTITUTE OF
MENTAL HEALTH AND
SUBSTANCE ABUSE
(CARIMENSA)
TRAINING
PROOF OF CONCEPT
EVIDENCED BASED OUTCOMES
SCALE UP
SERVICES
GOVERNMENTAL
ORGANIZATIONS
(Health, Educatio
n, Security etc)
NGO’S
TRANSITION TO
SCALE

17. 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

18. ACHIEVEMENT GAP OF CHILDREN IN UK

19. Carimensa & Allman Town Primary
Dream A World Cultural Therapy
‘Proof of Concept’ 2006

20. The Dream-A-World Process
• 30 who had failed Grade 3 Test, 30 controls

21. The Dream-A-World Process
• 40 hour 3-week workshops in summer vacation

22. The Dream-A-World Process
• 60 hours ‘top-up’ sessions during the term

23. The Dream-A-World Process
• 240 hours over 2½ years

24. The Dream-A-World Process
• Annual ‘Show and Tell’ performance

25. Laminated photo-ID’s boosted self esteem

26. The Dream-A-World Workshop
• Breakfast and lunch
• Daily literacy & numeracy

27. The Dream-A-World Workshop
• Psychotherapy ‘small groups’
• Identify things they like in their world

28. The Dream-A-World Workshop
• Invent a new Planet comprising
things they like - ‘Dream-A-World’

29. The Dream-A-World Show & Tell Pageant
• Created a play of their new World
• Created songs about their new planet

30. The Dream-A-World Show & Tell Pageant
• Created costumes and masks
• Performed to their community family

31. The Dream-A World Cultural Therapy
process:
• Catalyzes the creative imagination

32. The Dream-A World Cultural Therapy
process:
• Focuses on the drum and
homemade instruments

33. The Dream-A World Cultural Therapy
process:
• Creates
music, songs, dances, skits

34. We took the children on field
trips

35. We taught them to hug

37. PILOT PROOF OF
CONCEPT RESEARCH
ARTICLE
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 RobertsonHickling 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
Jaswant Guzder
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 TeacherVanessaForm (TRF) and end of term
Report Paisley
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
measuredH Robertson- more successful outcome amongst boys for
by the TRF, with
behavioral gains. No significant improvements were made by the girls.
Hickling
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
Fred Hickling
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.
Journal of the Canadian Academy of Child and
Adolescent Psychiatry, May 2013

38. CHANGES IN ASEBA BEHAVIOR
RATINGS OVER THE STUDY PERIOD
Significant improvements in school
social and behaviour adjustment
compared with controls

39. CHANGES IN ASEBA BEHAVIOR
RATINGS OVER THE STUDY PERIOD
Boys received significantly
improved teacher ratings in school
social and emotional adjustment
than the girls.

40. Dream-A-World Cultural
Therapy ‘Scale-up’
intervention for school-aged
high-risk primary school
Jamaican children July 2013

41. THE ‘SCALE UP’ - TASK SHARING
4 Primary Schools in Seaview Gardens
Dr. Hilary Robertson-Hickling, Principal Mrs. Elaine Jones, Dr. Duncan Pedersen

42. (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...”

43. Performers from 4 Primary Schools at
final “Show & Tell” of the 2013 ‘Dream-AWorld Scale Up’ in inner-city Kingston

44. (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…”

45. Scale up & transition to scale
(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 …”

46. “…Emancipate ourselves from
mental slavery…” Bob Marley

47. Teaching self control & selfconfidence
Shelly Ann
Fraser-Pryce

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

49. One love, brothers and
sisters, one heart, one
destiny