I WANT TO THRIVE, NOT JUST SURVIVE! : A MULTIPLE CASE STUDY OF AN ARTS-BASED INTERVENTION FOR ADOLESCENTS WITH FASD

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1 I WANT TO THRIVE, NOT JUST SURVIVE! : A MULTIPLE CASE STUDY OF AN ARTS-BASED INTERVENTION FOR ADOLESCENTS WITH FASD Keightley, M., Agnihtri, S., Clantni, A., Platajk, H., Camern, D., Wiseman-Hakes, C. Presented by: M. Keightley, PhD, C. Psych. 13 th Annual FACE Research Rundtable

2 ADOLESCENCE Rapid sci-emtinal behaviur changes Essential fr emergence f mre sphisticated cmmunicative skills Increased scial cmpetence thrughut adlescence: skills stay relatively stable int adulthd (Tnks et al., 2007)

3 Regulating emtins Awareness f scial rules SOCIAL COMMUNICATION Listening and understanding thers (Turkstra et al., 1996; Dahlberg et al., 2007)

4 SOCIAL COMMUNICATION DIFFICULTIES FACED BY YOUTH WITH FASD STUDY Olswang, Olsn & Timler (2003); Olsn, Mrse, & Huffinc (1998); Thmsn, Kelly, Mattsn, & Riley (1998); Cggins, Streissguth, Barr, Kgan, & Bkstein (1996) Chudley et al. (2005) Cggins, Friet, & Mrgan, 1998; Hamiltn (1981) Timler (2000); Timler & Olswang (2001) Streissguth et al. (1996) Slater and Khr (1989) FINDINGS Scial cmmunicatin deficits frequently cmprmised area f develpment Deficits in emtinal and scial functining Substantial difficulties prviding sufficient infrmatin Failure t take int accunt perspectives f ther peple Pr cause-and-effect reasning and seem unaware f the cnsequences f their actins Disruptins in linguistic behaviurs, underlying scial cgnitive behaviurs, executive functins Timler et al. (2005)

5 COMMUNITY INTEGRATION Can suffer frm scial withdrawal as a result f their injuries (Wiseman-Hakes et al., 1998) Limitatins in activity perfrmance and participatin restrictins (Dumas, Bedell and Hamill, 2003) Reduced participatin in typical scial activities (camps, clubs, sprts) Missing ut n stage related scial markers (babysitting, staying alne, learning t drive a car) Reduced scial pprtunities

6 KNOWLEDGE GAP Lack f research investigating cmmunity integratin interventins fr yuth with FASD Critical t develp strategies with these children that assist them with scial and cmmunity integratin

7 ARTS-BASED THERAPY Includes: drama, painting, sculpting, music, dance Creativity is encuraged, as it is cnsidered t play a key rle in the wellintegrated human experience (ISIS, 2004)

8 ARTS-BASED THERAPY Useful fr peple wh find meaningful verbal cmmunicatin difficult: - Schizphrenia, biplar affective disrder, depressin, recurrent depressive disrder, schizaffective disrder, dementia, eating disrder (Odell-Miller et al., 2006) - ADHD (Henley et al., 1998) - Adults with TBI (Berrl, Oi and Katz, 1997) - Adlescents delayed in sci-emtinal develpment (Walsh, 1990)

9 KNOWLEDGE GAP Lack f evidence cnnecting artsbased therapy directly t yuth with FASD Clse resemblance between drama and real life, therefre rehearsal ccurring within an arts-based therapy can be applied t actual situatins adlescents may face Medium fr scial skills training Peer feedback naturally stimulated by grup can imprve scial skills (Walsh and Swansn, 1988; Wiseman- Hakes et al., 1998)

10 RESEARCH OBJECTIVES Multiple descriptive case studies t: (1) Evaluate a pilt arts-based theatre skills training prgram fr yuth with FASD t target scial cmmunicatin skills, emtinal awareness and cmmunity integratin (2) Identify and refine methds t quantitatively measure the effectiveness f the theatre skills training prgram.

11 PARTICIPANTS Recruitment: Nrthwestern Ontari FASD Clinic and Lake f the Wds Child Develpment Centre Inclusin Criteria: Yuth with FASD Difficulties in scial functining accrding t self and caregiver reprting and neurpsychlgical evaluatins cmpleted by the FASD clinic Exclusin criteria: Teens nt reprting difficulty in these areas, even with a parental reprt

12 PARTICIPANTS Participant C. 9 year ld Abriginal female Participant E. 10 year ld Abriginal female Participant R. 14 year ld Abriginal female Delay in auditry attentin, memry, fine mtr skills N additinal difficulties mentined Difficulty with fine mtr crdinatin

13 PROGRAM LEADERS 3 Occupatinal Therapy (OT) students 1 artist facilitatr Inclusin Criteria: OT master s-level students: last clinical placement, interest in the prgram Artist: experience wrking with Abriginal yuth, wrking in an artistic way

14 INTERVENTION: THEATRE SKILLS TRAINING Grup met fr fur hurs a day, fur days a week fr three weeks Theatre training included vice wrk, breathing, mvement, physical warm-up, character develpment, script analysis, writing skills, three-dimensinal awareness, grup dynamics, stry develpment, circus training, and clwning amng thers Fllwing each warm up, grup exercises n a specific tpic, such as stry develpment Gray et al. (2012). Jurnal f Applied Arts and Health

15 CULTURALLY-SPECIFIC ASPECTS OF THE PROGRAM FOR YOUTH WITH FASD Abriginal cmmunity partner, Anishinaabe Abinjii Family services and WAASEGIIZ NANAANDAWE IYIGAMIG (Kenra Area Health Access Centre) Strytelling Winter Legends (e.g. turtle, rabbit) Dance and regalia Abriginal culture (e.g. becming an Elder) Als access thrugh the abriginal agency and the First Natin cmmunities: dance grups drum grups basketry grups sewing grups art expressin thrugh shw and tell grups

16 CULTURALLY-SPECIFIC ASPECTS OF THE PROGRAM FOR YOUTH WITH FASD The seven teachings als taught/illustrated in strytelling r in ther theatre type presentatins: Respect Hnesty Truth Humility Wisdm Bravery Lve

17 EAT Day Camp: Example Sessin 10:00 10:15 Intrductin Circle and Check In 10:15-10:30 Mrning Stretches 10:30 10:45 Snack Outside 10:45 12:15 Vcal exercises 12:15 12:45 Lunch break Questin: What is yur favurite music? 12:45 2:00 Individual Reflectin/Creative Tl Bx: Hw did yu feel tday, what d yu feel yu did well, and what d yu think yu culd imprve? Did yu ntice any changes in yur bdy when yu were ding the vcal exercises? (draw/paint hw yu felt) 2:00-2:45 Check ut Grup Reflectin: Wrk n mural Camp facilitatrs meet t make ntes n each child and t review the schedule fr fllwing day

18 THEATRE SKILLS TRAINING PROGRAM Invited Presentatin: Participants invited family & friends t share in prgram activities at end f the three weeks Presentatin f theatre exercises & Creative Tl Bx cntents

19 OUTCOME MEASURES Mixed-Methds Apprach Qualitative: Fcus Grups with participants, caregivers and facilitatrs Quantitative: Adaptive Behavir Assessment System: Versin II (ABAS-II; Harrisn and Oakland, 2003) Canadian Occupatinal Perfrmance Measure (COPM; Law et al., 2005) Children s Assessment f Participant and Enjyment (CAPE; King et al., 2004) Emtinal Qutient Inventry Yuth Versin (EQ-i: YV; Bar-On & Parker, 2004)

20 ADAPTIVE BEHAVIOUR ASSESSMENT SYSTEM VERSION II (ABAS-II) Assesses children s activities f daily living, cgnitin, language, play and scial cmpetency frm caregiver s perspective Ten adaptive skill areas measured: cmmunicatin, cmmunity use, functinal academics, hme living, health and safety, leisure, self-care, self-directin, scial, wrk Each skill is rated in terms f frequency (i.e. always, smetimes, never) Scaled change scre f 3 cnsidered clinically significant Harrisn and Oakland (2003)

21 CANADIAN OCCUPATIONAL PERFORMANCE MEASURE (COPM) Semi-structured interview Leisure dmain nly Self-reprt data t evaluate change in perfrmance and satisfactin with prblems in scial functining e.g. Spending time with friends: Perfrmance /10 & Satisfactin /10 Change scre f three frm pre t pst fund t be clinically significant Law et al. (2005)

22 DATA COLLECTION: QUANTITATIVE Assessment 1: 1 Week Pre Parent: ABAS-II Yuth: COPM Assessment 2: 1 Week Pst Parent: ABAS-II, fcus grup Yuth: COPM, fcus grup Assessment 3: 6 Mnths Pst Parent: ABAS-II Yuth: COPM

23 RESULTS: QUALITATIVE Themes Increasing self-esteem and self-efficacy thrugh the creative prcess Abstract vs. cncrete thught and the use f imaginatin as a skill The creative envirnment and its effect n the participants Increased scial skills and emtinal awareness

24 RESULTS Increasing self-esteem and self-efficacy thrugh the creative prcess E., lacking cnfidence, takes a lt f encuragement t get her t try things. I can get her t d it, but it takes a lt f encuragement and the right wrds. [Yu] have t be creative. T see her try new things, withut me having t be there t d it the grup did very well t encurage her t d things in frnt f ther peple. [She shws] a lt mre cnfidence. (Caregiver) and t see R. as a leader she wuldn t have dne that [befre]. [She] wn t participate in anything in schl that wuld invlve [ging] n stage. (Caregiver)

25 RESULTS Increased scial skills and emtinal awareness R. and I had t participate ne mrning and they had a thing n the bard, give it a number, the night befre we were ging t the shw she said her md was happy. When she saw the kids utside the arcade she said her md has changed - nw I am sad. She never verbalized it [befre]. I [culd tell] by her demeanr. Fr her t say that was a big step that sticks ut huge fr me. (Caregiver) [I was] getting t knw hw thers feel (R.) Yu have t give peple their wn space, peple have a little bubble, and [yu shuld] respect that. (C.)

26 RESULTS: ABAS-II

27 RESULTS: ABAS-II

28 RESULTS: ABAS-II

29 RESULTS: COPM Participant Gals C. Truble sleeping, putting thing away, making friends at schl, drawing skills, catching ball E. Shpping in new places, sitting still at Grandmther s F. Bathing, hmewrk, rle playing n cmputer, sprts, making friends

30 RESULTS: COPM

31 RESULTS: COPM

32 IMPLICATIONS Psitive Feedback Regarding Prgram Structure and Cntent Caregivers and facilitatrs bserved increased selfcnfidence, self-efficacy and cmmunicatin f emtins Small grup frmat beneficial Imprvements in perceived ccupatinal perfrmance and satisfactin related t leisure gals as measured by the COPM

33 LIMITATIONS Recruitment Participatin in prgram required significant amunt f cgnitive and physical effrt Lack f reliable and valid standardized measures that can assess cmmunity integratin and participatin in yuth

34 FUTURE DIRECTIONS Develp mdel f cmmunity integratin fr yuth with FASD and brain injuries Develp assessments fr cmmunity integratin fr yuth with disabilities Incrprate wait list cntrl cnditins

35 ACKNOWLEDGEMENTS Firefly Services (frmerly Lake f the Wds Child Develpment Centre) Abriginal cmmunity partners: Anishinaabe Abinjii Family Services and WAASEGIIZ NANAANDAWE IYIGAMIG Dean s Fund, Faculty f Medicine at the University f Trnt BrainFit Lab: Stefan Mrin, Mtria Sabat, Nick Reed, Stephanie Green, and Tali Dick

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