Mindfulness and self- regulation skills - Introduction Because FASD is a neurodevelopmental disability that can affect cognitive skills and executive functioning (i.e. inhibition, problem solving, attention, planning, impulsivity, etc) individuals with FASD often have trouble with self- regulation. Individuals who have experienced complex trauma can have difficulties coping with their emotions as well. Learning how to manage and respond to an external stimulus that is triggering is an important and effective skill that can help the individual reduce symptoms of stress, anxiety, depression, and aggression. Self- regulation involves developing the ability to notice and regulate emotions, such as anger, fear, and frustration and can offer a coping strategy for dealing with impulsivity. Mindfulness is a practice that can help to address issues related to self- regulation. It is about being awake or paying attention to one s surroundings, personal triggers (events/activities/people) and related responses. Mindfulness and self- regulation skills complement violence and trauma- informed and FASD informed approaches [program philosophy/theoretical framework]. In Aboriginal communities, attention- related skills can be built in a calm or natural environment for instance, being away from a chaotic lifestyle or being on the land. Associated with this is building trust and connection to self, to others, to culture. This can assist in building self- esteem and decreasing anxiety, which in turn helps improve mindfulness and self- regulatory skills. Traditional and cultural activities such as being on the land, drumming, crafts, singing, and sweats can be helpful in working with individuals to help them learn how to pay attention and connect with others. An example is using drumming as a tool to create awareness for coping with addictions. The activity begins with individual drumming and then drumming in a group. It is a step in the development of trust, building connections, and eventually tools for scripting refusal skills. Presented below is a chart containing examples of outcomes, indicators, outputs, and data collection methods and tools related to Reduced substance use outcomes. Following this chart are references and/or examples of survey/questionnaire items that have been used in evaluations to assess these participant outcomes, along with references for the evaluation- related resources used to create the chart below. We recognize that every program and every program evaluation is unique - differing as a function of a program s specific goals, setting and resources, as well as the community s context, history, and so forth. Thus, every program evaluation will have its own ideas about the outcomes, indicators, data collection methods and tools that are most appropriate and feasible and you need to decide what is best for you. Remember, success has many definitions and interpreting success outcome requires being flexible and generous in what success means (Kleinfeld, Morse & Wescott, 2000).
Mindfulness and Self- Regulation Skills Introduction (Please note that outcomes and outputs/indicators in bold have been used in at least two of the evaluations referenced.) Examples of program activities related to this outcome: o Identifying the individuals stressors and triggers in the community and in daily living; teaching skills of mindfulness and self- calming including; creating calm environments; teaching program staff and others about strategies of mindfulness; introduction of cultural activities Early positive response (participation, increased knowledge) Participants identify triggers - i.e. events, activities, people, - that are stressful or anxiety producing Participants are able to describe their feelings and responses to these triggering events and activities Staff, community members family members understand concepts of mindfulness and self- regulation Program participants form trusting relationships with staff Intermediate active engagement, attitude, behaviour Participants learn and practice (culturally relevant) techniques that help them to regulate their responses to triggering events Participants use strategies that help them to regulate/manage their feelings and/or help them to reduce Impulsive behaviours Participant feel calm(er) and (more) grounded Program staff help participants to create a structured and predictable environment/routine Program participants have opportunities to positively connect with their community, family, culture, traditions Participant Outcomes Long term desired outcome Participants ask for help when feeling stressed, anxious, triggered, etc. Participants experience fewer crises, as well as fewer problems with the law; issues with addictions; difficulties with relationships; difficulty in school or with work Participants demonstrate improved ability to carry out daily activities Participant uses calming and self- regulation skills or responds to prompts from support person. Outputs/Indicators # of crisis episodes # of times participant calls for help (instead of reacting to trigger ) # of strategies participant uses to stay calm/self- regulate Improved affect regulation Increased sense of self- efficacy # & type of cultural activities Data Collection Methods and tools Pre/post interview with participants using for example: a) General Self- efficacy Scale with questions related to self- regulation (see: Schwarzer & Jerusalem, 1995) b) Barratt Impulsiveness Scale (pre/post) c) Vineland Adaptive Functioning Staff ratings of participant outcomes Key informant interviews with program & community partners Output data
Possible Data Collection Tools and Sample Survey/Questionnaire Items 1) General Self- Efficacy Scale Source: Schwarzer, R. & Jerusalem, M. (1995). Generalized Self- Efficacy Scale. In J. Weinman, S Wright, & M Johnston, (Eds), Measures in health psychology: A user s portfolio. Causal and control beliefs (pp. 35-37) Retrieved June 12, 1012 via http://userpage.fu- berlin.de/health/engscal.htm Questionnaire item Not at all Hardly Moderately Exactly I can always manage to solve difficult problems if I try hard enough 1 2 3 4 If someone opposes me, I can find the means and ways to get what I want 1 2 3 4 It is easy for me to stick to my aims and accomplish my goals 1 2 3 4 I am confident that I could deal efficiently with unexpected events 1 2 3 4 Thanks to my resourcefulness, I know how to deal with unforeseen 1 2 3 4 situations I can solve most problems if I invest the necessary effort 1 2 3 4 I can remain calm when facing difficulties because I can rely on my coping 1 2 3 4 abilities When I am confronted with a problem, I can generally find several 1 2 3 4 solutions If I am in trouble, I can usually think of a solution 1 2 3 4 I can usually handle whatever comes my way 1 2 3 4
2) Barrett Impulsivity Scale Source: Patton, J., Stanford, M., & Barratt, E. (1995) Factor Structure of the Barratt Impulsivity Scale. Journal of Clinical Psychology, 51, 768-774. PubMed ID 8778124 http://www.impulsivity.org/pdf/bis11english.pdf DIRECTIONS: People differ in the ways they act and think in different situations. This is a test to measure some of the ways in which you act and think. Read each statement and put an X on the appropriate circle on the right side of this page. Do not spend too much time on any statement. Answer quickly and honestly. 1) I plan tasks carefully. 2) I do things without thinking. 3) I make-up my mind quickly. 4) I don t pay attention. 5) I concentrate easily. 6) I am a careful thinker. 7) I say things without thinking. 8) I buy things on impulse. 9) I am more interested in the present than the future. Rarely/Never Occasionally Often Almost Always/Always
Sample Survey/questionnaire items: 3) Staff Ratings of Participant Outcomes Source: Rutman, D., Hubberstey, C. & Hume, S. (2011). Youth Outreach Program, Final Evaluation Report. Prepared for the College of New Caledonia, Burns Lake, BC. Unpublished report. Please reflect on ways that you believe that the program has made a difference to each youth in the program, and, for each youth, please indicate your view of outcomes relative to how things were before their involvement with the program (Please use separate sheets if needed): Staff rating of youth participants adapted from the above source Program participant is able to identify feelings and stressful events that trigger impulsive behaviour Program participant asks for help or seeks help when feeling stressed, triggered, or anxious Program participant has strategies to use when feeling stressed, triggered, or anxious Program participant uses cultural strategies when feeling stressed, triggered, or anxious Program participant demonstrates increased ability to communicate positively with others Program participant demonstrates healthy connections with family and culture Program participant demonstrates increased self- confidence Other Strong positive Some positive No chg/ impact that I see Some negative Strong negative Don t know/ can t tell
References Kim Kearns. (ND). Mindfulness Training. http://web.uvic.ca/~fasd/?q=node/22 Kleinfeld, J., Morse, B., Wescott, S. (2000). Fantastic Antone Grows Up: Adolescents and Adults with Fetal Alcohol Syndrome. University of Alaska Press. Klinck, J., Cardinal, C., Edwards, K., Gibson, N., Bisanz, J. & da Costa, J. (2005). Mentoring Programs for Aboriginal Youth, Pimatisiwin. A Journal of Aboriginal and Indigenous Community Health, Vol 3 Number 2 Winter 2005, p110. Patton, J., Stanford, M., & Barratt, E. (1995) Factor Structure of the Barratt Impulsivity Scale. Journal of Clinical Psychology, 51, 768-774. PubMed ID 8778124 Rutman, D., Hubberstey, C. & Hume, S. (2011). Youth Outreach Program, Final Evaluation Report. Prepared for the College of New Caledonia, Burns Lake, BC. Unpublished report. Schwarzer, R. & Jerusalem, M. (1995). Generalized Self- Efficacy Scale. In J. Weinman, S Wright, & M Johnston, (Eds), Measures in health psychology: A user s portfolio. Causal and control beliefs (pp. 35-37) Retrieved July 23, 2013 via: http://userpage.fu- berlin.de/~health/engscal.htm (General Self- Efficacy Scale) Stewart, Bill. (2011). Personal communication: Whitehorse Yukon