Promoting Resilience in High-risk Children in Jamaica: A Pilot Study of a Multimodal Intervention.

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 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 2½ years spanning grade three to six with evaluation of outcomes using the ASEBA Teacher Report Form (TRF) and end of term 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 measured by the TRF, with more successful outcome amongst boys for behavioral gains. No significant improvements were made by the girls. 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 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.

OBJECTIF: Évaluer l'efficacité d'une intervention multimodale parascolaire en été, nommée Projet Dream-A-World (DAW, rêver un monde), pour une cohorte d'enfants d'âge scolaire jamaïcains issus d'une communauté pauvre défavorisée du centre-ville de Kingston, en Jamaïque. Les enfants ont été choisis par leurs enseignants en fonction de graves troubles perturbateurs et d'un mauvais rendement scolaire, et comparés avec un groupe témoin apparié. Le pilote était une modalité thérapeutique axée sur les enfants sans intervention parentale pour les conduites perturbatrices et l'échec scolaire. MÉTHODE: Une intervention psychothérapeutique de groupe basée sur des thérapies d'activités créatrices et un soutien de redressement scolaire, adaptée au contexte jamaïcain, a été mise en œuvre auprès de 30 enfants d'une école primaire du centre-ville. L'intervention a duré plus de 2,5 ans et a été appliquée de la 3e à la 6e année. Les résultats ont été évalués à l'aide du formulaire d'évaluation des enseignants (FEE) ASEBA et des notes de fin de session pour le groupe de l'intervention contre les groupes témoins appariés à qui des soutiens scolaires usuels ont été offerts. RÉSULTATS: Le groupe de l'intervention s'est amélioré significativement en ce qui concerne le redressement scolaire social et comportemental mesuré par le FEE, les résultats étant plus réussis chez les garçons pour ce qui est des améliorations du comportement. Aucune amélioration significative n'a été observée chez les filles. Les limitations de la taille de cohorte, l'absence de données des parents et les questions de disparité des résultats selon le sexe sont demeurées des questions interprétatives non résolues. CONCLUSION: Cette intervention multimodale et théorique en santé mentale, destinée aux enfants à risque élevé vivant dans un quartier défavorisé violent, améliorait le fonctionnement général davantage chez les garçons que chez les filles, et soulevait des questions quant à la méthode de futures planifications préventives.

Deinstitutionalization and attitudes toward mental illness in Jamaica: a qualitative study.

OBJECTIVE: To consider whether or not deinstitutionalization and the integration of community mental health care with primary health care services have reduced stigma toward mental illness in Jamaica. METHODS: A qualitative study of 20 focus groups, with a total of 159 participants grouped by shared sociodemographic traits. Results were analyzed using ATLAS.ti software. RESULTS: Participant narratives showed that stigma had transitioned from negative to positive, from avoidance and fear of violent behavior during the period of deinstitutionalization to feelings of compassion and kindness as community mental health services were integrated with Jamaica's primary health care system. The Bellevue Mental Hospital and homelessness were identified as major causes of stigma. CONCLUSIONS: Attitudes toward the mentally ill have improved and stigma has decreased since the increase of community involvement with the mentally ill. This reduction in stigma seems to be a result of the rigorous deinstitutionalization process and the development of a robust community mental health service in Jamaica.

Deinstitutionalization and attitudes toward mental illness in Jamaica: a qualitative study / Externamiento psiquiátrico y actitudes hacia las enfermedades mentales en Jamaica: estudio cualitativo

OBJECTIVE: To consider whether or not deinstitutionalization and the integration of community mental health care with primary health care services have reduced stigma toward mental illness in Jamaica. METHODS: A qualitative study of 20 focus groups, with a total of 159 participants grouped by shared sociodemographic traits. Results were analyzed using ATLAS.ti software. RESULTS: Participant narratives showed that stigma had transitioned from negative to positive, from avoidance and fear of violent behavior during the period of deinstitutionalization to feelings of compassion and kindness as community mental health services were integrated with Jamaica's primary health care system. The Bellevue Mental Hospital and homelessness were identified as major causes of stigma. CONCLUSIONS: Attitudes toward the mentally ill have improved and stigma has decreased since the increase of community involvement with the mentally ill. This reduction in stigma seems to be a result of the rigorous deinstitutionalization process and the development of a robust community mental health service in Jamaica.

OBJETIVO. Evaluar si el externamiento psiquiátrico y la integración de los servicios comunitarios de salud mental con los servicios de atención primaria de salud han reducido el estigma respecto de las enfermedades mentales en Jamaica. MÉTODOS. Estudio cualitativo de 20 grupos de opinión con un total de 159 participantes agrupados según sus características sociodemográficas. Se analizaron los resultados con el software ATLAS.ti. RESULTADOS: Los relatos de los participantes revelaron que, cuando los servicios comunitarios de salud mental se integraron con el sistema de atención primaria de salud de Jamaica, el estigma había pasado de negativo a positivo y de la evitación y el temor a un comportamiento violento durante el período de externamiento a sentimientos de compasión y amabilidad. Las principales causas de estigma identificadas fueron el modelo de atención del hospital mental Bellevue y vivir en las calles. CONCLUSIONES: Las actitudes hacia los enfermos mentales han mejorado y el estigma ha disminuido desde que aumentó la relación de la comunidad con los pacientes. Esta reducción del estigma parece deberse al proceso riguroso de externamiento psiquiátrico y al desarrollo de un servicio comunitario de salud mental sólido en Jamaica.

"Mad, sick, head nuh good": mental illness stigma in Jamaican communities.

Stigma may be an important factor in mental health service seeking and utilization. However, little work on stigma has been conducted in developing nations in the Caribbean, including Jamaica. We explored mental illness stigma in Jamaica by conducting focus groups with 16 community samples. Four overarching conceptual themes are discussed: (1) community members' definitions of stigma; (2) emotional responses towards those with mental illness, such as fear and love; (3) behavioral responses towards those with mental illness, including avoidance and cautious approach; and (4) perceptions of and beliefs about mental illness, including a distinction between "madness" and "mental illness."

Psychic centrality: reflections on two psychohistoriographic cultural therapy workshops in Montreal.

The use of psychohistoriographic cultural therapy (PCT) developed in Jamaica is described in the context of two workshops in Montreal. PCT is a form of group intervention that seeks to elicit and clarify the "psychic centrality" of a group. Psychic centrality refers to a sense of psychological containment or organization of diverse individual points of view through creating a historical map of collective experience. In PCT, this collective map is constructed and techniques borrowed from creative arts therapies are used to develop a performance. This performance provides additional containment and fosters a group process that can contain collective conflicts. The performance can also be used to engage an audience, working to contain conflict while representing diverse perspectives within the group. Factors that may contribute to the effectiveness of PCT and those that may derail the process are identified through the systematic comparison of the two workshops. PCT was demonstrated to cross successfully from a Third to a First World culture, and established potential as a method to facilitate group conflict resolution and for the promotion of pluralistic civil societies.

Fostering resilience in children at risk through a cultural therapy intervention in Kingston, Jamaica.

This report explores an initiative in Kingston, Jamaica to foster resilience in children in an inner-city community plagued by violence and other social problems. This initiative was undertaken by CARIMENSA, the Caribbean Institute for Mental Health and Substance Abuse.