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

2. 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

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

5. 12-17 years ― girls

6. boys

7. 18+ years – mixed

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

11. 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

12. 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?

13. 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

14. 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)

15. 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

16. 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%

17. Respondent history

18. Differences in the measures 6 months post-program

19. 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).

20. 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.

21. 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

22. 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.

23. 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.

24. 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.

25. Satisfaction with the Heal For Life program

26. 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

28. 2008-2009 Impact Evaluation

29. 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.

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31. 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.

34. Special care and safety ethics are needed when working with trauma.

36. All facilitators and carers are actively engaged in their own recovery and healing

37. Authentic empathy demonstrates emotional attunement in support of healing

39. A sense of community – sharing of meals, tasks, reflections and feelings

40. Encourage functional relationships – honest, open and accepting

42. Techniques may include relaxation, mindfulness, drumming and yoga

43. Allows access to the feeling centre – right hemisphere of the brain

47. Emotions are energy in motion and are often suppressed at the time of trauma

50. Abuse and trauma generally create a sense of powerlessness

52. Integration corresponds to ego strength, mature defenses, and mental health

53. Neuroplasticity research shows that neural connections can transform towards integration through processing traumaCozolino, 2002

55. Understanding that adaptive childhood responses can be maladaptive to adult well-being and can be changed supports a recovery-oriented perspective