03/10/2013

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A Place to Belong: Reflecting on the development, implementation, and assessment of a psychoeducational / support group pilot program for female ABI survivors

Jan Gelech, Ph.D. Candidate, U. of Saskatchewan Elizabeth Hummel, Executive Director, SARBI *** Special Thanks to the Shopper‟s Drug Mart Life Foundation for its Support of this Project

Presentation Outline

• Meet SARBI

• Why women‟s programming?

• Putting the pilot program together

• Implementation: Here we go!

• Assessing the SARBI Women‟s Program (SWP) Pilot

▫ Formative evaluation plan

• What‟s next?

▫ SWP

▫ Moving female ABI programming forward

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The Saskatchewan Association for the

Rehabilitation of the Brain Injured

(SARBI)

• Helping survivors of moderate to severe ABI realize the best possible quality of life through ongoing support and psychosocial rehabilitation.

Why Women’s Programming?

• Research literature ▫ (see, for example, Bay, Sikorskii, & Saint-Arnault, 2009;

Colantonio et al., 2010; Howes, Edwards, & Benton, 2005; Harris et al., 2012; Mukherjee, Reis, & Heller, 2003; Tarconish, 2011; Trudel, 2006)

• Professional experience

• Client need

“We Need a Place to be With Other Women”

– SWP participant

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Developing the SARBI Women’s

Program • Program Philosophy (Guiding Principles):

▫ Holistic health ▫ Feminist approaches to heath and healing

▫ (Evans, Kincade, & Seem, 2011).

• Mission Statement:

▫ The SARBI women‟s program is committed to helping female ABI survivors achieve optimal social, emotional, psychological, sexual, and physical wellbeing through engagement with a supportive and empowering community of women.

• Program Goals:

Goals

Research Literature

Program Philosophy

Local Service Gaps

Client Need

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Female ABI survivors achieve optimal social,

emotional, psychological, and physical wellbeing.

Social Connection / Support

Female Empower-

ment

Self Esteem

Body Image

Healthy Relation-

ships

Sexual Expression

Physical Health

Emotional Regulation

Personal Growth

Program Philosophy

Holistic Health

Feminist Approaches to

Health and Healing

Mission Statement

Helping female ABI survivors achieve

optimal social, emotional,

psychological, and physical wellbeing through continued engagement with a

supportive and empowering

community of women.

Program Goals

Social Connection and Support

Female Empowerment

Self Esteem

Body Image

Healthy Relationships

Sexual Expression

Physical Health

Emotional Regulation

Personal Growth

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• Program Format

▫ Two weekly meetings over five weeks (10 modules)

▫ Each module targets a specific program goal

▫ Standard delivery format

Assessment: Acceptability

Letting our Hair Down

Learning Activity

Learning Exercise

Warm Up Discussion

Review

Checking In

Assessment: Relevance

• Example: Body Image Module ▫ Goal: To encourage the development of positive body image

by deconstructing beauty norms in the media and focusing on the aesthetics of uniqueness.

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Program Implementation

• Fall, 2012 • Participants:

▫ 5 female ABI survivors Moderate to severe brain injuries Mean age = 52.4 years (range: 36-64) Mean years post-injury = 23.2 (range: 6-42) Low community integration, restricted social

networks

▫ Program development team / staff support

• Deviations from program plan: ▫ Screening of „Magic Mike‟

Formative Assessment of SWP Pilot

Project • “...conducted for the purpose of acquiring

information to be used to improve program design and delivery” (Hodges & Videto, 2005).

Client Feedback

• Relevance • Acceptability • Satisfaction

Critical-Interpretive Analysis (Good,

• Interpersonal and intrapersonal program processes

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Formative Program Assessment

Findings

• Client Feedback Data

▫ Relevance of Program Goals:

Support for most program goals

Least relevant : Pursuing Healthy and Satisfying Sexual Expression*; Self Esteem 2: The Role of Social Relationships

*Group discussions produced conflicting evidence

▫ Acceptability of Daily Modules

All modules reported to be enjoyable

0% 20% 40% 60% 80% 100%

Community Building *

Celebrating Womanhood**

Self Esteem 1: Thinking Positively

Self Esteem 2: Social Relationships**

Body Image

Sexual Expression

Physical Health

Emotional Health and Regulation

Did you enjoy today's session?

Yes

Somewhat

No

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• All modules reported to be interesting

0% 20% 40% 60% 80% 100%

Community Building

Celebrating Womanhood*

Self Esteem 1: Thinking Positively

Self Esteem 2: Social Relationships*

Body Image

Sexual Expression

Physical Health

Emotional Health and Regulation

Did today's topic interest you?

Yes

Somewhat

No

Variability in reported knowledge / skill acquisition ▫ Physical health module particularly low

0% 20% 40% 60% 80% 100%

Community Building *

Celebrating Womanhood**

Self Esteem 1: Thinking Positively

Self Esteem 2: Social Relationships**

Body Image

Sexual Expression

Physical Health

Emotional Health and Regulation

Did you feel you learned something new today?

Yes

Somewhat

No

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Thematic Analysis of Open-Ended Responses: Most Liked Aspects of Daily Module

What did you like most about today’s session?

Theme # of Responses Sample Responses

Enjoyment of food and

activities

16 “I liked the compliments card activity and the

candy crafts”.

Being with others /

Bonding

12 “Being with friends”.

Talking and sharing

with others

9 “Gabbing and laughing with others.”

General enjoyment

7 “All good.”

Learning

2 “Learning about ways of being healthy”.

• Thematic Analysis of Open-Ended Responses: Least Liked Aspects of Daily Module

What did you like least about today’s session?

Theme

# of Responses

Sample Responses

Nothing to

report

34 “I liked everything”.

“There was nothing I didn’t like”.

“When I have to go home”.

Comments on

Organization

3 “The messiness”.

“Nothing, except maybe the mess”.

“Not knowing the time”.

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• Thematic Analysis of Open-Ended Responses: Improvement Ideas

What could we have done differently to improve today’s session?

Theme

# of Responses

Sample Responses

Nothing to report 25 “Nothing. It was a good session.”

“Nothing.”

Increasing the time /

resources devoted to

particular activities

7 “Talk more at length about womanhood”.

“More laughter yoga!”.

Extend meeting

length

2 “More time.”

“Make the sessions longer”.

Add additional

sessions

2 “More sessions like this!”

“Add more session.”

▫ Global Program Satisfaction

Highest possible ratings on quality of service and global satisfaction

0

1

2

3

4

5

Excellent Fair Poor

How would you rate the quality of the service you

received?

0

1

2

3

4

5

Very Satisfied Somewhat Satisfied

Unsatisfied

Overall, how satisfied are you with your experience with the SARBI women’s

program?

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Additional Client Satisfaction Questions

0% 20% 40% 60% 80% 100%

Enjoy belonging to this group of women?

Make new friends?

Warm, welcoming environment created?

Recommend to other female survivors?

Continue to be involved with future events?

Topics interesting and relevant to your everyday life?

Help to manage the challanges of life?

Feel better about your life or yourself?

Yes

Somewhat

No

• Interpretive Analyses

▫ Processes operating within the program space:

1 – Accessing the therapeutic benefits of self-expression

2 - Developing a sense of belonging

3 – Engaging in identity work

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• 1 – Accessing the therapeutic benefits of self expression

▫ Narrating traumatic life experiences

ascribe meaning to traumatic experiences; achieve empowering sense of „meta-control‟; infuse life with hope

▫ (Frank, 1995; Good, 1994; Mattingly, 1998)

improves mental, emotional, and physical health ▫ (Pennebaker & Seagal, 1999; Smyth, True, & Souto, 2001)

▫ Sharing experiences of oppression, delegitimization, and disempowerment:

Recognizing how social inequalities and oppressive practices contribute to personal suffering

Finding one‟s „voice‟ / engaging in empowering acts of resistance

▫ (McLeod, 1994; Kim, in press)

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• 2 – Developing a sense of belonging ▫ Expressions of fondness, respect, and value

▫ (Goodenow, 1993)

▫ Recognition of shared experiences and characteristics

▫ (Hagerty, Williams, Coyne, & Early, 1996; Walton, Cohen, Cwir, & Spencer, 2012)

▫ Linked to improved physical, psychological, and emotional health

▫ (see, for example, Baumeister,

Twenge, & Nuss, 2002; Cohen,

2004; Lee & Robbins, 1998;

Hagerty & Williams, 1999;

Hagerty, Williams, Coyne, &

Early, 1996)

• 3 – Identity work

▫ Pursuing a more positive sense of self through key identity enhancement strategies

Examples:

Redefining the meaning of impairments and limiting threats to self

Engaging in favourable peer comparisons

Establishing a strong, positive sense of identity linked to wellbeing and increased quality of life

▫ (Cooney et al., 2009)

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Conclusions and Future Directions

• Strengths of the pilot program: ▫ addressed important goals, offered valuable

learning activities, promoted therapeutic and empowering acts of self-expression, provided a meaningful space of belonging, and facilitated the development of a more positive sense of self.

• The future of the SARBI Women‟s Program: ▫ Refining the program ▫ Offering long-term support through „Alumni

Nights‟

• Suggested ways forward in female ABI programming: Key projects:

▫ Evaluation of existing and emerging programs

▫ Improving knowledge transfer within the female ABI service community

▫ Exploring diversity within the female ABI population

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References • Baumeister, R. F., Twenge, J. M., & Nuss, C. K. (2002). Effects of social exclusion on cognitive processes: Anticipated aloneness reduces intelligent thought.

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• Bay, E., Sikorskii, A., Saint-Arnault, D. (2009). Sex differences in depressive symptoms and their correlates after mild-to-moderate traumatic brain injury. Journal of Neuroscience and Nursing, 41, 298-309. doi:10.1097/JNN.0b013e3181b6be81

• Cohen, S. (2004). Social relationships and health. American Psychologist, 59, 676-684. doi: 10.1037/0003-066X.59.8.676

• Colantonio, A., Mar, A., Escobar, M., Yoshida, K., Velikonja, D., Rizoli, S.,…Cullen, N. (2010). Women‟s health outcomes after traumatic brain injury. Journal of Women’s Health, 19, 1-8. doi:10.1089/jwh.2009.1740.

• Cooney, A., Murphy, A. & O‟Shea, E. (2009). Resident perspectives of the determinants of quality of life in residential care in Ireland. Journal of Advanced Nursing, 65, 1029–1038.

• Evans, K.M., Kincade, E.A. & Seem, S.R. (2011). Introduction to feminist therapy: Strategies for social and individual change. Thousand Oaks, CA: SAGE Publications.

• Frank, A. (1995). The wounded storyteller: Body, illness, and ethics. Chicago: The University of Chicago Press.

• Good, B. (1994). Medicine, rationality, and experience: An anthropological perspective. Cambridge: Cambridge University Press.

• Goodenow, C. (1993). Classroom belonging among early adolescent students. The Journal of Early Adolescence, 13, 21-43.

• Hagerty, B. M., & Williams, R.A. (1999). The effects of sense of belonging, social support, conflict, and loneliness on depression. Nursing Research, 48, 215-219. doi: 10.1097/00006199-199907000-00004

• Hagerty, B. M., Williams, R. A., Coyne, J. C., & Early, M. R. (1996). Sense of belonging and indicators of social and psychological functioning. Archives of Psychiatric Nursing, 10, 235-244. doi: 10.1016/S0883-9417(96)80029-X

• Harris, J. E., Colantonio, A., Bushnik, T., Constantinidou, F., Dawson, D., Goldin-Lauretta, Y.,…Warren, J. (2012). Advancing the health and quality-of-life of girls and women after traumatic brain injury: Workshop summary and recommendations. Brain Injury, 26, 1-6. doi:10.3109/02699052.2011.635361

• Hodges, B.C. & Videto, D.M. (2005). Assessment and planning in health programs. Sudbury, MA: Jones and Bartlett Publishers.

• Howes, H. F. R., Edwards, S., & Benton, D. (2005). Female body image following acquired brain injury. Brain Injury, 19, 403-415. doi:10.1080/02699050400025158

• Kim, S.-A. (in press). Re-discovering voice: Korean immigrant women in group music therapy. The Arts in Psychotherapy.

• Lee, R. M. & Robbins, S. B. (1998). The relationship between social connectedness and anxiety, self-esteem, and social identity. Journal of Counseling Psychology, 45, 338-345. doi: 10.1037//0022-0167.45.3.338

• Mattingly, C. (1998). Healing dramas and clinical plots: The narrative structure of experience. Cambridge, England: Cambridge University Press.

• McLeod, E. (1994). Women’s experience of feminist therapy and counselling. Buckingham, England: Open University Press.

• Mukherjee, D., Reis, J. P., Heller, W. (2003). “Men‟s” illness overlooked in women and “women‟s” illness misdiagnosed or dismissed. Women & Therapy, 26, 3-26. doi:10.1300/J015v26n01_01

• Pennebaker, J. & Seagal, J. (1999). Forming a story: The health benefits of narrative. Journal of Clinical Psychology, 55, 1243–1254. doi: 10.1002/(SICI)1097-4679(199910)55:10<1243::AID-JCLP6>3.0.CO;2-N

• Smyth, J., True, N., & Souto, J. (2001). Effects of writing about traumatic experiences: The necessity for narrative structuring. Journal of Social and Clinical Psychology, 20, 161-172. doi: 10.1521/jscp.20.2.161.22266

• Tarconish, E. (2011). Young Women’s Experiences and Perceptions of sexuality after traumatic brain injury. Unpublished master‟s thesis, Pennsylvania State University, University Park. Retrieved from https://etda.libraries.psu.edu/paper/12007/7327

• Trudel, T. M. (2006). Women and sexuality post-TBI. Brain Injury Professional, 3, 18-20. Retrieved from http://www.nabis.org/brain-injury-professional

• Walton, G.M., Cohen, G.L., Cwir, D. & Spencer, S.J. (2012). Mere belonging: The power of social connections. Journal of Personality and Social Psychology, 102, 513-532.

Accessing the Pilot Program Report in

its Entirety:

• Coming soon to www.sarbi.ca !