8/15/19
Like all my previous years 2019 has been interesting and very busy.
On the 30th of August Mary and I will have been married for fifty years.
My youngest grandson was born in July and my oldest Granddaughter graduated from High School and is now onto University. Time, oh good, good time where have you gone?
My daily endeavours’ finds me primarily running groups in Alternative education classrooms. The AE students so remind me of how full circle my work life has been. I spent my early working days with alternative education kids developing the journey to now again running alternative education groups in schools scattered across South Auckland.
Early in this year we filmed some of the back story at Creative Alternatives in California. It was a great privilege to go back to Creative Alternatives after 28 years. I hope the Documentary reflects how proud I am of the wonderful culture and environment of Creative Alternatives.
The Documentary is in the editing stage and a trailer should be ready soon.
Yet another event of 2019 is the final report of the research project conducted in 2018. I received the report in July.
I have included the research abstract and my response in this Blog; the entire report is in the research section of the website.
Naturally I’m disappointed in the outcome however I accept the results for what they are and have actually learned two lessons which have formulated into two important program outcomes.
Abstract
A school based cluster-randomised controlled trial of Therapeutic Storytelling Intervention (TSI) to promote youth mental health and wellbeing.
Context: The prevalence of mental health concerns among young people is increasing and efforts are warranted early in adolescence to prevent future mental health and behavioural concerns.
Objective: To determine if TSI delivered a classroom intervention reduces overall levels of psychopathology in young adolescents.
Design, Setting, Participants: We conducted a cluster randomized controlled trial in 378 students aged 10 to 13 years in an intermediate school in South Auckland.
Interventions: 12 sessions of therapeutic story intervention delivered over 12 weeks.
Main Outcome Measure: The primary outcome was child self-report SDQ Total Difficulties Score
Results: A total of 482 students from 16 classes were eligible and invited to participate. A total of 378 students and their parents agreed to participate and their classes randomised. Baseline data was collected from 210 students from 8 intervention classes and 168 students from 8 control classes. There were no differences at follow-up between the intervention classes and control classes in primary outcome or secondary outcomes.
Conclusion: There was no evidence of effectiveness of therapeutic story intervention in preventing psychopathology among 10 to 13 years at 6 month follow-up.
Data Access and Responsibility: The principal investigator, Simon Denny, had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Potential conflicts of interest: None
Financial support: Funding for this study was provided by the Kidz First Research Committee. The Kidz First
Research Committee had no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.
Trial registration: Australian and New Zealand Clinical Trials Registry (ACTRN12618000282280)
My response
Hi Simon,
Thank you for your report and requesting my response.
Frist of all, you, Sue and the Pukekohe Administration and teachers are to be congratulated on conducting an awesome and professional project. Every aspect of the research project ran smoothly from program delivery to data collection.
Pukekohe Intermediate School offered a wonderful environment for the research. It was a privilege to work in a school of such excellence. I also must add how much I appreciated being involved in such an authentic and elite project. It is one of my working career highlights, thanks Simon.
Naturally I am disappointed with the findings. However I do accept them as accurate for this design.
Simon I have learned two vital lessons from participating in the project. It has helped me establish the proper starting point for the Gem Journey in a young person’s developmental process and identify the environment(s) were I think the Gem Journey will flourish.
My first major take away for the research is the students were too young by two to three years for getting the most from a school based programme. Early on in the delivery I realised that some of the younger students, the year 7s, were struggling to ‘get it’. I believe the younger students in the project were not ready to fully comprehend the lessons because their developing brains were not at the maturation point to process the lateral thinking that metaphor requires. Many users of my programme are families working at home where there is more time and room for questions and clarification and this would suit these younger listeners better.
My second insight is that for some students the curriculum requires extension to develop the concepts to levels of consolidation and personal application, and in our project I do not think the teachers had the time to do this, because of their pressure to make up time they lost to the Gem
Journey project. They simply had no time to extend the Gem lessons properly. I usually recommend a follow up session with a teacher, who is well versed in the programme using the Student Workbooks to reinforce the key messages, this would have been ideal.
Simon your closing statement, my overall clinical impressions, plus the findings from my customary,
‘Ode to Research’ survey, all seem to suggest that there was excellent engagement with the Gem
Journey delivery.
“It is also important to note that these results need to be placed in the context of feedback from students and teachers which highly valued being a part of the program and reported significant personal gains from the experience.” Denny MD
I’ve learnt from your research findings that the Gem journey does not thrive with presentation only, and I agree it didn’t. Your findings were of immense importance to me for they gave me insight that aided in the creation of a curriculum ‘mission statement’. I’ve learned from your findings that the lessons of the Gem journey must be extended beyond the delivery. My presentation alone was not sufficient to achieve the degree of impact I want from the material.
Your study convinces me the necessity of really teaching the material to the level of learning consolidation by extending the lessons (beyond the initial presentation) with the expectation of achieving application of the learning outcomes. I have also determined the gem journey curriculum must be sanctioned, and recognised as a true curriculum we want our children to learn. In my opinion there is no academic curriculum more important than the models and rules that the Gem Journey teaches. If the curriculum is imposed on top of mountains of core Ministry of Education expectations it will not thrive in such environments’.
The Journey must be considered and taught with enthusiasm and outcome expectation. The teaching of new concepts is like the sowing of the seeds. To expect the harvest of consolidation and application, the seeds must be properly planted and then watered to allow the concepts to ‘germinate’. I think the lessons were properly taught (the seed were sown effectively) however they were not ‘watered’ and ‘allowed to germinate’ which I believe accounts for much of the Research project’s ‘Null findings.’
Here’s what I learned and applied from your study.
The Gem journey in schools is for children 12 years and older.
The Gem journey Curriculum is for environments where the facilitators’ (parents’ teachers, adults) embrace the theory and are genuinely enthused to teach the curriculum to the level of consolidation and application.
In Conclusion
I am not daunted in the least, even though I know some will take the research outcomes and discount the curriculum. A sad inevitability; however without a hint of doubt I believe the discerning will look deeper. And what they will discover is a curriculum without peer that is a new proactive and preventative mental health intervention.
The curriculum is what it is… a completely articulated framework that teaches the ‘Eight Elements of
Self’ Theory. The lessons teach in the form of five models and three rules how to achieve control of each of the Elements of their life. And when the curriculum is properly taught the achievement of Identify is a real learning outcome.
Your research has been invaluable. It has taught me great lessons in addition to being such a great life experience.
Thank you Simon for all your effort you did a great job.
Ron Phillips
Simon responded: “I thought your reply was spot on and very much in line with my thoughts”
I am pleased that Simon Denny agrees with my reply which gives me confidence to offer a few more observations.
In my opinion there is interesting anecdotal evidence that suggests the students in the research project received much more than the ‘null’ results indicated.
Simon Denny MD’s closing research feedback states that the students and teachers highly valued the experience and reported significant personal gain. My clinical impressions certainly support his statements, as does the ‘Ode to Research’ survey that I conducted at the end of the last session.
I have been running therapeutic groups since 1985 (Best guess is I’ve run around 20,000 gem journey sessions) the experience gives me a fair indication of whether any given group was a success or not, and I have run a few that were not so hot. It is my clinical impression that the Pukekohe groups were well delivered and well received. Below are some impression based on what I saw, my empirical observation.
• Great engagement-often achieving high levels of transference
• Enthusiasm for the Journey
• Excellent recall from last presentation
• Great post story discussion
• No discipline issues
• The journey captured the listener’s imagination. Intently listened to learn.
• It is my custom to finish my groups with the query, “What are you taking home with you?” (to ponder, think about to personally consider) Their response almost always nailed the lesson themes
I have had the practice of giving out my ‘Ode to Research’ survey at the end of each group’s last session. I consider it anecdotal evidence to gauge the success of each complete journey. Studies show that adolescents, given anonymity, will respond with honesty.
The following is how the Pukekohe students filled out the survey.
Five questions: circle one: that best describe my Gem journey experience
(No names please)
1. It has inspired me to become my best self: 76/207-36%
2. It was pretty good, I learned some important lessons: 80/207-38%
3. It was just OK: 28/207 13%
4. I was bored and really didn’t learn much: 21/207 10%
5. It was a complete waste of time: 6/207 3%
Comments: approximately 2/3’s of the surveys had comments: the top 74% reflect very positive impressions while the bottom 26% reflect corresponding impressions.
I learned a great deal from this simple survey. The most impressive aspect to me is that the kids (for the most part) really, really dug the journey. What I saw was a majority of the participants totally engrossed, which leads me to surmise they were making eidetic mind pictures as I spun the tale. The transference levels were high during the oral story and carried on into post story discussion. (Listening to learn)
The results of the survey suggest that much more was going on than the ‘null’ results of the testing would indicate.
The ability of this curriculum to be thoughtfully considered by most of the students is why I must not give up. Lessons in life are embedded within the curriculum and the children consider them because they are thoughtfully pondering on the nature of the story as well as its content. Throughout the years I have witnessed countless students absorbing the storytelling modality with genuine eagerness, suggesting their imaginations have been captured and the post story interaction causes me to believe lots and lots of kids identified, internalised and personally considered the curriculum. (Seeds of thought sometimes take years to germinate).
Nowhere, to my knowledge, is material like this being taught. The reason it is not, is because the Gem Journey is original and only delivered within my work capacity. The curriculum will be absolutely new to the market.
The good news is the curriculum is articulated and ready for general use. I am convinced that as people become aware of the eight ‘Elements of Self’ theory there will be a desire to teach the curriculum.
The Kits
I hope to have the training kits available for sale by the end of the year. All the components of each kit are now complete except for the interactive video training modules and corresponding Storyteller’s Guide Chapters which are being created as we speak.
Presently five modules are complete.
When there are six to eight modules complete, the kits will be made available for sale.
As each new video module is completed, it will be uploaded and available to those who have purchased the kit.
A new feature, the module syllabus, allows the kit purchaser to know essentially what to expect from the forthcoming modules before they are rolled out.
For those who have the patience, the other option will be to wait until all the modules are complete, sometime in 2020, and buy the complete kit at that time.
Once you buy either the Gem Journey kit or the Classroom kit you will gain access to the training page of video modules.
Purchase of the kits also gives you license to print the number of Gem Work Books you need for your family or classroom.
A school-based cluster-randomised controlled trial of Therapeutic Storytelling Intervention (TSI) to promote youth mental health and wellbeing
Abstract
Context: The prevalence of mental health concerns among young people is increasing and efforts are warranted early in adolescence to prevent future mental health and behavioural concerns.
Objective: To determine if TSI delivered a classroom intervention reduces overall levels of psychopathology in young adolescents.
Design, Setting, Participants: We conducted a cluster randomized controlled trial in 378 students aged 10 to 13 years in an intermediate school in South Auckland.
Interventions: 12 sessions of therapeutic story intervention delivered over 12 weeks.
Main Outcome Measure: The primary outcome was child self-report SDQ Total Difficulties Score
Results: A total of 482 students from 16 classes were eligible and invited to participate. A total of 378 students and their parents agreed to participate and their classes randomised. Baseline data was collected from 210 students from 8 intervention classes and 168 students from 8 control classes. There were no differences at follow-up between the intervention classes and control classes in primary outcome or secondary outcomes.
Conclusion: There was no evidence of effectiveness of therapeutic story intervention in preventing psychopathology among 10 to 13 years at 6 month followup.
Data Access and Responsibility: The principal investigator, Simon Denny, had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Potential conflicts of interest: None
Financial support: Funding for this study was provided by the Kidz First Research Committee. The Kidz First Research Committee had no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.
Trial registration: Australian and New Zealand Clinical Trials Registry (ACTRN12618000282280)
Increasingly schools are being faced with mental health and behavioural issues that impact of students’ ability to engage in education. Mental health concerns are common among young people and their median age of onset is during early adolescence. ‘Young people’s health in Counties Manukau (2014)’ identified that one in four secondary school students had deliberately self-harmed and one in fourteen had attempted suicide in the past 12 months. Furthermore, significant numbers of young people in Counties engage in cigarette smoking, binge drinking and other risk behaviours that threaten their wellbeing. Referrals of these young people to mental health services at Whirinaki (Child and Adolescent Mental Health Service in CM Health) and AOD services is placing considerable pressure on secondary health services and effective prevention programmes based in the schools are urgently needed.
This project evaluates an innovative socio-emotional learning programme, Therapeutic storytelling intervention (TSI). TSI was developed by Ron Phillips in 1989 based on his book “Gem of First Water” (Phillips, 1989). “Gem of First Water” is the story of a boy on a journey of discovery and adventure in a mythical land called ‘confusion’. Along the way the hero is faced with challenges and dilemmas that reflect the common adolescent struggles, such as poor impulse control, making connections between decisions and feeling, working through grief, drug and alcohol use and peer and parent relationship issues. TSI has been developed as a class room intervention and is currently being delivered in schools in South Auckland. TSI has been extensively used in South Auckland over the past 20 years and anecdotally the results are impressive. However it has not been previously evaluated in a rigorous study design. The Ministry of Health and Counties Manukau Health have highlighted the need for research to underpin not only clinical services, but community programmes that aim to improve health and wellbeing. Of concern is the lack of research specific to Maori and Pacific young people. To date, TSI has been delivered to large numbers of Maori and Pacific young people with a great deal of anecdotal success, but without formal evaluation. The aim of this research is to evaluate if TSI is effective in improving mental health and wellbeing outcomes among children aged 11 to 13 years.
Aims/objectives of project
The main objective of this study is to determine whether Therapeutic Storytelling Intervention (TSI) improves the wellbeing of young people attending secondary schools in South Auckland. The specific aims are:
1. To determine if TSI reduces overall levels of psychopathology
2. To determine if TSI improves overall level of wellbeing
Methodology
This was a cluster-randomised parallel group design conducted in an intermediate school (Years 7 to 8) during 2018. Institutional Ethics review was through the Health and Disability Ethics Committee (17/CEN/50/AMO4) and was pre-registered with Australian and New Zealand Clinical Trials Registry (ACTRN12618000282280).
Students were recruited through an intermediate school in South Auckland. Written consent was obtained from the principal on behalf of the Board of Trustees. Families were informed of the study and their written consent was requested. All students were informed of the study and their assent obtained to participate.
Randomization
After baseline data collection, classes were randomized to the intervention (n=8) or control group (n=8). Randomisation was by a statistician not involved with the project by random sequence generation by computer.
Intervention
Classes in the intervention group received 12 TSI in weekly 45 to 60 minute sessions over 14 weeks. Classes in the control group received the usual school curriculum. Students received the “Gem of First Water” book, a student workbook and teachers had access to a talking book to allow for students to catch-up any sessions they may have missed. Sessions were delivered weekly by the developer of TSI and teachers were encouraged to incorporate ideas and learnings from the sessions in their lessons.
Assessment and Outcome Measures
Data were collected at baseline, immediately after the intervention, and at six months after the intervention. Data are collected by trained research assistants who were blind to the allocation of classrooms to intervention or control. Questionnaires were self-administered on laptops/ tablets with the questions and response options displayed on screen as well as read-out over headphones.
Primary Outcome Measures
The primary outcome measures are indicators of the mental health using the Strengths and Difficulties Questionnaire. The Strength’s and Difficulties Questionnaire (SDQ) is a short behavioural questionnaire developed for use in children and adolescents, measuring emotional symptoms, conduct problems, hyperactivity/ inattention, peer relationship problems, and prosocial behaviour. The 25-item instrument was self-completed by children at baseline, following the intervention and at 6 month follow-up. Apart from the pro-social scale, higher scores indicate higher levels of psychopathology.
Secondary Outcome Measures
The Social Emotional Health Survey – Primary was developed to assess primary school students’ positive psychological traits: gratitude, zest, optimism, and persistence, and the higher-order latent construct of co-vitality. The 26-item survey was self-completed by children at baseline, following the intervention and at 6 month follow-up. Higher scores indicate higher levels of wellbeing.
Power and Sample Size Calculations
The primary outcome measure is the Total Difficulties Score generated by the students’ sef- report of the SDQ. Based on data from previous pre and post TSI evaluations, the study was powered to detect a decrease of 2.8 points on the Total Difficulties Score in the intervention group compared to control group, representing an effect size of 0.25.
Data analysis
Self-reported outcome measures are analysed comparing intervention and control classrooms at baseline, immediate follow-up and at 6 month follow-up. Differences are considered statistically significant if the 95% confidence intervals do not overlap. Outcome analyses used follow-up data as the dependent variables. The primary analyses compared differences between the intervention and control groups on the outcome variables (SDQ, co-vitality) using analysis-of-covariance models, controlling for baseline outcome measures as well as age, sex, and ethnicity. Differences between control and intervention groups were considered statistically significant at P<0.05. All analyses accounted for clustering of students from the same classroom.
Results
Table 1 shows the demographic characteristics of the participating students. The majority of students were 12 years of age, with roughly equal numbers of male students and female students. New Zealand European students accounted for approximately 60% of students and Maori students made up approximately 15% of students. There were small numbers of students of Pacific ethnicity, Chinese ethnicity and Indian Ethnicity. Intervention classrooms and Control classrooms were roughly similar, although there were higher numbers of male students (55%) in the control classrooms compared to intervention classrooms (50%).
Figure 1 shows the drop-out from enrolment though to final analyses. Of the 482 eligible students, 378 provided consent and their classes randomised. At the 6 months post intervention, 167 students in the intervention classrooms and 129 students control classrooms participated in the final follow-up assessment.
Table 2 presents the baseline, follow-up and 6 month follow-up of the self-reported strengths and difficulties measures, including the total difficulties score, emotional symptoms, conduct problems, hyperactivity/ inattention and peer relationship problems. The table also presents the self-report co-vitality measures, which included a total co-vitality score, as well as gratitude score, optimism score, zest score and persistence score. Overall there were no significant differences in any of the measures between intervention and control classrooms at post-intervention follow-up or 6-month follow-up.
Table 3 presents the effect of the intervention adjusting for baseline measures and demographic variables, including age, sex and ethnicity. There were no significant differences between the intervention classrooms and control classrooms in the total difficulties scores. Furthermore, there were no significant differences between intervention classrooms and control classrooms on any of the secondary outcomes measures presented in table 3.
Conclusion
The aim of this study was to determine whether Therapeutic Storytelling Intervention (TSI) improves the wellbeing of young people attending secondary schools in South Auckland. Overall the results show no improvement in self-reported psychopathology immediately following the intervention or at 6-month follow-up. There were also no differences in the wellbeing of students between intervention or control classrooms immediately following the intervention or at 6-month follow-up.
The reasons for the lack of effectiveness in this study of Therapeutic Storytelling Intervention to improve young people’s wellbeing could be due to a number of factors. It could be that the program itself is not effective at preventing psychopathology or improving wellbeing among early adolescence. This could be due to the age of the students being too young for this type of intervention. Developmentally early adolescence is a period of significant cognitive development with increasing ability to think abstractly and to ‘think about thinking’. TSI may require more maturity and developmental cognitive ability to process the material and lessons which require students to reflect on their own lives and change their thought and behaviour patterns to enable improvement in their wellbeing. It may also be the content of TSI is better delivered by classroom teachers, who know their students better than outside personnel and may have been able to better tailor the lessons and content to the students contexts.
It may also be the study was underpowered to detect significant improvement in students’’ psychopathology and/ or wellbeing. Especially as the design was a cluster randomised study which reduces overall power due to correlation between students from the same classrooms. It was unknown beforehand of the effect size of the intervention to base power calculations. However, the direction of most of the effects was not favouring the intervention suggesting that increased power may not have helped.
Lastly, it may be that the outcomes measures are limited by being from self-reported by the students, without triangulation from parents or teachers. It is well recognised the limitations of self-report measures during adolescence, especially for externalising behaviours such as hyperactivity and conduct problems. However for other measures including emotional symptoms and co-vitality measures there was little evidence that the direction of effects were favourable to the intervention.
Further research looking at the effectiveness of Therapeutic Storytelling Intervention needs to consider these issues, especially the age of participants as it may be more effective with older adolescence. It is also important to note that these results need to be placed in the context of feedback from students and teachers which highly valued being part of the program and reported significant personal gains from the experience.
