Queensland University of Technology

CRICOS No. 000213J

Melissa Haswell and many others…

Health, Safety and Environment Discipline School of Public Health and Social Work

Queensland University of Technology Melissa.haswell@qut.edu.au

Key learnings from the application of the Aboriginal-Informed Growth and Empowerment Measure (GEM)

>15 Years of Collaborative Research on Empowerment & Social & Emotional Wellbeing

Huge thanks to Creators, Developers and Participants of the Family Well Being Program, Aboriginal Education Development Branch, SA Many university researchers involved in the body of work: CREW/UQ: **Dr Arlene Laliberté, *Lyndon Reilly , *Rachael Wargent ,*Vicki Saunders ,*Teresa Gibson & *Victor Gibson (HV) ERP w JCU - Komla Tsey, Janya McCalman, *Yvonne Cadet-James, Mary Whiteside QUT - Sarah Gaskin, David Kavanagh (QUT), WSU - Sally Fitzpatrick, Ilse Blignault, *Lisa Jackson Pulver , *Megan Williams (UTS), Andrew Wilson, Kim Miller, Irene Paxton (USyd), Ernest Hunter, Kimina Andersen, Penny Dale, Ed Heffernan (QH), Kate Smith (UWA), Anthony Shakeshaft, Alice Munro (UNSW), Louise Livingstone Key Organisations involved along the way: ACCHS: Mulungu, Gurriny Yealamucka, Goondir, Waminda, Roworr Pormpuraaw, Wuchopperen, Tangentyerre Council, Apunipima CY Health Council, RFDS, Menzies, Queensland Health, Panyappi - SA Metropolitan Aboriginal Youth and Family Services, Balunu Healing Program, Ngala Nanga Mai pARenT Group, Gamarada Healing & Lifeskills, Oolong House, Waminda Women’s Group, Red Cross SAM Our Way, Life Life Well Mareeba and many more Main Funders: QH, NHMRC, AHMAC, CRCAH, Apunipima, NSPS and FAHCSIA

CRICOS No. 000213J a university for the world real R

Empowerment and control … the often overlooked Social Determinant?

Definitions from the Literature • Increased Control and Mastery means that people are better able to deal with

the forces that affect their lives, (Syme 2003) and have greater capacity to deal with day to day challenges of life without being overwhelmed by them (Syme 1998).

• A social action process that promotes participation of people, organisations and communities towards the goals of increased individual and community control, political efficacy, improved quality of community life, and social justice (Wallerstein 1992).

• Concept of multi-level empowerment at individual, organisational and structural levels

CRICOS No. 000213J a university for the world real R

Empowerment Program

Developed by the Aboriginal Education Development

Branch, Office of Vocational Education and Training, South Australia

CRICOS No. 000213J a university for the world real R

What is Empowerment?… how does it related to healing and wellbeing? …. some Aboriginal Australian

perspectives:

– Healing—coming to terms with the past and present situation, dealing with the pain

– Gaining control – Becoming strong culturally and spiritually – Remaining calm despite turmoil – Finding your voice, participating in change – Working together for a strong community “When a person takes the first step towards becoming empowered, it is also the first step of healing” “It’s about knowing who you are and where you belong,

it’s about being proud of who you are”. “With empowerment you are building people to have the

power to stand up and make change - what you put into your inner self, it shows on the outer”

CRICOS No. 000213J a university for the world real R

Empowerment tool Challenges: Getting it Right

• Tool must capture shared and valued change in levels

of empowerment (based on qualitative data from FWB participants)

• Tool must reflect cultural context and definition of empowerment for Indigenous people (their own

words and concepts)

• Tool must be strengths-based and able to promote the empowerment process (promoting hope &

guiding effort)

CRICOS No. 000213J a university for the world real R

CRICOS No. 000213J a university for the world real R

THE TOOLS PROJECT:

Tree of Empowerment; six steps pathway to empowerment

The Tools Packet: Aims to measure the empowerment pathway

The GEM The Growth and Empowerment Measure

“Its like a tree – there is a foundation (seeds, roots), then the energy and self-esteem to look after yourself (trunk), so you can grow – the more you grow the bigger it gets… on the branches (of the tree) are education, job opportunities,

housing”.

For full description of GEM story: https://www.youtube.com/watch?v=zD0UyG31qiU

http://en.wikipedia.org/wiki/Image:Kauri_Te_Matua_Ngahere.jpghttps://www.youtube.com/watch?v=zD0UyG31qiU

CRICOS No. 000213J a university for the world real R

Parts of the GEM

• S12 (Scenarios): Process of empowerment – which ‘story’ best matches your situation

• EES14 (Emotional Empowerment Scale) - Impact measure – from the interview codings “showing and feeling signs of empowerment”

• For validation, we used the Kessler scale but this component is interchangeable according to the Outcomes sought in a program or service.

Queensland University of Technology

CRICOS No. 000213J

half ‘n’ half

I feel like I don’t know anything.

I am knowledgeable about things

that are important to

me.

14 item Emotional Empowerment Scale Feeling and showing the signs of

empowerment

CRICOS No. 000213J a university for the world real R

Emotional Empowerment Scale good reliability on a range of tests Two principle component factors Cronbach’s alpha consistently >0.85

Inner Peace Subscale Items • Feel Skilful • Strong, full of energy • Confident • Centred, focused • Calm, relaxed • Happy with self & life • Safe and secure • Can deal with anger

Self-Capacity Subscale Items • Can speak out, people listen • Satisfied with opportunities • Feel Valued and Admired • Feel hopeful for a better future Loaded on Both Subscales

• Feel connected, I belong • Feel knowledgeable

CRICOS No. 000213J a university for the world real R

12 Scenarios Showed good reliability on a range of tests Cronbach’s alpha consistently >0.85

Two principle components emerged in factor analysis with oblimin rotation (Haswell et al., 2010)

Healing and Growth Subscale 1 Dealing with painful feelings 2 Personal and Family Safety 3 Able to say no 5 Engaging with Learning 8 Able to speak out and be heard 10 Improving relationships 11 Reaction to judgement

Meaning and Purpose Subscale 4 Able to make changes 6 Developing Spirituality 7 Establishing identity 9 Valued in workplace 12 Working toward a better community

CRICOS No. 000213J a university for the world real R

Methods Used

• Analysed 50 interviews with people who participated in the FWB program

• Identified themes in their explanations of how the program changed their life

• Consulted extensively with participants and specialists to make sure we got it right

• Increasingly improved visual representations of the pathway to facilitate engagement

• Developed a series of scenarios and scales to enable people to identify where they are

• Two studies now completed (Haswell et al, 2010; Berry et al., submitted)

CRICOS No. 000213J a university for the world real R

Confirmatory Factor Analysis: GEM Subscales (preliminary results)

Yuan-

Bentler χ2

df Robust CFI Robust

TLI AIC SRMR Robust RMSEA 90%CI

Robust N

Emotional Empowerment Scale (2 factors: Self-Capacity, Inner Peace) All 243.1 53 0.955 0.944 27773.505 0.032 0.069 0.060 - 0.078 966

Indigenous 162.588 53 0.957 0.946 18165.856 0.033 0.065 0.054 - 0.076 613

12 Scenarios (2 factors: Healing, Connection) All 157.878 53 0.941 0.926 22367.230 0.040 0.067 0.055 - 0.079 945

Indigenous 129.026 53 0.932 0.915 14255.108 0.044 0.071 0.055 - 0.087 595

CRICOS No. 000213J a university for the world real R

Scenario 11: Understanding &

improving relationships

Scenario 2: Creating safety for yourself

and family

Scenario 4: Having confidence in

making changes

Scenario 7: Sense of knowing who you

are

Scenario 1: Ability to deal with emotional pain and

move forward

Scenario 8: Ability to speak out in the

community

Scenario 3: Responding to others

who are not taking responsibility

Scenario 5: Engaging in learning

Scenario 6: Thinking about your

own spirituality

Scenario 9: Being respected in

workplace

Scenario 10: Dealing with judgment

and criticism

Scenario 12: Community working together for change

GEM: 12 Scenarios – w/ the six core scenarios that appear to be particularly linked to impact and outcome

Ivern Ardler & Tanya Bloxsome

Oolong House Residential Rehab.

strong roots strong spirit

CRICOS No. 000213J a university for the world real R

Oolong House’s Data Toolkit At Entry, 8 weeks and 16 weeks

•Applied at entry alone: • Parts of Psycheck (brief mental health check, suicidal thoughts) • Two items from the Brief Treatment Outcome Measures (BTOM) • Indigenous Risk Impact Screen (IRIS) (MH SS, AOD SS)

•Applied at entry, 8 weeks and 16 weeks (graduation) • Growth and Empowerment Measure (GEM) with 12 Scenarios

(Healing SS, Purpose SS, Core6 SS) & 14 item Emotional Empowerment Scale (Inner Peace SS, Self-capacity SS)

• Drug Taking Confidence Questionnaire (DTCQ) • Kessler 10 (K10) plus 2 questions on anger and feeling happy in

yourself

CRICOS No. 000213J a university for the world real R

Repeated measures during residential rehabilitation

0

1

2

3

4

5

6

7

EESIP EESSC S12HG S12CP

Entry

8wk

16wk

Berry, S., et al. (2012). Growth and Empowerment for Indigenous Australians in Substance Abuse Treatment. International Journal of Mental Health and Addiction, 10 (6), 970-983.

Chart1

EESIPEESIPEESIP

EESSCEESSCEESSC

S12HGS12HGS12HG

S12CPS12CPS12CP

Entry

8wk

16wk

3.48

4.29

4.65

3.93

4.53

4.71

4.5

5.3

5.69

4.74

5.47

5.63

Sheet1

Entry8wk16wk

EESIP3.484.294.65

EESSC3.934.534.71

S12HG4.55.35.69

S12CP4.745.475.63

To resize chart data range, drag lower right corner of range.

CRICOS No. 000213J a university for the world real R

Switch now – GEM as a tool for understanding PsyCheck questions

• “Has the thought of ending your life ever been on your mind” (Question 5a) and, if yes, the person is asked “Has that happened recently?” (Question 5b).

• We compared distress and disempowerment among three groups (total 388): – Never had thoughts (n = 186, 47.9%) – Ever but not recently had thoughts (n = 140, 36.1%) – Recently had thoughts (n = 62, 16.0%)

CRICOS No. 000213J a university for the world real R

What disempowerment processes might be underlying the thoughts?

Suicidal Thoughts:

Never

Mean (SD)

Previous

Mean (SD)

Recently

Mean (SD)

Not Recently+

Mean (SD)

Spearman’sRho Mann-Whitney U

(3 groups) Recently/not

Know who I amCP, Core

5.4

4.9

3.8

5.2

0.31***

5.8 ***

Can make changesCP, Core

5.4

5.1

4.2

5.3

0.26***

5.2 ***

Healing past painHG, Core

4.3

3.8

2.9

4.1

0.28***

4.9 ***

Safety for self & familyHG, Core

5.3

4.6

3.9

5.0

0.29***

4.9 ***

Able to say noHG

5.0

4.7

3.4

4.9

0.21***

4.9 ***

CRICOS No. 000213J a university for the world real R

2

2.5

3

3.5

4

4.5

5

5.5

6

6.5

7

Entry 8 Weeks 8* Weeks 16 Weeks

Mea

n Sc

ore

First Eight Weeks Second Eight Weeks

Never Previously Recently

Core Six Scenario subset – Change over time at

Oolong House

CRICOS No. 000213J a university for the world real R

GEM Scenarios as a potential screener for suicidal ideation?

CRICOS No. 000213J a university for the world real R

Learning about trauma from an empowerment lens

CRICOS No. 000213J a university for the world real R

The Family Business Findings

(page 63)

CRICOS No. 000213J a university for the world real R

PTSD is strongly associated with disempowerment of women in their daily lives – especially through unresolved emotional pain and

lack of safety, voice and identity

0

1

2

3

4

5

6

7

GEM Total Painful feelings Safety Voice Identity

Aver

age

Scor

e on

GEM

Item

GEM Scenario Item

No PTSD PTSD

From Heffernan et al., 2015

CRICOS No. 000213J a university for the world real R

Current and future work: Things we’re doing/ Questions we’re

exploring thru the GEM

• Identifying the most urgent areas of empowerment needing focus at individual, family and service level related to parenting, mental health, AOD and justice challenges, student learning, community development, ? addressing environmental loss and climate change

• Potential for use of key scenarios in Primary Health Care/screening • Optimising for young people : GEM Junior in development • Gaining deeper understanding of processes of gaining and

sustaining wellbeing and identity and in making positive change • Linking empowerment and empowering programs and services to

positive outcomes that can be applied to cost-benefit analysis • International applications – Kenya, Canada, US, PNG

>15 Years of Collaborative Research on Empowerment & Social & Emotional Wellbeing

Huge thanks to Creators, Developers and Participants of the Family Well Being Program, Aboriginal Education Development Branch, SA Many university researchers involved in the body of work: CREW/UQ: **Dr Arlene Laliberté, *Lyndon Reilly , *Rachael Wargent ,*Vicki Saunders ,*Teresa Gibson & *Victor Gibson (HV) ERP w JCU - Komla Tsey, Janya McCalman, *Yvonne Cadet-James, Mary Whiteside QUT - Sarah Gaskin, David Kavanagh (QUT), WSU - Sally Fitzpatrick, Ilse Blignault, *Lisa Jackson Pulver , *Megan Williams (UTS), Andrew Wilson, Kim Miller, Irene Paxton (USyd), Ernest Hunter, Kimina Andersen, Penny Dale, Ed Heffernan (QH), Kate Smith (UWA), Anthony Shakeshaft, Alice Munro (UNSW), Louise Livingstone Key Organisations involved along the way: ACCHS: Mulungu, Gurriny Yealamucka, Goondir, Waminda, Roworr Pormpuraaw, Wuchopperen, Tangentyerre Council, Apunipima CY Health Council, RFDS, Menzies, Queensland Health, Panyappi - SA Metropolitan Aboriginal Youth and Family Services, Balunu Healing Program, Ngala Nanga Mai pARenT Group, Gamarada Healing & Lifeskills, Oolong House, Waminda Women’s Group, Red Cross SAM Our Way, Life Life Well Mareeba and many more Main Funders: QH, NHMRC, AHMAC, CRCAH, Apunipima, NSPS and FAHCSIA

Key learnings from the application of the Aboriginal-Informed Growth and Empowerment Measure (GEM)>15 Years of Collaborative Research on �Empowerment & Social & Emotional WellbeingEmpowerment and control … �the often overlooked Social Determinant? �Definitions from the Literature Slide Number 4What is Empowerment?… how does it related to healing and wellbeing? …. some Aboriginal Australian perspectives:�Empowerment tool �Challenges: Getting it RightSlide Number 7Slide Number 8Parts of the GEM14 item Emotional Empowerment Scale�Feeling and showing the signs of empowerment Emotional Empowerment Scale �good reliability on a range of tests �Two principle component factors�Cronbach’s alpha consistently >0.85 �Slide Number 1212 Scenarios �Showed good reliability on a range of tests Cronbach’s alpha consistently >0.85 �Two principle components emerged in factor analysis with oblimin rotation�(Haswell et al., 2010)Methods UsedConfirmatory Factor Analysis: �GEM Subscales �(preliminary results)Slide Number 16Slide Number 17Oolong House’s Data Toolkit �At Entry, 8 weeks and 16 weeksRepeated measures during residential rehabilitationSwitch now – GEM as a tool for understanding�PsyCheck questions What disempowerment processes might be underlying the thoughts?Slide Number 22GEM Scenarios as a potential screener�for suicidal ideation?Slide Number 24The Family Business Findings PTSD is strongly associated with disempowerment of women in their daily lives – especially through unresolved emotional pain and lack of safety, voice and identity Current and future work: �Things we’re doing/ Questions we’re exploring thru the GEM>15 Years of Collaborative Research on �Empowerment & Social & Emotional Wellbeing