Sole Expression: Trauma-Informed Dance Intervention
Introduction
Mental health support and developmentally appropriate interventions are urgently needed for youth who have experienced and/or been exposed to violence. It is typical to wait 6-8 months for clinical services, which can escalate trauma symptoms. Additionally, some youth refrain from participating in traditional therapeutic services such as cognitive behavioural therapy, due to the reliance on the verbal expression of emotions, which may be uncomfortable for some. The aim of Sole Expression was to implement a trauma-informed dance intervention for youth who experienced and/or been exposed to violence in an effort to reduce trauma symptoms. Our five-year project included a pilot intervention in Toronto, a refinement of the curriculum, and a larger-scale intervention in both Toronto and Simcoe/Muskoka. The study purpose was to
determine if, and how, a dance program reduces trauma-related symptoms among youth who have had experiences or exposure to abuse and/or violence.
The dance intervention was guided by a trauma-informed curriculum and was delivered over a 10-week period throughout the project tenure. Participants in the program were not expected to directly speak about their experience of abuse or trauma at any point during the dance or research portions of this project. Each program was facilitated by a team consisting of a trained trauma therapist, and two dance instructors. The primary goal of Sole Expression was to collaboratively refine, implement, and evaluate a trauma-informed dance intervention that was innovative and creative, to promote healing and well-being for youth (ages 12–17) who had experienced abuse and/or violence. Our specific objectives were to 1) refine and pilot test a
trauma-informed dance intervention for male and female youth who have experienced child abuse and/or domestic violence; and 2) further refine the dance intervention based on pilot study findings, determine the sample size for statistical significance, and implement and evaluate a multi-site trauma-informed dance intervention in both Toronto and Simcoe/Muskoka. The Public Health Agency of Canada provided $1,140,736.00 from July 20, 2016, to March 21, 2022, through the Supporting the Health of Survivors of Family violence investment.
Background
Research has demonstrated that individuals react differently to traumatic events. For youth who experienced trauma at a very young age, the consequences can be particularly devastating and can result in negative effects on life course development, including brain development. Specifically, “trauma acts as a threat to an individual’s well-being, thereby activating a neurobiological stress response. Although necessary for survival, chronic and frequent physiological stress responses can alter brain development, leading to dysregulation of neural circuitry. Children exposed to traumatic stress may develop post-traumatic stress disorder (PTSD) or its symptoms (PTSS)” (Carrion and Wong, 2012: S23). This can make it difficult for youth to regulate their emotions and control their behaviour, and can lead to persistent states of
hyperarousal and hypervigilance where they may seem to underreact or overreact to various situations. Trauma may also be likely to affect physical health and cause chronic pains, headaches, gastrointestinal problems, and other conditions (BC Provincial Mental Health and Substance Use Planning Council, 2013).
The proposed project was intended to reduce trauma symptoms through a trauma-informed approach that was based on dance (specifically hip-hop), and creative expression. The demand for services for victims of child abuse and family violence has been increasing exponentially, and the existing resources are not adequate to meet the needs of this population. Boost Child & Youth Advocacy Centre (Boost CYAC) has invested considerable time and resources to develop a trauma-specific assessment and treatment model that is based on best practices and current research, that also offers an innovative and responsive approach to the needs of children/youth and families. However, the waitlist for this assessment and treatment is lengthy and not all children and/ or youth require such an intensive intervention.
Sole Expression: A Trauma-Informed Dance Intervention for youth who have experienced child abuse and/or domestic violence offered an alternative approach. A recent literature review conducted by Boost CYAC yielded strong evidence that dance-movement treatment (DMT) is effective in reducing trauma symptoms. In particular, one study found that DMT was effective in strengthening coping and improving emotion regulation among children who had experienced abuse (Betty, 2013). Bringing Boost CYAC, UNITY, and Child & Youth Advocacy Center Simcoe Muskoka (CACSM) together with university-based researchers in this collaborative project ensured that our innovative intervention would fill service and knowledge gaps with evidence based information and resources. In addition, our trauma-informed curriculum was further developed through phases of implementation and evaluation so that the final curriculum could take into account the various needs of youth who were victims of child abuse and/or domestic violence. All program facilitators received training in trauma-informed approaches including dancers from UNITY and research staff. The final outcome of the project will be a sustainable intervention that can be used by others across Canada.
Key activities and outputs
Over the duration of the project, the Sole Expression intervention was delivered in full, eleven times. Two other programs were started, one ended due to staffing challenges and the other due to COVID-19. The intervention was delivered both in Toronto and in Simcoe/Muskoka through Child & Youth Advocacy Center Simcoe Muskoka. Participant enrollment ranged from 5-to 16 youth per program, however, not all participants completed research measures. The program utilized a variety of accessible spaces to deliver the intervention, including privately owned dance studios, community centers and community hubs.
Team members took part in many knowledge dissemination activities including research briefings, conferences, outreach presentations, wellness workshops and experimental seminars. The audiences in attendance included researchers, practitioners, stakeholders, community organizations, expressive arts therapists, and legal and outreach workers. In total, project team members participated in 58 knowledge dissemination and exchange events, with an estimated reach of 2810 individuals. Additionally, the Sole Expression project has developed 113 new knowledge products, with an estimated reach of 2600 individuals. Additionally, one manuscript was published and one manuscript is currently under review, the
audience reach of these peer-reviewed publications is difficult to estimate at this point.
https://www.tandfonline.com/doi/abs/10.1080/10926771.2018.1544182
https://kh-cdc.ca/en/project-profiles/sole-expression.html
https://youtu.be/4ti5uXf9eEk
https://kh-cdc.ca/en/project-profiles/pdfs/Sole-Expression-Fact-Sheets.pdf
https://www.uvic.ca/hsd/cyc/assets/docs/2019-cycinaction-fullprogram.pdf (pg. 6)
Project Outcomes
Sole Expression was delivered eleven times over the course of the project to a diverse set of participants. The program was well-received, evidenced by the number of young people who requested to take part in additional programs for ‘fun’. Participants were asked to complete the Trauma Symptoms Checklist for Children (TSCC) and the Multidimensional Anxiety Scale for Children (MASC-2) prior to the group, and within two weeks after the group. Research analysis investigated the baseline scores and compared them to scores after engaging with Sole Expression. Additionally, participants were invited to take part in an interview with a research assistant after the program ended to share their experiences in the program and to explore how elements of Sole Expression supported or hindered their wellbeing and ability to cope. The total number of participants included in the quantitative analysis was 48, while 14 youth participated in qualitative semi-structured interviews.
Overall, study data indicated that there was a positive impact of the Sole Expression program on reducing trauma symptoms, supporting the further use of Hip-Hop to improve the wellbeing and healing of young people who have experienced violence and trauma. The TSCC and the MASC-2 demonstrated significant improvements on several of the sub-scales within these tools. Qualitative interviews describe the necessity for a non-judgemental environment where participants are able to regain power and harness the energy of others to support their ability to manage their mental health.
As a deliverable of Boost CYAC's 2022-24 Strategic Plan, the organization will be conducting comprehensive reviews for all programs and departments. For client-serving programs, such as the Assessment Directed Therapy Program, which implemented Sole Expression programming, this review will include various factors related to supporting our clients; including, what services are delivered and how, wait times, mitigating actions to existing wait times, etc. The results of the Sole Expression project will be strongly considered as a method of supporting youth awaiting comprehensive services as well as those who may not require such intensive services. Compared to individual support, group services are an efficient means of serving a larger
number of individuals; this is an important factor in increasing an organization's capacity to serve its community.
As a project, we gained significant insight into the power of movement, and hip-hop in particular as a trauma-informed intervention for young people. While working with experts from UNITY, there were many opportunities to learn about the legacy of hip-hop culture and integrate these learnings into knowledge dissemination activities as the project progressed.
Next Steps
At this time, the continuation of the Sole Expression is not possible due to the lack of resources. However, should those resources become available, the next steps would include gauging community interest in the program, securing resources, and planning for implementation. However, through the manual, video, scholarly journal articles and conference presentations we will continue to share the learning that was acquired through this project in the hopes of providing other organizations with the learning necessary to think about trauma services in ways that may not be typically considered.
