Resocialization through the Family Project in the Bahamas: Using Group Therapy to Heal Adverse Childhood Experiences

Abstract

Background: The Bahamas has undergone a severe social fragmentation process due to the crack cocaine epidemic of the 1980s. Marginalized persons were offered free group therapy through The Family: People Helping People Project. Methods: We hypothesized that many of our participants were traumatized as children, therefore causing them to experience various psychological and physiological challenges as adults. The Allen Resocialization Scale can measure the resocialization of traumatized participants. Results: The results indicate that 98% of participants who were traumatized scored ‘excellent’, ‘good’ or ‘average’ on the Allen Resocialization Scale. Conclusions: Without The Family, these participants may have been ‘poorly’ re-socialized, wreaking havoc in the society. Therefore, the results suggest that Family support groups can be a protective factor against trauma experienced in childhood.

1. Introduction

The Bahamas is a small island nation situated between Florida and Cuba. Originally an English Colony, it became independent in 1973 and had a population of about 400,000, most of which is of African descent. The Bahamas is a religion-centric country based on Judeo-Christian principles. Unfortunately, the country-wide crack cocaine epidemic of the 1980s produced severe family and community disintegration [1, 2], which, combined with the international economic downturn of 2008, led to high youth unemployment and the development of violent gangs. In response to this, The Family: People Helping People Project, a resocialization intervention, was initiated in 2008 [3, 4]. The program provides free group therapy to 23 marginalized communities, including the prison, juvenile offenders, and an orphanage. The Family is a group process model, representing a therapeutic replica of the home-based family, allowing members to confront their issues in a safe and non-judgmental environment led by a trained facilitator. The Family provides support and advocacy for its members, which in turn gives persons an avenue to discover themselves and grow as individuals [5]. More importantly, The Family encourages the expression of taboo emotions, such as early childhood trauma. Study findings repeatedly reveal a graded dose-response relationship between adverse childhood experiences and negative health and well-being outcomes across the life course [6, 7]. As such, persons should address cumulative childhood stress because doing so is paramount to thriving in adulthood.

Participants in The Family: People Helping People Project are traumatized and therefore engage in at-risk behaviors. The authors hypothesized that these at-risk behaviors can be co-morbid with various physical diseases, which could increase the risk of dis-socialization. Traumatization is counteracted when persons participate in The Family Program, consequently increasing resocialization. The authors also hypothesized that there is a direct correlation between traumatization and violent behavior. That is, as exposure to traumatic events increases, so does exposure to violence. The purpose of this study is to investigate these hypotheses.

2. Method

The authors carried out a prospective study in which five (5) psychological tests were given to 209 participants at 16 Family Groups. The tests included the Beck Depression Inventory (BDI) [8], the Adverse Childhood Experience (ACE) questionnaire [9], a Post-Traumatic Stress Disorder screen [10], the Generalized Anxiety Disorder (GAD-7) Scale [11], and the Allen Resocialization Scale [12]. Participants were also given a baseline survey measuring at-risk behavior and physical disease prevalence. A comparison was made between scores from the five tests and responses to the baseline survey. This was done to measure the effects of trauma on physiological and psychological illness. Participants received informed consent forms which they were required to sign. Authors did not attain Institutional Review Board (IRB) approval because the methods of this study involved minimal to no risk to the participants. However, the ethical standards of research in the Bahamas were adhered to.

The researcher, therapist and therapist facilitator all assisted with administering the tests. Participants were offered no incentives for participating in this study. All data were collected and analyzed by the authors during a five (5) month period (November 2019–March 2020).

3. Results and discussion

There were 209 participants in this study. Sixty-three percent (63%) (n = 132) of the participants were female and 37% (n = 77) were male. Due to the adolescent component of the program, the participants less than or equal to 19 years (23%) (n = 48) were almost equally represented with those who were 50–59 years (22%) (n = 46). Seventeen percent (17%) (n = 36) of the participants were 60 years and older. Eleven percent (11%) (n = 22) of the participants was 20–29 years, 13% (n = 28) was 30–39 years and 14% (n = 29) was 40–49 years. A third of the participants graduated from college/university (31%) (n = 65). Twenty-two percent (22%) (n = 47) had some secondary school education, 21% (n = 44) graduated from secondary school and another 21% (n = 43) had attained some college/university education. Three percent (3%) (n = 7) of the participants reported their highest level of education was primary school, and 1% (n = 3) reported having no formal education. More than half (56%) (n = 116) of the participants grew up in a middle-class neighborhood. Thirteen percent (13%) (n = 27) grew up in poverty, 17% (n = 36) lower middle class and 11% (n = 23) upper middle class. Only 3% (n = 7) of the participants grew up in a wealthy neighborhood. Concerning the prevalence of violence in the community, 59% (n = 123) of participants know 1–10 persons who was killed violently. Nineteen percent (19%) (n = 40) of participants know more than 11 persons violently killed. Ten percent (10%) (n = 21) of participants know 31 or more persons violently killed (Figure 1), illustrating the severity of the trauma and violence in the country. Regarding the incidence of violent crime (rape, murder, etc.) that occur within the community in an average week, 52% (n = 108) of participants said there were no incidences of violent crime that occur within their community per week. Forty-four percent (44%) (n = 92) of participants indicated there were 1–10 incidences, and 4% (n = 9) indicated there were more than 11 incidences. Regarding the incidences of burglary that occur within the community in an average week, 44% (n = 93) of participants indicated there were no incidences, 49% (n = 102) indicated there were 1–10 incidences and 6% (n = 12) indicated there were more than 11 incidences. One percent (1%) (n = 2) of the participants were unsure how many incidences of burglary occur within their community per week (see Figure 1). A third of the participants (32%) (n = 66) have been in The Family Program for 3 months or less. Eleven percent (11%) (n = 22) of the participants have been in the program for 4–6 months, 12% (n = 26) for 7 months to 1 year, and 19% (n = 39) for 1–2 years. Almost a third (27%) (n = 56) of them have been in the program for 3 years or more.

Figure 1.

Prevalence of violence in the community.

The Beck Depression Inventory (BDI) [8] was given to participants. Results indicate that 45% (n = 94) of participants have normal ups and downs, 18% (n = 38) have a mild mood disturbance, and 9% (n = 18) have borderline clinical depression. Ten percent (10%) (n = 21) of participants were not depressed (they scored zero on the BDI). Eleven percent (11%) (n = 22) of the participants have moderate depression and 7% (n = 16) have severe/extreme depression.

A 10-item questionnaire measuring adverse childhood experiences (ACE) [9] was given to participants. Any score greater than three (3) is significant. The higher the score, the greater the impact of life experiences [13]. The results indicate that 91 of the participants (44%) scored four (4) or higher on the ACE questionnaire (see Table 1).

ACE Score	# of Participants
0	30
1	37
2	25
3	26
4	23
5	22
6	20
7	14
8	4
9	5
10	3

Table 1.

Adverse childhood experiences (ACE) scores.

To further investigate the incidence of physical abuse in childhood, question two of the ACE [9] was analyzed “Did a parent or other adult in the household often push, grab, slap or throw something at you or ever hit you so hard that you had marks or were injured?”. Forty-four (44%) (n = 93) of participants answered ‘yes’ to this question. That is, almost half of the participants were physically abused before the age of 18 years. Punishment can easily turn into abuse, especially when anger is involved. Question three of the ACE [9] was analyzed to ascertain the incidence of sexual abuse in childhood. Question three asked “Did an adult or person at least 5 years older than you ever touch or fondle you or have you touch their body in a sexual way or try to or actually have oral, anal or vaginal sex with you?” Twenty-three percent (23%) (n = 48) of participants answered ‘yes’ to this question. That is, almost one-quarter of the participants were sexually abused before the age of 18 years.

Moreover, 23% (n = 48) of participants had a history of sexual abuse before the age of 18, and moderate/severe PTSD. If sexual abuse is the only adverse childhood experience a person has, moderate/severe PTSD in adulthood may still occur. Sexual offenses that transpired in the United Kingdom were prosecuted 40 years later, proving the length of time it can take for a victim to come forward. As such, victims can spend years living with the unresolved trauma of sexual abuse [14].

The Post-Traumatic Stress Disorder (PTSD) self-test [10] was given to participants. Authors edited the original questionnaire to make it more understandable to our cohort. The results indicated that 16% (n = 33) of the participants did not have PTSD, while 84% (n = 176) had moderate or severe PTSD. Participants with moderate or severe PTSD will display symptoms associated with it, which include flashbacks, murderous rage, poor impulse control, and hopelessness [15, 16]. Persons with PTSD can also be destructive. Given the prevalence of violence in the community (see Figure 1), it is not surprising that 84% of participants present with moderate/severe PTSD as PTSD can be triggered by witnessing or experiencing a terrifying event, such as murder [17]. Moreover, with 44% of the participants having a significant amount (four or more) of adverse childhood experiences (see Table 1), it is reasonable that 84% of participants would present with moderate/severe PTSD as PTSD may start within 1 month of the event but sometimes may not appear until years after [17]. Forty-one percent (41%) (n = 86) of participants had a significant ACE score and moderate/severe PTSD.

A Generalized Anxiety Disorder Scale (GAD-7) [11] was given to participants. Twenty-three percent (23%) (n = 48) of the participants did not have anxiety, 28% (n = 58) had minimal anxiety, and 23% (n = 48) had mild anxiety. Twenty-six percent (26%) (n = 55) of participants had moderate/severe anxiety. This phenomenon has been common in our work, where people who have murderous rage describe feeling more angry than anxious.

The Allen Resocialization Scale was given to participants. This scale defines resocialization based on many established constructs of personal growth. It is comprised of eight subscales that measure well-being, spirituality, awareness, resilience, stress management, friendliness, self-protection, and family bonds [12]. Six percent (6%) (n = 12) of participants scored ‘excellent’, 59% (n = 123) scored ‘good’ and 33% (n = 69) scored ‘average’. Only 2% (n = 5) of participants scored ‘fair’. No participants scored ‘poor’ (see Table 2). These results indicate that 98% of the participants are resocialized (defined by either an excellent, good, or average score). Since resocialization is the ultimate goal of The Family: People Helping People Program, these results signify a 98% success rate.

Allen Resocialization Scale Category	# of Participants
Excellent	12
Good	123
Average	69
Fair	5
Poor	0

Table 2.

Allen resocialization scale scores.

Felitti et al. [7] compared ACE scores and patients’ reports of at-risk behaviors and disease. There was a graded relationship between the number of adverse experiences in childhood and all 10 risk behaviors (including depression, suicide attempts, substance abuse, etc.) [7, 13]. In this study, the physiological illnesses coded for and used to compare the ACE scores to include: heart disease, cancer, stroke, chronic bronchitis/emphysema, elevated or low cholesterol, elevated blood pressure, diabetes, rheumatism (arthritis), and sexually transmitted disease. At-risk behaviors included alcoholism, regular consumption of alcohol, drug abuse, and regular consumption of drugs. Results indicate that (47%) (n = 98) of the participants had at least one physiological illness. While only 6% (n = 12) responded ‘yes’ to alcoholism, 32% (n = 67) admitted to regularly consuming alcohol. Nine percent (9%) (n = 19) responded ‘yes’ to drug abuse, while 23% (n = 48) admitted to regularly using drugs (see Table 3). Drugs of choice included marijuana (71%) (n = 34), tobacco (40%) (n = 19), cocaine (10%) (n = 5), ecstasy (4%) (n = 2), and other (often further described as use of medications) (21%) (n = 10). Some participants admitted to the regular consumption of more than one drug. Twenty-three percent (23%) (n = 48) of participants had a significant ACE score and physiological illness. Twenty-one percent (21%) (n = 43) of participants had a significant ACE score and at-risk behavior, defined by alcohol and/or drug abuse.

Physiological illness/at-risk behavior	# of Participants
Heart disease	23
Cancer	4
Stroke	7
Chronic bronchitis/emphysema	98
Elevated or low cholesterol	44
Elevated blood pressure	62
Diabetes	14
Rheumatism (arthritis)	18
Sexually transmitted disease	10
Alcoholism	12
Regular consumption of alcohol	67
Drug abuse	19
Regular consumption of drugs	48

Table 3.

Physiological illnesses and at-risk behaviors.

The self-protection subscale of the Allen Resocialization Scale [12] was used to assess the suicidality of participants. Fifty-eight percent (58%) (n = 121) of participants scored ‘excellent’, 20% (n = 42) scored ‘good’, 17% (n = 35) scored ‘average’ and 5% (n = 11) scored ‘poor’.

Suicidal ideations and attempts were measured using question #26 from the baseline questionnaire, which asks,

1. Have you ever experienced thoughts of suicide? YES or NO

2. Have you ever attempted suicide? YES or NO

Forty percent (40%) (n = 83) of participants had suicidal ideation and 21% (n = 43) had previously attempted suicide. Almost one quarter of participants (24%) (n = 51) had a significant ACE score, moderate/severe PTSD and a history of suicidality (defined as either having a low self-protection score, previous suicidal ideation, or suicide attempt).

Resilience of participants in this study was measured using the Allen Resocialization Scale [12] which includes a resilience subscale. Sixty-three percent (63%) (n = 132) of participants scored either ‘excellent’ or ‘good’, 37% (n = 77) scored either ‘average’ or ‘poor’. Eighteen percent (18%) (n = 38) of participants had low resilience (defined as a score of ‘average’ or ‘poor’ on the resilience scale), a significant ACE score and moderate/severe PTSD.

In keeping with Dorothy Lewis’ hypothesis that the perpetrators (of violence) were once victims themselves [18, 19], we investigated how many of our participants who admitted to being perpetrators of violence were once victims (defined by a significant ACE score or a ‘yes’ response to questions 27, 28, or 29 of the baseline questionnaire). In our sample, 17% (n = 36) of participants had a significant ACE score and a history of being a perpetrator of violence. Eleven percent (11%) (n = 24) had a history of being a victim and perpetrator of bullying. Thirteen percent (13%) (n = 27) had a history of being a victim and a perpetrator of a violent attack. Five percent (5%) (n = 11) had a history of being a victim and perpetrator of intimate partner violence.

4. Case vignettes

1. A female inmate shared she was incarcerated for fighting the police. When asked if she remembers always being so angry, she became emotional. She explained that her mother was very poor and it was really hard her whole life. She admitted to prostituting herself. Two other inmates said their story was the same. It is important to note that there were only six participants in this session, which means that 50% of them had prostituted themselves because of financial lack. The facilitator noted that the women in this group had many relationships with men where love was not the connection. Instead, anger/violence, a way of expressing emotion, is a powerful form of their communication.

2. A young man presented to one of the groups. He shared that he grew up in a religious home but had issues with his [step] father. His parents were married but divorced before he was born. He had a good stepfather. His mother died when he was 17 years old. He was introduced to sex from the age of four and described being molested by a pastor. He continued the cycle of abuse by sexually abusing his sister from age seven onwards.

3. A female inmate admitted to being imprisoned for murder. She started sessions with The Family Program 2 years ago, at which time she presented as tough, guarded, and seemingly unremorseful. Now, she seems to have grown immensely. She described the sequence of events preceding the incident, her responsibility in it, the warnings of her mother and the impact of leaving her child behind. She admitted that being with her friends was priority. She is now a comforter to new inmates. She believes that being incarcerated may have saved her life. If she had not come to prison, she may have been dead. The facilitator noted that it was riveting to hear the process of murder, which was preceded by a verbal altercation that escalated into a physical confrontation. Despite the incident being an intentional brawl, the perpetrator did not seem to realize murder would be the end result. Before the session ended, the participant shared that when she was 12, she witnessed her brother’s murder. It seems that she became detached from that day on. This aloofness eventually led to murder. This is an example of how a hurt child can become a dangerous adult, that is, how the perpetrator was once a victim herself.

5. Conclusion

As the Adverse Childhood Experiences (ACE) studies show [7], early physical and sexual child abuses produces deep shame that is lodged in the unconscious life of the person. This relational trauma and its accompanying dysregulation block the child from flourishing and enjoying life. It impedes their ability to grieve, express deep feelings of commitment, and appreciate simple experiences of joy. In essence, it destroys the child’s ability to thrive.

In our sample, 44% (n = 91) of the participants had a significant ACE score, 84% (n = 176) had moderate/severe PTSD and 41% (n = 86) had both a significant ACE score and moderate/severe PTSD. This means that during their time in The Family Program (1–6 or more years), these persons should have had severe violent acting out manifested as domestic violence, murder, suicide or destructive/abusive relationships. Instead, 98% (n = 204) of the participants in this sample who are traumatized and involved in The Family Program scored ‘excellent’, ‘good’ or ‘average’ on the Allen Resocialization Scale [12]. Without The Family Program, these participants may have been ‘poorly’ resocialized, wreaking havoc in the society. This shows some preliminary evidence that The Family support groups are a protective factor. Despite being traumatized in early childhood, participating in a Family support group can help you change your mind, which will change your life and eventually change your world.

Since this study was completed in March 2020, the COVID-19 pandemic started. Its associated restrictions led to closure of our groups, as we were not allowed to have any gatherings. This has had a detrimental effect on our participants. Many have expressed feeling depressed since not being able to meet. Some have struggled with suicidal ideations and some have attempted suicide. This phenomenon verifies the impact of The Family Group intervention, especially as it relates to providing support for the participants.

6. Limitations

1. On baseline questionnaire 22c, bronchitis is characterized with cough, cold, influenza, pharyngitis, tonsillitis, asthma, etc. As a result, a ‘yes’ response could have been to any one of these illnesses and not specifically bronchitis, therefore skewing the data. Same is true of question 22p, in terms of coding for diabetes.

2. Baseline questionnaire 20 asks the participant about regular consumption of various substances. However, it was never defined how many times per day/month/week should be considered ‘regular consumption’.

7. Software

Data were entered into Microsoft Excel and analyzed in a database created in Microsoft Access.

Acknowledgments

We acknowledge the therapists and the facilitators of the group sessions because without their support and efforts, this work would not have been possible. We also acknowledge all our participants in the program and commend them for taking the courage to embark on their journey to wholeness.

Funding details

This work is supported by the Templeton World Charity Foundation under Grant TWCF 0172.

Disclosure statement

Both authors declare that there were no conflicts of interest regarding this study. Both authors had access to the data at all times, and each had a role in writing the manuscript.