Program evaluation of a school-based mental health and wellness curriculum featuring yoga and mindfulness

BACKGROUND

Interest in the effectiveness of mindfulness-based interventions such as yoga in primary schools has grown. Evidence shows promise, as youth who engage in yoga to promote mindfulness show improved coping skills, increased socio-emotional competence and prosocial skills, academic performance, attention span, and ability to deal with stress.

OBJECTIVE

This study reports the results of a program evaluation of a universal health and wellness curriculum, Pure Power, designed to teach youth yoga techniques, mindfulness, and emotion regulation.

METHODS

A non-randomized comparison design examined outcomes among participants from schools that completed the intervention with highest fidelity of implementation (n = 461) and from students in matched comparison schools (n = 420). Standard measures of coping, emotion regulation and emotion dysregulation, spelling, and math achievement were collected.

RESULTS

Analyses suggest the youth in the intervention schools demonstrated relative improvement on measures of emotion regulation, spelling, and math.

CONCLUSIONS

Challenges in implementation in real-life settings are vital to identify. The data provide some real-world evidence for the effectiveness of a universal health and wellness curriculum on emotion regulation and positive academic outcomes. Training school staff to deliver the intervention may foster implementation. Future research should test the effectiveness of who delivers the intervention; for example, teacher-delivered groups vs. other wellness personnel.

Impact of anxiety and depression on academic achievement among underserved school children: evidence of suppressor effects

Anxiety and depression symptoms may leave children at risk for lower academic scores, though this unique linkage to academic achievement in underserved youth is less well established. This study aimed to examine how anxiety and depression are uniquely related to spelling and math achievement beyond attention and hyperactivity deficits in children in underserved schools. Children aged 8 to 11 (n = 1085, 47.3% female) from historically underserved groups (Hispanic 75.3%, American Indian 6.4%, Black 4.9%, and White 1.5%) from 13 schools across two public school districts in California participated in the assessment of emotional and behavioral health symptoms that included a spelling and math assessment. While there was no relationship between anxiety or hyperactivity on spelling and math scores, depression and attention problems were significantly negatively related to spelling and math scores. However, when entered simultaneously, evidence of suppressor effects emerged. Anxiety and hyperactivity both became positively predictive of math. Similarly, anxiety became positively predictive of spelling. Subsample analyses showed that these suppressor effects were only in females. The associations among anxiety, depression, attention, and hyperactivity with spelling and math achievement are complex, and when controlling for depression and attention, anxiety levels and hyperactivity may be motivating some level of achievement in these areas.

A school-based health and mindfulness curriculum improves children's objectively measured sleep: a prospective observational cohort study

STUDY OBJECTIVES

Poor sleep impedes children's cognitive, emotional, and psychosocial development. Pediatric sleep dysregulation is common, and children who live in communities of low socioeconomic status experience additional risk factors for short sleep duration and poor sleep quality. School-based training in mindfulness and yoga-informed practices can improve children's behavior and well-being, but effects on objectively measured sleep are unknown.

METHODS

Effects of a school-based health and mindfulness curriculum, which taught practices such as paced breathing, on sleep and stress were examined in 115 children (49 girls, ages 8 to 11 at baseline). Fifty-eight children in a community of low socioeconomic status received the curriculum twice weekly for 2 years. Fifty-seven children in a socioeconomic status-matched community engaged in their usual physical education class instead. In-home ambulatory polysomnography and perceived social stress were measured in all children at 3 time points: at baseline (ie, prior to curriculum exposure) and at 2 yearly follow-ups.

RESULTS

Children receiving the curriculum gained an average of 74 minutes of total sleep time, and 24 minutes of rapid eye movement sleep, per night over the 2-year study period. Children not receiving the curriculum experienced a decrease in total sleep time averaging 64 minutes per night, with no changes in rapid eye movement sleep. Sleep improved within the first 3 months of curriculum exposure, in a dose-dependent fashion. Higher curriculum engagement (eg, using the breathing exercises outside of class) was associated with larger gains in total and rapid eye movement sleep duration. Aggregate within-group changes in social stress were not significant. However, among children receiving the curriculum, those who experienced larger gains in total and rapid eye movement sleep duration also experienced larger increases in perceived social stress.

CONCLUSIONS

A school-based health and mindfulness curriculum improved children's objectively measured sleep over 2 years. Social stress did not mediate these effects; instead, mindfulness training may have increased awareness of environmental stressors, while developing tools to reduce stress vulnerability.

CITATION

Chick CF, Singh A, Anker LA, et al. A school-based health and mindfulness curriculum improves children's objectively measured sleep: a prospective observational cohort study. J Clin Sleep Med. 2022;18(9):2261-2271.

642 A School-Based Health and Mindfulness Curriculum Improves Children’s Objectively Measured Sleep

Introduction

Children of low socioeconomic status (SES) experience shorter sleep duration and poorer sleep quality, as well as more daytime sleepiness, compared to children of higher SES. Early interventions teaching skills for managing stress may mitigate the effects of SES-associated stress on trajectories of physical and mental health. We examined effects of a school-based health and mindfulness curriculum, teaching stress management skills such as paced breathing, on sleep and stress in school-aged children. We hypothesized curriculum exposure would improve children’s ability to manage stress, and that this would improve objectively measured sleep (i.e., increase duration of total and REM sleep).

Methods

Using a prospective observational cohort design, we recruited 115 children (49 girls, ages eight to 11) from two Northern California school districts. Of these, 58 children attended a school district that delivered a health and mindfulness curriculum twice weekly during their physical education time. 57 children attended an SES-matched school district that delivered a traditional physical education curriculum. Ambulatory polysomnography and perceived social stress were measured at baseline (before curriculum exposure) and at one- and two-year follow-ups.

Results

Children receiving the curriculum gained an average of 74 minutes of total sleep and 24 minutes of rapid eye movement (REM) sleep per night during the two-year study period. Children not receiving the curriculum experienced a decrease in total sleep of 64 minutes per night, with no changes in REM sleep. Sleep improved within the first three months of curriculum exposure. Children who reported higher curriculum engagement (e.g., using the breathing exercises at home) experienced larger changes in sleep architecture and perceived social stress. Social stress did not mediate effects of the curriculum on sleep.

Conclusion

We conducted the first study to examine effects of a school-based health and mindfulness curriculum on children’s objectively measured sleep. Children from a low-SES community who received the curriculum experienced increased total and REM sleep, compared to an SES-matched cohort not receiving the curriculum. Mindfulness training may have increased awareness of stress, while developing tools to reduce stress vulnerability. These results warrant additional investigation to assess whether benefits persist after curriculum cessation and/or generalize to other populations.

Support (if any):

Cue-Centered Therapy for Youth Experiencing Posttraumatic Symptoms

Purpose

Few of the existing evidence-based interventions for child trauma exposure were specifically designed to address experiences and outcomes of complex developmental trauma. Stanford's cue-centered therapy (CCT) was designed to address this gap by offering a flexible, integrative, and insight-oriented treatment approach that is grounded in principles of neuroscience, developmental trauma, client empowerment, and allostasis. This article reviews the CCT rationale, treatment components, evidence base, and training approach.

Recent findings

Studies demonstrate promising outcomes indicating CCT effectiveness in reducing child and caregiver posttraumatic stress, and in improving child functioning. Further research, however, is needed to identify which clients are best-suited for CCT (versus other available child trauma treatments) and to identify which components of CCT are most critical for addressing complex developmental trauma.

Summary

CCT advances the field of child trauma treatment by offering an intervention approach focused on addressing complex developmental trauma. Positive treatment and training outcomes indicate utility of CCT for clients and clinicians. Innovations in research and training approaches are needed to further dissemination and implementation of CCT and other related child trauma interventions for complex developmental trauma.

Tobacco use and its treatment among young people in mental health settings: a qualitative analysis

BACKGROUND

Youth with psychiatric disorders are at increased risk of tobacco use. Outpatient mental health settings have received little investigation for delivering tobacco treatment. This study obtained formative data to guide development of a tobacco cessation program for transitional age youth with co-occurring psychiatric disorders with a focus on outpatient mental health settings.

METHODS

Applying qualitative methods, we analyzed transcripts from interviews with 14 mental health clients (aged 16-23) and 8 mental health providers.

RESULTS

The youth identified internal (nicotine addiction and mood), social, parental, and media influences to their use of tobacco. Providers' viewed youth tobacco use as a normative developmental process, closely tied to management of psychiatric symptoms, supported by parents, and of lower priority relative to youth alcohol and illicit drug use. Youth and providers believed that clinicians can do more to address tobacco use in practice and emphasized nonjudgmental support and nondirective approaches. Top recommended quitting strategies, however, differed notably for the youth (cold turkey, support from friends, physical activity, hobbies) and providers (cessation pharmacotherapy, cessation groups, treatment referrals).

CONCLUSIONS

Mental health providers' greater prioritization of other substances and view of youth smoking as developmentally normative and a coping strategy for psychopathology are likely contributing to the general lack of attention to tobacco use currently. Integrating care within mental health settings would serve to reach youth in an arena where clinical rapport is already established, and study findings suggest receptivity for system improvements. Of consideration, however, is the apparent disconnect between provider and youth recommended strategies for supporting cessation.