We will partner with Charlottesville City Schools to pilot a mindfulness-based health curriculum, develop and test a protocol to examine student health outcomes, and pursue funding for a larger study.
This pilot project will (1) build upon both a) an existing partnership with Charlottesville City Elementary Schools (CCS) to integrate mindfulness and compassion practices into health education programming, and b) a recently created clinically integrated network that captures data to improve quality and cost of pediatric care;(2) pilot an innovative mindfulness-based health curriculum in one elementary school; (3) develop and test a protocol to examine student health outcomes, and (4) develop a grant proposal to NIH-NCCIH for a larger study.
We hypothesize that a set of mindfulness and compassion activities, already developed at UVA, can be implemented in an affordable fashion in Charlottesville elementary schools, and thereby improve the quality and reduce the cost of children’s health.
Existing Partnership with Charlottesville City Schools:
The Curry School and the Contemplative Sciences Center have been building relationships with the Charlottesville City Schools over the past 18 months. In the spring of 2017, Superintendent Dr. Rosa Atkins met with Dr. Jennings to discuss the latter’s research on mindfulness-based programs for teachers and children. This conversation began a year-long exploratory case study to examine the receptivity of the principals and teachers to mindfulness-based approaches in education. During the 2017-2018 school year, Jennings and two doctoral students provided workshops to teachers, introducing them to the concept of mindfulness and providing an overview of research-based activities that teachers could incorporate into their classrooms and found strong interest in such approaches. The proposed project has the potential to build on this existing relationship to pilot the Compassionate Schools Project Curriculum to children at one elementary school and examine the impacts of the program on students.
Fortify Clinically Integrated Network (CIN):
Importantly, the infrastructure to support this project has recently been established by the UVA Health System. On July 1, 2018, the University of Virginia Children’s Hospital and the Children’s Hospital of the King’s Daughters announced the formation of the nation’s first all-pediatric clinically integrated network that is supported by two independent academic health centers. The network (called Fortify Children’s Health) will establish digital and personnel infrastructure that will improve the coordination of clinical care and enable the pursuit of meaningful clinical metrics. The network will enroll primary care practices initially in the primary service areas of the two institutions (but not necessarily affiliated with either), and ultimately extend across the entire Commonwealth. The aims of the network will be to provide better clinical outcomes, a healthier population, more satisfied providers and families, and reduced cost of care. The IT platform for the network will enable to capture of meaningful health and economic data, including producing reports that will facilitate the proposed research.
Self-control, stress management, self-care, and healthy choices have a critical impact on children’s lives and the quality of life and productivity in their communities. The Compassionate Schools Project (CSP) curriculum teaches students to take care of themselves and care for others, while providing a foundation for their lifelong physical, emotional and social well-being. Designed by leading educational researchers from the Curry School of Education and Human Development, CSP is the first health curriculum to combine mindfulness, social and emotional learning, fitness, and healthy food choices. These skills are not typically taught in school, despite the central role that education could play in encouraging healthy lifestyles. The proposed project will test in Charlottesville a compassion-focused curriculum that is scientifically developed, user-ready, and which fits practically with the standards and practices of our schools. The curriculum is designed to be delivered during two 45 minute sessions per week across an entire school year. The curriculum has three levels corresponding to grades K-1, 2-3, and 4-5. The CSP curriculum emphasizes four major areas of work:
· Social and Emotional Learning.In this curriculum, students learn the social and emotional skills that years of research have demonstrated are critical to lifelong achievement. Five SEL primary skills have been identified: self-awareness, social awareness, relationship skills, self-management, and responsible decision making. These skills have been associated with a more cooperative learning environment, positive social behavior, fewer behavioral issues, less emotional distress, and improved academic performance. Learning such skills has been shown to improve academic achievement by an average of 11 percentile points.
· Mindful Awareness. The curriculum includes exercises and information to increase mindfulness or self-awareness, and the ability to stop, think, monitor oneself, and act with care. Mindful awareness practices can add value to social and emotional learning by providing explicit instruction in techniques that enhance self-awareness and self-management. Mindfulness also contributes to critical stress management and self-control skills that enable children to be more able to focus in class, to be ready to learn, and to be persistent toward achievement. These also will reduce behavior problems and student-to-student conflicts.
· Physical Health and Agility.Students learn strategies to maintain physical health through wellness exercises. These include learning stretches, poses, movement sequences, and monitoring of one’s body to improve agility, fitness, and self-control. Such exercises have been shown to not only improve these skills, but also to promote positive body image, and lead students to feel calmer and more ready to learn. The practice of the poses also serves to support self-awareness, self-control, and compassion for others.
· Nutrition and Mindful Eating.The fourth component is designed to apply mindfulness to promote eating competence, the ability to recognize how different eating habits and foods make us feel. The curriculum includes skills for making good choices in eating and in minimizing overeating. It aims to foster healthy eating and exercise patterns that will last a lifetime, can prevent immediate and long-term health problems, and help children develop their full academic potential.
Upon receiving funding, we will begin the project by meeting with our colleagues at CCS to begin planning the delivery of CSP. Together we will identify one elementary school as a site for the CSP pilot. We will employ one existing doctoral student who will deliver CSP in the school. We will work with the district, the Commonwealth and the Clinically Integrated Network (see below) to identify children for whom we will be able to access data. While the curriculum is being delivered, investigators will begin the process of obtaining IRB approval and consent for accessing children’s health and school data. Classrooms within the school will be randomized to the CSP condition or a treatment-as-usual condition. We will collect data from two time points: pre-treatment (end of the 2017-2018 school year) and post-treatment (end of the 2018-2019 school year). ANCOVA with pre-treatment measurements as a covariate will be used to examine the impact of CSP on student health and school outcomes. Because this is a feasibility pilot study, we will estimate effect size ranges from the study output, which will inform required samples size in the subsequent larger study. Using this output, a post-doctoral fellow will be employed to begin the process of writing a grant proposal to NIH to conduct a larger RCT of CSP in the Charlottesville and Albemarle County schools. Educators and parents will be invited to participate in focus groups that will be led by a Curry graduate student with training in qualitative methods. This student will also analyze these data and create a report, the results of which will be included in the NIH proposal.
The outcome measures we will track will include (but not be limited to) those recognized by the Virginia Department of Health as drivers of both quality and cost for children’s healthcare. Thus, success in moving these metrics will greatly improve the likelihood that the interventions we propose can be disseminated among elementary schools throughout the Commonwealth. On August 29, 2018, one of the investigators (JPN) discussed the proposed project with Virginia Secretary of Health and Human Resources, Dr. Daniel Carey, who suggested that the following metrics be followed to enable VA Medicaid to consider broader implementation under Virginia’s Plan for Well-Being. The relevant elementary school metrics for this proposal would include 1) “Percent of Children Who Do Not Meet the PALS-K Benchmarks in the Fall of Kindergarten and Require Literacy Interventions”; and 2) “Percent of Third Graders Who Pass the Standards of Learning Third Grade Reading Assessment.” These will be tracked by the Commonwealth and shared with our team. In addition, using our Network information technology (IT) infrastructure (see below) we will track prescription medication use (particularly medications given for mental and behavioral health complaints), emergency room and sick visits, hospital admissions, and compliance with care for chronic conditions. Of note, the Provider Agreement signed by all participating pediatric practices secures consent to capture and report the data relevant to the proposed project. In this project, we will identify students who are enrolled in the project, and generated reports every six months on the outcome measures proposed above. Providers will remain blinded as to what, if any, interventions the children are receiving in the schools.
The resources required for this project are largely already in place in the schools, at UVA Curry School, and as part of the Fortify Children’s Health CIN. The proposed project will leverage the first inter-connection of these powerful resources.
The total cost of this project is $60,000.
Personnel:As described above, we will employ two doctoral students and one post-doc for a total cost of $30,037 (Post-doc 11.7%, $6,554 in salary and $1,846 in fringe, total $8,400. GRA #1 Mischenko 50%, $9,000 in pay, $6,719 in tuition, $1,418 in health insurance. GRA #2 is 25%, $4,500 in pay).
Supplies:To deliver CSP in one school costs $15,000 for yoga mats, books and other supplies.
Equipment:We will purchase 2 laptop computers for this project at $700 each ($1400 total).
Publication Costs:We will spend $13,563 to print the CSP curriculum for use in the schools.
As a result of this project, we will obtain pilot data that will give us a preliminary indication of CSP’s efficacy for impacting the measures described above and will support our efforts to obtain further funding for expanding the project to examine the impacts of CSP with a larger sample of children.
This project will engage students in several schools and at multiple levels. We will hire Polina Mischenko, a 3rdyear Curry doctoral student, to deliver CSP in the elementary school. Polina has been working with Prof. Jennings on the CSP curriculum and has been studying CSP teaching quality. She is well-qualified to perform this job. Since she has finished her coursework and her comps, she has 50% of her time to devote to this project. A Curry graduate student will collect and analyze qualitative data (25% effort). We will engage Curry Youth and Social Innovations undergraduate researcher as volunteer research assistants. Finally, we will hire a post-doc working in the School of Medicine to help with data analyses, writing the NIH grant proposal and supporting our efforts to disseminate our findings (11.7% effort).