“Wellbeing in Schools” at Harkin on Wellness 2024

 

Our work at WholeHealthED to close the distance between school-based adherents of gardens, mindfulness, and other whole health learning practices, and the nation’s leadership in education and child health policy, program, and funding reached a milestone on April 3, when the Harkin Institute at Drake University in Des Moines, held its annual “Harkin on Wellness” Symposium.

We were excited to co-develop the agenda and content for this year’s theme — “Wellbeing in Schools” — the first significant exposure for our whole health learning framework and its context in redressing the child and adolescent mental health crisis. It was also a continuation of our June 2023 co-produced webinar, “First Line of Defense: Confronting the Adolescent Mental Health Crisis Through Interdisciplinary Whole Child Actions in K-12” and the interdisciplinary discussions among school-based whole health learning practitioners, professionals working in children’s mental health, whole health pediatrics, and care providers finding new ways to work with schools.

Those discussions could not have begun more auspiciously than with the presence and remarks of U.S. Surgeon General Vivek Murthy MD, who participated in a stirring and spirited conversation with Rekha Basu of the Des Moines Register, who stood in for Sen. Tom Harkin who was unable to attend.

Dr. Murthy’s inspiring vision and personal commitment for resolving the child and adolescent mental health crisis, and the equally concerning grip of isolation, set a high bar for the day. He reported on the concerns he has heard from students and parents during his travels around the country, many of which stem from a pervasive sense of disconnection that remains in the wake of COVID.

“If school is a time where we should be building the foundation for a healthy life,” he pointed out, “it turns out that our relationships — our social connections — are an important part of that foundation. It’s a critical part of our well-being: just as important as learning how to read and write and learning history is learning to build healthy relationships. It’s what’s going to assist sustain us for life.”

This role of relationships and connections turned out to be the theme most mentioned by speakers and panelists during the day’s discussions, no matter their areas of work. It was heartening to hear the Surgeon General reflect our belief that wellbeing-based studies that are building those healthy relationships are as important as math, reading, and writing.

The second keynote speaker, Kathleen Ethier PhD, the director of CDC’s Division of Adolescent and School Health (DASH [ 1 ] ), described the work her division has undertaken in support of school mental health programs. Notably, this includes the guidance released earlier this year: Promoting Mental Health and Well-being in Schools: An Action Guide for School and District Leaders.

Dr. Ethier’s remarks focused on a number of non-medical intervention measures included in the Guide to respond to children’s mental duress.

“We’re not going to ‘mental health professional’ our way out of this,” she advised. Pointing to primary prevention and working “upstream” she said that the overall objective is “to help reduce the need for health service and mental health into adulthood.”

“The more emphasis we can place on prevention,” she said, “the more services to schools are going to be for kids with the highest needs.”

The six primary strategies described in CDC ‘s important guide tap into Surgeon General Murthy’s primary concerns, including to “Enhance Connectedness Among Students, Staff, and Families.” Other recommendations include promoting mindfulness and social skills, inherently activities of connection.

UnSocial Media: Preying on Vulnerabilities

In the course of his comments Dr. Murthy recounted the prevailing forces that have taken children, schools, and parents off the rails since COVID, with heavy emphasis on the pervasive, unchecked access to social media platforms; designed as he noted, “to maximize how much time people spend on them.” He added:

“Then you take an adolescent who’s going through a critical phase of brain development, when their impulse control is not fully developed, when they’re especially sensitive to social suggestion and social comparison, and what’s happening is the platforms are effectively preying on those vulnerabilities that our children have.”

He continued: “We have done a real disservice to kids and parents in the country by not putting in place actual safety standards to ensure that we demand data around safety; demand that that be shared openly with the public; and then to also make sure that we have standards in place like what we put in place for cars.”

In a June 17 New York Times editorial Dr. Murthy seriously elevated those demands, borrowing directly from tobacco and car safety: by proposing adding warning labels to social media platforms, stating: “Social media is associated with significant mental health harms for adolescents.” The Congressional action required, he said, “would regularly remind parents and adolescents that social media has not been proved safe.”

The motivation for this recommendation — no doubt developed early in the year — was plainly evident during Dr. Murthy’s remarks at the April Symposium:

“The fact that we have not put in place any meaningful safety standards at a national level,” he said, “to me is an utter failure of responsibility and it’s an abdication of one of our most sacred responsibilities as a society which is to take care of our children.”

New Collaborations with Pediatric and Mental Health Care

Following Dr. Murthy’s inspirational opening, WholeHealthED senior advisor, pediatrician Lawrence Rosen MD led off the day’s first panel discussion in unflinching fashion, drawing from his pediatric practice in north New Jersey and his role guiding medical school students as a faculty member at Hackensack Meridian School of Medicine.

Presaging Dr. Ethier’s comment later in the day about not being able to “mental health professional our way out of this,” Dr. Rosen observed that the many solutions put forward to address children’s mental health “have not worked and are not working.” The solution, he said, is “not to add more therapists and psychologists for school children.” He noted CDC’s assessment that “80% of factors that drive health are social determinants of health. Why should it be different for mental health? It’s not.”

He described a new collaboration that Hackensack Meridian has organized to understand social determinants in ways that engage the thinking and objectives of K-12 school leaders, using a newly-coined frame: Social Determinants of Learning. Later in April HMSOM convened “The Social Determinants of Learning Summit: Advancing Systemic Solutions for K-12 Well-Being” that included the New Jersey chapter of the American Academy of Pediatrics and senior state school decision makers. The purpose was to start considering truly innovative structural solutions that foster a more holistic approach to supporting students’ wellbeing. (Report of the meeting is here.)

As a participating physician later observed, “This collaboration is helping us learn more about the systemic challenges school districts face and think critically how we can impact the upstream causes.”  This will create a way to connect those causes with the tools for upstream prevention, whose implementations would be made by heads of schools.

Dr. Rosen concluded by observing that although schools have access to some positive upstream determinants, such as school gardens and nutrition education, “Unless we address the structural and social determinants of learning, we won’t see the pivotal impact we need for children’s health.”

The HMSOM Social Determinants of Learning construct was one of several emerging approaches designed to address the persistent anxiety and mental duress that are outpacing schools’ ability to push back. These include healthcare and mental health organizations who are extending therapeutic uses of lifestyle and whole health clinical measures by applying those principles to support student self-care. This approach makes the distinction between: a) treatment-and-cure and b) first-line prevention as an outcome of learning rather than treatment.

• The American College of Lifestyle Medicine (ACLM) certifies physicians and medical professionals to treat patients with physical activity, improving sleep, nutritious food, managing stress, healthy relationships, and avoiding substances. ACLM has also recognized the upstream potential of organizing lifestyle knowledge and skills for high school students. Through a partnership with firm Big Picture Learning, a Robust library of resources has been created, including books and a podcast. BPL programs provide a range of student-driven practices.
• Kaitlyn Tollefson, representing ACLM and an undergrad at U Colorado Boulder, is a co-author of the book “Teen Lifestyle Medicine Handbook” which she reported is now available at 275+ schools.
• Michelle Simon, CEO of the Institute of Natural Medicine, described how INM organized selected principles of its naturopathic clinical care4] into a 10-week nutrition education program called “Naturally Well.” Focused on preventive potential of this learning to establish lifelong habits, the program “makes the connection between health and mental health and diet and the choices students can make.” The program is geared to 4th graders, who Dr. Simon described as “particularly adept at grabbing on to concepts and becoming ambassadors for them. They get an idea, bring it home and test it out.”
• Lauren Finke, senior policy director at the Kennedy Forum, now a formidable national force on mental health policy, noted that it took the organization several years coming out of COVID to start reaching out to school superintendents. This has resulted in the recently formed School Mental Health Industry Council, which is part of the very large national mental health collaboration, the Alignment for Progress.

Cross-cutting Conversations

The inter-professional nature of the day’s panel conversations can be seen in their composition below: in which diverse experiences and perspectives may lead to new partnerships and understandings that help schools make use of all proven and available practice and learning options.

In school-based Whole Health Learning Practices:

• Laura Bakosh, Inner Explorer, a major national school mindfulness provider
• Nancy Easton, Wellness in the Schools: leading school teaching kitchens and school food systems education
• Priya Cook, Green schoolyards leader at Children and Nature Network
• Kaitlyn Scheuermann, Waukee, Iowa School District gardens leader

In community pediatric whole child health program integration and research.

• Lawrence Rosen MD,Hackensack Meridian School of Medicine; Whole Child Center
• Kaitlyn Tollefson, for the American College of Lifestyle Medicine (ACLM), and an undergraduate, U Colorado Boulder
• Michelle Simon ND, Institute for Natural Medicine
• Wayne Jonas MD, Healing Works Foundation

In school-based and community mental health

• Lauren Finke, Senior Policy Director at The Kennedy Forum
• LeMar Yeager, National Alliance on Mental Illness: NAMI Iowa
• Gerta Bardhoshi, University of Iowa Scanlan Center for School Mental Health
• Bengu Erguner-Tekinalp, Professor of Counseling at Drake University

These cross-cutting presentations presented a rare opportunity for everyone to hear and think about the mutually reinforcing intersection of whole health learning activities and traditional child health and mental health assessments in practice and described in the research.

For instance, Gerta Bardhoshi PhD, Director of Research and Training for the Scanlan Center for School Mental Health at the University of Iowa, pointed to factors through which “schools have direct influences for improving social, emotional and behavioral health,” notably to strengthen psychological nourishment:

• The academic climate
• The school community— the quality of interpersonal relationships throughout the school (those “healthy relationships” Dr. Murthy described)
• A sense of safety: both physical and emotional

From a WholeHealthED perspective, when the academic climate includes whole health learning activities the school:

• Presents added opportunities for children to be and feel successfulat school
• Establishes positive social relationshipsfrom the earliest grades through the inherent social nature of working together in school gardens, teaching kitchens, and outdoor learning programs
• These practices, in particular mindfulness, have been shown to offset mental duress by attenuating daily stress for students, and thus helping to improve the emotional climate of the school

The 80% Homeless Solution

The efficacy of even a single practice like mindfulness suggests the potential power of integration and the favorable impact on factors that underlie or exacerbate stress. Inner Explorer co-founder and CEO Laura Bakosh described the amazing journey of the Sullivan Elementary School in Tampa Florida, which was one of the 12 education honorees selected by the Harkin on Wellness team this year.

Prior to its adoption of the Inner Explorer program, Sullivan ranked at the bottom of the school district in almost every measure: on one hand reflecting a student body 80% of whom are homeless.

Principal David McMeen decided to take a leap in 2017. All classrooms and students have participated in a 10-minute audio recording every day since. As the progress chart below indicates, Sullivan’s measures have advanced every year since, very noticeably through the rise of COVID. Students are now exceeding the national averages for Math by 36% and for English by 50%. After five years, Sullivan has settled into the top echelon in the district’s school. And as a result of the school’s mindfulness experience, disciplinary problems have dropped to near zero.

(Earlier this year National Public Radio featured the Sullivan experience, which you can see in A visit to one Florida school where mindfulness is helping youngsters succeed

The NPR reporter described a somewhat surprising behavior: “They high-fived and applauded each other when their classmates got things right.” Among the outcomes that Laura Bakosh emphasized: “It is not just about data and scores; they feel better and more connected.”)

A Wellbeing Continuum: Schoolyard ←→ Doc’s Office

With the research showing that nearly 80% of adult chronic ailments are preventable and even reversible through changes in lifestyle choices, the healing properties of nutrition, exercise, sleep and rest, stress management, creating social connections, and avoiding risky substances are becoming much more valued in clinical healthcare, including in whole health research.

Now with mental duress for children and adolescents so intransigent — and the Surgeon General’s number one public health issue — awareness of the role these activities are playing in schools to offset current day stress and to bolster student health and wellbeing is even more compelling.

It is worth noting that these clinical treatments for adults — which have been effective in reversing chronic conditions like type II diabetes and heart disease — depend for their success on the guided education of patients who over time learn (often 12+ months) how to re-set and newly value their own health and the lifestyles they adopt to sustain the changes. In other words, on education.

The Social Determinants of Learning initiative that Hackensack Meridian SOM is undertaking — training its medical students while mentoring K-12 school decision makers — may presage a new collaborative understanding for health and health education in schools: recognizing that whole health principles that successfully treat chronic illness have been shown to serve as tools for first-line prevention. Made part of children’s formal education from the beginning (i.e.: far upstream), schools can

• Strengthen children’s wellbeing as a basic K-12 learning task
• Mitigate current day stress, anxiety, and adverse experiences
• Confront the terrible one-time (we hope) disruptions in youth mental health
• Create the climate for developing healthy relationships

Pediatricians who embrace preventive whole health and lifestyle principals may thus complement a neighborhood school’s programs of garden, mindfulness, nutrition, and environmental education (where available). For parents, such synchronicity may even present some measure of relief if not confidence in their school’s proactive support.

Such a scenario may seem slightly far-fetched, but it circulated in the background of the conversations during the “Harkin on Wellness” symposium in April. It also touched on WholeHealthED’s own assessment that children’s involvement in whole health learning practices while in school can make wellbeing as basic a learning competency to prepare them for adulthood as are math, reading, and writing.

Finally, the 2024 Harkin on Wellness Symposium centering on Wellbeing in the Schools was an early occasion for the kind of inter-professional dialog we’ll continue to support. It was also helpful in the early formation for a Coalition for Whole Child Wellbeing in K-12 that we are developing with many partners from the symposium and colleagues creating new learning spaces and measures for schools.

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Video Recordings

YouTube — Surgeon General Vivek Murthy MD interview with Rekha Basu of the Des Moines Register

YouTube — Complete Day Harkin on Wellness Symposium recording

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WholeHealthED thanks the Harkin Institute, Executive Director Matt Reed, and director of the Wellness & Nutrition program, Adam Shriver, for the opportunity to work so closely to bring this unique convening to the Institute.  And Sen. Tom Harkin’s long-standing leadership in efforts to improve the health of the Nation.