Schools are key players in providing comprehensive health services to children. This region currently has screening mechanisms in place for rural settings; however, there is no formal health education currently in place. The focus of this school-based intervention is on prevention of obesity and diabetes and promotion of mental health for 5th and 6th grade children in the school-setting. The focus of this presentation is on the mental health component with this intervention. At the time of intervention, the only focus on mental health was related to core peer pressure and bullying content, plus the school had a counselor present on a daily basis. Schools in this state are grouped by developmental level, and there is an opportunity to build on current programs and implement a collaborative education project focused on encouraging student responsibility.
The southeastern states have identified marked increases in mental health outcomes over the past seven years. To highlight a few, we have seen adolescent suicide rates increase from 2.6% to 4.3% and major depressive episodes increase from 8.2% to 12.5% (2011, 2015 respectively). Currently, Alabama has some of the highest adult obesity rates in the U.S. near 36.7% and poverty rates from 22.4% to 29%, which is nearly double the national average of 13.5% (2015). Diabetes rates have risen dramatically to a rate of 14.6% in Alabama (rural county Alabama County, 16%, U.S., 8%) and hypertension rates are also high at 40.4% (US 29%). These statistics show a clear need for proactive health interventions.
TigerCHAT is a school-based educational program designed to integrate discussions with 5th and 6th graders at a rural elementary school on healthy eating, wellness, and managing emotions. This weekly program was initiated in a large, rural school system in Spring 2018 and held over 10 weeks. The PI trained undergraduate nursing students alongside graduate students from multiple disciplines (e.g. nutrition, psychology, animal therapy, medicine) to deliver content over 10 sessions.
Methods: TigerCHAT was designed as a simple measure, experimental design in one large cohort of 5th and 6th graders attending this rural elementary school. The intervention was focused on health related to heart, lungs, and brain, and incorporated topics of nutrition and activity, staying healthy, and understanding/managing emotions. For each session, we had pre and post test questions, large group engagement through discussions, 10-15 minute small group (8:1) discussions and 1-2 activities implementing active learning techniques. Year one, we incorporated take home information for families in the form of handouts or mini-projects, and provided incentives when students returned with completed family work.
Results: Over the 3 month period, we educated over 500 children for 10 sessions, and had significant results on active school participation (child, family, teacher/staff: 83% very favorable). After sending weekly mini-projects to transfer TigerCHAT content, we received 22% responses from families in the home setting. Qualitative analyses have initiated thematic foci including desire, unease, and uncertain. Students self-reported emotions over a one week period (n = 420) and identified Joy (38%), Anger (34%), Fear (15%), and Sadness (13%). Additional aggregate data was identified with Adverse Child Experiences and child perception of managing emotions. At this time, we are thoroughly examining these outcomes and will share data within presentation.
Conclusion: We believe enhanced education on mental wellness had a favorable impact and belongs in the school setting. The opportunity allowed undergraduate and graduate students trained in child health to provide interactive education focused on mental health to school-aged children. We identified outcomes with more impact than regular classroom teachers for these mental health subjects. After the intervention, school-aged students initiated discussions on mental health and wellness, and identified strategies to manage emotions like anger and sadness. In the school setting, we could aim to implement mental health discussions in unison with teachers, staff, and counselors for future measurement. Students engaged with the mental health strategies recommended and actively participated.