Date of Defense:
April 20, 2018
As a social work intern at the Day Treatment program at Washburn Center for Children, my role is to provide group therapy and skills training to children ages six through eight with a variety of mental health diagnoses. Youth are generally referred to day treatment because they have challenging behaviors that make it difficult to function at school and at home. Many of these youth have experienced early traumatic experiences that impede their ability to self-regulate and allow adults to help. Each day staff and interns lead a group activity that allows clients to practice their new skills to increase their functioning across settings. The focus of this field experience was to incorporate health education into these group activities. In addition to the mental health issues these clients face, elementary aged students face a variety of physical health issues, making health education an important intervention. According to research conducted from 2011 to 2014 in children age 2 to 19 in the United States, the prevalence of obesity was 17% while the prevalence of extreme obesity was 5.8% (Ogden et al., 2016). Furthermore, data from 2015 to 2016 found a significant increase in the prevalence of obesity and severe obesity among 2 to 5 year olds (Cockrell Skinner, Ravanbakht, Skelton, Perrin, & Armstrong, 2018). This data is concerning and indicative that more needs to be done to prevent and treat obesity in this population.
The goal of this field experience was to create a pilot project to incorporate health education into one mental health day treatment classroom to increase client’s knowledge about health behaviors. The learning objectives were to design eight group activities focused on health education, primarily nutrition, to be taught over a two-week period. To accomplish this, I observed the group environment during fall semester and formed relationships with clients. This was crucial to understanding the education needs of individual students. During the spring semester, I was able to implement eight group activities that focused on teaching clients about nutrition as well as education about the function of the heart. I developed each activity using a variety of resources such as the USDA’s MyPlate curriculum. Some examples included: taste tests of different varieties of apples, making healthy snacks, and teaching kids about how to find their heart rate. These activities, as well as recommendations for use in other day treatment classrooms, will be disseminated to Center staff.
Washburn Center for Children is a non-profit organization located in Minneapolis, Minnesota. Washburn is a community mental health center that provides a diverse array of services meant to meet the mental health needs of children and families. The mission of Washburn is “to help children with social, emotional and behavioral problems, and their families, lead successful lives” (Washburn Center for Children, 2017, p. 2). To accomplish this mission, Washburn provides outpatient therapy, in-home services, school-based services, and group treatment models. In 2016, Washburn served 2,893 children and 8,700 family members (Washburn Center for Children, 2017). This field experience took place in Washburn’s Day Treatment program, which provides half-day treatment four days a week to children ages three to nine years. Although nutrition education is not typically considered the realm of a mental health clinic, my intervention fits within Washburn’s mission because nutrition education helps children become healthier, which ultimately benefits them throughout their lives.
There were numerous lessons learned from implementing education interventions into existing Center services. Mental health day treatment is a great environment for incorporating nutrition education. Because structure is so important in the therapeutic model, structured educational activities fit well into the daily activities. Even though the focus was on health and nutrition, each activity provided a chance for clients to practice the skills they were working on as part of their treatment plans (i.e. waiting their turn, following directions, using words to ask for what they need). I also found that it was possible to combine self-regulation skills into nutrition education.
The most successful activity was a food taste test in which students tasted foods (i.e. apples or salsa) and rated the food based on color, smell, and taste. Kids practiced slowing their bodies down to assess the food and practice slow, mindful eating. Although the day treatment environment was a good fit for intervention, I learned that activities had to be short, flexible, and interactive in order to be successful. Many day treatment clients struggle with inattention so it was crucial for activities to quickly engage them. Clients especially enjoyed activities where they got to use creativity to make their own individualized snack. Additionally, it was crucial that I, as a trusted adult, led the activities rather than an outside educator. Many day treatment clients struggle with forming relationships with adults, because of their past trauma, so it was important that I had relationships with all the youth in order for them to engage in each activity.
There is enormous potential in the combination of health education and mental health treatment. For other day treatment programs, I would recommend that staff utilize a planned curriculum that offers flexibility and multiple options. Because the environment of the room is constantly changing in response to the needs of youth, staff need to have freedom to tailor the activity to the needs of their group. It would be beneficial to facilitate collaboration between school curriculum and curriculum in the mental health setting. For instance, if students are already exposed to USDA’s MyPlate curriculum in school, it would reinforce their learning to review this information in another setting. Ideally, future health education interventions could incorporate family outreach to generalize knowledge from the day treatment to the home setting. Staff could send materials home with clients or having families come to the clinic.
Health education in a mental health day treatment setting is a positive step towards addressing nutrition issues in elementary age students. By exposing children to knowledge about healthy eating and information on how to keep their body healthy, health professionals can address the physical health needs of this population in addition to their mental health treatment.
Cockrell Skinner, A., Ravanbakht, S. N., Skelton, J. A., Perrin, E. M., & Armstrong, S. C. (2018). Prevalence of obesity and severe obesity in US children, 1999-2016. Pediatrics, 141(3), 1-9. doi:10.1542/peds.2017-3459
Ogden, C. L., Carroll, M. D., Lawman, H. G., Fryar, C. D., Kruszon-Moran, D., Kit, B. K., & Flegal, K. M. (2016). Trends in obesity prevalence among children and adolescents in the United States, 1988-1994 Through 2013-2014. JAMA, 315(21), 2292-2299. doi:10.1001/jama.2016.6361
Washburn Center for Children. (2017). 2016 Annual Report. Retrieved from https://washburn.org/wp-content/uploads/2014/09/2016-Annual-Report.pdf