Month: November 2017

Collaboratory on School and Child Health Helping to Develop CT Model for Trauma-Informed Schools By Beth Krane

Sandra Chafouleas, PhD Board of Trustees Distinguished Professor, Department of Educational Psychology
Sandra Chafouleas, PhD Board of Trustees Distinguished Professor, Department of Educational Psychology

A growing awareness of the prevalence of childhood exposure to trauma and an increased understanding of its corrosive, potentially lifelong impacts on health and behavior together are fueling a national movement to create trauma-informed schools, says InCHIP Principal Investigator (PI) Sandra Chafouleas. Such schools foster environments that are responsive to the needs of trauma-exposed students using systematic approaches and implementation of effective practices, the Board of Trustees Distinguished Professor of Educational Psychology explains.

Chafouleas co-authored an introduction to a special issue of the journal School Mental Health devoted to the topic and also wrote an article for the issue offering a blueprint for trauma-informed schools in spring of 2016. Since then, UConn’s Collaboratory on School and Child Health (CSCH), which Chafouleas co-directs, has been working to coalesce efforts to build a state model for trauma-informed schools in Connecticut. Steps taken include hosting a documentary screening and panel discussion, co-sponsoring a well-attended conference, helping to form a monthly working group comprised of relevant state and local stakeholders, and taking part in a series of professional development opportunities offered for educators across the state this fall.

Its initiative in this area is an example of CSCH doing precisely what it was formed to do two years ago. CSCH, which represents a partnership between the University’s Neag School of Education, Office of Public Engagement and InCHIP, brings researchers, policy makers, and practitioners together to promote the health, safety, and well-being of the whole child.

“We don’t always ask the right questions when we see a student struggling academically, missing school, or getting into trouble repeatedly,” Chafouleas said. “Once educators look at student behavior through a trauma-informed lens, it is easier to reframe their questions from blaming the child to asking what happened to the child and how can we help.”

In reframing, schools then can respond by teaching students needed coping and self-regulation skills instead of possibly re-traumatizing students with harsh discipline policies that don’t address the underlying problems, she said.

In the special journal issue, Chafouleas highlighted the Substance Abuse and Mental Health Services Administration (SAMHSA)’s four key assumptions underlying trauma-informed approaches: (1) a realization of the widespread prevalence and impact of trauma, (2) a recognition of the signs of traumatic exposure, and (3) a response grounded in evidence-based practices that (4) resists retraumatization of individuals.

Substance Abuse and Mental Health Services Administration (SAMHSA, 2014)
Substance Abuse and Mental Health Services Administration (SAMHSA, 2014)

The blueprint she wrote with colleagues shared some of the best evidence-based interventions that schools could adopt, described using a familiar framework for multi-tiered service delivery within schools – the School-wide Positive Behavior Interventions and Supports (SWPBIS) framework developed by her Neag School of Education colleague, Professor George Sugai. That framework focuses on planning, implementation, and evaluation of services across different levels of student need.

Using a multi-tiered service delivery approach, a school system might adopt a curriculum for social-emotional learning to teach all students coping and resilience, provide a smaller portion of the student body exposed to traumatic events access to in-school counseling resources, and identify an even smaller group of students exhibiting negative effects of trauma exposure and assess whether they need a combination of in- and out-of-school services. For example, in New Haven, the Clifford Beers Clinic partnered with the New Haven Public Schools and other agencies to lead trauma-informed school services. Led by the Clifford Beers Clinic, all school personnel received what Chafouleas refers to as “Trauma 101” training, students with moderate need have been offered access to an evidence-based intervention delivered in schools, and care coordinators intervene with those students and families experiencing the most toxic effects of trauma.

“Schools form a great space for addressing childhood trauma and its lasting effects,” Chafouleas said. “The kids are already there. Prevalence research estimates that two out of three children will be exposed to trauma by the age of 17. We want to facilitate the early identification of children affected by trauma, and to create ease of access to the most appropriate services to facilitate child wellbeing.”

“There are a lot of people and groups around the state who are committed to this kind of work,” Chafouleas said. “The question at the outset was, how do we bring them together to do the work more efficiently and effectively?”

Last fall, CSCH hosted one of the first screenings of the documentary Resilience: The Biology of Stress and the Science of Hope followed by a panel discussion with the film’s director James Redford; Alice Forrester, Clifford Beers Clinic Chief Executive Officer and CSCH Steering Committee Member; and Paul Diego-Holzer, Executive Director from Achieve Hartford!. The documentary chronicles the work of the researchers who discovered the long-term biological, psychological, and social effects of abuse and neglect in childhood, and highlights the efforts of pediatricians, therapists, and educators using the best evidence-based interventions to help children exposed to chronic stress. New Haven Public Schools and Clifford Beers Clinic are among those featured in the film.

Then, in the spring, CSCH co-sponsored a symposium on trauma-informed schools attended by more than 100 education, mental health, and community leaders, including an introduction by Connecticut Department of Education (CT DOE) Commissioner Dianna Wentzell. The Neag School of Education, Capitol Region Education Council (CREC), CT DOE, Ana Grace Project, Clifford Beers Clinic and the Child Health Development Institute (CHDI) collaborated with CSCH on the conference.

Throughout this fall, Connecticut Association of Schools (CAS) and Clifford Beers Clinic have sponsored five additional screenings of Resilience, coupled with panel discussions across the state, in response to educators’ overwhelming interest in learning about trauma-informed approaches. The professional development opportunities have been offered in Hampton, New London, Cheshire, Norwalk, and Torrington. Chafouleas and Forrester have each participated on many of the panels.

And a working group consisting of the symposium collaborators and additional organizations continues to meet monthly to discuss what a state model for trauma-informed schools should look like in Connecticut and to create an action plan for developing it. Chafouleas said the working group is using a multi-tiered service delivery framework such as the one presented in her blueprint as a guide, but each partner also brings its own experiences and expertise to the process.

Chafouleas said a number of CSCH’s partners have indicated they are pleased to have UConn at the table committed to working with them, from helping to identify the best-evidence based policies and practices to eventually guiding effective implementation of the model and evaluating how it is working.

 

 

 

 

 

 

 

Some Posts in Online Weight Loss Communities More Predictive of Success Than Others By Beth Krane

Likes, followers, posts. These are the signs of popularity or success on personal social media pages.

When it comes to using social media to promote healthy behaviors, research has revealed that, in those spaces too, posting more often is generally associated with better outcomes. But the frequency of posts doesn’t tell the full story, according to new InCHIP Principal Investigator (PI) Sherry Pagoto. The content of posts may matter more.

“So many people are using online communities to manage their health, but so few people study what works best in them and how people can benefit the most from them,” said Pagoto, Director of the UConn Center for mHealth and Social Media. “We want to understand what types of posts by participants are most associated with healthy behavior changes.”

Sherry Pagoto, PhD

Pagoto, a clinical psychologist and Professor of Allied Health Sciences, moved to UConn and joined InCHIP this fall from the University of Massachusetts Medical School, bringing with her more than $6 million in federal grants, her Center, and its staff of 10. Pagoto’s collaborator, Molly Waring, an Assistant Professor of Allied Health Sciences and an InCHIP PI, also made the move.

The new InCHIP researchers are using a grant from the National Heart Lung and Blood Institute (NHLBI) to conduct a series of pilot studies examining engagement in online weight loss communities. Pagoto, the grant’s PI, will present their latest findings in early January at the Hawaii International Conference on System Sciences (HICSS), and the findings will be published in the conference proceedings.

The research team found that the three most common types of posts from a 12-week Facebook-delivered weight loss program were: (1) reporting a healthy choice such as “I just declined a doughnut. Go me!” (23%), (2) acknowledging another participant’s post such as “Great post!” (21%), and (3) sharing a challenge or slip-up such as “Ate way too much at the party!”(13%). The least common types of posts were: (1) negating such as “This recipe has broccoli. I hate broccoli” (1% percent), (2) irrelevant such as “Anyone see the game last night?” (2.5%), and (3) asking for help with a problem such as “I need ideas for low-cal snacks” (4%).

 

The types of posts most associated with weight loss were: reporting a healthy choice, asking for help with a problem, sharing a specific plan to eat better or exercise, and sharing progress on weigh-in days.

“We were intrigued that two types of posts that seemed similar – reporting a challenge and asking for help – actually were quite different in terms of predicting weight loss,” Pagoto said. “Reporting a challenge was one of the most common types of posts, but it wasn’t associated with weight loss. Asking for help was one of the least common types of posts but one of the most predictive of success. Asking for help is more proactive than just stating a problem and likely resulted in some ideas on how to move past the problem.”

Her team is testing ways to encourage participants to be more proactive in asking for help and to post content more likely to result in receiving personalized feedback and support from counselors and other participants.

After each study of online engagement, Pagoto’s team conducts focus groups with participants. Some have said they are not comfortable posting with strangers. Others are unsure of what to say.

“We are working on creating a supportive, confidential environment to make participants feel more at ease about participating. A weight loss group is also a new use of social media for a lot of people, so some might not be sure what is appropriate to post. We coach them on how to get the most out of these communities by telling them about what kind of posts are associated with greater success.”

Using popular social media platforms like Facebook to deliver behavioral interventions allows the researchers to reach the most people and to save time and money they otherwise would have to spend developing and marketing apps and websites. One potential drawback to social media delivery, however, is that people are used to sharing only good news on their personal social media pages, Pagoto said. This may account for why participants in the current study spent the most time reporting healthy choices they had made and less time asking for help.

“It’s a mental pivot for a lot of people, how to use one of these online communities differently than their regular social media pages,” Pagoto said. “When people do go out on a limb and share they have a problem, though, it’s actually very well-received. Other participants swoop in and offer advice, and they report that it made them feel better, not so alone.”

One of the research team’s next studies of engagement in online weight loss communities will test what happens when participants are allowed to invite family members and friends to join the community. The study will examine whether participants contribute more and ask for more help solving problems when they know people in the group and whether the number of people invited makes a difference.

While a number of her projects leverage existing social media platforms, Pagoto also is in the process of developing three mobile apps for weight loss.

“We’re moving toward integrating apps that help people with health behavior change, with social media communities that support them,” Pagoto said.

 

A New InCHIP PI Is Testing a Postpartum Weight Loss Intervention on Social Media By Beth Krane

New InCHIP Principal Investigator Molly Waring is bringing a postpartum weight loss program to women where they already come together – Facebook.

Molly Waring, PhD (Allied Health Sciences)
Molly Waring, PhD (Allied Health Sciences)

Waring specializes in technology-based weight loss interventions for women of childbearing age. She understands that new moms are extremely busy and don’t always have time for weight loss programs with in-person meetings. Waring also knows that more than 80% of online moms use Facebook, the most popular online social network, and about half of those moms already seek social or emotional support about parenting issues online.

“Delivering our intervention via Facebook allows us to connect with postpartum women where they are, more fully integrating into their lives and daily routines,” said Waring, an epidemiologist and an Assistant Professor of Allied Health Sciences. “A mom in our study may be looking at updates from her high school friends or photos of her sister’s vacation on Facebook, but then she’ll also see a post that says, ‘What’s your plan to be active today?’ or a post starting a conversation about stress management or how to get support from family or friends around lifestyle changes.”

Waring and her collaborator Sherry Pagoto, professor of Allied Health Sciences and Director of the UConn Center for mHealth and Social Media, joined UConn’s faculty this fall from the University of Massachusetts Medical School. Both Pagoto and Waring lead programs of research that merge the most compelling scientific evidence for health behavior change with technology and popular social media platforms to deliver interventions that are effective, convenient, and sustainable.

Waring and her team of researchers, including Pagoto, conducted a successful pilot study of their Facebook-delivered weight loss intervention for postpartum women to see if women would be interested in it and stay engaged. The findings of this pilot study, which will be published in the Journal of Nutrition Education and Behavior in early 2018, include a retention rate in the 12-week program of 95%, with 100% of women visibly engaging in the last four weeks of the intervention including 42% who engaged on the last day of the study.

Women enjoyed the intervention and achieved results participating in it, Waring reports in the article. More than 80% said they would participate in the program again and recommend it to a friend. Nearly 60% lost at least 5% of their starting weight.

women running on treadmills

Now, with a new three-year grant from the National Heart Lung and Blood Institute (NHLBI), Waring, the principal investigator, and Pagoto, a co-investigator, will build on their pilot study and conduct a randomized controlled trial involving 72 postpartum women who are overweight or obese and who gave birth 6 weeks to 12 months ago. Participants will be randomly assigned to receive a weight loss program designed for new moms delivered either in a private Facebook group or via weekly in-person group meetings.

All of the women in this trial will receive a lifestyle intervention based on an existing program but adapted for postpartum women, so it covers, for example, the caloric needs of nursing mothers, safe exercises to do in the early postpartum period, and fun ways to exercise with your baby. There will be a topic for each week of the program, ranging from diet and exercise to sleep, social support, and stress management.

Half of the women in the study will attend one 90-minute in-person group meeting with a trained coach each week, and the other half will be part of a private Facebook group in which a trained coach will post information twice a day, which women will see as part of their regular Facebook feeds.

”I’m predicting that women who participate in the weight loss program via Facebook will lose about the same amount of weight as women attending traditional weight loss meetings, but that Facebook delivery will be more convenient, cost-effective, and sustainable,” Waring said. “And that ultimately gives our Facebook-delivered intervention an edge in terms of potential for impacting women’s lives.”

Pregnancy and the postpartum period are critical times to change women’s weight trajectories, she said.

As many as half of postpartum women are at least 11 pounds heavier one year after delivery than they were pre-pregnancy. Pregnancy weight gain that isn’t lost after delivery also can lead to obesity for some women. A recent study found that 30% of women who were normal weight pre-pregnancy were overweight at one year postpartum, and 44% of overweight women had become obese.

Waring hopes to ultimately reach as many postpartum women as possible, and delivering the intervention through a widely available social media platform such as Facebook, can help with this goal. In addition to helping women lose weight after having a baby, Waring and her team aim to create a ripple effect that also positively impacts women’s families.

“We’re trying to catch women at a time in their lives when many are already highly motivated to make healthy behavior changes for themselves and their new babies. For instance, some women may give up smoking when they become pregnant,” Waring said. “It’s a great time to help women make choices that result in healthier lives for themselves and for their children.”

 

InCHIP Newsletter Nov 2017: Letter from the Director

In what promises to be a watershed year, we are off to a great start this fall at InCHIP with exciting new health behavior change research, and training programs and opportunities.

As always, we have a fabulous Lecture Series, with presentations by some of the best in our field at InCHIP on many Thursdays at 12:30 pm during the academic year. Presentations are live streamed and archived if you cannot attend in person.  If you are able to attend in person, you get a free lunch!

This year, for the first time, our Intervention Core will be offering an exciting series of workshops on aspects of the art and science of developing and implementing strong, state-of-the-science behavioral interventions. Our Training and Development Core (T&D Core) and our Community-Engaged Health Research Core have important developments in the works as well. The T&D Core is offering a Grant Writing Boot Camp comprised of ten sessions this academic year, and will create and support interdisciplinary mentoring teams for UConn faculty who are interested. The T&D Core will also host a manuscript writing group and a Graduate Student Writing Institute.

The Community-Engaged Health Research Core (CEHR Core) has developed a new listserv for people interested in community-based participatory research (CBPR) and other types of community-academic research partnerships to share their knowledge and experience in order to contribute to the field of CBPR and address Connecticut’s public health issues. People from Connecticut-based community organizations, academic institutions, and funding agencies as well as decision makers and policy makers with an interest in community-engaged health research in Connecticut are encouraged to subscribe. In addition to the listserv, InCHIP is offering a new type of InCHIP affiliation for those who work for community-based organizations and are interested in collaborating with InCHIP faculty. Lastly, the CEHR Core will be hosting a networking event in May 2018 for UConn researchers and community-based organizations interested in collaborating on research that addresses priority health issues in Connecticut (more details to follow).

Be sure to check the links for the various InCHIP events being offered (above), and sign up for them now, as some have limits on number of participants.

This year’s InCHIP seed grant opportunities include InCHIP Rolling Seed Grants to Develop New Interdisciplinary Teams, InCHIP Seed Grants for Faculty/Researcher Affiliates, and an InCHIP Community-Engaged Health Research Seed Grant. We will also be sponsoring the first ever InCHIP Knowledge Integration Sandbox with the goal of developing novel and transformative hypotheses for complex behavioral health problems in real time, and funding the most promising research plan which develops.

As many of you know, I am retiring in August 2018, and there is a national search underway for my successor. Recruitment and interviews will kick into high gear early next semester. The plan is to have preliminary telephone or Skype interviews in early January, followed by onsite interviews in late January and February. There will be many opportunities for InCHIP affiliates to meet the candidates, hear their presentations, and give their opinions to the search committee, so please participate. It is hoped that the new Director will be in Storrs in time to work in tandem with me for a few months before I move on to other things, the first of which will be a safari with my family to see the great migration in Kenya or Tanzania. I am excited to enter a new phase that will involve more free time, but also continued involvement in interesting scholarly projects.

All the best,

 

Jeffrey D. Fisher, Ph.D.

Board of Trustees Professor of Psychological Sciences

Director, Institute for Collaboration on Health, Intervention, and Policy (InCHIP)

University of Connecticut

A New InCHIP Grant Investigates Americans’ Perspectives on Health Equity By Beth Krane

A leading U.S. health foundation has enlisted an InCHIP expert to assist in its efforts to help build a national “culture of health.”

The Robert Wood Johnson Foundation approached UConn Associate Professor of Anthropology Sarah Willen to help broaden and strengthen its understanding of Americans’ perspectives on health equity and deservingness. The Foundation’s “culture of health” framework aims to promote health equity and cultivate a sense of health as a shared value.

Sara Willen, PhD (Anthropology)
Sara Willen, PhD (Anthropology)

With help, in part, from an InCHIP Rolling Seed Grant and advice from mentors at both InCHIP and CDC, Willen responded to the Foundation by building an interdisciplinary research team and advisory board, conducting a two-day planning workshop, and preparing a detailed proposal.

The Robert Wood Johnson Foundation awarded Willen and her research team a two-year grant to support a two-phase study, ARCHES (AmeRicans’ Conceptions of Health Equity), which launched last month. The team is beginning by conducting interviews in Cleveland, Ohio, with Americans from diverse socioeconomic, professional, and racial and ethnic backgrounds, and then will use those qualitative findings to develop and conduct a national survey. An additional study component is an ethnographic study of HIP-Cuyahoga, a regional health equity initiative based in Greater Cleveland.

Willen and her team plan to investigate “how Americans think about a question that plays a pivotal, but largely implicit, role in American public discourse about society’s obligations to its members – the question of ‘who deserves what in the health domain, and why,’” she said.

“Often we hear health researchers and folks in public health say things like, ‘Everyone deserves to live the healthiest life possible,’” Willen said. “That’s a bold statement, and we don’t know whether it’s supported by all Americans. In fact, it’s possible some see things quite differently. Our goal is to develop a better understanding of how people’s moral values and personal experiences influence their views and their actions.”

Willen’s focus on health-related deservingness emerged from her research on unauthorized migration and health in different countries, including Israel.

“Health researchers who work on international migration know full well that ideas about who is and who is not deserving of attention or investment vary considerably from one country to the next,” said Willen, who also directs the Research Program on Global Health and Human Rights at UConn’s Human Rights Institute. “Whether we are health officials, policymakers, voters, or researchers, our views are always influenced by moral values and commitments that tend to remain unspoken.”

“Now we want to open up these questions and pursue them more broadly here in the U.S.,” Willen said. “How do people think about what they themselves deserve in the health domain? How do people’s views and experiences influence their ideas about what others deserve? And, moreover, how might these ideas change over time?”

Willen said her group will examine how individuals’ positions on these issues might affect their health behaviors as well as their perspectives on health disparities, sense of social interconnectedness, and level of civic involvement.

Willen’s core research team includes co-investigators Colleen Walsh, an Assistant Professor of Health Sciences at Cleveland State University, and Abigail Fisher Williamson, an Assistant Professor of Political Science and Public Policy & Law at Trinity College, as well as UConn Anthropology PhD Candidate William Tootle, Jr. The project also involves research consultants from Brown University, Case Western Reserve University, Cleveland State University, Syracuse University, and University of South Florida.

The first study phase, in Cleveland, involves interviews with 140 people, including elected officials, public health professionals, community leaders, philanthropists, clergy, and local residents. Half of those interviewed will be active in HIP-Cuyahoga, and half will not. Researchers also will attend HIP-Cuyahoga meetings, observe its events, and track its public messaging.

Willen chose to conduct the study’s first phase in Cleveland because it is similar to many American cities, yet also exhibits some of the country’s greatest disparities in health outcomes by race/ethnicity and class, including indicators like infant mortality, childhood lead exposure, and life expectancy. And HIP-Cuyahoga presents a nationally-recognized model for responding to those health inequities.

The second phase of the study will test the team’s qualitative findings with a national survey of 3,000 Americans.

Willen said InCHIP Director Jeffrey Fisher, InCHIP Associate Director Amy Gorin, and InCHIP PI and Director of the Rudd Center for Food Policy and Obesity Marlene Schwartz, who has worked extensively with the Robert Wood Johnson Foundation, were all instrumental in helping her respond to the Foundation’s initial interest in her research.

In accepting the grant, Willen has committed to a host of deliverable products including academic papers and presentations, a case study and teaching module focusing on HIP-Cuyahoga, blog posts, and op-ed pieces for mainstream media.

“One of the most exciting things about working with RWJF is their challenge to consider the implications of our research from the outset, ” Willen said. “Not only do we need to produce rigorous findings, but we also need to think constantly about the bigger questions that researchers sometimes neglect: Why does this matter? Who should care about our findings, and how can we make our findings accessible to the right people, in the right way? How might our work change minds?”