SBIRT- Executive Summary

Middle School Executive Summary MARCH 13, 2015 Implementation of Middle School Workshop designed at Kaiser Permanente Colorado to meet educational standards and improve behavioral health

Experiential Learning Project Team: Katie Rose Wall, Betty Hart

Collaborators: Curtis Robbins, Manager, Carmen Martin, MPH

Evidence-based reasons for choosing conflict resolution as a topic

 Conflict resolution is the one communication/behavioral health topic that meets both educational standards for Reading, Writing and Communicating and Comprehensive Health for 7th and 8th graders

 Conflict resolution skill building meets needs of teachers and students as ascertained from interviews by facilitator

 Conflict resolution is an evidence-based strategy to:

o improve communication

o prevent violence and bullying

o enhance emotional and social wellness through skill-building

 Conflict resolution is an evidence-based strategy that fits in the Tier 1 category of a Multi-Tiered System of Supports

 Conflict resolution skills can be evaluated and connected to the following CHNA outcomes:

o ACP 2.5.b: Development of evidence-based prevention and treatment interventions to improve behavioral health o ACP 5.1.b: Increased reach of KP’s resources in schools

o HEAL 3.2.c: Improved social and emotional wellness among children

o HEAL 3.4.a: Improved school environments to support learning

o HEAL 3.4.b: Reduced absences and truancy related to not feeling safe at school, harassment, and bullying behavior  By focusing on conflict resolution, we meet our schools and communities “where they are at” because this is a topic that aligns with educational standards and addresses behavioral health, which is also a priority for schools

Summary of Evidence - Literature Review

 Reviews of the literature suggest that the most promising programs for addressing mental health are comprehensive school-based programs that promote generic coping, competence, and social skills as opposed to focusing on specific behavioral health issues.1 Carmen Martin 1 Middle School Executive Summary MARCH 13, 2015  Middle school students, in particular, have been shown to be a highly effective population for violence prevention curriculum.3

 Youth-identified prevention strategies include anger-management and conflict-resolution programs, relationships with caring adults, and physicians counseling youth about the consequences of fighting.2

 Role-playing is an effective means to teach conflict-resolution.1-3

Reference List

1. Gigantesco A, Del Re D, Cascavilla I. A student manual promoting mental health among high school students. Ann 1st Super Sanita 2013: 49:86-91.

2. Shetgiri R, Simon CL, Tillitski J, Wilson C, Flores G. Why adolescents fight: A qualitative study on youth perspectives on fighting and its prevention. Academic Pediatrics 2015: 15:103-110.

3. Thakore RV, Apfeld JC, Johnson RK, Sathiyakumar V, Janhangir AA. School-based violence prevention strategy: a pilot evaluation. Journal of Injury & Violence Research 2014.

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Abstracts of Literature Provided in Summary

1. Gigantesco A, Del Re D, Cascavilla I. A student manual promoting mental health among high school students. Ann 1st Super Sanita 2013: 49:86-91.

OBJECTIVES: We describe a school program based on a student manual for promoting mental health and preventing mental illness. METHODS: A preliminary version of the manual was assessed for face validity by two focus groups. The final version was evaluated for acceptability among 253 students in 10 high schools and 1 middle school in Italy. RESULTS: The manual included 18 chapters (or "units") which address skills for enabling students to cope with their daily lives: communication skills, problem-solving, assertive skills, negotiation, stress management, anger management and conflict resolution. The manual was found to have been acceptable by high school students. CONCLUSIONS: The effectiveness of the manual in actually promoting mental health and preventing mental illness is currently being evaluated. 2. Shetgiri R, Simon CL, Tillitski J, Wilson C, Flores G. Why adolescents fight: A qualitative study on youth perspectives on fighting and its prevention. Academic Pediatrics 2015: 15:103-110.

OBJECTIVE: To identify risk factors for fighting, factors that protect against fighting, and strategies to prevent fighting, among adolescents who fight and those uninvolved in fighting. METHODS: Focus groups were conducted with middle and high school students, stratified by fighting (fighter/nonfighter) status, race/ethnicity, and gender. Groups were audiotaped, transcribed, and analyzed using margin coding and thematic content analysis. Themes were independently identified by 3 coders; disagreements were resolved by consensus. RESULTS: The 65 participants in the 12 focus groups were 13 to 17 years old. Reasons for fighting include self- defense, to gain/maintain respect, or anger; having goals for the future is protective. Nonfighters state

Carmen Martin 3 Middle School Executive Summary MARCH 13, 2015 that their parents condone fighting only when physically attacked and that they teach adolescents strategies to avoid fighting. Fighters describe mixed messages from parents, and pro-fighting attitudes and modeling of aggressive behavior among some family members. Nonfighters avoid fighting by ignoring insults or walking away. Fighters feel unable to use nonviolent conflict-resolution methods effectively. Peers may instigate or encourage fights. Suggested prevention strategies include anger- management and conflict-resolution programs, relationships with caring adults, and physicians counseling youth about the consequences of fighting. CONCLUSIONS: Nonfighters use various strategies to avoid fighting, whereas fighters are aware of few alternatives to fighting. Conflicting parental messages about fighting may enhance the likelihood of fighting. Physicians can counsel youth about the negative consequences of fighting. Interventions that teach anger management and conflict resolution, promote adolescent self-efficacy for using nonviolent strategies, and address parental attitudes about fighting may be effective in preventing fighting. 3. Thakore RV, Apfeld JC, Johnson RK, Sathiyakumar V, Janhangir AA. School-based violence prevention strategy: a pilot evaluation. Journal of Injury & Violence Research 2014.

BACKGROUND: Violence has recently been reported among a primarily young, minority population in Nashville, Tennessee. School-based programs have been proven as effective methods of reducing violent behavior, beliefs, and actions that lead to violence among adolescents. METHODS: Investigators implemented a rigorous search for an appropriate school-based violence prevention program for Metropolitan Nashville middle school students utilizing a systematic review and discussion group with victims of violence. 27 programs nation-wide were reviewed and 2 discussion groups with African American males under the age of 25 admitted to a level 1 trauma center for assault-related injuries were conducted. Our findings led to a single, evidence-based conflict resolution program. In conjunction with educators, we evaluated the program's effectiveness in a pilot study in a Nashville middle school with high rates of violence. RESULTS: 122 students completed the conflict resolution program and described their behavior and experiences with violence in a pre-test/post-test self-rate questionnaire. Results showed a significant decrease in violent behavior and an increase in students' competencies to deal with violence (p less than 0.05). CONCLUSIONS: This study shows that a reduction in violent behavior and beliefs among middle school students can be achieved through the implementation of a targeted violence intervention program. A larger-scale intervention is needed to develop more conclusive evidence of effectiveness. 2014 KUMS, All rights reserved.

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