1 Getting through Change with the Power of Education by Annica Coombs A proposal submitted in partial fulfillment of the requirements for the degree of MASTER OF EDUCATION with an emphasis in FAMILY LIFE EDUCATION WEBER STATE UNIVERSITY Ogden, Utah December 14, 2023 GETTING THROUGH CHANGE WITH THE POWER OF EDUCATION 2 Acknowledgments I want to thank my very supportive family as I worked to finish this project and my master's degree. To my husband Trent and two boys Landon and Jedi, thank you for helping me apply what I learn on a daily basis and cheer me on with all that I set out to do in life. To my twin sister, best friend, business partner, and womb-buddy, thank you for talking with me daily and providing clear insights with ideas and thoughts. Creating and teaching with you is the best! I love that you can read my mind and we are so in sync in life. I look forward to many more fun times together! To my mom and dad who instilled a love of learning, helping others, and the importance of family. You supported me through all my waves of change and continue to do so as my guardian angels. I love and miss you both dearly. Thank you to all the amazing teachers in my life, in particular to the professors at Weber State University. You guided me through this whole process of finishing a master’s degree and creating a thesis project that radiates from the core of me. I learned so much from each one of you and I appreciate the friendships I have gained. Your example is ingrained in me, and I desire to pay it forward to those I help and teach. I believe teaching is the greatest profession to be a part of! GETTING THROUGH CHANGE WITH THE POWER OF EDUCATION 3 Abstract Change is an inevitable part of human lives. Change can come from a variety of sources including external or internal factors, as well as from the choices an individual makes and/or the choices that others make. Regardless of the source of change it can increase stress, impact an individuals’ health, and affect the relationships in the family unit. During times of stress, having support and access to resources of education can impact an individual and a family’s resilience and further help them cope. Unfortunately, in many communities the number of individuals needing resources are not adequately being provided for. Family life educators are professionals who focus on strengthening and enriching the well-being of individuals and families in the community. By increasing the accessibility of educational programs led by trained professionals like family life educators, individuals and families can go through change and stress in a more normative way and develop resiliency with coping skills. When individuals are more informed, empowered, and supported with educational programs they can navigate through an ever-increasing world of change, living with more self-awareness (with tools and resources to get through situations), and ultimately experience more joy in their lives. This thesis project included two parts. The first part was the creation of a curriculum helping individuals learn coping and resiliency skills when they are faced with change. The second part was gathering feedback from professionals determining if the proposed curriculum would add value to the individuals' lives they provide services for. The feedback was from professionals in both healthcare settings and educational settings. The feedback showed there was an increased concern with individuals experiencing anxiety when they were faced with change and stress as well as a need to have additional programs to help individuals to navigate through changes in their lives. Change is an inevitable part of human lives. It is ongoing and constant and by having resources to know how to navigate through change, individuals can recover more quickly from the change and be more optimistic. GETTING THROUGH CHANGE WITH THE POWER OF EDUCATION 4 Table of Contents NATURE OF THE PROBLEM 6 Change is an inevitable part of human lives 6 Change comes from a variety of sources 6 Change can increase stress, impact health, and affect family relations 6 Educational programs can provide resources to individuals 6 Lack of resources in community 6 Increasing accessibility to programs can help individuals cope through change 6 LITERATURE REVIEW Theoretical Framework 7 7 Family Relationships and Stress 10 The Body’s Response to Change 11 Ways to Cope with Change 11 Change Can Lead to Stress in the Body 13 Where is the Gap 15 How to Help 17 Moving Forward into the Future 19 PURPOSE 20 METHODS 21 Production of Curriculum 21 Context 22 Healthcare Setting 22 Public Educational Setting 23 Procedures 23 Evaluation 24 FINDINGS 26 GETTING THROUGH CHANGE WITH THE POWER OF EDUCATION 5 Healthcare Setting 26 Public Educational Setting 29 Common Themes and Differences with Feedback 32 LIMITATIONS 34 DISCUSSION 34 Future Research 34 CONCLUSION 36 REFERENCES 37 APPENDIX A. [Healthcare Provider Feedback Form] 40 APPENDIX B. [Counselor, Administrator, or Teacher Feedback Form] 41 APPENDIX C. [Outline of Waves of Change Curriculum] 42 GETTING THROUGH CHANGE WITH THE POWER OF EDUCATION 6 Getting through Change with the Power of Education Change is something that is new, different, or unfamiliar. And, change is an inevitable part of human lives (Feldmann, 2014). Change can come from a variety of sources including external or internal factors (Coombs & Harding, 2023; Feldmann, 2014), as well as from the choices an individual makes and/or the choices that others make. Individuals who are in a state of conscious living, or self-awareness, may recover more quickly from situations that involve change. They can also develop more resources to help them get through the change, generate solutions, and be more optimistic (Drigas & Chara, 2020). Regardless of the source of change, it can have a significant impact and even increase stress for individuals (Canady, 2020; Drigas & Chara, 2020; Feldmann, 2014). Furthermore, change and stress can impact an individuals’ health (Canady, 2020; Chen et al., 2017; Drigas & Chara, 2020; Feldmann, 2014; Harvard Health, 2020; Lark, 2010; Ma et al.; 2017; Varvogli & Darviri, 2011) and the relationships in the family unit (Darling & Cassidy, 2014; Smith & Hamon, 2017). Research and theories provide insight to individuals and families with the transition through change, stress, and family relationships (Boss, 2004; Smith & Hamon, 2017). Additionally, during times of stress, having support and access to resources of education, including community services (Canady, 2020), evidence-based programs (Ballard & Taylor, 2022), and social support (Smith & Hamon, 2017), can impact an individual and a family’s resilience and further help them cope. Unfortunately, in many communities the number of individuals needing resources are not adequately being supported (American School Counselor Association, 2022; Ball, 2020; Canady, 2020). By increasing the accessibility of educational programs, individuals and families can go through change and stress in a more normative way and develop resiliency with coping skills (Ballard & Taylor, 2022; Drigas & Chara, 2020; Smith & Hamon, 2017). GETTING THROUGH CHANGE WITH THE POWER OF EDUCATION 7 Literature Review This literature review includes a discussion on the impact change has on individual’s lives. It shows the connection between change and stress, looking at the design of the physical body’s way of responding and protecting itself when stress is present (Varvogli & Darviri, 2011). It addresses the research that has been conducted to show evidence that when stress is not managed, a large variety of health issues arise in people and can affect families. Additionally, this literature review discusses factors that contribute to change, including internal and external causes. The goal is to stay in a state of conscious awareness of change and develop the ability to recognize when a stress-response is present. When these are developed, individuals have the self-control to problem solve, act, and move through the situation (Drigas & Chara, 2020). Educational programs offered through the community can be a powerful resource to help individuals learn ways to recognize and get through change, discover the ability to manage stress, and learn positive coping strategies in their lives. Darling and Cassidy (2014) emphasized that family life educators' roles are to share, educate, and focus on strengthening and enriching the well-being of individuals and families. All in all, the desire is that individuals feel more informed, empowered, and supported with current research, data, and practices so they can navigate through an ever-increasing world of change, and live with more selfawareness because they are prepared with resources to get through situations, and ultimately experience more joy in their lives. Theoretical Framework For the purposes of this project, change is defined as something new, different, or unfamiliar. It can be seen by individuals as positive and/or negative and can cause an imbalance in one’s life. Experiencing change is not new (Smith & Hamon, 2017), it is an inevitable part of human lives (Feldmann, 2014), and the process is ongoing. Throughout the history of time, philosophers have been trying to find answers to life's questions with insights GETTING THROUGH CHANGE WITH THE POWER OF EDUCATION 8 and ideas (Boss, 2004; Darling & Cassidy, 2014; Smith & Hamon, 2017), as well as theorists have spent years developing research and theories to help society function successfully as a whole, including in family units. One such theory is symbolic interactionism (Smith & Hamon, 2017). Symbolic interactionism helps shed light in four ideas when it comes to how individuals can be helped through change in society. First, the world is always changing, rather than as a stagnant structure whose history was predetermined. Second, social structure is not fixed in time but constantly changing and developing. Third, there is a relationship individuals have with objects. And fourth, that advancements through science and research can help figure out how societies (people) grow and change within an ever-evolving demographic society (Smith & Hamon, 2017). At the time of the industrial revolution people were changing from working on the farm to working at the factory, leaving them feeling they had little or no control over their lives, which further meant that they probably had little control over society. The development of symbolic interactionism allowed people to feel as if they gained back a little more of control because the theory was based on the idea that people are not victims of some determined course of history but are instead able to change how things happen in society through communication and interactions (Smith & Hamon, 2017). Another theory is the family stress theory (Smith & Hamon, 2017). The family stress theory and Reuben Hill’s (1949) foundational ABC-X model explained what factors contributed to families in stress (Smith & Hamon, 2017). The ABC-X model consists of: A, the stressor event; B, the family’s resources; and C, the family’s perception of the event. If the family cannot figure out the problem, then it will lead to X, a crisis. Smith and Hamon (2017) described crisis as a state or period of disorganization that rocks the foundation of the family. This equation models the benefits of families having resources in their lives and problem-solving skills to help them navigate through a stressful GETTING THROUGH CHANGE WITH THE POWER OF EDUCATION 9 event. Stressor events can either and both be positive and negative because events are neutral before we interpret them (Smith & Hamon, 2017). Additionally, Smith and Hamon (2017) stated, “as people face more and more stressors in their lives and society becomes increasingly complex, the use of this theory (family stress theory) will remain strong” (p. 123). Understanding and applying the ABC-X model during stressor events can be an additional resource for families. Walsh (2014) explained, “family resilience perspective fundamentally alters the defect-based lens from viewing struggling families as damaged and beyond repair to seeing them as challenged by life’s adversaries, with potential for fostering healing and growth in family members” (p. 402). Understanding the family resilience perspective can be a valuable resource to help during times of great stress or struggle (Ballard & Taylor, 2022). In Walsh's (2014) concept of family resilience, she stated: A crisis can be a wake-up call, heightening attention to important matters. It can become an opportunity for reappraisal of life priorities and pursuits, stimulating greater investment and meaningful relationships. Studies of strong families have found that when family members weather a crisis together, their relationships were enriched and more loving than they otherwise might have been (p. 401- 402). In addition, Dr. Lisa Barrett’s (2017) work with understanding how emotions are made in the body can also help individuals see how emotions play a part in their lives as they go through change and experiences. Where once emotions were seen from a classical view of a “fixed” biological nature, meaning individuals experience similar instances of certain emotions (e.g., anger in response to irritations), to more current research finding that emotions have a tremendous variety, do not necessarily have the same meaning for everyone, and are constructed (Barrett, 2017). This added insight can help individuals feel more in control of the emotional state they are in and be in choice versus in a victim mode mentality. Additionally, by being in a state of conscious awareness of the fact that change is inevitable (Feldmann, 2014), one can choose to be more present with life experiences, including GETTING THROUGH CHANGE WITH THE POWER OF EDUCATION 10 the reality of change, their emotional state, and developing more resources to help them persevere through change. Change not only affects an individual but the effects can ripple into the family unit. Family Relationships and Stress Family relationships with children and adolescents are important (Chen et al., 2017). These early-in-life relationships, even in short-term responses to stressful childhood family experiences can have consequences across the individual’s lifespan and affect health outcomes into adulthood. When individuals are exposed to negative parenting and family conflict, physical issues have been found including increased risk of cardiovascular disease, autoimmune conditions, respiratory diseases, and some cancers (Chen et al., 2017). On the other hand, when a child is exposed to positive childhood family relationships in their ecosystem, they show signs of lower levels of psychological risk in adulthood. Parents serve as very important role models in childhood family relationships and shape the health behaviors early on in children's lives (Chen et al., 2017). In Pauline Boss’ (1999) research and family therapy practice on ambiguous loss (incomplete and uncertain loss with unresolved grief), she explained that the family that exists in people’s minds is more important than one that is written on a census. This is due to an everincreasing separation in family members because of work demands, unemployment, domestic break-ups, war, or just because of one’s choice. The change, loss, or absence of family members, either physical or psychological, can cause great uncertainty and block the coping and grieving processes because of situations beyond their control or outside constraints (Boss, 1999). Furthermore, Boss (1999) describes that individuals have difficulty functioning normally without knowing who is routinely and fully there for them as a family. Her research on helping individuals and families recognize the ambiguity of the loss, with the change and stress it may bring, frees people to understand, cope, and move on after the loss, even if the loss remains GETTING THROUGH CHANGE WITH THE POWER OF EDUCATION 11 unclear (Boss, 1999). This phenomenon, called ambiguous loss, is always stressful, often tormenting, the most distressful of all losses, and can lead to symptoms that are often missed or misdiagnosed (Boss, 1999). The Body’s Response to Change Change creates a general sense of anxiety and stress that can escalate to other emotions like anger and frustration (Feldmann, 2014). These mere moments in between when a change is present, an individual has a choice to respond or react, be in consciousness or not. The human body has survival mechanisms that are heightened when a change or stress is present, which is designed to keep an individual alive (Axe, 2016; Harvard Health, 2020; Varvogli & Darviri, 2011). When a stressful event is present, the behavioral and physical adaptive response in the body’s autonomic nervous system activates. The stress response system (known as the stress syndrome) unfolds an innate program of the organism that has evolved to coordinate homeostasis and protect the individual during stress (Harvard Health, 2020; Varvogli & Darviri, 2011). The body produces a reaction to stress known as the “fight-or-flight” response, where near instantaneous sequences of hormonal changes and physiological responses help to either fight the threat off or flee to safety (Harvard Health, 2020). Dr. Josh Axe (2016) warns that too many individuals today use this “fight or flight” not as an emergency survival mechanism, but as the default operating mode. He explains that the concern with this is that it leads to more health conditions, including chronic stress, leaky gut, and autoimmune diseases (Axe, 2016). Ways to Cope with Change There are many studies that highlight ways to cope with change and support better health when going through change or stress. When individuals are taught about the body’s innate design of the “fight-or-flight” mechanism, they can be more aware of their body when this is heightened and apply resources to help them cope more effectively. This can be one of the GETTING THROUGH CHANGE WITH THE POWER OF EDUCATION 12 first steps in helping individuals move from a “reaction state” to a “response state” and further into helping them through change. Another technique to help support an individual’s wellbeing is the practice of mindfulness. Tanner (2022) explained that by practicing mindfulness techniques, individuals can be in a place of focusing in the moment on only what is happening and dismissing other thoughts. This practice of being in conscious awareness, with breathing exercises and body scan practices, can work as well as a standard drug for treating anxiety (Ma et al., 2017; Tanner, 2022). Diaphragmatic breathing, or “deep breathing”, is an effective integrative bodymind training, that when implemented in moments of stress or psychosomatic conditions, can additionally reduce depression, anxiety, and stress (Ma et al., 2017). Developing reflective skills, through journaling, can help identify one's interpersonal thought process, unresolved emotions, core beliefs, and programmed behavior, and further be a way to learn how to cope with change. Banta and Palomba (2015) described that learning journals, logs, and reflective diaries are methods that can be used to share reactions, explore experiences, as well as to personalize and deepen learning. If individuals are unconsciously aware of the fact that change is a part of their life, then they can show up in behaviors like being in denial and “stuck” (Bolman & Deal, 2021). Factors that contribute to this state of being are experiencing stress, trauma, grief, and loss. At the 2023 Utah Council on Family Relations (UTCFR) conference, Coombs and Harding (2023) explained that sources of change can come from many factors, including external and internal ones. External factors can be things like restructuring in an organization, mandates from government agencies, weather, and natural disasters. Internal factors can be things like biological factors, the aging process, and emotions. Coombs and Harding (2023) placed an emphasis of the COVID-19 global pandemic, acknowledging that this very current external factor of unknown and stress created a lot of uncertainty and many changes in the world. Continued research is underway and needed to discover the effects from this event and GETTING THROUGH CHANGE WITH THE POWER OF EDUCATION 13 the impact it had on individuals physical, mental, social, and emotional health (Coombs & Harding, 2023). Guided group discussions can be another way to learn how to cope through change. Pauline Boss (2004) found through her years of research, theory development, and clinical application (especially with the aftermath of 9/11) having a place for community to vocalize, express, and share about their experiences and loss helped individuals come to closure and heal (Boss, 2004). When individuals are provided with an opportunity to share, with the support of a trained professional, it can provide such an experience and place to help cope through a change. Lastly, learning about stress, the effects it has on the body, and stress management techniques can help individuals cope with change. Adding stress management techniques to a daily routine practice (for either those in good health or with a health disorder) has been shown to be a valuable intervention for health enhancement and protection over a lifespan (Varvogli & Darviri, 2011). Education can be a powerful tool to help enlighten people’s minds on internal and external factors that could be affecting their level of stress in their life and their health. Change Can Lead to Stress in the Body Stress can impact a wide variety of areas in an individual's health including physical, emotional, and psychological. Health issues can show up in the form of anxiety, depression, addiction, heart disease, autoimmune conditions, emotional overeating, obesity, ulcers, infertility, leaky gut, chronic systemic inflammation, aches, coughs, respiratory diseases, and some cancers (Axe, 2016; Chen et al., 2017; Harvard Health, 2020; Varvogli & Darviri, 2011). Chen et al. (2017) described that when a child experienced adversity early in life, their white blood cells became calibrated to respond to future threats and can create an aggressive inflammatory response to microbes and develop an insensitivity to signal the normal turn off inflammatory responses. When repeated exposure to stress was present, the hormonal system that regulates organs and tissues in the body (example of cortisol), became less sensitive and GETTING THROUGH CHANGE WITH THE POWER OF EDUCATION 14 allowed chronic inflammatory states to persist. Over a lifetime this created a state of low-grade inflammation that led to both disease and an allostatic load, or a wear and tear on the body, which left an individual physically more susceptible to health issues (Chen et al., 2017). Additionally, Axe (2016) shared that stress can exacerbate almost any health condition, wear them out emotionally, and can make people sick. He believes that our country is “in the throes of an autoimmune storm”, with rates of chronic health conditions rising at alarming rates, caused by leaky gut (a deterioration of the gut wall that results in inflammation and weakened immune function). He stated, “more than 75 percent of all physician visits are stress-related ailments-many of them related to the gut” (Axe, 2016, p. 131). Current research found young people today are five times more likely to be diagnosed with celiac disease than youth in the 1950’s. Food allergies among children increased 50 percent between 1997 and 2011, growing at an alarming rate. There is an estimated fifty million Americans currently with autoimmune conditions, compared to individuals affected with cancer estimated at nine million (Axe, 2016). Axe (2016) suggested to help solve this hidden epidemic of leaky gut, individuals can address the mind-body connection to improve gut health with nutritious foods and implement stress reduction techniques with self-care practices to create more optimum health. The stress hormone cortisol can have a deleterious impact in the body when it is not regulated well. When stress is present, the body’s autonomic nervous system (composed of the sympathetic nervous system and the parasympathetic nervous system), in response to the environment, goes to work to add energy to help the person either “fight” or “flight” (Harvard Health, 2020). The sympathetic nervous system signals to the adrenal glands using hormones, including cortisol, and keeps the body revved up and on high alert. Once the threat passes, cortisol levels fall and the parasympathetic nervous system slows the stress response, returning to a more homeostasis (pre-stressor) state. The concern is that many people are unable to put the brakes on stress and cortisol levels do not get back in balance (Harvard Health, 2020). GETTING THROUGH CHANGE WITH THE POWER OF EDUCATION 15 On the other hand, there is a natural, daily cycle of cortisol levels that helps aid individuals in waking up (Lark, 2010). Without this early morning surge, one would literally not be able to transition from a deep sleep to wakefulness. This hormone is designed to eb and flow throughout the day and if it is not regulated, individuals can be at a higher risk for a variety of health conditions (Lark, 2010). Furthermore, psychological health issues can show up in the form of anxiety, fear, sadness or depression, uncertainty, anger, frustration, disappointment, and resentment (Feldmann, 2014; Forbes, 2021). These can tend to be more obvious in individuals but consider that there are additional less obvious outcomes in the form of loss of self-esteem, identity, emptiness, safety and security, control, power, and isolation (Feldmann, 2014). Both are important to recognize, seek help to heal from, and realize the impact stress can have on the body. Where is the Gap? Individuals, including children, experience change and stress in their lives and may not be aware that these normative experiences, if not coped with appropriately, can be debilitating to one’s health and relationships. There is a gap in the resources, programs, and professional support in the community to help the growing need of health concerns in the constantly changing world we live in. This gap can result in a financially costly experience for individuals, families, and the community. If more accessible resources, like educational programs were offered in the community, more people could receive help on how to cope and develop resiliency skills to navigate through life’s changes, experience better health, and feel more happiness in their lives. Early Childhood Mental Health in Utah (2020) found that not only effective programs improve children’s mental health but can lower physical health care costs over the child’s life as well. In 2020, the national cost of mental, emotional, and behavioral disorders in youth was $247 billion per year (Ball, 2020). Increasing the services that counselors can provide can GETTING THROUGH CHANGE WITH THE POWER OF EDUCATION 16 potentially lower these costs and have long-term positive impacts that last throughout a student's life. Currently in Utah there are only a few mental health programs offered exclusively to children. The programs provide help and resources for children in the area of mental health, yet are offered after school hours, range from only a few days to a few weeks, and have costs sometimes involved (Ball, 2020). These programs focus on helping children with emotional and behavioral challenges transition back into school. What about the children that do not fall into the category of “emotional and behavioral challenges” but because of the human nature of the world we live in are faced with stresses and challenges that maybe they have not been taught coping and resiliency skills to navigate them through. In Utah, the 2021-2022 ratio of student-to-school counselor was 516-to-1, well over the recommended ratio from the American School Counselor Association (ASCA) ratio of 250 students per school counselor and the Utah State Board of Education counselor to student ratio is at least one school counselor for every 350 students. With this data and the number of cases of mental help support needed, there is growing evidence that the number of school counselors to student ratio needs to increase. Boss (2022) also suggested updated programs to help with current needs of individuals are needed to help individuals understand and get through stress, loss, and change. Education is one thing that can help individuals and families get through change, but costs, time, community programs available, and limited access to qualified instructors to lead these programs need further attention. Tanner (2022) found that individuals’ time involved with programs of mindfulness meditation was a struggle. Furthermore, developing an educational program that is mindful of people’s time commitment and is focused on resiliency and coping skills to help individuals, including children, have resources they can apply in their lives as they face stresses and challenges would be a way to close this gap. Family life educators can be GETTING THROUGH CHANGE WITH THE POWER OF EDUCATION 17 added support to counselors in a school setting by being a great resource of teaching these types of programs. How to Help Change is something new, different, or unfamiliar and an inevitable part of human lives. Educational programs where positive coping strategies are offered need to be more accessible to individuals and offered in many places in the community. A supportive place to offer more education is in a healthcare setting. Here, change, stress, and coping strategies can help support patients and their families through transitions in health, including a health diagnosis. Another place where programs can be offered is to students in educational settings. Here students can learn about and develop resources to help them get through life changes, as well as be prepared for life events (stressors) in the future. Just like having the basics of reading, writing, and math can help students to know how to be better prepared in the future, learning coping skills to develop resiliency can help them be better prepared as members of society, including as employees, professionals, and family members. “The key isn’t to eliminate all stress. That’s impossible. The key is to avoid unnecessary stress and learn ways to control your body’s response to the stress that’s unavoidable” (Lark, 2010, p.8). Support and training from professionals can help individuals know how to process through change (Bolman & Deal, 2021; Feldmann, 2014). The unique role of family life educators is to share, educate, and focus on strengthening and enriching the well-being of individuals and families through an educational, preventive, and strengths-based approach (Ballard & Taylor, 2022; Darling & Cassidy, 2014). Furthermore, Darling and Cassidy (2014) explained the more developed, stable, and functioning families, the more stable and functioning society will be. Family life educators can be additional professionals in the community to help individuals and families be better equipped and empowered because they help others develop skills and knowledge to enhance the well-being of the individual and strengthen relationships, especially through times of stress, struggles, or change (Ballard & Taylor, 2022). GETTING THROUGH CHANGE WITH THE POWER OF EDUCATION 18 School counselors provide both social-emotional and academic support to students. A school counseling program can promote success and achievement for all students and with the aid of trained school counselors, they can help set students on a path for future success. With growing concern with children and youth having increased mental and physical health problems, medical and behavioral chronic conditions, and the finances involved nationwide to help support these needs, family life educators, alongside with counselors, can help in educational settings as an important part of a school’s support team. Research and studies are increasingly recognizing the connection of early life experiences to individuals' health throughout their life. The Centers for Disease and Control Prevention (CDC) collected data that included Adverse Childhood Experience (ACEs) in adults nationwide. ACEs are potentially traumatic events that occur in childhood and can range from events of direct abuse and neglect to indirect living environments like parental conflict, substance abuse, or mental illnesses (CDC, 2020). The CDC found that over 60% of adults had experienced at least one type of ACEs and more than 15% experienced four or more types of ACEs (2019). That is 1-6 in adults across the nation! In the state of Utah, the data showed 15.3%, just 0.3% from the national average, of adults who have experienced four or more ACEs in their lives (Ball, 2020). ACEs are linked to more mental and physical health problems including obesity, heart disease, substance abuse problems, anxiety, depression, cancer, and greater premature mortality in adults (Hughes et al., 2017). The adult data can serve as a proxy for estimating ACEs among children since ACE score data for children 0-8 is not available. This data is good to help see the possible need for services in early childhood mental health. According to Smith and Hamon (2017), “If the family has many resources and the developmental transition is normative (and therefore expected), it (stress) will be easier to handle. When the family successfully negotiates the transition, stress is relieved, and the family GETTING THROUGH CHANGE WITH THE POWER OF EDUCATION 19 returns to stability” (p.78). Having resources is one way to have families connect through a stress event and avoid going into crisis. Moving Forward into the Future Future directions for family life educators could be helping in both the physiological and biological aspects of the body, as well as improving an individual's microsystem with relationships in family units. In the area of physiological and biological aspects, it could look like teaching individuals and families about their bodies functions when stress is present (“fight-orflight”) and practicing resources like diaphragmatic breathing to help them have resources to regulate their bodies back to a homeostasis state. Additionally, in the area of improving individual’s microsystem, it could look like teaching the ABC-X model so they can use this equation to “plug-in” areas when a stressful event is present, helping them see areas to work on, with the goal of getting back to a state of homeostasis in their family unit. When these resources are applied, individuals and families (in both the body and family relationships) can shorten stress cycles, see areas to eliminate unneeded stresses, and develop skills, helping them to become independent, problem-solving individuals. Furthermore, by increasing the number of trained family life educators in the school system, it could help provide more mental and emotional resources to all children in the public school system. Increasing support in schools with family life educators as specialists to lead and guide programs could provide more time in classrooms where students get help with lessons, practical application practices, small group discussions, and individual guidance. This could also help alleviate the load the counselors have in meeting the needs of so many students. The students can have life skills taught to them for the whole school year, without extra costs involved for parents. The hope of increasing support to those in school settings, we can see numbers decreasing in the area of mental health issues with a focus of more preventative mental health. GETTING THROUGH CHANGE WITH THE POWER OF EDUCATION 20 The lessons and support students can gain can strengthen this rising generation with skills to be mentally prepared to get through their life stresses and challenges. In a 2022 podcast interview with Pauline Boss, she explained that through the COVID-19 pandemic she has seen a maturity, especially in the young people, of how they have coped in creative ways through hard times. Boss (2022-present) stated: If you can think in a more resilient way, if you can act in a more resilient way, flexible, but learning from it, growing stronger each time, you will also be optimistic, because what that means is you can cope with most anything that comes along in life, the death of your loved ones, accidents, loss of a job. Change is something we experience. It is a part of life. It is inevitable. If we as individuals and families can come to a place of consciousness, being present and with reality, noticing when a stress response is in our lives, then we can see “it” as a choice to get through. As society moves forward in history, more individuals can have a sense of what they can have control over by being empowered with knowledge, resources, and support to better ride the waves of the ongoing change that life brings. Purpose The nature of life has many factors, including having a physical body, making choices, and developing relationships, all of which involve experiencing change. Change is something that is new, different, or unfamiliar and something we face as humans on a daily basis. d Change can create stress in both the physical body and in family relationships. Learning ways to cope with stress and change can shorten stress cycles and help individuals and families become more connected and resilient as problem-solving individuals. Educational programs, taught by family life educator specialists, are one way in which individuals can learn about change and persevere. The purpose of this curriculum development project is to develop a program to be used within a healthcare setting or a public-school setting, focusing on helping individuals and GETTING THROUGH CHANGE WITH THE POWER OF EDUCATION 21 families to get through change. The goal as a family life educator is to teach resources and tools to help others navigate through the current changes they are facing, as well as help them be better prepared for future changes. The objectives guiding this project are: • Individuals will identify an area of change in their life. • Individuals will learn about the human body’s response to stress with the “fightor-flight” response. • Individuals will be taught techniques and resources to help them navigate through change. • Individuals will learn positive coping strategies to help develop a more resilient mindset. • Individuals will develop the skill of reflection through the process of change. Methods Production of Curriculum Since personally experiencing life stressors, including a chronic health diagnosis which created change in my life and in the life of my family, I began a journey of learning more about change. Realizing that change is something everyone experiences, is inevitable, and is ongoing, I had a desire to create a program that could be incorporated with both children and adults alike. This program would help others to navigate through change more successfully. My thesis project is the curriculum development for a group support program called “Waves of Change”. The program could be implemented into the community in two ways. One way as a part of patient care services in the healthcare setting, offering education and resources of coping and resilience skills after any diagnosis. It is a year-round program, taught by a qualified family life educator, which is offered bi-monthly to patients to provide continuous support through their journey of living beyond a diagnosis. Each group support class will be 60 minutes in length. The GETTING THROUGH CHANGE WITH THE POWER OF EDUCATION 22 curriculum layout will be organized by research-based practices, individual reflection time, open share opportunities, and implication of coping and resiliency resources. The second way the Waves of Change program could be implemented in the community would be in the public educational setting. The focus here is supporting the student load Utah school counselors may face with the student-to-counselor ratio being well over the recommended ratios. It provides a class, taught by a qualified family life educator, where students can learn how to navigate through change, stress, the functions of the human body, and develop coping and resiliency skills. The timeframe of the lessons will be modifiable for the grade/age of students in class (ex: a 6th grade class would have a 30-minute lesson vs. a 10th grade class would have up to a 60-minute lesson). The curriculum layout will be organized with research-based practices, individual reflection time, open share opportunities, and implication of coping and resiliency resources. Context The curriculum is designed on the basis of dealing with change as a whole, making the lessons easily adaptive to different environments. It will be research-based and incorporate best teaching methods. My focused target audience is twofold: one for individuals in the healthcare setting after a health diagnosis and the other for school-aged children in the public educational setting. Healthcare Setting Researchers have found an increase in health diagnoses, especially with autoimmune diseases and GI issues. This creates a need in healthcare settings where individuals experience life-changing news of a diagnosis and could use further support in education as well as resources to cope mentally, emotionally, and physically with the diagnosis and changes it may entail. The Waves of Change group support program can serve as an additional option practitioners can refer patients to for living beyond a diagnosis, being led by a qualified family life educator. The collaboration of practitioners and family life educators can help provide more GETTING THROUGH CHANGE WITH THE POWER OF EDUCATION 23 resources to the community and increase the level of patient care. Patients can learn best practices from family life educators on how to cope and develop resiliency skills with others going through similar experiences. Public Educational Setting The recommended student-to-counselor ratio from the Utah State Board of Education (section R277-462-6) is 350-1. The American School Counselor Association (ASCA) student-tocounselor ratio is 250-1. According to the ASCA data, Utah’s 2021-2022 student-to-school counselor ratio was 516-to-1. This shows Utah’s numbers for the student-to-counselor support are well over the recommended ratios. In a world with ever-increasing mental health concerns, the Waves of Change program can serve as an additional support to school counselors, being led and facilitated by a qualified family life educator. The curriculum lessons and activities are designed to help students in their formative years of development learn coping and resiliency skills. It can provide knowledge and skills for students to apply with current change(s) they may be experiencing as well as increase preparedness by providing resources for when additional changes inevitably arise. Procedures The curriculum will educate participants on what is stress, what are stressors, and how those are impacted by change. For the completion of my thesis project, I will do the following: ● Create a curriculum with 24 lessons on topics around change, stress, the body, and family relationships. ● These lessons will be typed up, organized, and bound into a course program/guidebook. ● The curriculum program will be called Waves of Change, a group support program. ● Present the Waves of Change group support program to providers in the healthcare setting and gather feedback to help determine whether the proposed curriculum would add value for their patients. GETTING THROUGH CHANGE WITH THE POWER OF EDUCATION ● 24 Present the Waves of Change group support program to professionals (ex: counselors, administrators, or teachers) in the area of an educational setting. Gather feedback to help determine whether the proposed idea of a curriculum like Waves of Change could be implemented in the future to provide additional support to students and staff in an educational setting. Evaluation In order to collect feedback for this proposed curriculum, I have tailored feedback forms to meet the needs of each setting. The forms are listed below: Feedback will be gathered from a healthcare provider about the generalization they observe from patients when a new health diagnosis (or change in their health) is addressed, can provide helpful insight with the future development of the group support curriculum Waves of Change. The questions are listed below. “Waves of Change” Healthcare Provider Feedback Form: 1. After a patient receives the news of a health diagnosis, what do you notice that their body does (cry, anger, shock, silence, laugh, etc.)? If others are present at the appointment, what do you notice they do? 2. What tends to be the patient's concerns after the news of a diagnosis? What tends to be the family, friends, or caretakers’ concerns? 3. Do you feel an additional support program offered to patients would be beneficial to help them navigate through this new change and teach resources to help them cope in a more normative way? (Share with the provider my developed group support curriculum “Waves of Change”. Then gather additional feedback on this program to help determine if the proposed curriculum would add additional support to their patients, seeing if they feel there is sustainable quality in the lessons and materials. This feedback can provide great insights on areas in the curriculum to keep, grow, and refine in this topic of change. GETTING THROUGH CHANGE WITH THE POWER OF EDUCATION 25 Having a successful program that provides a service to the community means listening to the feedback from others and adjusting as needed.) 4. Do you think a program like Waves of Change would help alleviate the stress load providers may face, because it provides additional education to their patients? 5. Would there be a reason why a program like Waves of Change would not be implemented in your practice? Any additional feedback is welcome: Feedback will be gathered from a counselor, administrator, or teacher to see the needs in an educational setting can help with the future development of the curriculum Waves of Change. The questions are listed below. “Waves of Change” Counselor, Administrator, or Teacher Feedback Form: 1. What is your biggest concern with students today? 2. In a world with ever-increasing mental health concerns, what is the biggest concern in the area of mental health? 3. Do you think students have adequate support and education around the topic of “change and stress”? 4. Do you feel you have enough support in your profession? 5. Utah’s most current student-to-school counselor ratio was 516-to-1, putting Utah’s numbers well over the recommended ratio for student-to-counselor support (Utah State Board of Education 350-1 and The American School Counselor Association 250-1 ratios). Do you think a program like the Waves of Change could serve as an additional support in the educational setting, not only to students, but to the educational staff as well? Please explain your reasoning. Any additional feedback is welcome: GETTING THROUGH CHANGE WITH THE POWER OF EDUCATION 26 Findings I was able to gather feedback from eight professionals, three in the area of a healthcare setting and five in the area of an educational setting. Where the feedback was unique from each of the professionals, the insight and information they shared provided a great snapshot of the current state of things around change, people’s health, and resources that are available in the community. All the professionals had a focus on helping people. The feedback questions were slightly different for the professionals in the healthcare setting compared to those in an educational setting. The following are specific findings for both of these areas. Healthcare Setting The three providers I gathered feedback from came from a background in oncology, gynecology/women’s health, and internal medicine. They also ranged from years in practice being two years post-residency to newly retired with 50 years with patients. The first question I asked providers was what physiological response they noticed their patients’ doing after they received the news of a health diagnosis. Shock was the most common response, as well as tears and going quiet. Patients expressed a variety of feelings including being numb, indifferent to the news, gratitude, anxiety, being positive about the outcome, sadness, a determination to get better, and being in a state of disbelief (see Figure 1). Expressions of anger by patients were not noticed by any of them. GETTING THROUGH CHANGE WITH THE POWER OF EDUCATION 27 I then proceeded to ask when others (family, friends, caretakers) were present with a patient when a diagnosis was given, what was their physiological response. They tended to have similar responses as the patient did. The providers noticed that they were in a state of shock, working on internalizing the information, and trying to come to acceptance with the new information. One provider mentioned he breathes a sigh of relief when a patient has a caretaker with them at appointments because he knows the patient will have support from others and not go through the change alone. Another provider mentioned when she has given news of STDs (sexually transmitted diseases) to women, the dynamics of the room and responses change dramatically if the woman is unaware of the unfaithfulness of a partner. At that point it was not just about the new diagnosis, but also the news that could potentially upset the family system and spousal subsystem. The next questions I asked were about the patient's concerns after the new diagnosis. Some patients had a desire to know what could have caused this new diagnosis, others wanted to know life expectancy, treatments available, side effects from additional drugs/medications, surgery options, and what they can do outside of doctor appointments (with food and GETTING THROUGH CHANGE WITH THE POWER OF EDUCATION 28 supplements) to help. As one provider mentioned, the appointment shifts to an action mode of what they can “do” to be well and make a plan to move forward. Referrals are also discussed at this point. In one provider’s opinion, grieving happens after they go home from the appointment and the shock phase sets in. One of the providers noticed a pattern of concerns with his patients who are 65 years and older. They either wanted the “next steps” to try to heal or they had no interest in future care. If they do not want any further care, the appointment turns more into palliative care where they help them to enjoy the quality and time they have left. Again, if there were others (family, friends, caretakers) present with a patient when a diagnosis was given, their concerns tended to be very similar to the patients. It seems to be very helpful to have others present at appointments because they tend to ask questions that either the patient forgot about or that did not come to their mind to ask. In the end, the providers said caretakers seemed to support whatever the patient voices for their choice in health moving forward after a diagnosis. My next question was if providers felt like additional support programs could help patients navigate through this new change of diagnosis in a more normative way and teach them resources to help them cope. I also shared with the providers my developed group support curriculum “Waves of Change”. Unanimously the answer was yes! They mentioned there is power in numbers and it is helpful to have support from others who are going through similar things, including a health diagnosis and/or lifestyle change. Additionally, I asked if a program like Waves of Change would help alleviate the stress load that providers may face, because it provides additional education to their patients. Two out of the three said yes that it would help. The third said it would not be a huge relief to him because he does not allow time with patients to discuss a lot when it comes to education about getting through a diagnosis. Appointments are more focused on getting results and making a plan, not teaching per say. GETTING THROUGH CHANGE WITH THE POWER OF EDUCATION 29 The final question asked reasons why a program like Waves of Change would not be implemented in their practice. Time and resources were the top reasons. One provider said they had wanted to do something of this nature but when he looked at his staff they were not trained in this manner and that would require additional time to organize and lead a group. Two out of the three providers said they did not know where to even start to do something like this. One provider said they have never been offered a program like this to patients to even consider. Another provider said most patients find support groups through social media platforms. And one mentioned they were not sure they as a provider could lead a program like this because of HIPPA laws and patient health confidentiality. Public Educational Setting The five professionals in the public educational setting included one elementary school teacher, two high school counselors, one administrator of a charter school, and the student services specialist at a local school district. The first question I asked inquired about what they felt was the biggest concern with students today. This had a variety of answers including students having a lack of commitment, increased anxiety, a mindset focused on instant pleasure, being easily distracted, lack of motivation, chronic absenteeism (this has increased post covid), boredom, and the increased amount of things they are exposed to with information overload (see Figure 2). GETTING THROUGH CHANGE WITH THE POWER OF EDUCATION 30 The concern with information overload is that it is not research-based and the sources of technology that are layered in their lives (ex: TV, video games, and social media) can have students misinterpret messages in the world. Attitudes and comments like “why do I have to do this”, “I don’t want to do this”, and “I don’t care” are very common. An interesting concern one sees with the way students express themselves through their writing assignments is that most have a focus ending in death and/or are about their pets. This has been since the global Covid19 pandemic. My next question focused specifically on the concern they had with students in the area of mental health. Having a skillset to manage emotions, thought processes, behavior, and reflective thinking are some of the top concerns mentioned. The perception of social media portraying a “snapshot” in time could be altering the way young minds are constructing real life. On one end common things like students are not enough, unsuccessful, and failures to the other end with students portraying too much rigidity that they have to finish things before they move GETTING THROUGH CHANGE WITH THE POWER OF EDUCATION 31 on to the next thing. As one professional mentioned, unfortunately school becomes a place to not feel good about oneself. Children self-diagnosing themselves (and others) with anxiety and depression is also a concern. An interesting comment one professional made was when we learn something more about a topic (mental health for this example) there will be an increase in the prevalence of hearing about that topic in society. The next question I had wondered if they thought students had adequate support and education around the topic of “change and stress”. This was interesting in the variety that some said yes there is tons of information, to another with a vague answer of “in some situations”, to one flat out saying no. How the school system is set up (with time and resources) was mentioned in more than half of the responses. Additionally, I wondered if they as professionals felt they had enough support in their profession. Three out of the five professionals felt they did. The two that did not were both high school counselors. For this one school, there is a total of five school counselors that serve approximately 1,500 students. This makes the ratio of student-to-counselor within the state board of education recommendations. From their perspective trying to do all that is required they could use additional support. Interesting to know they said that for elementary schools there is only one school counselor per school. In the Weber County School District, the one counselor can service anywhere from 325-800 students depending on the specific school. The high school counselors said that the one thing that helps them is the support from other counselors in the school because they can understand and relate to their stresses and workload. The final question asked if they thought a program like the Waves of Change could serve as an additional support in educational settings (not only to help students but to support the educational staff as well). All replied that programs of this nature can help meet the needs of students more. Funding allocations, grants for specialists and programs, and making discussions outside their job title seemed to be the reasons that stops more programs from GETTING THROUGH CHANGE WITH THE POWER OF EDUCATION 32 being available to students. One professional mentioned that the additional help they did receive in the form of a program from the school counselor did not come regularly enough to the classroom. I offered to have them share any additional thoughts or feedback from our time together and the following were nuggets of wisdom they shared. • Students could use more help with the transition from Jr. High to High School. • “School is a reflection of the community in which we serve.” Looking at students' issues, problems, and strengths can be a reflection of what is happening in the home environment. • Parents are a big part of the equation too and getting them to come to support things is not the easiest. • “The drug of choice for anxiety is avoidance. The treatment is exposure.” • Home learning has created a “comfort” level of learning for some students. It is a harder transition to have them work as a team and have structure in the classroom when they are in-person learning. • “We need to teach life skills (referring to programs like the Waves of Change) like we do reading. It is not an innate thing we know, but we can be taught!” Common Themes and Differences with Feedback As I mentioned the feedback questions were tailored to the specific settings of either the healthcare or educational setting with the common curiosity I had with wondering what professionals noticed about those they helped when they were faced with change and/or stress as well as what programs were available. It was interesting to notice that anxiety was mentioned by professionals in both settings. According to Feldmann (2014), change creates a general sense of anxiety and stress. Stress can impact a wide variety of an individual’s physical, emotional, and psychological health. It can also increase almost any health condition, wear GETTING THROUGH CHANGE WITH THE POWER OF EDUCATION 33 individuals out emotionally, and make people sick (Axe, 2016). Healthcare providers referred to anxiety in the form of a response to a health diagnosis whereas educational professionals referred to it as one of the biggest concerns in general with students today. This leads me to conclude that regardless of the setting source anxiety is a factor that is alarming professionals. A difference I noticed between the two settings was healthcare providers seemed to have resources they offered in the form of “other” things outside their practice. They verbally informed patients of programs they knew of in the community, referred them to other providers with specific specialties, and left information for the patient about the new diagnosis. All these require the patients to connect with a resource on their own versus a service that is included as part of the care from the provider. The educational settings seemed to have more resources inside their organization. They had school counselors and teachers in place to help teach educational programs. Programs were taught as part of the school curriculum, and students did not need to spend additional time or financial resources outside of the school day learning the new information. It was interesting to note that the three professionals who had the title of either a school counselor or a teacher felt overwhelmed with the amount of responsibilities they had to do. On the other hand, the two professionals (an administrator at a charter school and a specialist at the school district level) who had different job responsibilities did not voice this overwhelm. This leaves me to conclude that maybe teachers and school counselors doing the daily teaching day-in and day-out could use additional support. Family life educators could be the specialists to fill in the gap with updated educational programs and help alleviate the high numbers of student-to-counselors in educational settings. Boss (2022) suggested that programs need to be updated to meet the current needs of individuals going through stress, loss, and change. Family life educators could teach the program Waves of Change to students and provide additional resources to help the students GETTING THROUGH CHANGE WITH THE POWER OF EDUCATION 34 navigate through change without the teachers and counselors adding one more thing to their plate of responsibilities. Limitations It was more challenging to connect with providers in their healthcare system than it was with professionals in educational settings. Providers' time seemed to not be as available to have a conversation and gather feedback from than it was with educators. If I was a patient needing services it was easy to schedule a time, but to gather research it was a whole other story. From this experience, if I knew a provider personally (or had a referral) I had a better chance to connect for an appointment to gather feedback for my project. I even had one clinic tell me that providers' emails were not available to give out and I would need to call individually to each of the provider's offices inquiring if they could help me further. I reached out to one of the office coordinators of a major healthcare service located in the Weber and Davis County areas. This specific healthcare service has over 200 providers and 20 specialists. She kindly sent out an email to admins who work with providers in the fields of gastroenterology, OB/GYN, allergies and immunotherapy, cardiology, oncology, and pediatrics and I received only one email back from a provider being willing to help with my thesis project. From this I conclude that time and a common passion for helping patients with education is a factor in connecting further with providers. Discussion Future Research After completing the curriculum for the Waves of Change group support program and gathering feedback from professionals, I was left with the following thoughts about moving forward with research in the future around the topic of change. First, I am curious to know how individuals’ view change. Symbolic interactionism teaches individuals that the world is always changing, and that society is constantly developing. This can leave people feeling they have little or no control over their lives (Smith & Hamon, GETTING THROUGH CHANGE WITH THE POWER OF EDUCATION 35 2017). This leads me into wanting to organize a quantitative research study to see if individuals’ view change as more of a positive experience or a negative one. I noticed there was a lack of excitement with the news of a health diagnosis and wondered if a negative view is more the norm. Second, there is a new high school in the Weber County school district that is under construction and will be opened for the 2024-25 school year. It would be interesting to gather research from the lives of adolescents and teachers/faculty because the nature of the entire school would all be going through change. There are normative physiological changes that occur in individuals as they go through adolescence, as well as factors of cognitive development where adolescents gain understanding of the physical and social world. This can provide a foundation for a wide range of development in the lives of adolescents when it comes to family relations, friendships, school performances, and risk behavior (Arnett, 2018). I would be curious to see what changes adolescents are aware of as they transition to a new environment of a new high school, what resources help them navigate through this and other normative changes, and maybe what obstacles may come from this change. School is one important area in which friends influence adolescents, sometimes more than the influence of parents, (Arnett, 2018) and I would also be curious to know how peers/friends play a part through this change of a systemwide new school. Third, I received a lead to a gastroenterologist in the Odgen area that would be a great place to do a trial run of the program Waves of Change. With the rising rates of chronic health conditions and current research showing that young people today are five times more likely to be diagnosed with celiac disease (an autoimmune disease that affects the digestive system) than youth in the 1950’s (Axe, 2016), there is a need to help gastroenterologists. Following up with that referral would be interesting to see the benefits of the Waves of Change program in action with patients. GETTING THROUGH CHANGE WITH THE POWER OF EDUCATION 36 Fourth, school settings seemed to have professional counselors in place to help address topics of change verses healthcare settings did not seem to have a specialist or a name of a person who would teach additional education to their patients. The resources and programs providers would offer to patients were more outsourced, meaning there was not an extension from that office to get help from anyone more than the provider. The role of a family life educator is to educate and enrich the well-being of individuals through educational, preventative, and strengths-based approaches (Ballard & Taylor, 2022; Darling & Cassidy, 2014). Additionally, support and training from professionals can help individuals know how to process through change (Bolman & Deal, 2021; Feldmann, 2014). I would be curious to see if a specialist like a family life educator could work side by side with a provider to collaborate and help patients have both tests/labs/scans and education/support with a guided support group. Conclusion A common finding in reading research is the statement “further research is needed”. Completing this process of a master’s thesis by developing a curriculum and gathering feedback from professionals has been my way of answering that statement and fulfilling my curiosity of what is available in the community to help others on the topic of change. Knowing that change is an evitable part of life, it is constant, and ongoing, I for one want to be as versed with the topic as much as possible. I want to have continuous education and knowledge about what it does to humans when they are under stress, the impacts it can have on the physical body, and the ripple effect of impact it can have in relationships in family units. The program that I created does just this! Through this process the Waves is Change group support program is not just an idea or thought to help others but is now in an organized complete form and a resource back up by years of research and best teaching practices that can better help serve as an option for the community. GETTING THROUGH CHANGE WITH THE POWER OF EDUCATION 37 References American School Counselor Association. (2022). Student-to-school-counselor ratio 2021-2022. https://www.schoolcounselor.org/getmedia/b9d453e7-7c45-4ef7-bf9016f1f3cbab94/Ratios-21-22-Alpha.pdf Arnett, J. J. (2018). Adolescence and emerging adulthood (6th ed.). Pearson Education, Inc. Axe, J. (2016). Eat dirt: why leaky gut may be the root cause of your health problems and 5 surprising steps to cure it. Harper Wave. Banta, T., & Palomba, C. (2015). Assessment essentials: planning, implementing, and improving assessment I higher education. John Wiley & Sons. Ballard, S., & Taylor, A. (2022). Family life education with diverse populations. 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Speaking of psychology: ambiguous loss and the “myth of closure,” with Pauline Boss, PhD [Audio podcast]. https://www.apa.org/news/podcasts/speaking-of-psychology/ambiguous-loss Swick, K. J., & Williams, R. M. (2006). An analysis of Bronfenbrenner’s bio-ecological perspective for early childhood educators: implications for working with families experiencing stress. Early Childhood Education Journal, 33(5), 371–378. https://doi.org/10.1007/s10643-006-0078-y Varvogli, L., & Darviri, C. (2011). Stress management techniques: evidence-based procedures that reduce stress and promote health. Health Science Journal, 5(2), 74–89. http://www.gpscbc.ca/sites/default/files/Stress%20Management%20TechniquesHealth%20Science%20Journal.pdf GETTING THROUGH CHANGE WITH THE POWER OF EDUCATION Appendix A 40 GETTING THROUGH CHANGE WITH THE POWER OF EDUCATION Appendix B 41 GETTING THROUGH CHANGE WITH THE POWER OF EDUCATION Appendix C “Waves of Change” Outline of Group Support Program curriculum 42