Digital Repository Doctoral Projects Fall 2022 Improving Adolescents’ Mental Health by Teaching Healthy Life Skills Celeste Christensen Weber State University Follow this and additional works at: https://dc.weber.edu/collection/ATDSON Christensen, C. (2022). Improving Adolescents’ Mental Health by Teaching Healthy Life Skills. Weber State University Doctoral Projects. https://cdm.weber.edu/digital/collection/ATDSON This Project is brought to you for free and open access by the Weber State University Archives Digital Repository. For more information, please contact archives@weber.edu. HEALTHY LIFE SKILLS 1 Improving Adolescents' Mental Health by Teaching Healthy Life Skills by Celeste Christensen A project submitted in partial fulfillment of the requirements for the degree of DOCTOR OF NURSING PRACTICE Annie Taylor Dee School of Nursing Dumke College of Health Professions WEBER STATE UNIVERSITY Ogden, Utah October 3, 2022 _______________________________ ______________________________ Celeste Christensen, DNP-FNP, RN Date _______________________________ _____________________________ Kristy A. Baron, PhD, RN Date Faculty Lead _______________________________ ______________________________ Melissa NeVille Norton DNP, APRN, CPNP-PC, CNE Date Graduate Programs Director Kristy A. Baron December 16, 2022 December 16, 2022 Celeste Christensen December 16, 2022 HEALTHY LIFE SKILLS 2 Table of Contents Abstract ........................................................................................................................................... 3 Improving Adolescents' Mental Health by Teaching Healthy Life Skills ...................................... 4 Background and Problem Statement ........................................................................................... 4 Diversity of Population and Project Site ..................................................................................... 6 Significance for Practice Reflective of Role-Specific Leadership ............................................. 6 Literature Review and Framework ................................................................................................. 7 Search Methods ........................................................................................................................... 7 Synthesis of Literature ................................................................................................................ 7 Risk factors ............................................................................................................................. 8 Consequences .......................................................................................................................... 8 Barriers for Treatment............................................................................................................. 9 Education for Healthy Life Skills ........................................................................................... 9 Teaching Methods for Adolescents .......................................................................................... 11 Conceptual Framework for Early Adolescence ........................................................................ 12 Discussion ..................................................................................................................................... 12 Implication for Practice............................................................................................................. 13 Project Plan ................................................................................................................................... 14 Project Design ........................................................................................................................... 14 Needs Assessment of Project Site and Population .................................................................... 14 Cost Analysis and Sustainability of Project .............................................................................. 15 Project Outcomes ...................................................................................................................... 15 Instruments to Measure the Effectiveness of Intervention ....................................................... 15 Consent Procedures and Ethical Considerations....................................................................... 16 Project Implementation ................................................................................................................. 16 Interventions ............................................................................................................................. 16 Project Timeline ........................................................................................................................ 17 Project Evaluation ......................................................................................................................... 18 Data Maintenance/Security ....................................................................................................... 18 Data Collection and Analysis.................................................................................................... 18 Findings..................................................................................................................................... 19 Table 1 ...................................................................................................................................... 19 Strengths ............................................................................................................................... 20 Weaknesses ........................................................................................................................... 20 Quality Improvement Discussion ................................................................................................. 20 Translation of Evidence into Practice ....................................................................................... 20 Implications for Practice and Future Scholarship ..................................................................... 21 Conclusion .................................................................................................................................... 22 References ..................................................................................................................................... 23 Appendix A ................................................................................................................................... 31 Appendix B ................................................................................................................................... 35 Appendix C ................................................................................................................................... 48 Appendix D ................................................................................................................................... 50 Appendix E ................................................................................................................................... 52 Appendix F.................................................................................................................................... 53 HEALTHY LIFE SKILLS 3 Abstract Purpose: The project's focus was to educate students on healthy life skills at Valley View Middle School, helping them cope more effectively with stress. Methodology: Personal stress plan topics were taught once a week in a classroom over a six-week time frame to 12 middle school students. Knowledge gain was assessed using a pre-and post-assessment consisting of 10 questions. Student learning and teaching were analyzed at the conclusion of each class for updates on future classes. Results: All participants showed a knowledge gain in the pre-and post-assessment results. Qualitative data showed that students were engaged in healthy life skills classes. Implications: Adolescents is a time of rapid growth and learning. Mental health is an essential part of adolescent development. Promoting healthy life skills can help them deal with stressors during adolescence. Keywords: adolescents, depression, anxiety, life skills, coping skills HEALTHY LIFE SKILLS 4 Improving Adolescents' Mental Health by Teaching Healthy Life Skills Mental health issues are a growing problem experienced by 1 in 5 adults and almost 50% of adolescents living in the United States (National Institute of Mental Health, 2021). Identifying at-risk adolescents early can help prevent long-term effects, such as severe anxiety, depression, substance abuse, and suicide. Teaching healthy life skills can help decrease the negative impact mental health has on adolescents. The primary purpose of this project is to teach healthy life skills to adolescents at Valley View Middle School, helping promote positive mental health outcomes. Background and Problem Statement Adolescence is a time of rapid physical and emotional changes happening simultaneously, which can be overwhelming to navigate (Copeland et al., 2014). In addition, adolescents are transitioning to more demanding schoolwork, experiencing new hormones, and showing increased stress sensitivity. These added stressors put them at a higher risk of experiencing mental health issues (van Loon et al., 2019). When mental health is not addressed, it becomes a problem that can escalate into a significant health crisis, such as depression, anxiety, risky behavior, and suicide (Patel et al., 2007). Adolescents experience stressful feelings, fear, and anxiety during social development (Hilt et al., 2016). These feelings are considered an anxiety disorder when they become unmanageable, remain persistent, and affect an individual's ability to carry out day-to-day activities. About 30% of adolescents suffer from anxiety disorders (Bennett & Walkup, 2021). Moreover, when an adolescent becomes withdrawn or sad for more than two weeks, these symptoms reflect the first signs of depression (Hilt et al., 2016). Other feelings they can experience that reflect depression are fatigue, brain fog, eating habit changes, and feelings of HEALTHY LIFE SKILLS 5 worthlessness (Dupere et al., 2018). Unfortunately, often these symptoms are overlooked and dismissed as "moodiness" (Hilt et al., 2016). The American Psychological Association (2016) guidelines provide options to help direct the providers' care for their patients experiencing depression or anxiety. These care options include psychological, complementary, pharmacological, alternative, or a combination of them. However, psychotherapy interventions are considered a better approach for adolescents than pharmacological interventions. With standardized guidelines for psychotherapy, the hope is to decrease depression and anxiety and improve mental health by providing age-specific and prevention-focused care (Hilt et al., 2016). Most anxiety and depression disorders start during adolescence; however, only 1 in 5 adolescents struggling with mental health issues is diagnosed, and only half of those diagnosed receive treatment (Hilt et al., 2016; World Health Organization [WHO], 2020). Furthermore, Hilt et al. (2016) suggest that the lack of resources, communication barriers, and limitations of mental health professionals contribute to inadequate treatment. Adolescent suicide rates have been steadily rising over the past few years. Over 20% of all students considered attempting suicide in Utah, and 18% had a suicide plan. At the same time, almost 10% of them attempted suicide during that period. In 2017-2019, the Payson-Salem area experienced 20 suicides in the community (Utah Department of Health, Center for Health Data and Informatics, 2021). Teaching and promoting healthy life skills can provide adolescents with coping skills to navigate daily stressors and promote healthy habits, thus, empowering students with the skills to help manage stress, decrease depression, and reduce substance abuse (Enkema et al., 2020). The HEALTHY LIFE SKILLS 6 DNP project aims to introduce healthy life skills at Valley View Middle School to prevent or ease the effects of mental health issues that adolescents experience. Diversity of Population and Project Site Valley View Middle School is a new middle school in Salem, Utah area. Most students who attend Valley View Middle School were enrolled in one of the following schools the prior year: Foothills, Mount Loafer, Taylor, and Barnett Elementary School or Salem Junior High. Ninety percent of White students are represented from Foothills Elementary, Mount Loafer Elementary, and Salem Junior High. However, Barnett and Taylor Elementary represent 75% White and 20% Hispanic. The poverty levels for Foothills, Mount Loafer Elementary, and Salem Junior High is around 20% (National Center for Education Statistics, 2021). Conversely, Barnett and Taylor Elementary schools show a poverty level of 45% (National Center for Education Statistics, 2021). Significance for Practice Reflective of Role-Specific Leadership As a family nurse practitioner leader, improving person-centered care promotes positive outcomes, improves relationships, and promotes healthy communication skills using evidence to implement a universal preventative approach (Brown & Carr, 2019). This DNP project focuses on person-centered care by teaching middle school students healthy life skills and improving their mental health. Helping the students develop healthy life skills provides them with a tool to navigate stress (American Academy of Pediatrics, 2014). Empowering patients to develop healthy life skills when they are younger can help improve their overall health in the long term (Youth.gov, 2021). Healthy life skills can promote competence development and improve many students' social, emotional, cognitive, and behavioral skills. (National Research Council et al., 2009). HEALTHY LIFE SKILLS 7 Literature Review and Framework Early evaluation of adolescents for mental health disorders is becoming more acceptable, and with these evaluations, treatment and coping skills can be taught and initiated before adverse complications become apparent (Bennett & Walkup, 2021). Teaching adolescents the difference between stress and anxiety and sadness and depression is a start to help them understand what normal feelings are and when they should seek help (Weersing et al., 2016). School is an ideal setting to manage stress and help teach confidence, encourage resilience, and promote coping skills for adolescents (van Loon et al., 2019). Promoting stress-reducing methods can facilitate a balance for the students by maintaining good mental health (Duivis et al., 2018). This literature review and framework evaluate evidence of healthy life skill methods that adolescents can utilize to improve mental health outcomes, which can decrease anxiety and depression symptoms. Search Methods Databases and the search engine utilized for the literature review were UpToDate, Utah Health Indicator, and Google Scholar. Search terms for this project included adolescents, depression, anxiety, life skills, coping skills, prevention, breathing, suicide, school-based setting, school dropouts, sleep, emotional intelligence, mental health literacy, and social and emotional skills. In addition, peer-reviewed journal articles of less than five years and studies addressing age ranges through puberty, adolescents, and young adulthood were included in this review. Synthesis of Literature The WHO (2020) defined health as a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmary. Therefore, to promote health, one must treat the body and mind (Ghebreyesus, 2019). Unfortunately, mental health issues are a growing problem experienced in half of all adolescents in the United States. Most anxiety and HEALTHY LIFE SKILLS 8 depression disorders start during adolescence. This developmental phase is incredibly stressful and associated with increased mental health issues that need to be addressed early to hopefully reduce long-term effects (Dick & Ferguson, 2014; National Institute of Mental Health, 2021; WHO, 2020). Risk factors Many factors can cause depression and anxiety. Before a diagnosis can be made, other health issues, such as abuse, bullying, and traumatic event, need to be ruled out (Bennett & Walkup, 2021; Hilt et al., 2016). Unmanaged anxiety during adolescence can lead to lifelong anxiety due to the inability to develop coping mechanisms (Lijster et al., 2016). Disruption to sleep patterns due to excessive worrying can also occur in adolescents experiencing anxiety or depression. Furthermore, peer pressure, substance abuse, cyberbullying, and isolation can contribute to adolescents' anxiety and depression (Hawes et al., 2020; Hilt et al., 2016). Consequences Anxiety and depression can cause adolescents to become withdrawn, decreasing healthy peer interactions. Social interaction is vital at this age. When adolescents stop finding joy in things they previously loved, they tend to close off everything around them. Once adolescents stop interacting with others, they are at a higher risk of self-harm, substance abuse, risky sexual behavior, and suicide (Dick & Ferguson, 2014; Hilt et al., 2016). Suicide is the leading cause of death in adolescents (Mayo Clinic, 2019). Even with this information about adolescent suicide, studies are limited regarding treatment for adolescent mental health; therefore, mental health treatment is commonly delayed until adulthood (Patel et al., 2007). Education attainment is neglected in adolescents suffering from anxiety or depression due to the overload of worrisome thoughts. They do not have the mental capacity to process any HEALTHY LIFE SKILLS 9 more information, becoming school dropouts. Dropping out of school increases when adolescents experience a lack of motivation to learn, such as decreased engagement during class time and discontinued of planning for the future, causing them to disconnect from their peers and future goals. Multiple studies found that untreated or undiagnosed anxiety negatively impacts adolescents' learning ability or enjoying being in the social school setting. Nevertheless, another consequence of dropping out is that it removes the last formal setting for adolescents to receive help using a school-based program. (Bennett & Walkup, 2021; Dupere et al., 2018). Many schools have successful anti-bullying, drug-free programs, and safe technology initiatives. Even with these programs, mental health complications are increasing (Duivis et al., 2018; Dupere et al., 2018). Barriers for Treatment In 2019, the Centers for Disease Control and Preventions Youth Risk Behavior Survey showed an increasing trend in adolescent suicide, sadness, and hopelessness. Then COVID happened, reducing school-based mental health services to 3.5 million students. This reduction significantly impacted lower-income and minority students whose only access to care was through school programs (Hertz & Barrios, 2021). Education for Healthy Life Skills School-based mental health programs can increase the following attributes: emotional skills, emotional intelligence, confidence, resilience, and coping skills. Teaching students ways to achieve these attributes can reduce stress and anxiety, reducing complications caused by unmanageable anxiety (Didacus et al., 2019). Similarly, school-based programs can decrease stress and reduce suicide attempts by improving healthy life skill techniques by understanding what mental health is, managing toxic thoughts, learning coping strategies, performing breathing HEALTHY LIFE SKILLS 10 techniques, encouraging better sleeping patterns, improving healthy eating habits, and increasing emotional intelligence (Hertz & Barrios, 2021; van Loon et al., 2019). Mental Health Literacy. Mental health literacy is understanding what good mental health is and knowing how to recognize, manage, and prevent adverse effects. Incorporating mental health literacy into the standard health education curriculum is the first step to improving adolescent mental health. (Jorm, 2018; Seedaket et al., 2020; Swartz et al., 2017). For example, the Adolescence Depression Awareness Program is a school-based program designed to teach students to identify symptoms, understand treatments, and see differences between depression and other illnesses while understanding the potential consequences of depression (Swartz et al., 2017). In addition, a better understanding of good mental health can improve attitudes and increase recognition to promote early intervention and decrease the stigma of mental health issues in adolescents (Seedaket et al., 2020; Skre, 2013). Quality Sleep. Focusing on healthy sleep habits to prevent mental health issues can be an excellent strategy to help improve adolescents' mental health. Sleep disturbances and fatigue are common symptoms in adolescents suffering from anxiety or depression. Providing more training for adolescents and families on strategies and habits for better sleep might improve resilience and decrease anxiety and depression symptoms, making them more manageable (Higson-Sweeney et al., 2020; Hilt et al., 2016). Healthy Diet. Diet is a significant contributing factor to one's overall health. The old phrase "we are what we eat" has some lasting truth. Diets consisting of high saturated fats, refined sugars, and processed foods cause neurotransmitter signaling to decrease, resulting in impaired learning and memory while increasing anxiety-like behavior (Aden et al., 2019; Bodden et al., 2021; Emerson & Cabert, 2019). In addition, increasing evidence shows that the HEALTHY LIFE SKILLS 11 intake of a poor diet is associated with anxiety and depression. Further research needs to be conducted on specific diets to treat anxiety and depression, yet there is evidence that diets high in fresh fruits and vegetables have been linked to increased happiness and improved mental health (Aden et al., 2019; Emerson & Cabert, 2019). Emotional Intelligence. Emotional intelligence is when one can express, control, and recognize one's emotions. Understanding physical, emotional, and mental changes during adolescence is an essential skill that needs to be learned. Education systems educate students academically but are now starting to recognize the importance of social-emotional learning. This learning can help the students become self-aware, teach responsibility, feel empathy, and improve decision-making (Kothari & Wesley, 2020). In addition, positive adolescent development nurtures relationship-building skills, responsible choices, and self-management of impulses and emotions (Shek et al., 2019). Coping Skills. Adolescent development is a time full of stress and strong emotions. Accepting these emotions and learning to deal with them constructively is part of their development. Many coping exercises, like deep breathing, mindfulness, exercise, and yoga, can be utilized. For example, studies have found that guided imagery and breathing exercises performed in class, for just 10 minutes, can reduce anxiety, increase relaxation, and improve mental and physical well-being (Moore et al., 2021; Toussaint et al., 2021). Teaching Methods for Adolescents Adolescents learn best when they can be fully engaged in their learning. Engagement starts with a stable and safe environment that clearly states the expectations. Making the information relevant to them through creativity, technology, and engagement of multiple senses promotes learning. Promoting an environment that encourages asking questions can also improve HEALTHY LIFE SKILLS 12 engagement and learning. The promotion of self-determination can improve understanding by helping the students make a personal connection to the information. Personal engagement and drive are essential milestones to motivate adolescents to make positive progress in their education (Grant-Skiba & Orwa, 2018; Shogren et al., 2019). Conceptual Framework for Early Adolescence Adolescence development is a complex process as they form a personal foundation transitioning into socially, emotionally, and intellectually functioning adults. There are four cornerstones of development in the conceptual framework for early adolescence that promote effective progression: engagement in learning, emotional-physical safety, positive sense of self, and decision-making skills (Blum et al., 2014). Engagement in the learning objective is essential to get the Valley View Middle School students excited about the new tools and objectives to improve their healthy living habits. Adolescents need to feel safe emotionally and physically. Providing a safe environment for students to learn healthy life skills and feel comfortable asking for help can promote a positive sense of self. Finally, promoting positive decision-making skills utilizing healthy life skills learned through the modules can provide a solid foundation to promote good mental health for the Valley View Middle School students (Association of Maternal and Child Health Programs and the National Network of State Adolescent Health Coordinators, 2005). Discussion A gap still exists in the research and report on adolescent mental health treatments (Vasileva et al., 2020). However, research in this area is growing, and understanding of the importance of good tools and proper evaluation of adolescents regarding depression and anxiety is increasing. School-based programs are a good start due to adolescents' time in the school HEALTHY LIFE SKILLS 13 setting (van Loon et al., 2019). Early treatment goals in programs are to help reduce school dropout rates, isolation, substance abuse, mental health issues, and suicides in adolescents. In addition, improved coping skills can positively impact adolescents' overall physical and mental health, and improved evaluation tools can increase teachers' and counselors' ability to recognize at-risk adolescents (Costantini et al., 2021; Ghebreyesus, 2019; Hilt et al., 2016). Implication for Practice The middle school setting is ideal for implementing healthy life skills and coping strategies to support students' developmental challenges. Students at Valley View Middle School are between 12 and 13 years of age and transitioning from childhood into adolescence. During this DNP project, the school district is screening students who show signs of developing anxiety or depression when symptoms are mild and still manageable in hopes of preventing chronic complications and long-term effects (van Loon et al., 2019). A Valley View Middle School licensed social worker implements Patient Health Questionnaire 9 (PHQ-9) identification tool to identify high-risk students for mental health issues. PHQ-9 is considered the most accepted evaluation tool to utilize as a universal screening tool (Hilt et al., 2016). Furthermore, the PHQ-9 depression scale can efficiently and effectively be utilized by trained school counselors and licensed social workers (Costantini et al., 2021). When students are identified as at-risk, the school social worker arranges referrals to Wasatch Mental Health and licensed therapists. These therapists commonly treat adolescents and teach them how to manage toxic thoughts, learn coping strategies, and set up a crisis plan. In addition to these referrals, teaching healthy life skills to students can improve their mental health. Many people working at the middle school can help support the DNP project. Getting buy-in from school nurses can connect other schools within the district with the available resources. In HEALTHY LIFE SKILLS 14 addition, working with the school's social worker and teachers helps improve healthy life skills knowledge for the students to use confidently. Project Plan Adolescence is an incredibly stressful time and is associated with increased mental health issues (Bennett & Walkup, 2021). Providing healthy life skills education can help these adolescents by providing tools and coping skills to help them navigate this crucial time in their lives. This quality improvement project aims to teach students healthy life skills while managing stress. The project design and instruments, needs assessment, sustainability, and ethical considerations are outlined below. Project Design The project reflected a quality improvement design aimed at helping students develop knowledge, skills, and attitudes in managing stress in their lives. The project's purpose was to increase students' knowledge, skills, and attitudes by creating a personal stress plan that addressed the importance of tackling the problem, taking care of my body, taking care of emotions, and helping family members or the community. These healthy life skills are outlined in a document (see Appendix A). Needs Assessment of Project Site and Population The Valley View Middle School counselor had been working closely with a group of students and identified some as needing more support in coping with school and stressors. After the school counselor identified students, the pilot class started with 12 male students. If evaluations showed improvement, a female group would start next. The groups were in a school-based setting that allowed the students to participate during school hours. Over the six weeks, they would be excused from the latter part of a class, rotating classes not to interrupt their academic learning. HEALTHY LIFE SKILLS 15 Cost Analysis and Sustainability of Project The cost for the project consisted of time, art supplies, and various activities. The classes were completed during school hours, and the resources were already available. Sustainability was supported through developed deliverables that provide future group instructions. These deliverables included lesson plans uploaded into a Canvas course for parents, counselors, and teachers to access (see Appendix B). Canvas courses were easily integrated into the school curriculum due to Valley View Middle School already utilizing this platform. Creating this quality improvement project was a low-cost sustainable pilot program. Project Outcomes The outcomes of this quality improvement plan were to evaluate if teaching healthy life skills on stress management in 20-minute classes for selected students at Valley View Middle School helped students cope more effectively with stress. Project outcomes were measured by the following: 1. The school counselor evaluated selected students through pre-and post-student assessments of coping skills, anxiety, and stress management. 2. DNP student used pre-and post-knowledge assessments provided at the beginning and end of this six-week course to measure knowledge and attitudes (see Appendix C). 3. Lesson learning objectives were assessed during the classes by group discussion, participation, and completion of each section in the students' personal stress plan with appropriate healthy life skills utilized. Instruments to Measure the Effectiveness of Intervention The DNP student used two instruments to measure intervention benefits. First, the pre-and post-knowledge assessments were given to the students at the beginning and end of the six HEALTHY LIFE SKILLS 16 weeks. The assessment consisted of ten questions (see Appendix C). The second instrument was the lesson plan evaluation for each class time (see Appendix B). Consent Procedures and Ethical Considerations Privacy and ethical considerations were taken into account to protect students during this quality improvement project. An IRB approval was granted through Weber State University. Since the project was working with adolescents, parental consent was obtained through the school counselor (see Appendix D). No identifiable markers were linked to individual knowledge assessments. Project Implementation This quality improvement project to promote healthy life skills in adolescents was implemented with the Valley View Middle Schools social worker, teachers, and a counselor. Lesson plans were developed and followed the personal stress plan template topics (American Academy of Pediatrics, 2014). The Healthy Life Skill lessons provided the students with the knowledge to complete their personal stress plans catered to their interests and abilities learned over the six weeks. Interventions The project interventions utilized for this project were knowledge gain assessments, evidence-based lesson plans, and school counselor collaboration. Previously, each student was evaluated by the school counselor with a pre-assessment and identified as a student who could benefit from this Healthy Life Skills Class. Students who participated in these group lessons were excused for 20 minutes each Monday for six weeks. In addition, they were excused from a different class each week to reduce disruption to their academic work. A different section of the personal stress plan was introduced and discussed with the group in each class. The main topics HEALTHY LIFE SKILLS 17 included tackling the problem, taking care of my body, taking care of emotions, and helping make the world a better place. Subtopics related to the main topics reflected the following: The power of exercise, active relaxation, eating well, sleeping well, and making the world better (see Appendix A for the personal stress plan). The information was delivered through discussions, lectures, videos, and activities (see lesson plans in Appendix B). At the end of each class, the student would fill out their personal stress plan in the section they discussed. At the end of the six weeks, each student had a personalized stress plan filled with healthy life skills learned during this class. For this pilot class, the school counselor performed exit assessments on each student who participated in the group and compared it to their pre-assessment to determine if the classes were beneficial. In addition, students completed a pre-knowledge assessment on the first day of class and a post-assessment on the last day of the six-week classes (see Appendix C). Students were evaluated whether they were engaged and learned each week through class discussion, participation, and in-class activities (see Appendix B). Project Timeline The project timeline covered a literature review, IRB approval and implementation, evaluations, and dissemination. The first part of the project included the gathering of resources and evidence. Next, IRB approval was obtained in the Fall of 2021, following project implementation during a six-week block. Next, project evaluation and dissemination occurred after the completion of the implementation phase (see timeline details in Appendix E). HEALTHY LIFE SKILLS 18 Project Evaluation The healthy life skills classes were taught weekly to 12 students during flex time over six weeks. A pre-knowledge assessment was given to the participants in the first class consisting of 10 multiple-choice questions. Then the same test was provided to them at the conclusion of the group classes to assess their knowledge growth. In addition, student learning and teaching were evaluated after each class. This section outlines the evaluation results. Data Maintenance/Security All participant's identities were kept confidential in the evaluation results, and data was obtained with parental consent and through the school counselor. The teaching material was made available to the school counselor and students. All learning material was approved before implementation by Weber State University faculty and Valley View Middle School counselor. Data Collection and Analysis Survey data were collected and compared using an Excel spreadsheet comparing the pre-and-post-knowledge assessment scores. The Panorama Survey was used to collect data by the school counselor to compare outlooks and coping skills improvements. In addition, all life skills lessons were evaluated by analyzing qualitative data focused on student learning and teaching by answering the following questions (see Appendix B): 1. What did the students learn in this lesson? 2. What did the students do? 3. What were they not able to do or understand? 4. What went well? 5. If you were to teach this lesson again, what would you do differently? HEALTHY LIFE SKILLS 19 Findings An improvement was shown with knowledge obtained through the healthy life skill classes, as shown by the pre- and post-assessments (see Table 1). Table 1 Pre- and Post-Knowledge Assessments Student Pre-Assessment Post-Assessment Difference Student 1 0.5 0.9 0.4 Student 2 0.6 1.0 0.4 Student 3 0.4 0.6 0.2 Student 4 0.5 0.7 0.2 Student 5 0.2 0.5 0.3 Student 6 0.6 0.8 0.2 Average % 0 .47 0.75 0.28 Note: Pre-assessment was given to participants before the Healthy Life Skills Lessons, and post-assessment was given when the lessons were completed. Besides the healthy life skills classes, Valley View Middle School also provided the students with a support room, youth support meetings, individual counseling, and mediation during flex time for the students that met specific criteria. With these interventions, all participants showed an increase in positive outlook and utilization of coping and self-regulation skills. In addition, information obtained from the Panorama Survey performed by the school counselor showed the results exceeded the initial goal of an improvement of 5%. The post-survey showed at least a 6% increase in all students participating (see Appendix F). HEALTHY LIFE SKILLS 20 During the healthy life skills classes, students would actively participate in lessons and have open discussions and suggestions about the topics. After each class, student learning and teaching were evaluated. This analysis provided suggestions and updates for lesson plans organized in the learning management system for future use (see Appendix B). Strengths A quality improvement project using healthy life skills lessons is a cost-effective tool that can be easily integrated into the school curriculum for the whole student body. In addition, it can be utilized in a smaller group setting as implemented for this quality improvement project. The support of the school counselor was an essential part of the success of this project. Weaknesses The weakness of the quality improvement project was a small study size of 12 students, but only six students attended all the sessions with pre-and post-assessments to compare data on knowledge growth. However, all students who participated had pre- and post-coping strategy assessments completed by the school counselor (see Appendix F). Quality Improvement Discussion This quality improvement project provides adolescents with personal stress plans (see Appendix A), resulting in increased knowledge of coping skills. This project uses a cost-effective, sustainable program that can be implemented at any school utilizing Canvas courses. Project results are presented to Weber State University and made available to the public through the repository. Translation of Evidence into Practice This project's positive results of knowledge gain of healthy life skills reiterate the importance of incorporating healthy life skill strategies into student education. Every participant HEALTHY LIFE SKILLS 21 shows knowledge growth about coping skills. The primary learning outcome from this improvement project is that simple, early education about healthy habits can significantly improve one's knowledge about them. Providing more resources to the schools and proactive programs addressing the knowledge gap and improving coping skills can provide adolescents with a steady foundational knowledge to navigate everyday stressors (American Academy of Pediatrics, 2014). Implications for Practice and Future Scholarship Future implications of implementing healthy life skills in a school setting can help provide strategies to adolescents in promoting coping skills, healthy habits, and stress reduction exercises. The positive improvements in this pilot class show potential for future growth and expansion in efforts to address the adolescent population's mental health. Incorporating these simple classes into homerooms and more middle schools may help students gain better knowledge of coping skills. The information gathered during this project highlights the importance of coping skill education. Primary care providers can also incorporate some of these tools into well-child checks by providing them with access or information regarding mental health resilience through healthy life skills. Sustainability For sustainability, all lesson plans are provided to the Valley View Middle School counselor and are uploaded to a Canvas course made available to the whole student body. In addition, the counselor updates evidence as new resources become available or different needs become apparent. HEALTHY LIFE SKILLS 22 Dissemination Project implementation and results are disseminated to peers and faculty during a poster presentation at the Annie Taylor Dee Son of Nursing in Fall 2022. In addition, the project paper is available at the WSU Stewart Library DNP Repository for public access. Conclusion Adolescents is a time of rapid growth and learning, making teaching healthy life skills to this demographic an ideal time. Mental health is essential to adolescent development (Enkema et al., 2020; Hertz & Barrios, 2021). Teaching coping skills using a personal stress plan provides them with knowledge on dealing with stressors during adolescence. Every participant in the project shows they gained knowledge from a cost-effective, simple intervention in the school setting. Promoting healthy life skills in adolescents can reduce anxiety and depression through self-regulation and lifestyle changes in a proactive approach rather than a reactive approach to mental health, improving the overall well-being of our future generation (Kothari & Wesley, 2020; Moore et al., 2021; Seedaket et al., 2020; van Loon et al., 2017). HEALTHY LIFE SKILLS 23 References Aden, R. A. H., van der Beek, E. M., Buielaar, J. K., Cryan, J. F., Hebebrand, J., Higgs, S., Schellekens, H., & Dickson, S. L. (2019). Nutritional psychiatry: Towards improving mental health by what you eat. 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A quasi-experimental study to assess the effectiveness of Jacobson's progressive muscle relaxation technique on social anxiety among adolescent girls of selected schools of Kashipur, Uttarakhand. International HEALTHY LIFE SKILLS 25 Journal of Nursing & Midwifery Research, 6(2&3), 12-16. http://doi.org/10.24321/2455.9318.201914 Duivis, H. E., Kupper, N., Vermunt, J. K., Penninx, B. W., Bosch, N. M., Riese, H., Oldehinkel, A. J., De Jonge, P. (2015). Depression trajectories, inflammation, and lifestyle factors in adolescence: The tracking adolescents' individual lives survey. Health Psychology, 34(11), 1047-1057. http://dx.doi.org.hal.weber.edu:2200/10.1037/hea0000210 Dupere, V., Dion, E., Nault-Briere, F., Archambault, I., Leventhal, T., & Lesage, A. (2018). Revisiting the link between depression symptoms and high school dropout: Timing of exposure matters. Journal of Adolescent Health, 62(2), 205-211. https://doi.org/10.1016/j.jadohealth.2017.09.024 Emerson, S. D., & Carbert, N. S. (2019). An apple a day: Protective associations between nutrition and the mental health of immigrants in Canada. Social Psychiatry Epidemiology, 54, 567–578. https://doi.org/10.1007/s00127-018-1616-9 Enkema, M. C., McClain, L., Bird, E. R., Halvorson, M. A., & Larimer, M. E. (2020). Associations between mindfulness ad mental health outcomes: A systematic review of ecological momentary assessment research. Mindfulness, 11, 2455-2469. https://doi.org/10.1007/s12671-020-01442-2 Ghebreyesus, T. A. (2019). The WHO special initiative for mental health (2019-2023): Universal health coverage for mental health. World Health Organization. https://apps.who.int/iris/handle/10665/310981 Grant-Skiba, D., & Orwa, J. O. (2018). Raising Lazarus: Creative teaching and learning strategies to engage middle high school students. Literacy Learning: The Middle Years, 26(1). HEALTHY LIFE SKILLS 26 https://link.gale.com/apps/doc/A524380200/AONE?u=ogde72764&sid=summon&xid=c8f84337 Hawes, T., Zimmer-Gembeck, M. J., & Campbell, S. M. (2020). Unique associations of social media use and online appearance preoccupation with depression, anxiety, and appearance rejection sensitivity. Body Image, 33, 66-76. https://doi.org/10.1016/j.bodyim.2020.02.010 Hertz, M. F., & Barrios, L. C. (2021). Adolescent mental health, COVID-19, and the value of school-community partnerships. Injury Prevention, 27, 85-86. http://dx.doi.org/10.1136/injuryprev-2020-044050 Higson-Sweeney, N., Loades, M. E., Hiller, R., & Read, R. (2020). Addressing sleep problems and fatigue within child and adolescent mental health services: A qualitative study. Clinical Child Psychology and Psychiatry, 25(1), 200-212. https://doi.org/10.1177/1359104519838573 Hilt, R. J., Nussbaum, A. M., & American Psychiatric Association. (2016). DSM-5 pocket guide for child and adolescent mental health. American Psychiatric Association Publishing. Jorm, A. (2018). Mental health literacy: Public knowledge and beliefs about mental disorders. 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Nurse Education in Practice, 50. https://doi.org/10.1016/j.nepr.2020.102948 National Center for Education Statistics. (2021). Valley View Middle school directory information. https://nces.ed.gov/ccd/schoolsearch/school_detail.asp?Search=1&Zip=84664&Miles=10&SchoolPageNum=3&ID=490063001561 National Institute of Mental Health. (2021). Mental illness. https://www.nimh.nih.gov/health/statistics/mental-illness.shtml National Research Council (US) and Institute of Medicine (US) Committee on the Prevention of Mental Disorders and Substance Abuse Among Children, Youth, and Young Adults: Research Advances and Promising Interventions. (2009). Preventing mental, emotional, and behavioral disorders among young people: Progress and possibilities. National Academies Press. http://doi:10.17226/12480 Patel, V., Flisher, A. J., Hetrick, S., & McGorry, P. (2007). Mental health of young people: A global public-health challenge. The Lancet, 369(9569), 1302-1313. https://doi.org/10.1016/S0140-6736(07)60368-7 HEALTHY LIFE SKILLS 28 Utah. (2020). School mental health funding amendments, H. B. 323 https://le.utah.gov/~2020/bills/static/HB0323.html Utah Department of Health, Center for Health Data and Informatics, Indicator-Based Information System for Public Health. (2021). Complete health indicator report of suicide. http://ibis.health.utah.gov/ Seedaket, S., Turnbull, N., Phajan, T., & Wanchai, A. (2020). Improving mental health literacy in adolescents: Systematic review of supporting intervention studies. A European Journal Tropical Medicine & International Health, 25(9), 1055-1064. https://doi.org/10.1111/tmi.13449 Shek, D. T. L., Dou, D., Zhu, X., & Chai, W. (2019). Positive youth development: Current perspectives. Adolescent Health, Medicine and Therapeutics, 131. https://link.gale.com/apps/doc/A604107037/HRCA?u=ogde72764&sid=bookmark-HRCA&xid=bb9c7a95 Shogren, K. A., Burke, K. M., Antosh, A., Wehmeyer, M. L., LaPlante, T., Shaw, L. A., & Raley, S. (2019). Impact of the self-determined learning model of instruction on self-determination and goal attainment in adolescents with intellectual disability. Journal of Disability Policy Studies, 30(1), 22–34. https://doi.org/10.1177/1044207318792178 Skre, I., Friborg, O., Breivik, C., Johnsen, L. I., Arnesen, Y., & Wang, C. E. A. (2013). A school intervention for mental health literacy in adolescents: Effects of a non-randomized cluster-controlled trial. BMC Public Health, 13, 873. https://doi.org/10.1186/1471-2458-13-873 Swartz, K., Musci, R. J., Beaudry, M. B., Heley, K., Miller, L., Alfes, C., Townsend, L., Thornicroft, G., & Wilcox, H. C. (2017). School-based curriculum to improve depression HEALTHY LIFE SKILLS 29 literacy among US secondary school students: A randomized effectiveness trial. American Journal of Public Health, 107(12), 1970–1976. https://doi.org/10.2105/AJPH.2017.304088 Toussaint, L., Nguyen, Q. A., Roettger, C., Dixon, K., Offenbacher, M., Kohls, N., Hirsch, J., & Sirois, F. (2021). Effectiveness of progressive muscle relaxation, deep breathing, and guided imagery in promoting psychological and physiological states of relaxation. Evidence-Based Complementary and Alternative Medicine, 2021. https://doi.org/10.1155/2021/5924040 van Loon, A. W. G., Creemers, H. E., Vogelaar, S., Saab, N., Miers, A. C., Westenberg, P. M., & Asscher, J. J. (2019). The effectiveness of school-based skills-training programs promoting mental health in adolescents: A study protocol for a randomized controlled study. BMC Public Health, 19(1). https://link.gale.com/apps/doc/A590735098/PPNU?u=ogde72764&sid=PPNU&xid=17bf ebde Vasileva, M., Graf, R. K., Reinelt, T., Petermann, U., & Petermann, F. (2020). Research review: A meta-analysis of the international prevalence and comorbidity of mental disorders in children between 1 and 7 years. The Journal of Child Psychology and Psychiatry, 62(4), 372-381. https://doi.org/10.1111/jcpp.13261 Weersing, V. R., Jeffreys, M., Do, M. T., Schwartz, K. T. G., & Bolano, C. (2016). Evidence base update of psychosocial treatments for child and adolescent depression. Journal of Clinical Child & Adolescent Psychology, 46(1), 11-43. HEALTHY LIFE SKILLS 30 World Health Organization. (2020). Enhancing mental health pre-service training with the mhGAP intervention guide: Experiences and lessons learned. https://www.who.int/publications/i/item/9789240007666 Youth.gov. (2021). Promotion and prevention. https://youth.gov/youth-topics/youth-mental-health/mental-health-promotion-prevention HEALTHY LIFE SKILLS 31 Appendix A My Personal Stress Plan Part 1: Tackling the Problem Point 1: Identify and Then Address the Problem. When I have too many problems, I will work on just one at a time. For example, I am going to pick one huge problem and break it into smaller pieces.  I will seek advice from family members and learn from their experience how to better handle problems.  I will take big assignments and learn to make lists or timelines.  I will work in teams so that I will learn that when people work well together they can do much more than if they each work alone. Point 2: Avoid Stress When Possible. I know that everyone has stress, but there are things that I could stay away from that really stress me out. I will  Avoid certain people, like ___________________________________________  Avoid certain places, like ___________________________________________  Avoid certain things, like ___________________________________________  Avoid certain memories that create pain for me, like ____________________ Point 3: Let Some Things Go. I realize that I waste some of my energy worrying about things I can't fix. Here are some things that I will try to let go so I can focus on the problems I can change.  _________________________________________________________________  _________________________________________________________________  _________________________________________________________________ I know I waste some of my energy when I take things personally that really have nothing to do with me. I am going to learn this lesson by remembering a time I did this and by choosing not to repeat that mistake. ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ Part 2: Taking Care of My Body Point 4: The Power of Exercise. I will do something that makes my body work hard for at least 20 minutes every other day—more is better. I know that strong bodies help people better deal with stress, and this will keep me in shape. The kinds of things I like to do include  _________________________________________________________________  _________________________________________________________________  _________________________________________________________________ I can commit to ________ minutes of exercise a day. If I have trouble focusing in school, I will try exercising before school for ______ minutes (recommended minimum: 20) to see if it helps me concentrate better. I know that a really hard physical workout will help me calm down when I am feeling most worried, stressed, or fearful. This is especially true when I can't concentrate on my homework because it feels like too much. The kinds of things I might do include HEALTHY LIFE SKILLS 32  _________________________________________________________________  _________________________________________________________________  _________________________________________________________________ Point 5: Active Relaxation. I will try to teach my body to relax by using  Exercise that controls the body and releases tension like tai chi or boxing.  Deep breathing.  Yoga.  Meditation.  Warm, long baths or showers.  My imagination. I will imagine I am someplace peaceful and relaxing. The place I could imagine myself being is _________________________________ Point 6: Eat Well. I know that having a healthy body helps people deal with stress better. I have already agreed to exercise more. I understand that good nutrition also makes a difference in my health and how well I deal with stress. The changes I am ready to make include  Eating a good breakfast  Skipping fewer meals  Drinking fewer sodas and sugary drinks  Drinking more water  Eating smaller portions  Eating less greasy meals or snacks  Eating more fruits, vegetables, and whole-grain foods  Going to ChooseMyPlate.gov to learn more  _________________________________________________________________  _________________________________________________________________ Point 7: Sleep Well. I know that people who get a good night's sleep do a better job of dealing with stress and do better in school. For me to get the sleep I need, I will try to go to bed at ____:____. I will consider the following plan to help me get the best night's rest:  Avoid caffeine at least 6 hours before bed.  Exercise 4 to 6 hours before bed.  Finish homework after exercise because I will be my calmest, clearest, and most focused.  Take some time to relax or hang out after homework.  Shower or bathe 1 hour before bed.  Begin to dim the lights 30 minutes before bed.  Let go of my emotional tension before bed in a place other than bed (see point 9). If I am really troubled, I will do this earlier in the evening.  Use my bed only for sleeping. I will use another place to do some of the things I do in bed now. I will stop reading in bed.  Stop doing homework in bed.  Stop watching television in bed.  Stop talking to my friends or instant messaging in bed.  Stop worrying in bed.  Dock my cell phone in a charger that is not in my bedroom.  Deal with the things that stress me out by having a time to let go of my thoughts and feelings in a place other than my bed. HEALTHY LIFE SKILLS 33 Part 3: Taking Care of Emotions Point 8: Take Instant Vacations. Everyone needs to be able to escape problems for a while by taking an instant vacation. I will  Read a book.  Take a mini-vacation to a local park or recreation center.  Imagine I am someplace peaceful and relaxing. The place I could imagine myself being is _______________________________________________  Watch television.  Listen to music.  Play video games that are not violent or stressful.  Take a warm bath.  _________________________________________________________________ Point 9: Release Emotional Tension. I will try to let my worries go, rather than letting them build up inside.  I will talk to a friend I have chosen wisely because I know he or she will give good advice.  I will talk to my  Mother.  Father.  Teacher.  I will ask my parents or a teacher to help me find a counselor to help me work out my problems.  I will pray to gain strength.  I will meditate.  I will write out my thoughts in a diary, journal, or blog.  I will let myself laugh more.  I will let myself cry more.  I will make lists to get organized.  When it seems that I have too many problems and they seem like more than I can handle, I will work on one at a time.  I will express myself through  Art  Music  Creative writing  Poetry  Rap  _________________________________________________________________  _________________________________________________________________ Part 4: Helping Can Make Your World—And the Way You Feel—Better Point 10: Contribute. I know that people who realize they are needed feel better about themselves because they can make a difference in other people's lives. I plan to  Help a member of my family by ______________________________________  Volunteer in my community by ______________________________________  Help the environment (or animals) by_________________________________ HEALTHY LIFE SKILLS 34 When to Turn for Help Even if you are great at dealing with problems, there may be times when stress feels like it is getting to you. You are not alone. This does not mean you are crazy or a failure. Strong people turn to others for support when they have too much to handle. It's OK to turn to wise friends for advice, but it is also important to turn to your parents or another adult to help you. Nobody will solve your problems; they might just help you figure out how to better deal with them. You deserve to feel good. The following signs suggest that you should seek some extra guidance:  Your grades are dropping.  You worry a lot.  You easily get moody or angry.  You feel tired all the time.  You get a lot of headaches, dizziness, chest pain, or stomach pain.  You feel sad or hopeless.  You feel bored all the time and are less interested in being with friends.  You are thinking about using alcohol or drugs to try to feel better.  You ever think about hurting yourself.  You are using unhealthy coping strategies and are having trouble replacing them with healthier ones. Remember that one of the best ways to be happy and successful is to manage stress well. You can do it! Ginsburg, K. R., & Jablow, M. M. (2015). My personal stress plan. https://downloads.aap.org/HC/EN/BR3_My_Personal_Stress_Plan.pdf HEALTHY LIFE SKILLS 35 Appendix B Lesson Plans and Evaluations Lesson Plan Week 1 Tackling the Problem 02/07/2022 Learning Outcomes Plan/Methodology Time Resources/ Materials Assessment Student should be able to 1. Explain the importance of identifying stressors 2. Identify how your body handles stress 3. List Healthy ways to deal with stress 1. Introduction Pre-knowledge assessment Breathing exercise 2. Main Activity Show: Feed the wolf story (Identifying stressors) Feed the right wolf.docx Discuss: https://youtu.be/sTpo1FuYQ9I (Show the first five minutes that includes the information below) Identify and address problems • Small pieces at a time • Lists • Timelines • Letting things out of your control go Stress in your body • Hormones • Nervous system • Purpose of stress for our bodies Dealing with stress • Positive coping • Negative coping Apply: Stress Catcher (Healthy ways to cope with stress activity) Stress Catcher Template.docx Introduce personal stress plans Personal Stress Plan.pdf 5 10 3 Breathing Activity Stress Catcher 1. Identify healthy ways to address a problem 2. Identify the difference between good and bad stress 3. Identify what stress does in their body 4. Explain the importance of identifying stressors Assess through discussion HEALTHY LIFE SKILLS 36 3. Wrap-up Breathing Exercise https://youtu.be/gLbK0o9Bk7Q Evaluation of Student Learning What did the students learn in this lesson? Understanding what stress is and ways to identify and manage stressful situations. Identified healthy ways to manage stress and talked about unhealthy ways to deal with stress and why they are ineffective. What did the students do? The students made the stress catcher and participated in partner interaction using the stress catcher. The students watched the video about what happens in their brains and body during stress. The students took a pre-knowledge assessment survey and were introduced to the personal stress plan outline. What were they not able to do or understand? The students had a more challenging time understanding the effects stress has on their bodies and that unmanaged stress is not just a part of life. Evaluation of Teaching What went well? The boys were responsive to the feed the wolf story and the stress catcher activity. There were some technical difficulties, but I could work through them. If you were to teach this lesson again, what would you do differently? Not show the video and do more of a lecture-discussion with the information. Some of the students checked out during the video. HEALTHY LIFE SKILLS 37 Lesson Plan Week 2 The Power of Exercise 02/14/2022 Learning Outcomes Plan/Methodology Time Resources/ Materials Assessment Students should be able to 1. Understand the importance of exercise 2. List strategies they can do to help them become more physically active 3. Learn how exercise benefits their physical and mental well-being 1. Introduction Breathing Exercise https://youtu.be/gLbK0o9Bk7Q 2. Main Activity Show: https://teenshealth.org/en/teens/exercise-wise. html https://teenshealth.org/en/teens/strength-training. html (What is a healthy routine section) Discuss: • The difference between aerobic, strength training, and flexibility • Benefits of mental health • How often they should be active • Activities/hobbies they can try to become more active Energy Out_ Daily Physical Activity Recommendations - HealthyChildren.org.docx Apply: Fill in Personal Stress Plan: The Power of exercise section 3. Wrap-up Name Exercises.docx 5 10 5 Breathing Activity Name workouts Students will be assessed on their ability to 1. Discuss the benefits exercise has on their physical and mental health 2. Identify the benefits being physically active has on the body and mind 3. List activities they can do for exercise HEALTHY LIFE SKILLS 38 Evaluation of Student Learning What did the students learn in this lesson? The students were able to have a group discussion and list activities they could do to increase their active minutes during the day. They were able to describe active activities when they are stressed or feeling overwhelmed. They learned that exercising does not have to be a set workout. It can be hobbies, playing, and anything that increases their heart rate for 30 minutes. What did the students do? They filled in their personal stress plan section of The Power of Exercise. Next, they discussed activities and hobbies that they could do to become more active and decrease stress. Finally, they committed to exercising and increasing their active minutes to at least 30 minutes daily. What were they not able to do or understand? Some students still did not understand that being active is not about weight. Evaluation of Teaching What went well? Most of the students participated in the verbal discussion and contributed personal insight to the discussion. If you were to teach this lesson again, what would you do differently? I would do an exercise during class. Then, I would talk more about the benefits of exercise physically. HEALTHY LIFE SKILLS 39 Lesson Plan Week 3 Active Relaxation 03/07/2022 Learning Outcomes Plan/Methodology Time Resources/ Materials Assessment Students should be able to: 1. List exercises they can use to relax and release tension 2. Learn how to deep breath 3. State the benefits of active relaxation 1. Introduction • Ask if they did their exercises, they committed to the last class • Mandala coloring pages 2. Main Activity Show: Box breathing exercise https://youtu.be/n6RbW2LtdFs Discuss: https://www.mayoclinic.org/healthy-lifestyle/ stress-management/in-depth/ relaxation-technique/art- 20045368 Apply: Relaxation script https://depts.washington.edu/uwhatc /PDF/TF- %20CBT/pages/4%20Emotion%20Reg ulation%20Skills/Client%20Handouts/ Relaxation/Relaxation%20Script%20fo r%20Younger%20Children.pdf Fill out Personal Stress Plan-Active Relaxation 3. Wrap-up Positive affirmations 5 10 5 Mandala coloring books -structured geometric coloring for meditation and stress reduction (Martin et al., 2018) Students will be assessed on their ability to 1. Able to participate in breathing exercises 2. Identify ways they can take instant mini-vacations 3. Name the benefits active relaxation has on their bodies HEALTHY LIFE SKILLS 40 Evaluation of Student Learning What did the students learn in this lesson? The students learned a few activities they can do independently for active relaxation. In addition, the students learned the different types of relaxation autogenic, progressive, and visualization. What did the students do? The students participated in the box breathing exercise, progressive muscle relaxation story, and mandala coloring pages with positive affirmations. The student participated in the discussion and gave examples of things they can do to take instant vacations and head-to-toe muscle tension and relaxation before a stressful situation. The students listed ways they will relax on their personal stress plan. What were they not able to do or understand? They understood the topics from the group discussion, but some chose not to participate in some of the activities. Evaluation of Teaching What went well? Most of the students seemed receptive to the information and participated in the breathing, muscle relaxation, and coloring activities. If you were to teach this lesson again, what would you do differently? I would start the class with positive affirmations and have the students make a positive affirmation they can put in their room and see daily. Then do the discussion and finish with the coloring while answering questions. HEALTHY LIFE SKILLS 41 Lesson Plan Week 4 Eating Well 03/14/2022 Learning Outcomes Plan/Methodology Time Resources/ Materials Assessment Students should be able to: 1. Identify healthy eating habits 2. State benefits of a healthy diet has on their bodies 3. List the benefits of drinking water over sugary drinks 4. Utilize the MyPlate app for resources and support 1. Introduction Follow up on active relaxation from last week Word Search activity: https://myplate-prod. azureedge.net/sites/default/files /2020-12/HaveFunWordSearch.pdf 2. Main Activity Discuss: https://www.healthychildren.org/Engli sh/ages-stages/ gradeschool/nutrition/Pages/ Making-Healthy-Food-Choices.aspx https://www.healthychildren.org/Engli sh/healthy-living/ nutrition/Pages/Choose-Water-for- Healthy-Hydration.aspx Show: https://www.myplate.gov/myplate-quiz Apply: https://myplate-prod. azureedge.net/sites/default/files /2020- 12/MyPlatePlanMenuTemplate.pdf 3. Wrap-up Fill out Personal Stress Plan- Eating well Take their own MyPlate quiz at home 5 10 5 http://www. choosemypla te.gov/ https://www. dietaryguidel ines.gov/site s/default/file s/2020- 12/DGA_202 0- 2025_The4G uidelines.png Healthy Snacks Students will be assessed on their ability to 1. Identify benefits a healthy diet has on physical and mental health 2. List ways they can improve their healthy eating habits 3. Describe how they can use the MyPlate app 4. Identify food groups and daily requirements HEALTHY LIFE SKILLS 42 Evaluation of Student Learning What did the students learn in this lesson? The importance of each food group and recommended servings. The benefit of proper hydration. How to use the MyPlan.gov resource. What did the students do? Had group discussions about healthy food choices. The students filled out a MyPlate quiz to become familiar with the resource and the information it can provide them to fill it out at home. What were they not able to do or understand? A few of the students still did not understand that food is fuel for their body and is not just about weight and that even if you are underweight, it still matters what types of foods your body needs. Evaluation of Teaching What went well? The introduction activity of the word search went well to grab their attention—the discussion on types of food groups, fats, fiber, sugar, and daily servings. Then, the whole group participated in filling out the MyPlate survey. If you were to teach this lesson again, what would you do differently? I would bring samples of different uncommon fruits and vegetables to encourage them to try new things. I do not think the weekly meal template worked well, and they did not seem overly excited to do it. So I would replace that with simple recipes for them to try at home. HEALTHY LIFE SKILLS 43 Lesson Plan Week 5 Sleeping Well 03/14/2022 Learning Outcomes Plan/Methodology Time Resources/ Materials Assessment Students should be able to: 1. Identify healthy sleep habits 2. List the sleep cycles and what happens during each cycle 3. Identify things to avoid to improve sleep 4. Describe the importance sleep has on mental and physical health 1. Introduction Follow up on healthy eating from last week. See if any of the students did the MyPlate Quiz Sleep BINGO.pdf https://bingobaker.com/view/342400 0#:~:text=This%20bingo%20card%20h as%20a%20free%20space%20and,a%2 0book%20and%20Close%20window% 20to%20avoid%20noise. See below for the Bingo template. Mix spaces up. 2. Main Activity Discuss: https://www.healthychildren.org/Engli sh/healthy-living/sleep/Pages/Sleep-and- Mental-Health.aspx https://www.ninds.nih.gov/Disorders/ Patient-Caregiver- Education/Understanding-Sleep Show: https://www.sleephealthfoundation.o rg.au/pdfs/World%20Sleep%20Day/W orld_Sleep_Day_Presentation_Slides_- _Ages_11-18_years.pdf (Slides 1-15) Harry Potter Sleep Story https://youtu.be/OFBDQSNsOc0 (Intro to sleep stories) Apply: Fill out Personal Stress Plan- Sleeping Well 3. Wrap-up Challenge them to try and listen to a sleep story and use the sleep habits this week 5 10 5 SleepyCat sleep story (YouTube) Students will be assessed on their ability to 1. List healthy sleep habits 2. Identify the sleep cycles and purposes of each cycle 3. Discuss mental and physical benefits of sleep HEALTHY LIFE SKILLS 44 Evaluation of Student Learning What did the students learn in this lesson? They learned why their body needs sleep. The different cycles of sleep. Strategies and practices they can use to improve sleep. Things to avoid before bed to promote sleep. The importance of sleep has on their physical and mental health What did the students do? They played BINGO to stay engaged and identify important topics and concepts taught during the sleep lesson. Finally, they listened to a sample of a sleep story. What were they not able to do or understand? They still like to stay up late and did not like the concept of turning electronics off two hours before bed. Evaluation of Teaching What went well? The BINGO went well, and it kept them listening throughout the lesson. If you were to teach this lesson again, what would you do differently? I would use markers over candy and, as the lesson goes on, give them the treats as they get the BINGOs. HEALTHY LIFE SKILLS 45 B I N G O Sleep on a comfortable mattress and pillows Teens need about 8 to 10 hours of sleep each night You think sleeping is a waste of time, you are wrong Avoid caffeine within 6 hours before bedtime Do away with screens before bed Do not secretly play games or read comics in bed Warm milk helps you go to sleep Relaxing activities such as reading can help Many teens suffer from treatable sleep disorders Sleep is food for the brain Make Sleep a priority Do not have caffeinated drink before he goes to sleep Free! Lack of sleep can contribute to skin problems Establish a bed and wake-time and stick to it Not getting enough sleep limits your ability to learn Sleep in a room that is dark, quiet, comfortable and cool Lack of sleep affects mood Take a warm shower or bath before bed Do you snore really loudly Skipping sleep can be harmful Dreams appear in stage 5 Elephants sleep standing up REM means Rapid Eye Movement Stages 1 and 2 are light sleep HEALTHY LIFE SKILLS 46 Lesson Plan Week 6 Making the World Better 03/28/2022 Learning Outcomes Plan/Methodology Time Resources/ Materials Assessment Students should be able to: 1. Identify ways they can serve their families, communities, and environment 2. List the benefits of serving others 3. Identify the benefits serving others has on their mental health 1. Introduction Follow up on if any of them tried the sleeping resources 2. Main Activity Show: https://youtu.be/-kOdaFQtX1s Discuss: https://www.healthychildren.org/Engli sh/family-life/ Community/Pages/Creating- Opportunities-for-Children-Teens-to- Contribute.aspx • "Recognize themselves as part of larger communities in which they can make a difference." • Become aware that "contribution directly fosters resilience because it helps children gain a sense of purpose, something positive to strive toward and achieve." https://www.healthychildren.org/Engli sh/family-life/ Community/Pages/Helping-Teens- Connect-With-Their-Community.aspx • "By connecting with the community, a teen is never alone. He has a place to go and people to talk with when he needs it." • "The more a teen helps others, the better he feels and the more likely that someone will be there for him." Apply: 5 10 Students will be assessed on their ability to 1. Identify simple things they can do to make the world a better place 2. Discuss the benefits of serving others 3. List positive outcomes serving others can have on their mental well-being HEALTHY LIFE SKILLS 47 1. Have a contest with a friend about how much trash is picked up in a limited time period. 2. Donate your clothes that you no longer wear. 3. Teach your favorite subject to someone that struggles with it. 4. Meet your older neighbors and introduce yourself. 5. Write a positive note to a classmate 6. Sign up for a charity 5k Project Post Knowledge assessment (Appendix C) 3. Project Wrap-up Review Personal Stress Plans Help any that missed any classes fill them out. 5 Evaluation of Student Learning What did the students learn in this lesson? The student learned the benefits of being involved with their family, peers, and community. In addition, they learned simple ways they can make a difference around them. What did the students do? They wrote positive notes to give another peer "I like your shoes, have a good day, I am glad you are here..." Next, they watched the video about how a small kindness or service can change your perspective. Next, the students finished filling out their personal stress plans. Then they took the project post-knowledge assessment to wrap up these sessions. What were they not able to do or understand? They understood the concepts taught. Evaluation of Teaching What went well? They liked the video for this lesson. The activities for them to get involved went well. I could cater to the interests I learned from working with them over the last few weeks. Overall, the Healthy Life Skills lessons went well. The students participated, asked questions, and showed personal knowledge growth through discussion. If you were to teach this lesson again, what would you do differently? I would get together with the school beforehand to see if they have any service projects and involve this class with them. HEALTHY LIFE SKILLS 48 Appendix C Pre/Post Knowledge Assessment 1. What is a healthy way to address a problem? A. Ignore it B. Learn how to solve it C. Do not think about it 2. What is a positive way to manage stress? A. Talking about it B. Breathing exercises C. Meditating D. Recognizing negative stress E. All of the above 3. How does exercise improve your mental health? A. Controls stress B. Builds a strong, healthy body C. Helps you think better D. All of the above 4. Eating does not affect my emotional health. True or False 5. Ways to improve my sleep include A. Staying up late B. Watching TV in my bed C. Going to bed at the same time every night D. Working out just before bedtime 6. What is Emotional Intelligence? A. Ability to prevent emotions B. Knowledge of the definition of each emotion C. The ability to express, identify, and manage one's emotions D. The same as IQ 7. How can you improve your emotional intelligence? A. Being mindful B. Engaging in positive self-talk C. Recognizing your emotional triggers D. All of the above 8. What is the benefit of having an emotional stress plan? A. Avoid things on your stress plan B. Gives you a game plan when you become stressed C. Prevents stress D. There is no benefit 9. What is the purpose of serving others in your community? A. Focusing on others B. Seeing the bigger picture and how you fit in it C. Connecting with others D. Having a sense of pride and belonging HEALTHY LIFE SKILLS 49 E. All of the above 10. What are some helpful ways to de-stress? A. Focusing on things I cannot change B. Skipping meals C. Being active for 20 minutes a day D. Staying up late Post Test Same as above, but adding these three questions What did you like about these healthy activities? What did you not like about these healthy activities? What would you like to learn more about? Did you find the personal stress plan helpful? HEALTHY LIFE SKILLS 50 Appendix D Consent Form IRB STUDY #IRB-AY21-22-111 WEBER STATE UNIVERSITY INFORMED CONSENT Healthy Life Skills for Adolescents Your child is invited to participate in a quality improvement project to promote healthy life skills education. These classes are available to any Valley View Middle School student. We ask that you read this form and ask any questions you may have before agreeing to have your child participate in these wellness classes. The quality improvement study is being conducted by Celeste Christensen a DNP student at Weber State University in the advanced nursing program. STUDY PURPOSE The purpose of this quality improvement study is to educate students on healthy life skills at Valley View Middle School in the wellness room classes using a Canvas course. These skills can help students cope more effectively with stress by building resilience. NUMBER OF PEOPLE TAKING PART IN THE STUDY: If you agree to participate, you will be one of up to 20 studentswho will be participating in this education. PROCEDURES FOR THE STUDY: If you agree for your child to be in the study, they will do the following things: Learn healthy life skills on the follow topics: o Identify stress/stress management o Healthy body habits o Dealing with emotions o Making a personal stress plan o Making a world a better place RISKS OF TAKING PART IN THE STUDY: For face-to-face classes, the risks include the possibility of being infected by the novel coronavirus 2019 (COVID-19) or other communicable diseases. CONFIDENTIALITY Efforts will be made to keep your child’s personal information confidential. We cannot guarantee absolute confidentiality. Information collected will only be used to assess knowledge gain. CONTACTS FOR QUESTIONS OR PROBLEMS For questions about the study, contact the researcher Celeste Christensen at (801)836-4727 HEALTHY LIFE SKILLS 51 For questions about your rights as a research participant or to discuss problems, complaints or concerns about a research study, or to obtain information, or offer input, contact the Chair of the IRB Committee IRB@weber.edu. VOLUNTARY NATURE OF STUDY Taking part in this study is voluntary. You may choose not to take part or may leave the study at any time. Your decision whether or not to participate in this study will not affect your current or future relations with Valley View Middle School or Weber State University. SUBJECT’S CONSENT In consideration of all of the above, I give my consent to participate in this research study. I will be given a copy of this informed consent document to keep for my records. I agree to take part in this study. Subject’s Printed Name: Subject’s Signature: Date: (must be dated by the subject) Printed Name of Person Obtaining Consent: Signature of Person Obtaining Consent: Date: If the study involves children who will be providing their assent on this consent document, rather than on a separate assent document, use the following signatures: Printed Name of Parent: Signature of Parent: Date: HEALTHY LIFE SKILLS 52 Appendix E Timeline Timeline for Project Implementation and Completion Summer 2021 • Gather literature related to healthy life skills, adolescent mental health and resources-June 2021 • Meet with department heads and clinical staff to discuss current procedures and design future implementation model-June 2021 • Identify Corom Hughes as project consultant-July 2021. • Obtain approval by project consultant-June 2021 • Complete Project Proposal-August 9, 2021 Fall 2021 • Present Project Proposal for approval. • Obtain IRB approval for the project-December 2021 • Complete all documents, identification or creation of instruments, and/or presentations that are essential for project implementation. Spring 2022 • Begin project implementation at Valley View Middle School. • Identified Reilee Brinkerhoff project consultant-January 2022 • Present topics: tackling the problem, the power of exercise, active relaxation-February 2022 • Present topics: eating well, sleeping well, making the world a better place-March 2022 • Assess students’ knowledge Summer 2022 • Begin Canvas course resource for sustainability • Begin project evaluation. Fall 2022 • Complete project evaluation. • Complete project dissemination. • Submit Canvas course to Valley View Middle School • Present project HEALTHY LIFE SKILLS 53 Appendix F School Counselor Assessment DirectionGroupData ElementsDate of OutcomeThis project is: by the end of the 4th termThe Panorama survey results showed that males more than females were struggling in more social and emotional areas of the survey, which were highlighted in red. Expected Goal Explanation (Optional)The Panorama Survey from September showed that male students at Valley View Middle School felt more worried, frustrated, or sad than female students. The survey measured on a scale of 1-5 from almost never to almost always. Of the 261 male participants of the survey, 45% of male students had little or no coping strategies. Increasemale studentsunderstanding and use of coping strategiesby 5%by the end of 2021-2022 school year.Example: Increase9th grade male emergent bilingual studentscredit completion rates byAccountability and Data ProjectSchool Counseling Programs - Access, Attainment, AchievementDistrict NameSchool NameValley View MiddleThis project provides targeted supports to students…Area of Focusmales who need understanding of coping strategiesGoal StatementNebo DistrictSchool Year2021-22*Number of previous years on project: Baseline DataHow does this project support the School Improvement Plan?How will achieving this goal lead to significant and meaningful outcomes for students?10%Students will feel less anxiety when at school, and students will learn helpful stress management and coping techniques that will ultimately improve their success and feelings of happiness and success at school. N/AAttainmentAccessAchievementFrom low-income familiesWho are emergent bilingualWho need academic supportWho need academic enrichmentExperiencing homelessnessWith disabilitiesOther (please specify):Who are refugeesWho are first-generation college goingContinuingNewWho are immigrantsOf ethnically or culturally diverse backgroundsmale students are being invited to participate in weekly groups where we discuss stress management and coping skills, as well as resiliency building skills and techniques. District LevelStudents are being taught SEL lessons that coencide with the CASEL framework that our District is implementing. Along with classroom lessons, our school is also implementing a Flex Time social/academic skills support room, youth support meetings, individual counseling to students, group counseling, meditation during Flex. All material and lessons are posted on our school webiste. Community Resources are also posted on our school website.School LevelFamily LevelCommunity LevelClassroom LevelGrade LevelIndividual LevelSystemic Interventions Student Group Level6th and 7th grade students are receiving the same SEL lessons and curriculum interventions. All students are being taught SEL lessons this year once a month. These lessons are focused on coping skills, stress management, and building resiliency. FallWinterSpringProgress Monitoring: How is it going?Data GraphicResults/Outcome StatementGroups were post tested and there was a 6% increase in students' ability to self-regulate and use coping skills. Groups are going well. Students are asking if we can meet more frequently. Students are demonstrating the skills they are learning from group.Did you meet your goal? Groups are being invited on November 2. Males are being selected from our rolls taken from the Raptor Den/referrals. UndeterminedNoYesPre Test Resultsof Focus GroupPost Test Results ofFocus GroupMaleStudents understanding and use of coping strategies Reflection: Learning and Next StepsReflection: Project Outcome AnalysisThere was a noticeable increase in our male students and their abilities to self-regulate and utilize coping skills they learned from the group. Our 6% increase on favorable scores on the Panorama Survey was great, although we would like to see even more increase. As we continue to use the Panorama Surveys as a measuring tool of emotional regulation in our school, our next steps involve running more groups throughout the year in an effort to reach more students.