OTSH 65: Journal Club - Promoting Mental Health in the Cafeteria



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Welcome to the show notes for the Episode 65 of the OT School House Podcast.


In episode 65, we are having a discussion about a recent journal article that looks at school-based occupational therapists' role and capabilities in implementing a mental health tier 1 MTSS intervention. Today's article is titled The Comfortable Cafeteria Program for Promoting Student Participation and Enjoyment: An Outcome Study. This journal comes from the American Journal of occupational therapy and it was published in 2018. The research study itself occurred in 2014, and 2015, The Authors are Susan Bazyk. Luis Demirjian, Francis Horvath, and Laurie Doxsey.


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OTSH Episode 65 Transcription
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Jayson Davies 00:00

Hey there, everyone. Welcome to Episode 65 of the OT School House podcast. We are doing things a little bit different today. No guests, just you and me. And a journal article straight from the American Journal of Occupational Therapy, we are going to be looking at the article titled The comfortable cafeteria program for promoting student participation and enjoyment and outcome study. And, as you likely know, I am a huge advocate for RTI and MTS s in the schools, especially when it comes to OT helping out OTs with that process. And so I'm going to share with you a little bit more exactly why we're looking at this article after the break. But first, I want to highlight the primary author of this article, Dr. Susan Bazyk. Dr. Susan Bazyk is an occupational therapist and Fellow of the American Occupational Therapy Association. She is professor emeritus of the Occupational Therapy Program at Cleveland State University where she taught for 34 years. She is the project director of every moment counts, which was launched in 2012. And the main topic of today's journal article, this multi pronged mental health promotion initiative focuses on helping all children and youth participate successfully throughout the day and academic and non academic settings. Her current efforts focus on building capacity of OT practitioners and interdisciplinary teams to do this work. longtime listeners of the OT School House podcast may recognize her from Episode 36 of the OT School House podcast when we highlighted every moment counts and the comfortable cafeteria program which we are going to dive into.


Jayson Davies 01:43

Although Dr. Bazyk won't be joining us today to talk about this article, I am proud to announce that she will be speaking at the OT School House back to school conference later in August. And to learn more about this conference you can head over to OT School House.com forward slash back to school. And in case your hands and eyes are a little preoccupied right now let me share with you a little description about what she will be presenting.


Jayson Davies 02:09

Dr. Bazyk knows the small moments make a big difference in how children feel and function in school. Research confirms that positive interactions and experiences such as enjoying lunch, having fun during recess. These help children feel positive and connected to school. Every moment counts as a mental health promotion initiative developed to help all children and youth become mentally healthy in order to succeed in school, at home and in the community. Participants aka you and me will learn about a multi tiered public health approach to mental health involving promotion, prevention and intervention and be introduced to every moment counts occupation based programs, not just the one we're talking about today. Comfortable cafeteria, not just the one we're talking about today, the comfortable cafeteria, but also refreshing recess, calm moment cards and making leisure matter.


Jayson Davies 03:03

And while she's been on the podcast before to talk about some of those programs, I am excited to sit there and watch her present all of her knowledge that she has and how she focuses on knowledge translation to help kids throughout all school programs. If you'd like to hear from Dr. Bazyk as well at the back to school conference, be sure to head over to OT School House.com forward slash back to school to reserve your spot. Now stick with me just a moment as I cue the intro and we'll be right back to discuss the journal article.


Amazing Narrator 03:34

Hello and welcome to the OT School House podcast, your source for school based occupational therapy tips, interviews and professional development. Now to get the conversation started. Here is your host Jayson Davies. Class is officially in session.


Jayson Davies 03:51

Hello and welcome back everyone. I hope that intro just put a little pep in your step I know some of you probably haven't memorized and some of you we probably even kind of novel long as she introduces myself and the podcast. I know I can't listen to it without kind of getting a little happy and and just doing that. So welcome back to Episode 65 of the OT school health podcast. Man that number is getting bigger. I can't believe it's been 65 episodes now but I'm excited to be here with you today we're doing a journal article which is a little different haven't done a journal article in a bit but I'm excited for it. I know many of you don't have the time to read articles. As much as you may or may not want to. I know you don't have the time to so I'm here to help you out with that. Again, this is an article with the primary author as Susan Bazyk, Dr. Susan Bazyk and I'm excited to share this with you so I'm not gonna really waste your time any longer. Let's go ahead and dive into it.


Jayson Davies 04:47

Today's article is titled The Comfortable Cafeteria Program for Promoting Student Participation and Enjoyment: An Outcome Study. This journal comes from the American Journal of occupational therapy and it was published in 2018.


Jayson Davies 05:00

Although the actual research study itself occurred in 2014, and 2015, the authors, there are four of them, are Susan Bazyk. Luis Demirjian, Francis Horvath, and Laurie Doxsey. Susan Bazyk, who I mentioned earlier is the program director at every moment counts. Louise is an occupational therapy consultant at every moment counts. And Francis and Laurie are both school based occupational therapist in the state of Ohio.


Jayson Davies 05:28

Now, the reason we are looking at this article and having a discussion about this particular article is because I get so many questions from everyone on social media, in my email about how to move on from your typical fine motor and sensory based programs at ot. So many of you want to help more students. So many of you want to really see kids in the natural environment, as opposed to working with them, one on one in the OT room, the OT hallway, or whatever that might be. And so that's why we are talking about this article today. And what I want to bring to the forefront of your brain as we talk about this today is something you already know and I'm just going to, like I said bring it to the forefront of your brain is that mental health and wellness is such an area of demand right now, whether it's in an application, that was the push of a button promises to make you happier for five minutes every day, or accessing a therapist online, via again, a push of a button with mental health and wellness coming to the forefront of everyone's brains. So is it also coming to the forefront of schools. And that's what leads us to today's article as using occupations as a way to promote mental health, specifically in the natural context. And that brings us to this specific article. Before I jump into the methodologies and the outcomes of the article, I do want to briefly discuss some of the research that they found while completing their own project. And here's a few snippets of that. They found that research shows that when students enjoy lunch or when they have good friend and then when they perceive school personnel as supportive and caring for the students then more feel more connected to school. This connectedness in turn, enhances classroom engagement, academic performance, and school completion rates. That was found in an article by bloom in 2005. The authors also make a point that past research has shown that a positive cafeteria atmosphere results in children eating more of their lunch, which is great for growing kids, right. And they also have fewer behavioral problems. And it also so happens that the cafeteria is an important location for students to develop adaptive strategies for physical health and social interaction. It is a time for them to relax and take a break and socialize with their peers before returning back to their classroom. Now for students who are primarily in a special education class and have limited access to the general education classes, this is also their primary time to interact and learn from their typical developing peers. Along with recess, lunch is sometimes the only time that they have to spend with kids outside of their classroom. And the last key point that I want to bring to your attention is that at lunchtime, there is a very large discrepancy between the amount of adults to the amount of children that are in one place at a time. Typically, in a classroom, you have maybe a one to 30 ratio. Well, they found that a majority of the schools had closer to a one to 50 ratio inside of the cafeteria, so maybe one to 52 to 100, or potentially 350 kids at a time. Alright, so now let's talk about the goals that the research team had. Overall, they wanted to measure the outcomes of the comfortable cafeteria program, I'll get more into what that program


Jayson Davies 08:50

looks like in just a moment. But these goals, they had three specific goals, where they wanted to measure the outcomes for both the students as well as the supervisors, and then also the therapist. So there are three goals. Let me read them here for you. First, does participation in the comfortable cafeteria program affects student perceptions of participation and enjoyment of lunchtime? Number two, does participation in the program resulting cafeteria supervisors enhanced knowledge of and perceived ability to be effective in the cafeteria? And three, what is occupational therapists overall assessment of the comfortable cafeteria program after implementation? So in order to measure that they had three different groups of participants, they had the students who were 366 in total that actually took the pre and post test. They had 18 cafeteria supervisors and for Midwestern school based occupational therapist who had been trained in every moment counts building capacity initiative. So now we get to the good part. What did they actually do? What did the therapist do?


Jayson Davies 10:00

What did the supervisors do all of that? Well, I'm gonna kind of spoil the surprise right now first, you can get this entire program the cafeteria, comfortable cafeteria program at every moment. counts.org 100% free, Sue Bazyk, the director at every moment counts has it up on her website 100% free and you can get it, you can learn all about it. In synopsis, this is a six week program, in which the Occupational Therapist supports the entire school team, really, the Occupational Therapist provides education to the cafeteria supervisors as well as other relevant stakeholders. So maybe there's some parent volunteers, maybe the administrators need to kind of know what's going on. Right. So the OT provides that training, then the OT also provides a weekly embedded activities to address the weekly theme. It's a six week program, six weekly themes, though T goes in during lunchtime to do that. And then the final part of the program is kind of the maintenance part of the program. And that is when the Occupational Therapist continues to provide ongoing coaching of supervisors such as modeling positive social interactions and offering additional activities that the supervisors can then implement in the cafeteria. Without the occupational therapist. I know you want to know what those six themes are. So I went ahead and went over to every moment counts.org click on the comfortable cafeteria program. And I can tell you right now I'm just looking at the website. Those six week themes are week one kickoff, friendship, conversations, including others sensory input and healthy foods. Those are your six weekly themes. So after you are done with those six weekly themes, then you continue to work with the lunchtime supervisors on you know, an as needed basis to provide them ongoing support.


Jayson Davies 11:51

Now that you know a little bit about the actual program, let's look at the assessments that they used. Quantitative data was taken one week prior in a pretest. And one week after the program post test for both the students and the supervisors. In addition, they also got some qualitative data through a group session with the students and a few of the supervisors. For the students, they use what is called a visual analog scale, I had never heard of this. But what it is is basically a small piece of paper exactly 100 millimeters in length. And when they asked the student a question, they would mark were on that paper they feel in that paper would kind of be like a Likert scale and might have some happy faces on it or something. But instead of picking only one of four options, the student can make a tick mark anywhere along the paper. So if they wanted to say they were kind of between, you know, two faces, they could do that. And then what would happen is the, the reader would then have to measure from the left side of the paper, how many millimeters from the left side of the paper, they made that mark, and that is the score. So it could be somewhere between one and 100. Because the paper is exactly 100 millimeters in length. The four questions that they asked of the students was, how much did you enjoy time at lunch? how friendly are the lunch supervisors? how friendly are the students at lunch? And how much did you enjoy conversations during lunch? I want to point something out here really quickly. Because that first question, how much did you enjoy time at lunch? They use that response to categorize students into either low enjoyers, medium enjoyers or high enjoyers. If I remember, right, it was if they marked a 25 or lower, they were considered low enjoyers 25 to 75, medium enjoyers 75 or above would be high enjoyers. Remember that because we're going to use that when we get to our results. For the supervisors. They used a 12 item five point Likert scale. That's pretty straightforward. We'll talk about the results in a little bit. And I already mentioned the qualitative part where they asked students and supervisors a few questions. They asked the students, what did you learn from the cafeteria program in a group setting? And the supervisors they asked what did you think about and learn from the comfortable cafeteria program? The occupational therapist, the four of them, were then asked to type a written reflection on for open ended questions after the program. Those four questions were what are the overall strengths of the program? What are the limitations of the program? How did the students respond to the program? And how did the supervisors respond to the program? So let's go ahead and talk about the results. Obviously, I would not be sharing this article if there weren't some great results. So let's start by talking about the students first. Remember how I had told you about how students were either grouped into low enjoyers, mid enjoyers or high enjoyers? Well, it turns out that both low enjoyers and mid enjoyers have lunch Each made statistically significant improvement on all four of the survey questions for the kids. In fact, the low enjoyers of lunch went from an average score of about five to seven on that 100 point scale, all the way up 48 points to around a 50. Like That is insane. From a five to seven, they went up, actually, it was 48 points in the post test to enjoin lunch at a rate of let's call it about 55 to 60, as opposed to five to seven in the pretest.


Jayson Davies 15:38

pretest scores for the mid enjoyers hovered around the midpoint 53 during the pretest. And it went up 13 points on average to 66 in the post test, so both low and mid enjoyers are both made statistically improved are both made statistically significant increase in the amount of enjoyment that they experience from lunch after the program. No statistical improvement could be identified for high enjoyers. But that makes sense. Because if you're already above a 75, there's only so many points that you're probably going to move upward. So there wasn't any significant improvement in scores for those high enjoyers for that population. However, at the same time, there wasn't like a mass. I no longer enjoy lunchtime scores either. So there wasn't any improvement or regression and how much those high enjoyers enjoyed lunchtime. Now let's talk about the supervisors. There were three main findings when it came to the supervisors. The first is that lunchtime supervisors reported increased knowledge, skills and resources needed to supervise the kids at lunchtime. And that is great to hear, right, we want to help everyone we want it to be a win win win situation for the OT, the lunchtime supervisors as well as the kids. Next data also revealed statistically significant improvement from the pretest to the post test on items related to the supervisors ability to encourage healthy eating. So now we have the supervisors helping kids in the physical realm physical health, by encouraging them to eat healthy. And finally, supervisors better understood how to promote positive behavior and resolve conflicts in the lunchroom. How amazing is that? They feel better, they feel like they have the skills they need. And they're promoting healthy eating. And they better understand how to promote positive behavior and resolve conflicts in their realm. And finally, we have the themes that emerged from the therapist reflections. Remember, this was not quantitative. This was qualitative. And there were a few takeaways from that let me share those students enjoyed and learned from the activities is how the therapist interpreted what they saw. And they also felt that supervisors were receptive to new information and demonstrated new skills. One therapist even noted that they felt the supervisor had a better understanding of sensory processing. If you remember, right, when I talked about the six weekly themes, there was one sensory processing week in there. So that is great that the supervisors were able to take that and then apply it to where they were seeing the kids in the cafeteria. And


Jayson Davies 18:25

the final takeaway that I have here from the therapist is that the Occupational Therapist did simply enjoy implementing the program and developing relationships with students and cafeteria supervisors. And again, one noted that they love how it helped them to form relationships with cafeteria staff, and students not on their caseload. I don't want to jump too far ahead to my own conclusions. But I definitely know the people that I do not know on campus, when I'm walking around, tend to be some of the noon duty aides or the staff that I don't interact with. And so I don't know a lot of the people that are not teachers on campus, especially if they're not a special education teacher, or a special education paraprofessional. Same time, I don't know students that are not on my caseload, maybe if they're in another special education classroom that I go into frequently, but definitely not a general education kid that I never see ever. So that's great that the therapist felt better about knowing all students and the staff on campus. So the key takeaways that the author makes is that data suggests that this six week comfortable cafeteria program focused on enjoyable occupations may be effective in transforming negative student experiences into positive ones. Those promoting feelings of emotional well being and developing a positive school climate. There's a key word against school climate and I know that is a topic of interest for educators, not something that comes up very often and in relationship to occupational therapy, but that is a key term for your administrators. That is something that if you mentioned It might get them listening to you. All right. So school climate keep that word in mind. This was especially true for the students who had initially said, they did not enjoy lunchtime. And then after the program, we're now moving up into that mid enjoyer, as opposed to low enjoy or for lunch. So six week program, some training, going in once a week to do a fun activity. And now, all those low, I shouldn't say all, but a lot of those low enjoyers have now moved into an area where they are enjoying lunch a little bit more. And what does that mean? Obviously, they didn't really look at, you know, do you have more friends or whatnot. But hopefully that does correlate, right. If kids are enjoying lunchtime, they're, they're probably enjoying lunchtime because they're more interactive with other children and more interactive with the supervisors in the lunchroom. So that is all great to hear. The main limitation of this study pointed out by the authors was that this is not an optimal control study, there wasn't an a group and a B group and going back and forth, to really study that. But this was a small study, and the qualitative data is still very valuable. Maybe now they can move forward with more of a quantitative larger study where they can look at this site compared to this site where the program is implemented. So hopefully, there is so much more going on. And who knows, maybe in a year from now, we will be looking at another article that has to do with the comfortable cafeteria program, and how it was a very large quantitative study within a and b cohorts. It'll be phenomenal. I can't wait for that. So my personal takeaways from all of this first, the biggest one, it is possible for OTS to complete tiered interventions within a whole school population. This is basically the definition of a tier one intervention right here, you are going in and helping the mass the large amount of kids with not that much time you're doing training, and spending a small amount of time making sure that a majority of the school has access to meaningful occupations that improve their educational outcomes. For those of you who would like to be more ingrained into the RTI or the MTS s program, I think this is definitely an article that you should have in your folder that you can show to your administrators and say, hey, look, occupational therapy can be embedded into an RTI program. And look, it even talks about school culture. This is how we can improve your school culture. Let me help you let me help the lunchtime supervisors Let me help the students I want to be a part of this school program. As I was reading this article, there was one thing that I almost wished was part of it. And that was looking at the general education population versus the special education population, and also how they co-mingled during this program, I would have loved to see how the two populations that are so often separated both physically and socially, if this program could bring them together to interact more,


Jayson Davies 23:11

not only to see if it helps students in the special education classroom to develop some skills to interact with the general education peers, but also vice versa. Did it help the students who are in general education for most of the day, learn compassion and learn understanding and how to work with students and how to be friends with students who are in a classroom that's different from theirs. I would love to see something like that. If any of you are out there working on a doctoral project or your Capstone, whatever that might be, feel free to take that idea and run with it. I would love to see a project and some research about a program that really integrates the special education population with with the general education population using meaningful occupations, that would be fantastic. Be sure to send me an email when you do that. And with that, I'm going to go ahead and wrap up this discussion on the comfortable cafeteria program for promoting student participation and enjoyment and outcome study. This is again, it was a 2018 study in the American Journal of occupational therapy, be sure to check out the entire article if you would like to learn more, or check out the show notes where I will have links to both the article as well as the website that I mentioned earlier, every moment counts.org.


Jayson Davies 24:31

Also, be sure to check out the back to school conference that's going to be happening in August, where the author of this study Susan Bazyk is actually going to be presenting. And you can guarantee this is part of what she will be talking about. She is all about the power of knowledge translation, which is basically the idea that we need to collaborate and so she is going to be brilliant when she speaks in August. I can't wait to have her speak, to hear her speak and to have all of you in awe as you listen to her it's going to be awesome. Check it out OT schoolhouse comm forward slash back to school is where you will find all the details. Be sure to register early because there is an early bird registration. Alright, so until next time, take care and have a great day. Bye bye.


Amazing Narrator 25:17

Thank you for listening to the OT School House podcast. For more ways to help you and your students succeed right now head on over to otschoolhouse.com until next time, class is dismissed.



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