mind, body and life skills for at-risk youth

Introduction to MBA Research

The goal of this section of the MBA website is two-fold. The first goal is to share information about the research that MBA is undertaking on our programs as we seek to deepen the evidence-base for mindfulness-based interventions with at-risk and adjudicated youth. MBA is unique for an organization of its size with respect to the sophistication of its research efforts.

The second and broader goal is to share resources with the larger community about research done on mindfulness and emotional literacy programs – particularly research done on attempts to adapt adult interventions to the needs of youth populations. Because we serve youth in detention environments (as well as in educational and community-based settings), we also have an interest in many of the mindfulness studies that have been conducted with adult incarcerated communities.

As mindfulness-based programs are increasingly being perceived as promising interventions for a wide variety of challenges faced by youth (e.g.; depression, substance abuse, violence), MBA joins with other organizations and academics in the mindfulness field in calling for more resources to conduct better and more specific research. We have no doubt that mindfulness is destined to be an important strategy for working with young people in a variety of contexts. However, the speed at which diverse and underserved communities have access to mindfulness interventions will be in part determined by our ability, as a field, to show it’s benefits to policy makers via well executed research.

Image: Poster summarizing MBA’s three pilot studies, presented by Research Advisory Council member Angela West at the 2010 MBSR conference: Investigating and Integrating Mindfulness in Medicine, Health Care, and Society. Click here to download.

MBA Research Background

As an evidence-based program, part of MBA’s reputation is based on our ability to demonstrate quantitative behavioral change as a result of our interventions. To demonstrate behavioral change, we need to measure behavior, and over eight years we’ve spent a great deal of time designing and refining our evaluation measures to do that.

For our intensive 10-session program, MBA performs a number of pre- and post-intervention tests, using a wide variety of standard psychological instruments, including one that a member of our Research Advisory Council developed specifically to measure adolescent mindfulness. To gain as complete a picture of the effects of the intervention as possible, we measure using a variety of quantitative instruments that are filled out both by participants in MBA programs and those who are supervising them (in probation environments, this would be line staff; in school-based environments it would be teachers).

The following scales/measures are used across all program sites:

Perceived Stress Scale (PSS-10)
Healthy Self-Regulation Scale (HSR)
Mindful Attention Awareness Scale (MAAS)
Rosenberg Self-Esteem Scale (RSE)
Teen Conflict Survey – Impulsivity
Medical Outcomes Quality of Life Scale – 36

Additionally (and arguably of greater importance), we code and analyze qualitative data on a regular basis from in-depth interviews conducted with youth participants and staff.

Where possible, we also integrate external behavioral measures (e.g., incident reports from detention units) into our research and evaluation efforts. For example, in our research at Camp Glenwood (San Mateo County’s long-term boys detention facility) with Stanford Medical School, we will analyze external behavioral changes of youth who participate in MBA’s intervention by making use of Glenwood’s behavior points system. The behavior points system is used for every boy in the camp and is designed to “score” behavior by taking into account behavioral infractions as well as positive behavioral changes. In our last pilot study at Glenwood in 2005-2007, there was a correlation between positive behavior points and youth who participated in MBA’s program (i.e., youth who participated had fewer behavioral infractions than their counterparts in the control group). We hope to replicate that success in the current study.

Over the medium-term, MBA is seeking funding (principally with the National Council on Crime & Delinquency) to conduct longitudinal research that would include a wider bandwidth of qualitative data and more external behavioral measures.

Image: Graph from our 06 study

Past Research - Camp Glenwood

Our first cycle of research data collection occurred in 2005 at Camp Glenwood (San Mateo County’s long-term detention camp for boys). We administered four standardized self-report measures—The Novaco Anger Scale (NAS) and the Provocation Inventory (PI), developed by Dr. Raymond Novaco in conjunction with the Violence Risk Project of the MacArthur Foundation Research Network on Mental Health and the Law, the Perceived Stress Scale (PSS) developed by Sheldon Cohen and colleagues (Cohen et al., 1983), and the Mindfulness Thinking and Acting Scale for Adolescents (MTASA), developed by Angela M. West and colleagues. Statistically significant improvements were observed for study participants on the Perceived Stress Scale (PSS) (p = .001) and the Novaco Provocation Inventory (PI) (p = .016). These results suggest that the program was effective in lessening participants’ tendency to be provoked into anger and decreasing feelings of stress and loss of control. Additionally, we gathered information on program effectiveness by examining changes in behavior points given out by staff. This analysis involved comparing the average weekly positive behavior points given out by supervising staff prior to the intervention to the average weekly positive behavior points for the week following the intervention. We compared program participants to a “control” group who had not received the intervention. Participants in the mindfulness program (N = 22) showed statistically significant improvements in positive behavior points given out by staff for the week following the intervention as compared with the week preceding the intervention.

These results help support the findings from the self-report measures (NAS, PI, and PSS), indicating that the program not only impacted subjective feelings and moods positively but led to significant changes in behavior as well. We also surveyed staff to better understand the impact of the program on youth from their perspective. 43 staff completed evaluations for 33 class participants. They reported positive changes for the majority of youth in the areas of: attitude toward self and others, expression of anger, dealing with stress, and resolving conflict.

Selected Outcome Measures

MBA Project Programming :: San Mateo County Probation Department. Residential Detention Camp Setting, Severe Risk Young Male Offenders :: Camp Glenwood, La Honda California. MBA mindfulness-based rehabilitation program :: Experiential Inquiry-based curriculum with 3 core practice skills: 1) meditation (vipassana), 2) yoga, 3) council (group process). 10-week intensive program. 1.5 hrs/week: 15 program hours total & day-long retreat: 8 hours = 23 program hours/ youth

SUMMARIZED RESULTS, 2 year pilot study:
January 2005- June 2007

QUANTITATIVE:
•perceived stress decreased: 17.7% – 28%
•anger/provocation decreased: 10.5%
•conflict resolution ability increased: 25% – 29.8%
•emotion regulation ability increased: 13% – 15%
•overall mindfulness increased: 10.5%

QUALITATIVE:
Percentage of youth who say they-
•feel physically better after coming to class: 95%
•feel less stressed after coming to class: 93%
•feel better about themselves after coming to class: 85%
•noticed less conflict with others: 64%
•reported sleeping better: 78%
•able to use what they’d learned to deal better with being in the hall: 82%
•are better able to ‘cool off’ when they get angry or upset: 78%
•spend some time each week doing breathing meditation or stretching: 66%
•plan to use the skills they’ve learned in class once they leave the hall: 89%

n=54. Data collected pre- and post-intervention; evaluated independently. Perceived Stress data from PSS-10. Anger/Provocation data from NAS-PI. Conflict Resolution data from staff questionnaire. Emotion Regulation and Overall Mindfulness data from MTASA.

Past Research - Hillcrest

Sam Himelstein – formerly incarcerated youth, MBA Program Manager, and Research Advisory Council member – completed a pilot project at the San Mateo County Youth Services Center in 2009 that specifically measured the effects of MBA’s new 2008 curriculum. The study investigated the effects of MBA’s 10-week mindfulness-based intervention on self reported mindfulness, impulsiveness, perceived stress, and healthy self-regulation in a group of 32 incarcerated youth. Thirty-two participants completed questionnaires pre and post intervention. Additionally, 23 participants were interviewed upon completion of the intervention.

A mixed-method triangulation model was used, and quantitative and qualitative data were collected and analyzed separately, but weighted equally. A two-factor analysis of variance (ANOVA) revealed no significant differences between two 10-week cycles (cycle one: n = 14, cycle two: n = 18) on pretest questionnaire data. Paired t-tests revealed a significant decrease (p < .05) in perceived stress and a significant increase (p < .001) in healthy self-regulation from pre to posttesting.

Analysis of the qualitative data revealed five major clusters of 19 unique themes. The first was an increase in subjective well-being, which included increases in relaxation, self-esteem, and sleep, and a decrease in stress. The second was an increase in self-regulation, which included an increase in emotional, cognitive, and behavioral regulation. The third was an increase in awareness, which included increases in self-contemplation, emotional, cognitive, physical, and present-moment awareness. The fourth was positive experiences related to the group context, which included expression, other perspective, common experiences, relational development, and new experiences. This fifth was comprised of one major theme: an accepting attitude toward the treatment intervention. Results suggest that mindfulness-based interventions for incarcerated youth may mitigate the numerous psychological stressors associated with incarcerated living.

Image: MBA Program Manager Sam Himelstein teaching at Hillcrest Juvenile Hall, San Mateo County, Spring 2010.

Current Research - Stanford

MBA is currently partnering with the Pediatric Advocacy Program of Stanford Medical School to research the effects of adding in a daylong mindfulness intensive into our 12-week curriculum at Camp Glenwood (San Mateo County’s long-term boys detention camp).

PROJECT ABSTRACT

Background
Incarcerated youth are a particularly vulnerable group with a disproportionately higher medical and psychiatric morbidity and mortality compared to the general population. While the general adolescent population has an estimated prevalence of serious psychiatric illness at approximately 10% , the prevalence of serious psychiatric illness in incarcerated youth is reported as 70%. Existing studies have demonstrated that there is an unmet need for mental health care and for rehabilitation among this population as incarcerated youth have higher rates of homicide, suicide, and future incarceration compared to the general adolescent population; for example, incarcerated youth have a completed suicide rate four times that of non-incarcerated adolescents. Several studies have demonstrated the value of providing community services and mental health treatment programs for reducing recidivism and high-risk health behaviors among incarcerated youth. Furthermore, several studies document a positive impact of meditation and mindfulness-based courses on adult prisoners. Meditation can be defined as “deliberate self-regulation or attention in the present moment.” The term mindfulness describes paying attention to the present moment in a non-judgmental fashion. While many studies in the pediatric literature report that meditation and mindfulness can promote the physical and mental wellbeing of children, only two prior studies, both currently unpublished in the peer-reviewed literature, assess the efficacy of a meditation-based program among incarcerated youth. Given the potential for meditation and mindfulness-based interventions to enhance the physical and mental wellbeing of youth, and the powerful impact of this strategy seem in incarcerated adults, further exploration of meditation and mindfulness training as a rehabilitation strategy for incarcerated youth is warranted.

Description of Research
A mixed methods approach will be used to examine the following two research questions:

Is MBA Project’s one-day intensive course in combination with the 10-session course more effective than the 10-session course alone at affecting wellbeing of participating youth?

What are the youth’s attitudes towards the one-day intensive session?

Youth will be recruited through MBA’s 10-session meditation courses at San Mateo County Probation’s secure detention center, Camp Glennwood. Half of the study participants will receive MBA’s regular 10-session meditation course plus the one-day intensive session (treatment group) and half will receive only the 10-sesion meditation course (control group). Quantitative data collection will entail administration of validated psychometric scales that assess wellbeing at strategic time points as well as the corroboration of the ongoing “points system” collected by Camp Glennwood staff that records behavioral events such as arriving to activities in a timely fashion (points awarded) and fights or outbursts (points detracted). Qualitative data collection will involve focus groups and interviews that invite the youth to elaborate on their attitudes toward the one-day intensive. Although we aim to focus on eliciting their feedback on a one-day intensive, we recognize that the experience of concentrating on mindfulness may evoke powerful emotions, particularly from a group who has a higher incidence of trauma and stress than the general population. We anticipate that our partners from MBA, who know the youth well, will help assess and guide these discussions.

We plan to evaluate whether the one-day intensive is an efficacious intervention for these young adults and to offer specific suggestions that may help improve the program. To this end, quantitative data will be analyzed to assess for statistically significant differences between those youth who receive the 10-session course plus the one-day intensive session compared to those who attend only the 10-session course. The focus groups and interviews will be audio-recorded and transcribed, and analyzed for transcript-based themes. Follow-up interviews one week and two months after the course will invite youth to reflect on how the mindfulness training, and particularly the one-day intensive, has impacted their wellbeing and emotional awareness. Their voices at this time will likely be critical for guiding further interventions that sustain the wellbeing of the youth after release from the juvenile justice system.

Anticipated Outcomes
As described in previous studies, we anticipate uncovering signs and symptoms of psychological morbidity among the incarcerated youth. This research would add to existing studies to determine the role of meditation and mindfulness training in overcoming the mental health issues prevalent in this population. Several studies have examined mindfulness-based interventions among prisoners but to our knowledge, only one peer-reviewed study has applied this approach to youth. Additionally, among the community-based movements that bring meditation to prison settings, MBA is the first to offer a one-day intensive course to young adults. We feel it is important to promptly discern how this new innovation impacts the young adults. Therefore, we are interested in hearing from the youth themselves about their experiences in the one-day intensive meditation and mindfulness course. Their voices will be essential in guiding future interventions. By identifying the youth’s struggles within the course we can help MBA address and anticipate problems accordingly. MBA has already received eager requests from judges in juvenile justice departments in several Bay Area counties to provide data on the efficacy of the one-day intensive course. Working alongside MBA, we hope to identify whether the one-day intensive is an effective strategy and offer specific programmatic suggestions that will enhance MBA’s work in San Mateo County and across the Bay Area.

In contributing to the evidence-based development of this innovate tool for rehabilitation of incarcerated youth we hope to enhance the psychological, physical, and social wellbeing of this vulnerable population. If the course proves to provide benefit to these youth, our study findings may help dedicate more funding to these programs and offer a framework for a national model for rehabilitation of incarcerated youth.

Furthermore, it is our hope that reflecting on the youth’s experiences with inner exploration and reform will heighten awareness of not only the tremendous challenges faced by incarcerated youth but also the resiliency and strength of these young adults.

Principle Investigators
Dr. Lisa Chamberlain, Director of the Pediatric Advocacy Program at Stanford, has extensive experience working to reduce child health disparities by collaborating with community partners to identify and address problems jeopardizing the health and wellbeing of children and families in our community. Dr. Chamberlain’s commitment to the values and application of community-based participatory research (CBPR) is evident through her dedication to equitable community collaborations that meet with communities to identify needs and assets, as well as through her work teaching and mentoring pediatric residents and medical students about population health, social determinants of health, and health disparities. Over the last 10 years, Dr. Chamberlain has created a leading pediatric resident training program (Stanford Advocacy Track = StAT) that provides the training, infrastructure, and technical assistance for residents to engage in longitudinal community collaborations that address community-identified child health needs. Residents gain skills in community engagement, research methodology, program management, grant writing, and evaluation. StAT faculty and program staff supports the implementation of resident-led community-based research projects.

Dr. Liz Barnert is a first-year pediatric resident participating in the StAT program. She has a long-standing passion for and commitment to advocacy for underserved communities. She has international experience leading community-based research projects and has served as a community organizer at home and abroad for over 10 years. Over the past year she has worked with Dr. Chamberlain and the advocacy program staff to develop a partnership with MBA.

Image: MBA class at Hillcrest Juvenile Detention Facility, San Mateo County, CA, Spring 2010

Current Research - CHRCO

MBA is currently partnering with Children’s Hospital & Research Center Oakland (CHRCO) on a pilot project at Camp Sweeney (Alameda’s long-term youth detention camp) that utilizes MBA’s intervention as a prescription for anxiety and insomnia for youth in detention.

Dr. Tomás Magaña, the Medical Director of the Alameda County Juvenile Justice Center, initiated the project with MBA in response to the large number of anxiety and insomnia complaints his office was receiving from detained youth. The idea was to use a mindfulness-based intervention as an alternative to Benadryl and other common drug prescriptions.

To our knowledge, this partnership represents the first instance nationally of adolescent physicians in the probation system writing a prescription for mindfulness training as a way to counteract conditions that have been traditionally treated with pharmaceutical interventions.

We began data collection in the Spring 2010 using several quantitative self report measures, including the Overall Anxiety Severity & Interference Scale (OASIS) and the Insomnia Symptom Questionnaire (ISQ-13). We are also conducting in-depth qualitative interviews of program participants.

Research Tables

EFFICACY OF MINDFULNESS WITH INCARCERATED POPULATIONS

SOURCE: Samuelson, M., Carmody, J., Kabat-Zinn, J., Bratt, M.A., (2007). Mindfulness-Based Stress Reduction in Massachusetts Correctional Facilities. The Prison Journal, Volume 87 Number 2 June 2007, 254-268

TAKE-HOME: Mindfulness-Based Stress Reduction program significantly improves self-reported hostility, self-esteem, and mood disturbance levels for 1,350 inmates incarcerated in 5 Massachusetts prisons.

EXCERPTS: “Depending on each institution’s overall program schedule,class sessions varied from 1 to 1.5 hours. In some cases,where individual classes were shorter, two sessions were held per week. Course lengths varied from 6 to 8 weeks. In no case was there an opportunity for the all-day retreat or intensive experience. Opportunities for independent daily meditation practice outside of class were minimal,and shared cells and other constraints of prison life limited the ability to practice alone and in relative quiet.”

“Given the fact that a prison environment can be a very hostile environment, the demonstration of significantly decreased hostility scores in the 6% to 9% range following participation in an MBSR program in these correctional settings is encouraging.”

“The significant post-MBSR course improvements (Table 3) in self-esteem provide encouragement that this dimension can also be improved for incarcerated individuals through training in mindfulness meditation.”

“The improvements in TMD [Profile of Mood States Scale] reported here (38.5% for women and 28.4% for men) are striking and suggest that the affective state of these inmates can be improved substantially by participation in an MBSR program.”

“…the finding that the improvements associated with participation in the program in this setting were maintained for an additional 6 to 8 weeks in the stressful correctional institution environment holds promise for the longer-term endurance of the effects of MBSR programs in supporting inmates in these settings.”

SOURCE: Marlatt, G.A., Witkiewitz, K., Dillworth, T.M., Bowen, S.W., Parks, G.A., MacPherson, L.M., Lonczak, H.S., Larimer, M.E., Simpson, T., Blume, A.W., Crutcher, R. (2004). Vipassana Meditation as a Treatment for Alcohol and Drug Use Disorders. Mindfulness and Acceptance, Guilford Press, 2004, 261-283

TAKE-HOME: 10-Day Vipassana course has dramatic impact post-course and at 3-month post-course interval on emotional well-being and substance abuse profile of incarcerated adults with substance use profiles.

EXCERPTS: “Many of the findings from these studies suggest that meditation results in neurological changes that are associated with increased levels of alertness, relaxation, attentional control, and reduced readiness for action.”

“The neurobiological findings support the hypothesis that meditation enhances awareness and the cultivation of alternatives to mindless, compulsive behavior.”

“The positive findings…lend support for the generalizability of Vipassana as an intervention for substance use and psychiatric disorders for both incarcerated and non-incarcerated individuals.”

“…provides further evidence for the applicability of Vipassana as a low-cost alternative to current systems of addiction treatment.”

“Cognitive-behavioral approaches and interventions based on the Minnesota model [AA] are primarily focused on reducing substance use, whereas Vipassana appears to influence more metacognitive processes, which may have broader and more long-term effects.”

“A combination of mindfulness training coupled with a therapy program (individual or group format) designed to help clients apply meditation to their personal problems may be more effective than a more generic approach, such as the Vipassana course.”

SOURCE: Bowen, S., Witkiewitz, K., Dillworth, T.M., Chawla, N., Simpson, T.L., Ostafin, B.D., Larimer, M.E., Blume, A.W., Parks, G.A., Marlatt, G.A. (2006). Mindfulness Meditation and Substance Use in an Incarcerated Population. Psychology of Addictive Behaviors, Vol.20, No.3., 343-347

TAKE-HOME: After release from jail, participants in Vipassana course show significant reductions in alchohol, marijuana, and crack cocaine use.

EXCERPTS: “We found that individuals who participated in the Vipassana course reported significantly lower levels of psychiatric symptoms, more internal alcohol-related locus of control, and higher levels of optimism.”

“VM participants showed decreases in alcohol-related problems and psychiatric symptoms as well as increases in positive psychosocial outcomes.”

“Residents who participated in VM reported significantly less use of each of these substances [alcohol, marijuana, crack cocaine] and significantly fewer alcohol-related negative consequences 3 months following release from NRF.”

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