The Use of Arts in Awareness & Prevention of Eating Disorders

The Use of Arts In Awareness & Prevention of Eating Disorders

A 3-part series by Robyn Hussa Farrell, Founder and CEO of mental fitness

This is the third and final part in a series (View Part 1 View Part 2)

Summary: It has been an 8-year journey to evolve an evidence-based model of building and delivering award-winning prevention-focused programs in collaboration with educators, researchers and practitioners.

These arts-infused programs are created with five main elements:

– documentary style films featuring the nation’s researchers in prevention

– handouts written by researchers and practitioners

– resources

– strategies for finding CEDS and FAED specialists

– links to validated screeners and more.

Most importantly, creating and delivering the programs requires a community effort and multiple collaborations.

Today we offer an array of online and live courses. A complete listing is available here. Mental Fitness live programs have been implemented in the following school districts across the country:

  • Greendale, Wisconsin
  • Central Wisconsin (in collaboration with WI American Academy of Child and Adolescent Psychiatrists and Wisconsin School Nursing Association)
  • Spartanburg, South Carolina (in collaboration with Veritas Collaborative, Judy Bradshaw Children’s Foundation and Mary Black Foundation)
  • Columbia, South Carolina (in collaboration with Hearth Center and SCEDA)
  • Weston, Connecticut (in collaboration with Weston, CT Youth Services)
  • Western Suffolk, New York (in collaboration with NY AHPERD)
  • Reading, Pennsylvania (in collaboration with Veritas Collaborative, Perfect as You Are and Reading Hospital)

But leading professional development workshops that educate about disordered eating awareness and prevention is only the beginning. As with many things, the more we know, the more we learn what we don’t know. The real work still lies ahead of us …

(PLEASE NOTE: the remainder of this article contains confidential information that is property of Robyn Hussa Farrell, Mental Fitness, Inc., and various research teams. For permissions or more information, please contact Robyn Hussa Farrell at rfarrell@mentalfitnessinc.org.)

Inspired by Dianne Neumark-Sztainer’s research[1], in 2012 we began to further investigate the shared risk and protective factors that underlie serious mental illnesses, eating disorders, obesity and addictions. We pulled together research from developmental psychology, looking at the overlap between prevention and kindergarten readiness. Gathering publications from multiple areas of science, we located validated assessments, evidence-based interventions and put them together into our Mental Fitness Map. This has become our mechanism for linking evidence-based prevention programs to schools and universities.

To help us bring together these resources, we built a prevention site (BResilient.co) and the NOURISH prevention center (NOURISHSpartanburg.com), where parents and children can take classes and attend workshops.

Generally, we are in the process of investigating and learning that communities can improve behavioral health, overall health and improve kindergarten readiness by focusing on the shared protective factors that can be taught to children ages 0-5 and their parents. In addition to Mental Fitness’s findings in Spartanburg schools in 2013-2014 (see Part 2 for complete detail), the below appendix contains supporting data emphasizing the overlap in four key areas. The below hypotheses have led to our key research and design projects for 2015-2016 which are available on our website at MentalFitnessInc.org.

We are especially grateful to the primary researchers with whom we have had the privilege of collaborating on the below report; including, Christina Anderson, Ph.D., Cynthia Bulik, Ph.D., Deb Burgard, Ph.D., Melissa DeRosier, Ph.D., Camden Elliott, MD., and Christine Peat, Ph.D.

  1. The Mental Fitness “Map” is based on the below research at University of Minnesota, emphasizing the importance of focusing on the shared risk and protective factors for mental health and obesity as the new way for preventing obesity, mental illnesses, and improving health outcomes. [2]

o   “A major challenge to developing interventions that are able to prevent both obesity and eating disorders is the identification of potent and modifiable factors that have relevance for both conditions[3]. Identification of appropriate risk factors for the condition being targeted is essential to developing effective prevention interventions[4].”

o   “Other potential shared risk and protective factors that may be worthy of further etiologic inquiry include self-esteem, depression, dietary intake patterns (e.g. meal patterns), the role of parental encouragement or role modeling of weight-related behaviors and the role of a home environment that is supportive of healthy eating and physical activity behaviors.[5]” (these have all been integrated into our Mental Fitness map)

  1. Studies that look at the long-term impact on individuals who benefitted from early childhood education at ages 0-5, show profound improvement in social and emotional learning skills, less crime, higher graduation rates and increased employment.[6]

o   “The High/Scope Perry Preschool study followed 123 children from preschool well into adulthood. … the study found a persistent effect on achievement tests through middle school, a finding consistent with results from the meta-analysis of all relevant research literature. In addition, the preschool group had better classroom and personal behavior as reported by teachers, less involvement in delinquency and crime, fewer special education placements, and a higher high school graduation rate.[7] Through age 40, the program was associated with increased employment and earnings, decreased welfare dependency, and reduced arrests. Long-term effect sizes are in the range from 0.30 to 0.50 standard deviations. High school graduation increased from half to two-thirds, the number of arrests by age 27 fell by half, and employment at age 40 showed an increase of 14 percentage points.[8]”

o   “Multiple meta-analyses conducted over the past 25 years have found preschool education to produce an average immediate effect of about half (0.50) a standard deviation on cognitive development.[9] This is the equivalent of 7 or 8 points on an IQ test, or a move from the 30th to the 50th percentile for achievement test scores. For the social and emotional domains, estimated effects have been somewhat smaller but still practically meaningful, averaging about 0.33 standard deviations.[10] To put these gains in perspective, it’s important to realize that on many measures, a half standard deviation is enough to reduce by half the school readiness gap between children in poverty and the national average.”

  1. Social and emotional learning skills, similar to those taught through the Mental Fitness programs, contribute to the prevention of obesity.[11]

o   “There is tremendous overlap between the social skills targeted in Social Skills Training programs and the skills necessary to produce lifelong change in obesogenic habits. For example, in order to change dietary habits, children need to have nutritional knowledge, as well as impulse control to resist energy dense foods. The impulse control strategies used for maintenance of a healthy diet are parallel to the impulse control and emotion regulation strategies used in social interactions wherein children may need to resist aggressive impulses and maintain a calm and cooperative attitude. In addition, learning respect for oneself and others, improving perspective taking ability, maintaining a positive attitude, understanding responsibility, and learning to use action plans to achieve short and long-term goals are important skills for obesity prevention and the development of positive peer relations and provide benefit when used in an independent social skill intervention[12] or when used in conjunction with other intervention program components[13]. Given the strong evidence supporting the positive and reinforcing effect of peers on diet and activity, the novel, collaborative approach combining the best practices in obesity prevention with complimentary social skill training can provide potent, long-lasting effects for all children, regardless of weight, and therefore can contribute to the prevention of obesity.”

  1. Emotional well-being, social competence, and cognitive abilities – together – are the brick and mortar that comprise the foundation of human development.[14] These have been linked to improving mental fitness, obesity prevention and children’s readiness for school.

o   “Being able to regulate emotion, pay attention, work independently and with peers, and make good choices are paramount in determining children’s readiness for school[15]. These early SEB skills are critical prerequisites for school entry [16]. Young children with low SEB skills are more likely to display antisocial behaviors, dislike school, perform poorly on academic tasks, and experience grade retention and drop out [17], and are more likely to be inattentive, disruptive, or withdrawn in the classroom[18].”

The Mental Fitness national nonprofit is devoted to prevention research that expressly serves children, educators and families. We hope that you will join us in our mission of building mental fitness in all youth through evidence-based prevention programs.

  • mentalfitnessinc.org — main website 
  • bResilient.co — prevention tools, curricula and trainings by national prevention researchers
  • ThinkEatPlay.org — optimizing athlete health
  • WeAreTheRealDeal.com — top rated body image site featuring 40+ contributors
  • NOURISHSpartanburg.com — live prevention center in Spartanburg’s Chapman Cultural Center
  • SelfEsteemStomp.com — an annual fun walk for families

Watch the 3-minute trailer of NORMAL (the musical that began this process), featuring Robyn Hussa Farrell by clicking here.

About the author:

ROBYN HUSSA FARRELL is an award-winning New York producer and performer, educator and author. She is co-Adaptor of the Jonathan Larson award-winning musical, NORMAL, which she has been producing and performing in for 7 years to educate about mental fitness in schools … and which is the inspiration for forming mentalfitness, inc. (formerly called NORMAL In Schools).  As a writer, she re-imagined and is Author/Editor of the award-winning body image blog site WeAreTheRealDeal.com, she is Author of the books Healthy Selfitude and Meditation & Mindfulness For Eating Disorder Recovery.  Hussa Farrell also has collaborated as investigator and author on several research publications.  Her work in this area is in collaboration with more than 50 researchers; including those from Harvard School of Public Health, UNC Chapel Hill, Coastal Carolina University, MUSC and others.

As an E-RYT yoga instructor, Hussa created eating disorder recovery yoga programs for inpatient, partial and outpatient treatment programs and has offered free recovery yoga to patients (and their families) in recovery for over a decade in Wisconsin, New York City and in Spartanburg, South Carolina.  The “NOURISH” recovery yoga workshops infuse arts, writing, poetry and movement to support the recovery journey.  She has led seminars for treatment professionals to highlight how to lead safe and effective recovery yoga and mindfulness workshops.  She was invited to provide a chapter in a new book by Carolyn Costin about yoga for recovery that will be published in 2016 by Routledge.

For years Robyn has also been co-creating and producing documentary films with her husband Tim Farrell, through their production company whitelephant.  Some of the documentary films she has co-directed; include, Speaking Out About Ed and ED 101 – and both are the result of her interviewing national experts in the fields of neurobiology, eating disorders, obesity and nutrition.  Their next documentary film is Beneath The Floorboards – a commissioned project through ANAD and BEDA.  Hussa Farrell is also responsible for creating and implementing the more than 25 award-winning mentalfitness programs that serve as content to more than 20 national nonprofits, corporations and that are created in collaboration with more than 50 national researchers in medicine, nutrition, mental health and wellness. She recently co-created the ThinkEatPlay program to optimize health in athletes and created the 5 Minute Mindfulness program for classroom educators.

In 2014, Hussa Farrell and her husband launched Resiliency Technologies to provide mental health prevention tools to corporations.  More information is available at BResilient.co.

For her work creating mentalfitness, inc. and its programs and initiatives, Robyn received the 2014 Peace Award from Converse College Westgate Family Therapy and 2010 Champion in Women’s Health award from Wisconsin First Lady, Ms. Sue Ann Thompson.

Prior to her work with mentalfitness, inc., Robyn was co-Founder of the award winning New York Theatre Company, Transport Group.  During her six year tenure as Founding Executive Director, the company won the 2007 Drama Desk award for the company’s breadth of vision and challenging productions and more than 20 nominations from Drama Desk, Obie and others.  Transport Group continues to thrive in the West Village of Manhattan.  Please visit them at TransportGroup.org.

Robyn holds an MFA-Acting from the University of Virginia, is a member of AEA, AFTRA/SAG, the Academy for Eating Disorders (AED), The International Association for Eating Disorders Professionals (IAEDP), Women In Film and Television (NYWIFT), and is an E-RYT Certified Yoga Teacher with the Yoga Alliance.  She and her husband recently relocated to Spartanburg, SC where she runs the Mental Fitness NOURISH prevention center and is a proud board member of the Spartanburg Philharmonic Orchestra.

References:

[1] Haines, J., and Neumark-Sztainer, D. (2006). Prevention of Obesity and Eating Disorders: A Consideration of Shared Risk Factors. Published by Oxford University Press. Health Education Research Vol. 21 no. 6, p. 770-782. Retrieved from: http://her.oxfordjournals.org/content/21/6/770.abstract

[2] Haines, J., and Neumark-Sztainer, D. (2006). Prevention of Obesity and Eating Disorders: A Consideration of Shared Risk Factors. Published by Oxford University Press. Health Education Research Vol. 21 no. 6, p. 770-782. Retrieved from: http://her.oxfordjournals.org/content/21/6/770.abstract

[3] Neumark-Sztainer D. Can we simultaneously work toward the prevention of obesity and eating disorders in children and adolescents. Int J Eat Disord 2005; 38: 220–7.

[4] Perry C. Creating Health Behavior Change: How to Develop Community-Wide Programs for Youth. Thousand Oaks, CA: Sage Publications, 1999.

[5] Haines, J., and Neumark-Sztainer, D. (2006). Prevention of Obesity and Eating Disorders: A Consideration of Shared Risk Factors. Published by Oxford University Press. Health Education Research Vol. 21 no. 6, p. 770-782. Retrieved from: http://her.oxfordjournals.org/content/21/6/770.abstract

[6] From Barnett, W. S. (2008). Preschool Education and Its Lasting Effects: Research and Policy Implications. Boulder and Tempe: Education and the Public Interest Center & Education Policy Research Unit. Retrieved 8/1/2014 from: http://nieer.org/resources/research/PreschoolLastingEffects.pdf

[7] Berrueta-Clement, J.R., Scwheinhart, L.L., Barnett, W.S., Epstein, A.S., & Weikart, D.P. (1984). Changed lives: The effects of the Perry Preschool program on youths through age 19. Ypsilanti, MI: High/Scope Press.

Schweinhart, L.J, Barnes, H.V., Weikart, D.P. (1993). Significant benefits: The High/Scope Perry

Preschool study through age 27. Ypsilanti, MI: High/Scope Press.

[8] Schweinhart, L.J., Montie, J., Xiang, Z., Barnett, W.S., Belfield, C.R., & Nores, M. (2005). Lifetime effects: The High/Scope Perry Preschool study through age 40 (Monographs of the High/Scope Educational Research Foundation, 14). Ypsilanti, MI: High/Scope Press.

Karoly, L.A., Kilburn, M.R., & Cannon, J.S. (2005). Early childhood interventions: Proven results, future

promise. Santa Monica, CA: Rand Corporation.

[9] Camilli, G., Vargas, S., Ryan, S., & Barnett, W.S. (in press). Meta-analysis of the effects of early education interventions on cognitive and social development. Teachers College Record.

Gorey, K. M. (2001). Early childhood education: A meta-analytic affirmation of the short- and long-term benefits of educational opportunity. School Psychology Quarterly, 16 (1), 9-30.

Guralnick, M.J., & Bennett, F.C. (Eds.),(1987). The effectiveness of early intervention for at-risk and handicapped children. New York, NY: Academy Press.

McKey, R.H., Condelli, L., Ganson, H., Barrett, B.J., McConkey, C., & Planz, M.C. (1985). The impact of Head Start on children, families, and communities. Washington, DC: Head Start Evaluation Synthesis and Utilization Project.

Nelson , G., Westhues, A., & MacLeod, J. (2003). A meta-analysis of longitudinal research on preschool prevention programs for children. Prevention and Treatment, 6, 1-34.

Ramey, C.T., Bryant, D.M., & Suarez, T. M. (1985). Preschool compensatory education and the modifiability of intelligence: A critical review. In D. Detterman (Ed.) Current topics in human intelligence (pp.247-296). Norwood, NJ: Ablex.

White, K., & Casto, G. (1985). An integrative review of early intervention efficacy studies with at-risk children: Implications for the handicapped. Analysis and Intervention in Developmental Disabilities, 5, 7-31.

[10] Camilli, G., Vargas, S., Ryan, S., & Barnett, W.S. (in press). Meta-analysis of the effects of early education interventions on cognitive and social development. Teachers College Record..

McKey, R.H., Condelli, L., Ganson, H., Barrett, B.J., McConkey, C., & Planz, M.C. (1985). The impact of Head Start on children, families, and communities. Washington, DC: Head Start Evaluation Synthesis and Utilization Project.

White, K., & Casto, G.(1985). An integrative review of early intervention efficacy studies with at-risk children: Implications for the handicapped. Analysis and Intervention in Developmental Disabilities, 5, 7-31.

[11] From Sarah Salvy, Ph.D., University of Southern California, California Obesity Prevention Program

[12] Brightwood LH, DeRosier ME. LifeStories for Kids: Enhancing character development and social skills through storytelling (Grades 3-5). Cary, NC: 3-C Institute for Social Development. 2007.

DeRosier ME. Social Skills GRoup INtervention (S.S. GRIN) – Parent Guide (S.S. GRIN – PG). Cary, NC: 3-C Institute for Social Development. 2006.

DeRosier, M. E. Social Skills GRoup INtervention (S.S.GRIN): Group interventions and exercises for enhancing children’s communication, cooperation, and confidence (Grades K-2) (4th Edition). Cary, NC: 3-C Institute for Social Development. 2007.

DeRosier ME. Social Skills GRoup INtervention (S.S.GRIN): Group interventions and exercises for enhancing children’s communication, cooperation, and confidence (Grades 3-5) (4th Edition). Cary, NC: 3-C Institute for Social Development. 2007.

DeRosier ME, Brightwood LH. LifeStories for Kids: Enhancing character development and social skills through storytelling (Grades K-2). Cary, NC: 3-C Institute for Social Development. 2007.

Harrell A, DeRosier ME. Social Skills GRoup INtervention – Adolescents (S.S. GRIN – A). Cary, NC: 3-C Institute for Social Development. 2007.

[13] Botvin GJ. Preventing drug use in schools: Social and competence enhancement approaches targeting individual-level ecological factors. Add Behav. 2000; 25: 887-897.

[14] National Scientific Council on the Developing Child, Harvard University (2007). The Science of Early Childhood Development: Closing the Gap Between What We Know and What We Do.

[15] Pianta, R. C., Cox, M.J., Taylor, L., & Early, D. (1999). Kindergarten teachers’ practices related to the transition to school: Results of a national survey. The Elementary School Journal, 100, 71-86.

[16] Pianta, R. C., & Kraft-Sayre, M. (2003). Successful Kindergarten Transition: Your Guide to Connecting Children, Families, & Schools. Baltimore, MD: Paul H Brookes Pub Co.

[17] Raver, C., & Knitzer, J. (2002). Ready to enter: What research tells policy makers about strategies to promote social and emotional school readiness among three- and four-year-old children. NY: NCCP.

[18] Raver, C., & Knitzer, J. (2002). Ready to enter: What research tells policy makers about strategies to promote social and emotional school readiness among three- and four-year-old children. NY: NCCP.

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