Effects of an outdoor education intervention on the mental
Transcript Of Effects of an outdoor education intervention on the mental
Effects of an outdoor education intervention on the mental health of schoolchildren
Per E Gustafsson, Anders Szczepanski, Nina Nelson and Per A Gustafsson
Linköping University Post Print
N.B.: When citing this work, cite the original article.
This is an electronic version of an article published in: Per E Gustafsson, Anders Szczepanski, Nina Nelson and Per A Gustafsson. Effects of an outdoor education intervention on the mental health of schoolchildren, 2011, Journal of Adventure Education and Outdoor Learning, 12(1), 63-79. Journal of Adventure Education and Outdoor Learning is available online at informaworldTM: http://dx.doi.org/10.1080/14729679.2010.532994 Copyright: Taylor & Francis (Routledge): SSH Titles
http://www.routledge.com/ Postprint available at: Linköping University Electronic Press
http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-70047
Outdoor education and mental health
1
Running head: OUTDOOR EDUCATION EFFECTS ON MENTAL HEALTH
Effects of an Outdoor Education Intervention on the Mental Health of School Children
Per E Gustafssona,*, Anders Szczepanskib, Nina Nelsonc, Per A Gustafssona
a Dept of Public Health and Clinical Medicine, Family Medicine, Umeå University, SE-901 85 Umeå, Sweden b Center for Outdoor Environmental Education, Dept of Arts, Craft and Design, Linköping University, SE-581 83 Linköping, Sweden c Dept of Clinical and Experimental Medicine, Division of Pediatrics, Linköping University, SE-581 85 Linköping, Sweden d Dept of Clinical and Experimental Medicine, Division of Child & Adolescent Psychiatry, Linköping University, SE-581 85 Linköping, Sweden
*Corresponding author: Per E Gustafsson, Dept of Public Health and Clinical Medicine, Family Medicine, Umeå University, SE-901 85 Umeå, Sweden. Phone no: +46 90 785 3524, Fax no: +46 90 776 883, E-mail: [email protected]
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Author note Acknowledgements: We thank Elin Allansson-Kjölhede for participation in the data collection as well as the staff at the participating schools. The study was financially supported by The Erik Johan Ljungberg Educational Fund, HAGS Aneby AB, The Swedish Medical Society/The Foundation of Söderström-Königska Sjukhemmet and the County of Östergötland.
Outdoor education and mental health
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Author biographies Per E Gustafsson, Ph.D., has in his dissertation within Child & Adolescent Psychiatry studied psychosocial, psychiatric and physiological aspects of stress in childhood. Currently, his main area of interest is on life course epidemiology and specifically the long-term health consequences of adverse social conditions over the life course. E-Mail: [email protected]
Anders Szczepanski, Ph. Lic., has in his licentiate dissertation studied the variation of teachers´ perceptions of outdoor education and the landscape as a learning environment. The study indicates a multiplicity of varied perceptions of the special nature of outdoor education and can thus be said to characterise this as richly diversified. E-Mail: [email protected]
Nina Nelson, M.D., Ph.D., is associate professor in paediatrics and formerly head of the paediatric clinic at the University Hospital in Linköping, at present director of research and development in the county of Östergotland, Sweden. Her research interest began from within neonatology and cardiology, and has increasingly been focused on stress and health issues in the growing individual, and care givers and teachers, from biological, pedagogical and socioeconomical viewpoints. E-Mail: [email protected]
Per A Gustafsson, M.D. Ph.D., is associate professor in child and adolescent psychiatry and also works clinically as a child psychiatrist. His research field has mainly focused on mindbody interactions in children and adolescents, and its interplay with the immediate social environment, but also neuropsychiatric disorders in young people. E-Mail: [email protected]
Outdoor education and mental health
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Abstract This study aimed at examining the effects of an outdoor educational intervention on the mental health of school children. Two elementary schools participated (N=230), one experimental school where the intervention was done, the other a reference school. Demographic questions and the Strengths and Difficulties Questionnaire were completed by the parents. An outdoor educational intervention was implemented at the experimental school, and the data collection was repeated after one year. The results point towards a small but non-significant improvement in mental health at the experimental school while adjusting for demographics. However, this effect was significantly moderated by gender: boys generally fared better than girls at the intervention school, relative to the reference school. The results indicate that it may be important to address gender issues when educational programs are implemented in schools.
Keywords: School Children, Outdoor Education, Response to Intervention, Mental Health, Gender
Outdoor education and mental health
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Children spend most of their waking hours in school. It is therefore no surprise that the school environment affects the mental well-being of children (Anderman, 2002). The nature of this influence may be further understood from an ecological perspective. The school, much like the family and peer group, is an important developmental context for the child; a microsystem (Bronfenbrenner, 1979; Farmer & Farmer, 1999). A microsystem is the web of relations between the individual and its environment, and constitutes a physical setting, where the participants engage in particular activities in particular roles for a particular period of time. The microsystems are themselves embedded in and influenced by a context; the mesosystem, which describes the interrelations of major Microsystems; the exosystem, which is the broader formal and informal social structure not directly containing the individual; and the macrosystem, which describes the general institutional patterns of the relevant culture or subculture (Bronfenbrenner, 1979).
There are several mechanisms through which the school as a microsystem may influence the mental well-being of the child (Farmer & Farmer, 1999). First, at the level of exosystem or macrosystem, the educational context itself is influenced by structural factors such as stratification of school districts, funding source and special education needs. This stratification creates different microsystems where education takes place, and thus influences instructional aspects of the school (Gamoran, 1986) with social, psychological and behavioural consequences for the individual child . The school also influences children through the peer network (Farmer & Farmer, 1999), which constitutes a microsystem for school children that considerably overlaps with the school microsystem. These mediating and moderating roles of the school environment may be a partial explanation as to why early problems in school (Kellam, Ling, Merisca, Brown, & Ialongo, 1998; Masten, 2003; Rutter, 1980) or negative perceptions about the school (Andersson & Strander, 2004) may predict later maladjustment.
Outdoor education and mental health
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This importance of the school for child development stresses the need for a school environment that is supportive for the child and promotes mental health and well-being. Because of this, as well as for administrative reasons, the school provides a physical and organizational basis in which preventive interventions may be undertaken (Cowen & Durlak, 2000).
There is a multitude of school-based mental health programs, and the growing research field of school mental health continuously evaluate the effectiveness of different programs to reduce the “research-practice gap” (Durlak, 1995; Durlak & Wells, 1997). Most of these programs focus on the individual (Durlak, 1995). Examples of such individual-centred interventions are affective education, directed at increasing children’s awareness and expression of feeling and the causes of behaviour, and interpersonal problem-solving training, focusing on developing cognitive skills to recognize interpersonal problems and effective approaches to solve them (Durlak & Wells, 1997). Less common are interventions aimed at changing the environment, even though there are strong theoretical grounds that environment-centred interventions may produce broader psychosocial benefits for children (Berryhill & Prinz, 2003; Bronfenbrenner, 1979). Most commonly, environment-centred interventions focus on improving the psychosocial classroom milieu (Durlak & Wells, 1997). For example, an intervention directed at reducing childhood aggression described by Hawkins et al. (1991) consisted of, in addition to parent training, teacher training in the use of proactive classroom management, cognitive social skills and interactive teaching methods. Others have however employed even more ambitious programs involving several actors (teachers, administrators, mental health professionals and parents) to change the structural and functional aspect of the school (Comer, 1985), or implementing a child development centre as a completely new setting supporting behavioural adjustment in school (Johnson & Breckenridge, 1982).
Outdoor education and mental health
7
Outdoor education is an environment-focused educational approach characterized by action-centred and thematic learning processes, often related to outdoor activities (Dahlgren & Szczepanski, 1998). It aims to foster learning through the interactions between emotions, actions and thoughts, based on practical observation in authentic situations (Dahlgren & Szczepanski, 2004). This perspective on knowledge and learning in which a varied learning environment is given importance contrasts with the traditional educational system, which is based on theoretical knowledge taught in a classroom setting, limiting these interactions. Outdoor education has the potential to become an integrative, complementary education form in a pragmatic and progressive pedagogy tradition that can offer students and teachers opportunities to learn based on observations and experiences in authentic situations. Moreover, with outdoor education, a more movement-intensive form of learning is created (Grahn, Mårtensson, Lindblad, Nilsson, & Ekman, 1997). Although the literature on the psychological effects of physical activity in youth is under-developed and mostly concerns adolescents, available results suggest beneficial effects on self-esteem (Ekeland, Heian, Hagen, Abbott, & Nordheim, 2004), depression and anxiety (Larun, Nordheim, Ekeland, Hagen, & Heian, 2006). These psychological gains may be partly mediated by a buffering effect of exercise on stress exposure (J. D. Brown & Lawton, 1986; J. D. Brown & Siegel, 1988; Norris, Carroll, & Cochrane, 1992). The stress-buffering effects could possibly be explained by counter conditioning mechanisms, where initially negative stimuli (exercise) obtain positive motivational properties through the association to other positive stimuli (e.g., social interaction) and influence general stress tolerance (Salmon, 2001). School policies have been shown to be important determinants in accomplishing increased physical activity in children (Ferreira, et al., 2007; Gordon-Larsen, McMurray, & Popkin, 2000), which makes school-based interventions a particularly promising prospect.
Outdoor education and mental health
8
In addition to the potential beneficial effects of physical activity, a growing body of literature also suggests that the natural environment has profound effects on the well-being, particularly in children due to their greater plasticity or vulnerability (Wells & Evans, 2003). A study of ten schools and a state-wide program by the National Environmental Education and Training Foundation (2000) found that when schools use the context of local areas and naturalized schoolyards in their instructional practices, academic performance improves in reading, math, science, social studies and writing. A study of 40 schools in California that used the natural environment as "an integrated context of learning" with hands-on, projectbased learning found that student performance improved in standardized test scores, grade point average, willingness to stay on task, adaptability of different learning styles and problem solving (Leiberman & Hoody, 1998). Examples of beneficial effects for child development and well-being of experiences in nature are improved cognitive functioning (Wells, 2000) and ability to apply self-disciplined behaviour (Taylor, Kuo, & Sullivan, 2002), better psychological well-being and capacity to cope with adversity (Wells & Evans, 2003) and a reduction in anti-social behaviour such as violence, bullying, vandalism and littering a drop in absenteeism (Coffey, 2001; Moore & Cosco, 2000). Thus, the potential benefits of outdoor education for children’s well-being can be a combined effect of both increased physical activity and its situation in the natural environment.
Although various educational changes are common in the schools, few are systematically evaluated with respect to their potential impact on the mental health of the children; when the impact of various school factors is examined the common main focus is the effect on achievement (Anderman, 2002; Lipsey & Wilson, 1993; Watt, 2003). The benefit of children’s well-being is a factor seldom examined but rather assumed when new programs or other organizational or pedagogical changes are implemented (Cowen & Durlak, 2000). In a recent systematic review (Gustafsson, et al., 2010, pp. 155-156) it was concluded
Outdoor education and mental health
9
that the amount of research which investigates relations between different aspects of schooling and mental health is limited, and particularly so research concerning organizational factors and different educational factors, such as teaching methods and activities. However, a relatively large enough amount of research concerned with relations between mental health on the one hand, and the individual students’ academic and social achievements and failures on the other exists. The reviewers major conclusions were that academic achievement and mental health are reciprocally related; that early school failures and in particular reading difficulties cause internalizing and externalizing mental health problems; that problems of academic achievement and mental health tend to be stable over time; that investment of time and effort in schoolwork without achieving expected outcomes is related to development of depression; that relations with peers and teachers are involved in establishing the negative effects of school failure on mental health, but relations with peers and teachers can also protect against development of mental health problems. Thus, there is obviously a potential that educational measures can influence psychological well-being in school children.
When outdoor educational programs are quantitatively evaluated, low-constraint designs such as post-test or pre-test-post-test designs are most common. Of these, the most frequent outcome measures of well-being are self-concept, self-confidence or locus of control (Neill & Richards, 1998). The mental well-being of the child from a psychiatric perspective has not been examined in this context. Even when improved mental health is not the explicit aim of the intervention, it is an important factor to consider when an intervention is being implemented in a school. For example, it would be beneficial to develop and evaluate nontraditional interventions that are relevant both to the needs of the educational system as well as the mental health field (Ringeisen, Henderson, & Hoagwood, 2003). Moreover, any intervention that fundamentally changes an important microsystem likely affects the wellbeing of the child, for better or for worse. Therefore, in addition to the specific psychological
Per E Gustafsson, Anders Szczepanski, Nina Nelson and Per A Gustafsson
Linköping University Post Print
N.B.: When citing this work, cite the original article.
This is an electronic version of an article published in: Per E Gustafsson, Anders Szczepanski, Nina Nelson and Per A Gustafsson. Effects of an outdoor education intervention on the mental health of schoolchildren, 2011, Journal of Adventure Education and Outdoor Learning, 12(1), 63-79. Journal of Adventure Education and Outdoor Learning is available online at informaworldTM: http://dx.doi.org/10.1080/14729679.2010.532994 Copyright: Taylor & Francis (Routledge): SSH Titles
http://www.routledge.com/ Postprint available at: Linköping University Electronic Press
http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-70047
Outdoor education and mental health
1
Running head: OUTDOOR EDUCATION EFFECTS ON MENTAL HEALTH
Effects of an Outdoor Education Intervention on the Mental Health of School Children
Per E Gustafssona,*, Anders Szczepanskib, Nina Nelsonc, Per A Gustafssona
a Dept of Public Health and Clinical Medicine, Family Medicine, Umeå University, SE-901 85 Umeå, Sweden b Center for Outdoor Environmental Education, Dept of Arts, Craft and Design, Linköping University, SE-581 83 Linköping, Sweden c Dept of Clinical and Experimental Medicine, Division of Pediatrics, Linköping University, SE-581 85 Linköping, Sweden d Dept of Clinical and Experimental Medicine, Division of Child & Adolescent Psychiatry, Linköping University, SE-581 85 Linköping, Sweden
*Corresponding author: Per E Gustafsson, Dept of Public Health and Clinical Medicine, Family Medicine, Umeå University, SE-901 85 Umeå, Sweden. Phone no: +46 90 785 3524, Fax no: +46 90 776 883, E-mail: [email protected]
Outdoor education and mental health
2
Author note Acknowledgements: We thank Elin Allansson-Kjölhede for participation in the data collection as well as the staff at the participating schools. The study was financially supported by The Erik Johan Ljungberg Educational Fund, HAGS Aneby AB, The Swedish Medical Society/The Foundation of Söderström-Königska Sjukhemmet and the County of Östergötland.
Outdoor education and mental health
3
Author biographies Per E Gustafsson, Ph.D., has in his dissertation within Child & Adolescent Psychiatry studied psychosocial, psychiatric and physiological aspects of stress in childhood. Currently, his main area of interest is on life course epidemiology and specifically the long-term health consequences of adverse social conditions over the life course. E-Mail: [email protected]
Anders Szczepanski, Ph. Lic., has in his licentiate dissertation studied the variation of teachers´ perceptions of outdoor education and the landscape as a learning environment. The study indicates a multiplicity of varied perceptions of the special nature of outdoor education and can thus be said to characterise this as richly diversified. E-Mail: [email protected]
Nina Nelson, M.D., Ph.D., is associate professor in paediatrics and formerly head of the paediatric clinic at the University Hospital in Linköping, at present director of research and development in the county of Östergotland, Sweden. Her research interest began from within neonatology and cardiology, and has increasingly been focused on stress and health issues in the growing individual, and care givers and teachers, from biological, pedagogical and socioeconomical viewpoints. E-Mail: [email protected]
Per A Gustafsson, M.D. Ph.D., is associate professor in child and adolescent psychiatry and also works clinically as a child psychiatrist. His research field has mainly focused on mindbody interactions in children and adolescents, and its interplay with the immediate social environment, but also neuropsychiatric disorders in young people. E-Mail: [email protected]
Outdoor education and mental health
4
Abstract This study aimed at examining the effects of an outdoor educational intervention on the mental health of school children. Two elementary schools participated (N=230), one experimental school where the intervention was done, the other a reference school. Demographic questions and the Strengths and Difficulties Questionnaire were completed by the parents. An outdoor educational intervention was implemented at the experimental school, and the data collection was repeated after one year. The results point towards a small but non-significant improvement in mental health at the experimental school while adjusting for demographics. However, this effect was significantly moderated by gender: boys generally fared better than girls at the intervention school, relative to the reference school. The results indicate that it may be important to address gender issues when educational programs are implemented in schools.
Keywords: School Children, Outdoor Education, Response to Intervention, Mental Health, Gender
Outdoor education and mental health
5
Children spend most of their waking hours in school. It is therefore no surprise that the school environment affects the mental well-being of children (Anderman, 2002). The nature of this influence may be further understood from an ecological perspective. The school, much like the family and peer group, is an important developmental context for the child; a microsystem (Bronfenbrenner, 1979; Farmer & Farmer, 1999). A microsystem is the web of relations between the individual and its environment, and constitutes a physical setting, where the participants engage in particular activities in particular roles for a particular period of time. The microsystems are themselves embedded in and influenced by a context; the mesosystem, which describes the interrelations of major Microsystems; the exosystem, which is the broader formal and informal social structure not directly containing the individual; and the macrosystem, which describes the general institutional patterns of the relevant culture or subculture (Bronfenbrenner, 1979).
There are several mechanisms through which the school as a microsystem may influence the mental well-being of the child (Farmer & Farmer, 1999). First, at the level of exosystem or macrosystem, the educational context itself is influenced by structural factors such as stratification of school districts, funding source and special education needs. This stratification creates different microsystems where education takes place, and thus influences instructional aspects of the school (Gamoran, 1986) with social, psychological and behavioural consequences for the individual child . The school also influences children through the peer network (Farmer & Farmer, 1999), which constitutes a microsystem for school children that considerably overlaps with the school microsystem. These mediating and moderating roles of the school environment may be a partial explanation as to why early problems in school (Kellam, Ling, Merisca, Brown, & Ialongo, 1998; Masten, 2003; Rutter, 1980) or negative perceptions about the school (Andersson & Strander, 2004) may predict later maladjustment.
Outdoor education and mental health
6
This importance of the school for child development stresses the need for a school environment that is supportive for the child and promotes mental health and well-being. Because of this, as well as for administrative reasons, the school provides a physical and organizational basis in which preventive interventions may be undertaken (Cowen & Durlak, 2000).
There is a multitude of school-based mental health programs, and the growing research field of school mental health continuously evaluate the effectiveness of different programs to reduce the “research-practice gap” (Durlak, 1995; Durlak & Wells, 1997). Most of these programs focus on the individual (Durlak, 1995). Examples of such individual-centred interventions are affective education, directed at increasing children’s awareness and expression of feeling and the causes of behaviour, and interpersonal problem-solving training, focusing on developing cognitive skills to recognize interpersonal problems and effective approaches to solve them (Durlak & Wells, 1997). Less common are interventions aimed at changing the environment, even though there are strong theoretical grounds that environment-centred interventions may produce broader psychosocial benefits for children (Berryhill & Prinz, 2003; Bronfenbrenner, 1979). Most commonly, environment-centred interventions focus on improving the psychosocial classroom milieu (Durlak & Wells, 1997). For example, an intervention directed at reducing childhood aggression described by Hawkins et al. (1991) consisted of, in addition to parent training, teacher training in the use of proactive classroom management, cognitive social skills and interactive teaching methods. Others have however employed even more ambitious programs involving several actors (teachers, administrators, mental health professionals and parents) to change the structural and functional aspect of the school (Comer, 1985), or implementing a child development centre as a completely new setting supporting behavioural adjustment in school (Johnson & Breckenridge, 1982).
Outdoor education and mental health
7
Outdoor education is an environment-focused educational approach characterized by action-centred and thematic learning processes, often related to outdoor activities (Dahlgren & Szczepanski, 1998). It aims to foster learning through the interactions between emotions, actions and thoughts, based on practical observation in authentic situations (Dahlgren & Szczepanski, 2004). This perspective on knowledge and learning in which a varied learning environment is given importance contrasts with the traditional educational system, which is based on theoretical knowledge taught in a classroom setting, limiting these interactions. Outdoor education has the potential to become an integrative, complementary education form in a pragmatic and progressive pedagogy tradition that can offer students and teachers opportunities to learn based on observations and experiences in authentic situations. Moreover, with outdoor education, a more movement-intensive form of learning is created (Grahn, Mårtensson, Lindblad, Nilsson, & Ekman, 1997). Although the literature on the psychological effects of physical activity in youth is under-developed and mostly concerns adolescents, available results suggest beneficial effects on self-esteem (Ekeland, Heian, Hagen, Abbott, & Nordheim, 2004), depression and anxiety (Larun, Nordheim, Ekeland, Hagen, & Heian, 2006). These psychological gains may be partly mediated by a buffering effect of exercise on stress exposure (J. D. Brown & Lawton, 1986; J. D. Brown & Siegel, 1988; Norris, Carroll, & Cochrane, 1992). The stress-buffering effects could possibly be explained by counter conditioning mechanisms, where initially negative stimuli (exercise) obtain positive motivational properties through the association to other positive stimuli (e.g., social interaction) and influence general stress tolerance (Salmon, 2001). School policies have been shown to be important determinants in accomplishing increased physical activity in children (Ferreira, et al., 2007; Gordon-Larsen, McMurray, & Popkin, 2000), which makes school-based interventions a particularly promising prospect.
Outdoor education and mental health
8
In addition to the potential beneficial effects of physical activity, a growing body of literature also suggests that the natural environment has profound effects on the well-being, particularly in children due to their greater plasticity or vulnerability (Wells & Evans, 2003). A study of ten schools and a state-wide program by the National Environmental Education and Training Foundation (2000) found that when schools use the context of local areas and naturalized schoolyards in their instructional practices, academic performance improves in reading, math, science, social studies and writing. A study of 40 schools in California that used the natural environment as "an integrated context of learning" with hands-on, projectbased learning found that student performance improved in standardized test scores, grade point average, willingness to stay on task, adaptability of different learning styles and problem solving (Leiberman & Hoody, 1998). Examples of beneficial effects for child development and well-being of experiences in nature are improved cognitive functioning (Wells, 2000) and ability to apply self-disciplined behaviour (Taylor, Kuo, & Sullivan, 2002), better psychological well-being and capacity to cope with adversity (Wells & Evans, 2003) and a reduction in anti-social behaviour such as violence, bullying, vandalism and littering a drop in absenteeism (Coffey, 2001; Moore & Cosco, 2000). Thus, the potential benefits of outdoor education for children’s well-being can be a combined effect of both increased physical activity and its situation in the natural environment.
Although various educational changes are common in the schools, few are systematically evaluated with respect to their potential impact on the mental health of the children; when the impact of various school factors is examined the common main focus is the effect on achievement (Anderman, 2002; Lipsey & Wilson, 1993; Watt, 2003). The benefit of children’s well-being is a factor seldom examined but rather assumed when new programs or other organizational or pedagogical changes are implemented (Cowen & Durlak, 2000). In a recent systematic review (Gustafsson, et al., 2010, pp. 155-156) it was concluded
Outdoor education and mental health
9
that the amount of research which investigates relations between different aspects of schooling and mental health is limited, and particularly so research concerning organizational factors and different educational factors, such as teaching methods and activities. However, a relatively large enough amount of research concerned with relations between mental health on the one hand, and the individual students’ academic and social achievements and failures on the other exists. The reviewers major conclusions were that academic achievement and mental health are reciprocally related; that early school failures and in particular reading difficulties cause internalizing and externalizing mental health problems; that problems of academic achievement and mental health tend to be stable over time; that investment of time and effort in schoolwork without achieving expected outcomes is related to development of depression; that relations with peers and teachers are involved in establishing the negative effects of school failure on mental health, but relations with peers and teachers can also protect against development of mental health problems. Thus, there is obviously a potential that educational measures can influence psychological well-being in school children.
When outdoor educational programs are quantitatively evaluated, low-constraint designs such as post-test or pre-test-post-test designs are most common. Of these, the most frequent outcome measures of well-being are self-concept, self-confidence or locus of control (Neill & Richards, 1998). The mental well-being of the child from a psychiatric perspective has not been examined in this context. Even when improved mental health is not the explicit aim of the intervention, it is an important factor to consider when an intervention is being implemented in a school. For example, it would be beneficial to develop and evaluate nontraditional interventions that are relevant both to the needs of the educational system as well as the mental health field (Ringeisen, Henderson, & Hoagwood, 2003). Moreover, any intervention that fundamentally changes an important microsystem likely affects the wellbeing of the child, for better or for worse. Therefore, in addition to the specific psychological