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Exploring the Utility of Community-Based Participatory Research to Investigate Mindfulness-Based Interventions in Schools

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Title: Exploring the Utility of Community-Based Participatory Research to Investigate Mindfulness-Based Interventions in Schools
Language: English
Authors: Mathur Grunewald, Nikki (ORCID 0000-0003-0118-9557), Foley-Nicpon, Megan
Source: Psychology in the Schools. 2024 61(1):398-412.
Availability: Wiley. Available from: John Wiley & Sons, Inc. 111 River Street, Hoboken, NJ 07030. Tel: 800-835-6770; e-mail: cs-journals@wiley.com; Web site: https://www.wiley.com/en-us
Peer Reviewed: Y
Page Count: 15
Publication Date: 2024
Document Type: Journal Articles
Reports - Evaluative
Descriptors: Metacognition, Program Effectiveness, Intervention, Participatory Research, Cooperation, Context Effect, Program Implementation, Children, Adolescents
DOI: 10.1002/pits.23059
ISSN: 0033-3085
1520-6807
Abstract: Mindfulness-based programs have become popular, empirically supported treatment modalities for increasing positive psychological outcomes for children and adolescents, with an overall effect size of 0.4. We argue for implementing community-based participatory research (CBPR) methodology to investigate the specific effects of mindfulness-based intervention (MBI) programs within schools. While interest in MBIs in schools has resulted in their increased application, research based on CBPR methodology can fill several gaps in the existing literature by collaborating with school personnel and viewing teachers, students, and staff members as equal research partners. A CBPR approach could help recognize individual differences and contextual factors that often inhibit MBI success, as well as address implementation issues, interventionist factors, and fill the science-to-practice gap. We end by providing practical information to help translate CBPR approaches into the school setting.
Abstractor: As Provided
Entry Date: 2023
Accession Number: EJ1403827
Database: ERIC
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  Value: <anid>AN0174180907;pis01jan.24;2023Dec14.04:59;v2.2.500</anid> <title id="AN0174180907-1">Exploring the utility of community‐based participatory research to investigate mindfulness‐based interventions in schools </title> <p>Mindfulness‐based programs have become popular, empirically supported treatment modalities for increasing positive psychological outcomes for children and adolescents, with an overall effect size of 0.4. We argue for implementing community‐based participatory research (CBPR) methodology to investigate the specific effects of mindfulness‐based intervention (MBI) programs within schools. While interest in MBIs in schools has resulted in their increased application, research based on CBPR methodology can fill several gaps in the existing literature by collaborating with school personnel and viewing teachers, students, and staff members as equal research partners. A CBPR approach could help recognize individual differences and contextual factors that often inhibit MBI success, as well as address implementation issues, interventionist factors, and fill the science‐to‐practice gap. We end by providing practical information to help translate CBPR approaches into the school setting.</p> <p>Practitioner points: Authors argue that community‐based participatory research (CBPR) may be a useful approach to investigating the specific effects of mindfulness‐based interventions (MBI) in schools.CBPR can fill several gaps in the existing literature by working together with school personnel and viewing teachers, students, and staff as equal research partners.A CBPR approach could help recognize individual differences and contextual factors that inhibit MBI success, along with addressing implementation issues, interventionist factors, and fill the science‐to‐practice gap.</p> <p>Keywords: community‐based participatory research; mindfulness; mindfulness‐based school interventions</p> <hd id="AN0174180907-2">INTRODUCTION</hd> <p>Mindfulness‐based interventions (MBIs) have become a popular and effective method of supporting student mental health in schools. While the research base continues to improve, holes still exist regarding what specifically works for whom in what setting. We propose implementing community‐based participatory research (CBPR) methodology to fill these holes because it could provide critical information about maximizing effectiveness in a flexible and iterative manner. While MBIs have been shown to be effective in supporting students' mental health (e.g., Segal et al., [<reflink idref="bib39" id="ref1">39</reflink>]), the wide variance in both the interventions themselves and the research methodology employed have created questions about proper implementation by whom, what specific intervention components are effective, and how to translate research to practice. CBPR is a methodology that allows researchers to more closely study schools as communities, engage with teachers as coresearchers, and more comprehensively discover specific intervention effects. CBPR methodology may be a unique and powerful way of adding to the existing MBI literature to maximize the utility and impact of these interventions for school‐based populations. Thus, the purpose of this paper is to review the knowns and unknowns about MBI's effectiveness in schools and describe how CBPR would be a methodological approach to consider. Thus far, CBPR often has not been implemented in school‐based research and has yet to be utilized specifically for MBIs.</p> <hd id="AN0174180907-3">MBI</hd> <p>Mindfulness includes the act of nonjudgmentally and purposefully paying attention to and being aware of present moment experiences (Kabat‐Zinn, [<reflink idref="bib16" id="ref2">16</reflink>]). One of the most popular definitions of mindfulness is offered by Kabat‐Zinn ([<reflink idref="bib15" id="ref3">15</reflink>], p. 4), who described it as "paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally." Although specific terminology may vary, there are at least two core components to all definitions of mindfulness: first, orienting one's attention toward what is happening in the here‐and‐now, and second, responding to one's experiences in the here‐and‐now in a purposeful and positive way (Renshaw & Cook, [<reflink idref="bib36" id="ref4">36</reflink>]).</p> <p>Originally derived from eastern traditions and Buddhist psychology, mindfulness can be cultivated by various techniques, such as focused attention, decentering, and emotion regulation (Zoogman et al., [<reflink idref="bib48" id="ref5">48</reflink>]). Mindfulness exercises teach practitioners continually to bring their attention back to present moment experience, noticing current thoughts, emotions, or body sensations. Through this redirection of attention, behavioral outcomes can be improved as the individual can make a choice about the best way to act, rather than reacting instinctively in the moment, and to employ strategies to modulate overwhelming emotions (Zoogman et al., [<reflink idref="bib48" id="ref6">48</reflink>]).</p> <hd id="AN0174180907-4">MINDFULNESS WITH YOUTH</hd> <p>The perceived stigma in accessing mental health services and the shortage of mental health professionals make it difficult for many young people with mental health issues to receive adequate support (Mckeering & Hwang, [<reflink idref="bib26" id="ref7">26</reflink>]). Left untreated, mental health issues can have a significant and detrimental effect on students' well‐being, functioning, and development. It is therefore important that early intervention and prevention strategies are developed for this age group (Mckeering & Hwang, [<reflink idref="bib26" id="ref8">26</reflink>]).</p> <p>Taking a cue from the promising findings observed with adults, researchers, and clinicians interested in promoting the well‐being of youth began piloting MBIs with children and adolescents in the early 2000s (Renshaw & Cook, [<reflink idref="bib36" id="ref9">36</reflink>]). Most of the research on mindfulness for youth largely stems from a clinical perspective, mirroring research trends with adults. Initial reviews suggested that MBIs were feasible with children and adolescents and seemed to be beneficial in both clinical and nonclinical samples (Zenner et al., [<reflink idref="bib47" id="ref10">47</reflink>]).</p> <p>MBIs can be effective in reducing symptoms across a wide range of presenting concerns. Studies confirmed that MBI for children and adolescents are beneficial, with improvements seen in cognitive (i.e., executive functioning, attention—both major contributors to school and academic achievement), mental health (i.e., anxiety and depression, stress), sleep, cardiovascular, behavioral, and interpersonal outcomes (Meiklejohn et al., [<reflink idref="bib27" id="ref11">27</reflink>]; Shin et al., [<reflink idref="bib42" id="ref12">42</reflink>]; Wright et al., [<reflink idref="bib46" id="ref13">46</reflink>]; Zenner et al., [<reflink idref="bib47" id="ref14">47</reflink>]). MBIs have been successfully implemented among children and adolescents with presenting concerns such as attention deficit hyperactivity disorder (van der Oord et al., [<reflink idref="bib33" id="ref15">33</reflink>]) and other externalizing disorders (Bögels et al., [<reflink idref="bib5" id="ref16">5</reflink>]). MBIs lead to a reduction in symptoms of depression among children of color (Liehr & Diaz, [<reflink idref="bib21" id="ref17">21</reflink>]) and to a decrease in anxiety and improved social skills in students with learning disorders (Beauchemin et al., [<reflink idref="bib3" id="ref18">3</reflink>]). In a study of "at‐risk" and HIV‐positive youth, less hostility and general emotional discomfort were reported, while qualitative data indicated improvements in academic performance, interpersonal relations, stress‐reduction, and physical health (Zenner et al., [<reflink idref="bib47" id="ref19">47</reflink>]).</p> <p>A comprehensive meta‐analysis of mindfulness interventions with youth from 76 studies across school and nonschool settings, with clinical and nonclinical samples, by Klingbeil et al. ([<reflink idref="bib19" id="ref20">19</reflink>]) yielded a small overall therapeutic effect (<emph>g</emph> =0.305) for studies using both pre−post and controlled designs, with larger treatment effects measured at follow‐up (<emph>g</emph> = 0.462). Results from this study confirmed and extended findings from previous meta‐analyses, providing stronger evidence indicating that MBIs have universally small, yet positive therapeutic effects across a variety of youth outcome domains: academic achievement and school functioning, externalizing problems, internalizing problems, negative emotion and subjective distress, positive emotion and self‐ appraisal, physical health, and social competence and prosocial behavior. Additionally, the treatment effects of MBIs obtained in school settings were on par with those obtained in clinical settings, suggesting that MBIs are just as functional in this context (Klingbeil et al., [<reflink idref="bib19" id="ref21">19</reflink>]).</p> <hd id="AN0174180907-5">MINDFULNESS IN SCHOOLS</hd> <p>Mental health and stress‐related concerns among children are rising (Zenner et al., [<reflink idref="bib47" id="ref22">47</reflink>]). One way to address these concerns at a system‐level is through school‐based interventions like MBIs. Educational settings are in a unique position to support students' mental health as school services are (<reflink idref="bib1" id="ref23">1</reflink>) extremely accessible, (<reflink idref="bib2" id="ref24">2</reflink>) can help decrease the stigma associated with mental illness, and (<reflink idref="bib3" id="ref25">3</reflink>) can be cost‐effective relative to clinical or hospital‐based intervention (Carsley et al., [<reflink idref="bib6" id="ref26">6</reflink>]). Schools are ideal settings for MBIs because they can be brought directly to children as a preventative approach at little cost (Meiklejohn et al., [<reflink idref="bib27" id="ref27">27</reflink>]; Segal et al., [<reflink idref="bib39" id="ref28">39</reflink>]; Zenner et al., [<reflink idref="bib47" id="ref29">47</reflink>]). Scholars suggest that school‐based service delivery of MBIs can be useful for reducing a range of student problem behavior as well as promoting wellbeing (Klingbeil et al., [<reflink idref="bib19" id="ref30">19</reflink>]). An interesting aspect of MBIs is their potential preventive and health promoting capacity in nonclinical populations by reducing stress, increasing well‐being, and strengthening immune functions (Davidson et al., [<reflink idref="bib8" id="ref31">8</reflink>]), and teaching personal development skills, such as self‐compassion, empathy, and perspective taking (Shapiro et al., [<reflink idref="bib40" id="ref32">40</reflink>]). In one randomized control study with 89 children from three different primary schools, the use of a mindfulness‐based program (mindfulness‐based cognitive therapy for children [MBCT‐C]) or CBT was administered (Wright et al., [<reflink idref="bib46" id="ref33">46</reflink>]). Results demonstrated that specific MBIs could be used as a clinically oriented preventative program within schools to also reduce internalizing symptoms (Wright et al., [<reflink idref="bib46" id="ref34">46</reflink>]). Two additional reviews (Carsley et al., [<reflink idref="bib6" id="ref35">6</reflink>]; Segal et al., [<reflink idref="bib39" id="ref36">39</reflink>]) generally implied MBIs are related to reductions in internalizing and externalizing symptoms, particularly in adolescents, but note variability in intervention and implementation practices in schools as problematic.</p> <p>Klingbeil et al. ([<reflink idref="bib19" id="ref37">19</reflink>]) suggested that MBIs in schools might be best understood as a subtype of social emotional learning (SEL) interventions. SEL interventions are a broad class of prevention‐oriented programs that aim to train five interrelated competencies, including self‐awareness, self‐management, social awareness, relationship skills, and responsible decision‐making. MBIs address two of the five SEL competency domains: self‐awareness and self‐management. More specifically, Klingbeil et al. ([<reflink idref="bib19" id="ref38">19</reflink>]) noted that the self‐regulation of attention to one's immediate experience can be understood as the most basic and necessary self‐awareness skill—a prerequisite upon which other self‐awareness competencies are built (e.g., recognizing and labeling emotions, assessing ones' strengths and limitations, etc.). The results of this study provide support for conceptualizing mindfulness as a particular SEL skillset or process that facilitates, like other SEL skills, a broad range of positive youth outcomes (Klingbeil et al., [<reflink idref="bib19" id="ref39">19</reflink>]), such as the ability to respond to everyday stressors, challenges, and difficulties (Sheinman et al., [<reflink idref="bib41" id="ref40">41</reflink>]). Within this framework, mindfulness‐based skills (such as mindful breathing or mindfulness to sounds) can be considered behavioral processes that can be activated by the child and achieve beneficial results (Renshaw & Cook, [<reflink idref="bib36" id="ref41">36</reflink>]). Additionally, Meiklejohn et al. ([<reflink idref="bib27" id="ref42">27</reflink>]) suggested that mindfulness training can further enhance students' capacities in self‐regulation of attention and emotion, as well as buffer the developing brain from the deleterious effects of excessive stress.</p> <hd id="AN0174180907-6">RESEARCH LIMITATIONS</hd> <p>Despite MBIs' many positive outcomes and the extensive clinical application and popularization of the approach, research examining mindfulness interventions in schools has many limitations. In fact, the adoption of MBIs in community settings (including schools) has outpaced scientific research (Renshaw & Cook, [<reflink idref="bib36" id="ref43">36</reflink>]). These limitations can be described at the individual, intervention, and systems levels.</p> <hd id="AN0174180907-7">Individual‐level limitations</hd> <p>Findings suggest that individual differences can impact receptivity and effectiveness of MBIs in schools (Carsley et al., [<reflink idref="bib6" id="ref44">6</reflink>]). Unfortunately, little is known regarding the potential moderating effects of client characteristics (i.e., age, cognitive maturity, etc.) on these interventions (Renshaw & Cook, [<reflink idref="bib36" id="ref45">36</reflink>]). For example, age groups of students appear to be a factor impacting intervention success, with early adolescent students reporting the lowest impact (McKeering & Hwang, [<reflink idref="bib26" id="ref46">26</reflink>]), though issues such as wide ranges of student ages involved in interventions have made it difficult to guide future implementations of MBIs (McKeering & Hwang, [<reflink idref="bib26" id="ref47">26</reflink>]). Researchers have noted concern that their interventions may have been too "homogenous" and not sensitive enough to developmental differences (Bakosh et al., [<reflink idref="bib1" id="ref48">1</reflink>]). Overall, there is limited research examining whether individual differences (i.e., developmental period, gender) have the potential to impact effectiveness of and students' responses to mindfulness training (Carsley et al., [<reflink idref="bib6" id="ref49">6</reflink>]).</p> <p>Also questionable is the influence of cultural factors, such as the goodness of fit (or lack thereof) between MBIs and the values and worldviews of different ethnic groups, particularly those from historically marginalized populations (Renshaw & Cook, [<reflink idref="bib36" id="ref50">36</reflink>]). For example, research has shown that individuals of marginalized, underserved, or non‐Western backgrounds may benefit from acceptance‐based behavioral therapies that include aspects of mindfulness as these therapies recognize clients' experiences are influenced by sociopolitical and historical factors that affect the way distress is experienced and expressed (Fuchs et al., [<reflink idref="bib11" id="ref51">11</reflink>]). Therapies that include mindfulness techniques within an acceptance‐based behavioral therapy may resonate with clients who feel they lack control over their environment due to systemic oppression and discrimination (Fuchs et al., [<reflink idref="bib11" id="ref52">11</reflink>]).</p> <p>Contextual factors may individually or cumulatively interact with any potential treatment effect and introduce variability in outcome measures (Bakosh et al., [<reflink idref="bib1" id="ref53">1</reflink>]). It has been noted that scholars should build contextual data collection into their research designs to improve the interpretability of any positive or negative effects, such as recording school‐related data, characteristics of teachers and pupils, as well as other implementation‐relevant details (Bakosh et al., [<reflink idref="bib1" id="ref54">1</reflink>]). Researchers have recognized that future studies should document the impact of MBIs in different contexts to specifically pinpoint when they can be most useful as a stress and emotional regulation tool for youth (Malboeuf‐Hurtubise et al., [<reflink idref="bib24" id="ref55">24</reflink>]). Additionally, future researchers should investigate which participant characteristics moderate the effectiveness of MBIs (Klingbeil et al., [<reflink idref="bib19" id="ref56">19</reflink>]).</p> <hd id="AN0174180907-8">Intervention‐level limitations</hd> <p>There are several intervention‐level limitations that exist within the school‐based MBI literature, suggesting we know little about the impact of program characteristics on effectiveness (Carsley et al., [<reflink idref="bib6" id="ref57">6</reflink>]). First, the current evidence for MBIs for children and adolescents is limited due to issues of sample size, design, and methods of measurement (Meiklejohn et al., [<reflink idref="bib27" id="ref58">27</reflink>]). The research methodologies employed in school settings are still evolving and lack sufficient precision, thus limiting the validity of most findings (Meiklejohn et al., [<reflink idref="bib27" id="ref59">27</reflink>]). Yet evaluating school‐based applications of mindfulness is challenging (Sheinman et al., [<reflink idref="bib41" id="ref60">41</reflink>]). Self‐report measures have potential response biases, and many of the scales being used as treatment outcome measures may not be sensitive enough to fully capture the influence of the treatment (Zenner et al., [<reflink idref="bib47" id="ref61">47</reflink>]). Overall recommendations are to investigate (<reflink idref="bib1" id="ref62">1</reflink>) the effects of MBIs across more precise outcome domains; (<reflink idref="bib2" id="ref63">2</reflink>) the therapeutic processes underlying the intervention; (<reflink idref="bib3" id="ref64">3</reflink>) variable outcomes as a function of measurement methods; and (<reflink idref="bib4" id="ref65">4</reflink>) potential moderating effects of key study and treatment characteristics (Klingbeil et al., [<reflink idref="bib19" id="ref66">19</reflink>]; Zoogman et al., [<reflink idref="bib48" id="ref67">48</reflink>]).</p> <p>Second, efforts should be made to improve the methodological quality of school based MBIs, including minimizing recall bias and providing transparency about how students are selected to attend qualitative interviews or focus groups (Sapthiang et al., [<reflink idref="bib38" id="ref68">38</reflink>]). Including more qualitative investigations would help researchers explore students' experiences of learning and practicing mindfulness that would inform implementation strategies (McKeering & Hwang, [<reflink idref="bib26" id="ref69">26</reflink>]), and help scholars generate new hypotheses and methods of measuring intervention impact (Zenner et al., [<reflink idref="bib47" id="ref70">47</reflink>]). There is a marked discrepancy between the relatively small, measured effects found in many studies (Zoogman et al., [<reflink idref="bib48" id="ref71">48</reflink>]) and the rich empirical information obtained in the narrative responses of students to open‐ended questions (Sheinman et al., [<reflink idref="bib41" id="ref72">41</reflink>]). Mixed methods approaches also should be considered to assess outcome, such as utilizing written teacher reports, review sessions, individual interviews, observations of training sessions, and student questionnaires and interviews (Zenner et al., [<reflink idref="bib47" id="ref73">47</reflink>]). Third, there often is a broad range of translation techniques (i.e., a lack of uniformity in program implementation), which impact implementation fidelity and integrity (Klingbeil et al., [<reflink idref="bib19" id="ref74">19</reflink>]). The diversity of programs and outcome measures combined with the fact most studies are pilot designs makes it difficult to get a general impression of effectiveness directions for further research (Zenner et al., [<reflink idref="bib47" id="ref75">47</reflink>]). Many of the treatment protocols are vague and likely not replicable (Klingbeil et al., [<reflink idref="bib19" id="ref76">19</reflink>]). Other concerns include that the descriptions of mindfulness training exercises and other treatment mechanisms are poorly operationalized, making differentiating effectiveness of various components challenging (Klingbeil et al., [<reflink idref="bib19" id="ref77">19</reflink>]). Researchers have noted that few schools could provide information about implementation integrity which had been assessed via protocols, detailed scripts, feedback formulas, or fidelity logs (Zenner et al., [<reflink idref="bib47" id="ref78">47</reflink>]).</p> <p>Finally, even in studies with positive outcomes, the long‐term effects of MBIs are unknown (Felver & Jennings, [<reflink idref="bib9" id="ref79">9</reflink>]; Sheinman et al., [<reflink idref="bib41" id="ref80">41</reflink>]). Most of the mindfulness in school programs assess relatively short‐term outcomes and long‐term data are not readily available (Sheinman et al., [<reflink idref="bib41" id="ref81">41</reflink>]). Long‐term implications for MBI consistently have been missing within the literature base and could provide meaningful information relevant to the sustainability and efficacy of these interventions over time.</p> <hd id="AN0174180907-9">Systems‐level limitations</hd> <p>Broadly, interventions employed in school settings require a need for flexibility and awareness of the realities of classroom dynamics. For example, the effects on specific mindfulness and mental health outcomes have been shown to differ according to whether the intervention was delivered by an outside facilitator or a trained educator (Carsley et al., [<reflink idref="bib6" id="ref82">6</reflink>]), with a trained teacher being most effective in terms of managing mental health symptoms long‐term. Additionally, relatively little is known about the feasibility of integrating MBIs into the school‐routine and educators' acceptability of different program elements (Zenner et al., [<reflink idref="bib47" id="ref83">47</reflink>]). Problems exist regarding scheduling, administration completion, program disruption, participants arriving late (Zenner et al., [<reflink idref="bib47" id="ref84">47</reflink>]).</p> <p>As described, there are various individual, intervention, and systems‐level limitations to MBIs, despite their relative popularity and success. Employing a CBPR approach could help address some of these limitations by enhancing the relationship between school staff and students and understanding of school systems. Critical information about the culture and context of the school system likely is better known by members of the school community than by academic researchers; therefore, establishing equitable partnerships between school personnel and researchers could bridge these existing gaps and increase our understanding of MBIs and their effectiveness within schools.</p> <hd id="AN0174180907-10">CBPR</hd> <p>CBPR is regarded as an equitable research approach that is operationalized within a social justice framework (Wilson, [<reflink idref="bib45" id="ref85">45</reflink>]). Minkler and Wallerstein ([<reflink idref="bib30" id="ref86">30</reflink>]) described it as an umbrella term that refers to an orientation to research and practice in which the focus is on respectful engagement with communities while combining research with education and action for change. Although not a single method or approach, participatory research tends to focus on "processes of sequential reflection and action, carried out with and by local people rather than on them" (King & Gillard, [<reflink idref="bib18" id="ref87">18</reflink>], p. 2). Key principles of CBPR include recognizing the community as a unit of identity; building on strengths and resources within the community; and facilitating collaborative, equitable partnerships in all research phases. CBPR challenges traditional power relationships between researchers and instead creates a research reinforcing partnership for mutual benefit (Wilson, [<reflink idref="bib45" id="ref88">45</reflink>]). Community members can participate in CBPR studies as coresearchers, directing involvement away from passive interactions between traditional ideas of subject and researcher that can signal exploitation. Coresearchers usually live or work in the partnering community and engage in activities, such as translating between community members and academic researchers, assisting with recruitment, and administering surveys. Because coresearchers can bring local knowledge and cultural understanding to the partnership, they are able to facilitate access to community members through their social ties and common perspectives. CBPR also promotes colearning and capacity building among all partners and works toward achieving a balance between research and action for everyone's mutual benefit. This methodology disseminates findings and knowledge gained to all partners and requires a long‐term process and commitment to sustainability (Wilson, [<reflink idref="bib45" id="ref89">45</reflink>]). Finally, CBPR addresses issues of race/ethnicity, discrimination, and social class, and embraces "cultural humility" (Israel et al., [<reflink idref="bib14" id="ref90">14</reflink>]). These social justice goals can be achieved through a commitment to inclusive practices that promote equity of opportunities to participate (Wilson, [<reflink idref="bib45" id="ref91">45</reflink>]) and cross‐cultural situations can be addressed with a "humble attitude characterized by reflection on our own biases and sources of invisible privilege, an openness to the culture and reality of others, and a willingness to listen and continually learn" (p. 691).</p> <p>The principles of CBPR are neither absolute nor comprehensive. It is a flexible approach that must be adapted for diverse community partnerships (Collins et al., [<reflink idref="bib7" id="ref92">7</reflink>]). Although CBPR is well aligned with psychology's ethical principles and research aims, it has not been implemented widely (Wilson, [<reflink idref="bib45" id="ref93">45</reflink>]). Applying CBPR to psychological research may increase the effectiveness of interventions for individuals and their communities and may help close the research‐practice gap (Collins et al., [<reflink idref="bib7" id="ref94">7</reflink>]).</p> <hd id="AN0174180907-11">CBPR WITH SCHOOL‐BASED MBIS</hd> <p>We have identified individual, intervention, and system level limitations within the school based MBI literature. Many of these limitations potentially could be addressed with CBPR, yet this approach has yet to be utilized. Examining school based MBIs from this novel research lens may improve our ability to understand its effectiveness and serve a greater number of students with variable presenting concerns. CBPR has the potential to be a methodology that provides underserved populations with a more equitable form of research and work toward creating research that works against systemic inequities. While the use of CBPR methodology has been fairly limited in the school setting, CBPR offers enticing and important potential benefits to research and society, contributing to research informing effective interventions that support community health and well‐being (Kia‐Keating & Juang, [<reflink idref="bib17" id="ref95">17</reflink>]). Psychologists can no longer justify the status quo of walking into communities with single‐sided (i.e., researcher‐produced) questions and procedures, and walking out with data "parachute" or "helicopter" researchers who acquire what they want and depart (Kia‐Keating & Juang, [<reflink idref="bib17" id="ref96">17</reflink>]). Table 1 provides a summary of how CBPR can address the limitations identified in MBI school‐based research, details of which are expanded upon in this next section.</p> <p>1 Table How CBPR methodology could address limitations in current MBI research in schools.</p> <p> <ephtml> <table><thead valign="bottom"><tr valign="bottom"><th>Broad limitation of MBI research in schools</th><th align="left">How CBPR could address the limitation</th></tr></thead><tbody valign="top"><tr><td>Individual level</td><td><graphic href="" /></td><td>Prioritizing equitable relationships with coresearchers to allow for understanding of individual needs</td></tr><tr><td><list list-type="Bullet"><list-item><p>Individual differences in students (age, gender, engagement, receptivity)</p></list-item></list></td><td><list list-type="Bullet"><list-item><p>Viewing schools as a key unit of identity and recognizing the larger familial, community, societal, and political factors at play in students' and teachers' lives and how these identities impact interest in and receptivity to interventions. Community coresearchers can provide invaluable information about ways to connect with students.</p></list-item></list></td></tr><tr><td><list list-type="Bullet"><list-item><p>Cultural</p></list-item></list></td><td><list list-type="Bullet"><list-item><p>Buy‐in and support of trusted in‐group of community helps to increase cultural/contextual knowledge and diversity, and the appropriateness and appeal of the intervention.</p></list-item></list></td></tr><tr><td><list list-type="Bullet"><list-item><p>Contextual</p></list-item></list></td><td><list list-type="Bullet"><list-item><p>Decrease attrition and selection bias by enhancing recruitment and retention efforts via community partnerships (Collins et al., <xref ref-type="bibr" rid="bibr7">2018</xref>).</p></list-item></list></td></tr><tr><td>Intervention level</td><td><graphic href="" /></td><td>Researchers' colearning with community stakeholders and coresearchers</td></tr><tr><td><list list-type="Bullet"><list-item><p>Measurement Issues (diversity of programs, sample sizes, design, measurement method, outcome measures)</p></list-item></list></td><td><list list-type="Bullet"><list-item><p>Engaging in consistent communication with research partners, stakeholders, and community members (gathering quantitative and qualitative data) to understand the most developmentally appropriate measurement techniques.</p></list-item></list></td></tr><tr><td><list list-type="Bullet"><list-item><p>Exclusion of qualitative and mixed method methodologies</p></list-item></list></td><td><list list-type="Bullet"><list-item><p>Involving the community in measure development, iterative field testing, and revision of research measures, which has been shown to improve psychometric properties (Collins et al., <xref ref-type="bibr" rid="bibr7">2018</xref> ; Nicolaidis et al., <xref ref-type="bibr" rid="bibr31">2015</xref> ; Viswanathan et al.,).</p></list-item></list></td></tr><tr><td><list list-type="Bullet"><list-item><p>Poorly operationalized translation techniques from research to practice</p></list-item></list></td><td><list list-type="Bullet"><list-item><p>Engaging with communities in long‐term, sustainable ways to create relevant and positive change. Long‐term engagement can provide critical data about long‐term impacts of interventions.</p></list-item></list></td></tr><tr><td><list list-type="Bullet"><list-item><p>Unknown long‐term effects</p></list-item></list></td></tr><tr><td>System level</td><td><graphic href="" /></td><td>Community (school) is the unit of identity</td></tr><tr><td><list list-type="Bullet"><list-item><p>Recognition of differences between controlled research environments and practicalities of classroom settings</p></list-item></list></td><td><list list-type="Bullet"><list-item><p>Engaging with coresearchers with cultural humility to understand and become cognizant of classroom realities and improve the validity of the research methods.</p></list-item></list></td></tr><tr><td><list list-type="Bullet"><list-item><p>External validity of research/applicability</p></list-item></list></td><td><list list-type="Bullet"><list-item><p>Approach methodologies with flexibility to meaningfully work with groups outside of academia.</p></list-item></list></td></tr><tr><td><list list-type="Bullet"><list-item><p>Implementation of research in community settings versus tightly controlled laboratory environments may boost studies' real‐world generalizability (De Las Nueces et al., <xref ref-type="bibr" rid="bibr32">2012</xref>), as well as their rigor, relevance, and reach (Collins et al., <xref ref-type="bibr" rid="bibr7">2018</xref>).</p></list-item></list></td></tr></tbody></table> </ephtml> </p> <p>1 Abbreviations: CBPR, community‐based participatory research; MBI, mindfulness‐based intervention.</p> <hd id="AN0174180907-12">CBPR to address individual differences limitations</hd> <p>CBPR prioritizes equitable relationships by establishing teachers and staff as coresearchers, which could broadly address how individual differences in students (age, gender, engagement, receptivity, etc.) within the cultural and contextual norms of schools could affect treatment responses. By investing in relationships with teachers, staff, and students, researchers could learn about individual differences in students (e.g., which students are most and least engaged) and ask teachers to share their feedback, as well as students' feedback, about program components. Teachers would be able to provide meaningful feedback about implementation, such as enablers and barriers to MBIs in school. For example, McKeering and Hwang ([<reflink idref="bib26" id="ref97">26</reflink>]) noted time pressure, crowded curriculum content, and student disengagement with the program as major limitations in MBI effectiveness. MBI instructors should work closely with classroom teachers and administrators to monitor student factors (i.e., absenteeism) that may have impeded the impact of the program (Mendelson et al., [<reflink idref="bib28" id="ref98">28</reflink>]). By working with teachers and staff to enhance recruitment and retention efforts, CBPR may decrease attrition and selection bias and thereby improve internal validity (Collins et al., [<reflink idref="bib7" id="ref99">7</reflink>]). Many issues of implementation could be addressed by researchers being willing to engage meaningfully with teachers, school staff, and students. For example, a school‐based intervention implemented using curriculum from Mindfulness.org encouraged the children who participated to suggest approaches for delivery that would be meaningful to them (Liehr & Diaz, [<reflink idref="bib21" id="ref100">21</reflink>]).</p> <p>CBPR also increases the cultural and contextual relevance and the appropriateness of interventions and initiatives (Fleischhacker et al., [<reflink idref="bib10" id="ref101">10</reflink>]), which may make these approaches more appealing to communities (Collins et al., [<reflink idref="bib7" id="ref102">7</reflink>]). Partnering with schools could provide an understanding about the context in which interventions occur—such as an understanding of the inner context (i.e., school building or district), as well as the broader and external economic, political, and social contexts in which an organization exists (i.e., federal educational policies, local cultural norms; Owens et al., [<reflink idref="bib34" id="ref103">34</reflink>]). Contextual and relational dynamics impact research outputs and promote or constrict proximal and distal outcomes at the individual, agency, cultural‐community, and health status levels (Lucero et al., [<reflink idref="bib22" id="ref104">22</reflink>]).</p> <hd id="AN0174180907-13">CBPR to address intervention limitations</hd> <p>By using the tenets of CBPR, researchers can intentionally facilitate collaborative, equitable partnerships, and power‐sharing with school staff to better understand the contextual factors and nuances of the settings in which MBIs are implemented. This can facilitate understanding of children and school systems that researchers do not have (i.e., knowing the way children best express themselves for data collection, what feedback students and staff have about the type of implementation used, dosage amounts, etc.). For example, one study showed that when compared to outside mindfulness coaches or researchers, teachers trained in mindfulness interventions were the most effective in terms of engagement—noting that the students felt comfortable receiving ongoing support from their teachers as they had more time to establish trust in the relationship (Carsley et al., [<reflink idref="bib6" id="ref105">6</reflink>]). Additionally, CBPR often entails community involvement in measure development, iterative field testing, and revision of research measures, which has been shown to improve their psychometric properties (Nicolaidis et al., [<reflink idref="bib31" id="ref106">31</reflink>]; Viswanathan et al., [<reflink idref="bib43" id="ref107">43</reflink>]). CBPR could help answer questions related to methodology and implementation, and greater involvement by teachers with researchers could result in more effective intervention strategies (Mendelson et al., [<reflink idref="bib28" id="ref108">28</reflink>]).</p> <p>Teacher feedback, along with other forms of data collection, can be used in CBPR methodology through mixed methods approaches. As has been mentioned by Bannirchelvam et al. ([<reflink idref="bib2" id="ref109">2</reflink>]), in addition to understanding and evaluating the available evidence amassed through the quantitative studies of mindfulness that have been conducted "on" young people, it is essential to appraise and synthesize the evidence of qualitative mindfulness studies that have been conducted "with" young people. This fits directly within the CBPR framework, emphasizing the equitable engagement of the community (schools, and thereby students receiving interventions) with researchers—transitioning from research "on" orientation to research "with" orientation. Mixed methods are helpful to study CBPR outcomes because the inclusion of qualitative data can provide contextual analyses that are salient to understanding outcomes found through quantitative data (Lucero et al., [<reflink idref="bib22" id="ref110">22</reflink>]). Additionally, qualitive feedback from community members can be utilized to design an intervention where quantitative outcome data are gathered (Hamilton et al., [<reflink idref="bib12" id="ref111">12</reflink>]; Henson et al., [<reflink idref="bib13" id="ref112">13</reflink>]). For example, Henson et al. ([<reflink idref="bib13" id="ref113">13</reflink>]) engaged in a CBPR process to define self‐compassion as a helpful school‐based intervention for female‐identified youth with mental health concerns. Intervention effectiveness was then measured quantitatively with pre‐ and post‐intervention assessments of well‐being values and symptoms of depression and anxiety. Furthermore, given the emphasis on the external validity of research findings and the need to better translate research to diverse contexts, the grounding of interactive and iterative mixed methods designs in complex CBPR contexts makes sense (Onwuegbuzie & Burke Johnson, [<reflink idref="bib32" id="ref114">32</reflink>]). One example of using a mixed‐methods approach to examine CBPR effectiveness is Rodríguez Espinosa et al. ([<reflink idref="bib37" id="ref115">37</reflink>]) national cross‐site CBPR study. Results from the comprehensive community‐engagement survey and in‐depth case studies revealed relationship dynamics, such as respect in the partnership, voice and influence in decision‐making among partners, and stewardship, were key factors in intervention outcomes.</p> <p>Finally, the sustainable nature of CBPR addresses the lack of data investigating long‐term effects of MBIs and how context, culture, and subtleties of the schools impact these long‐term effects. Factors critical to school delivery must be considered, and researchers must be willing to seek the support and knowledge of those most engaged in school systems as they design MBI interventions.</p> <hd id="AN0174180907-14">CBPR to address system limitations</hd> <p>CBPR methodology recognizes the differences between research environments and classroom settings and how this affects intervention applicability. The implementation of research in community settings versus tightly controlled laboratory environments may boost real‐world generalizability (De Las Nueces et al., [<reflink idref="bib20" id="ref116">20</reflink>]). CBPR methodology denounces the privileging of some forms of knowledge over others and recognizes that input from teachers and schools fits directly within this framework. This methodology promotes colearning, allowing researchers to acknowledge what they may not know about implementing psychological interventions in larger, school‐based systems. CBPR improves relationships between researchers and community members, which can facilitate moving cocreated research, interventions, and policies into practice (Minkler et al., [<reflink idref="bib29" id="ref117">29</reflink>]).</p> <p>The CBPR approach can be effective in empowering communities that typically are marginalized in healthcare and other systems. When members of marginalized communities are left out of data collection we do not get a full understanding of who would benefit from the findings (Kia‐Keating & Juang, [<reflink idref="bib17" id="ref118">17</reflink>]). Funding agencies that are not well versed in the merits of CBPR perpetuate these broader institutional and structural controlling mechanisms that affect who have access to and can benefit from interventions such as MBIs. To transform and decolonize scientific methodologies, systemic and individual commitment to change is necessary (Kia‐Keating & Juang, [<reflink idref="bib17" id="ref119">17</reflink>]). For example, Mammen et al. ([<reflink idref="bib25" id="ref120">25</reflink>]) used a CBPR approach to develop targeted health messages to decrease health disparities in rural, low‐income populations. To develop and disseminate appropriate and culturally relevant content, researchers completed interviews and focus groups with mothers and community stakeholders. Applied to the school setting, the same approach could be used to design culturally responsive MBIs that target needs specific to building and community environments. This approach to intervention development has been used with positive outcomes for school‐based physical activity interventions (Hamilton et al., [<reflink idref="bib12" id="ref121">12</reflink>]), where community input was used to design physical activity videos. The empowerment that happens when communities are collaborators instead of receivers of expertise can positively change systems, influence power relations, and help sustain the intervention well after researchers leave the community (Wallerstein et al., [<reflink idref="bib44" id="ref122">44</reflink>]).</p> <p>The focus on the balance between research and action inherent to CBPR also provides support for a practical, useful approach to furthering the literature base. Several limitations of MBIs in schools can be approached with "cultural humility" if researchers recognize the limitations of their work. Individuals "in the weeds" (and with potentially discordant levels of education) are important knowledge‐holders who can work with academic researchers to fill the research gaps, thereby valuing all forms of knowledge equally. For example, one group of researchers in California worked with a group of high school students using a youth‐focused form of participatory action research (yPAR) to create school programming to promote a more inclusive learning environment for immigrant‐origin students (Maker Castro et al., [<reflink idref="bib23" id="ref123">23</reflink>]). Multiple data sources, including weekly student reflections and ethnographic field notes, were used to document the students' experiences, and students were viewed as equal partners in the research process. Results indicated that collaborative research supported immigrant‐origin youths' civic development as evidenced by growing confidence that the program could generate positive change, enhanced sense of connection with classmates, and increased commitment to future civic engagement (Maker Castro et al., [<reflink idref="bib23" id="ref124">23</reflink>]).</p> <p>A second group of researchers worked with youth from diverse ethnic backgrounds in urban schools using a collaborative, community‐based approach to inform the planning of prevention programs and policies to address students' health and developmental needs (Ozer et al., [<reflink idref="bib35" id="ref125">35</reflink>]). There was a collaborative partnership with a university school of public health and community‐based organizations to build capacity for long‐term, sustainable implementation within the local school system (Ozer et al., [<reflink idref="bib35" id="ref126">35</reflink>]). Students and researchers employed multiple research methods to investigate the topic and the setting, noting that research efforts in a school setting‐whether led by adult or youth investigators‐requires flexibility and creativity (Ozer et al., [<reflink idref="bib35" id="ref127">35</reflink>]). Researchers noted being "on the ground" in the schools to observe implementation helped the researchers study contextual factors that influence the effectiveness and sustainability (Ozer et al., [<reflink idref="bib35" id="ref128">35</reflink>]).</p> <p>A third example comes from a study where researchers worked alongside parents and families of students in rural schools and living in poverty to increase parental engagement in student school success (Blitz et al., [<reflink idref="bib4" id="ref129">4</reflink>]). A CBPR approach was used to examine a systems‐focused intervention aimed to facilitate the school system to be more responsive to the families' needs and strengths (Blitz et al., [<reflink idref="bib4" id="ref130">4</reflink>]) and improve school climate. Local university researchers collaborated with key community stakeholders (parents and teachers) to build relationships that fostered genuine connection and feedback on what could be done to improve the school climate. Researchers concluded the positive, systemic outcomes were not the result of "some critical mass of parent engagement, but in response to deeper relationships among a few people that built an understanding for the need for systemic change" (Blitz et al., [<reflink idref="bib4" id="ref131">4</reflink>], p. X).</p> <hd id="AN0174180907-15">LIMITATIONS OF IMPLEMENTING CBPR METHODOLOGY IN SCHOOLS</hd> <p>While we demonstrated the various ways CBPR is an effective approach to investing MBIs in schools, it has limitations. First, school personnel and researchers may not have the resources (i.e., time, money, ability) to actively be involved in this type of research process. The deleterious effects of COVID‐19 on school personnel may have diminished their ability or willingness to engage in activities additional to their multiple demands in and out of the classroom. Second, data collection is complex and can be somewhat messy, making rigid expectations or timelines difficult to follow. School personnel may expect change at a rate faster than what a research institution operates (Collins et al., [<reflink idref="bib7" id="ref132">7</reflink>]). In these cases, both groups' expectations should be discussed regularly. Third, communities may feel uncomfortable with the unique, dynamic nature of CBPR methodology, hoping instead for researchers to be the experts and share knowledge more one‐directionally. For example, within CBPR, ethical guidelines that psychologists must follow are collaboratively considered with school personnel stakeholders (Collins et al., [<reflink idref="bib7" id="ref133">7</reflink>]), but schools may feel uncomfortable with this power‐sharing approach. Additionally, the multiple relationships that are bound to occur between researcher and educator should be balanced by including outside consultation (Collins et al., [<reflink idref="bib7" id="ref134">7</reflink>]). Fourth, it is important to maintain student and educator confidentiality while collaborating throughout the research process (Collins et al., [<reflink idref="bib7" id="ref135">7</reflink>]). This may be challenging within schools where regulations maintaining confidentiality may be different than they are for psychologists in clinical practice. Researchers engaged with this methodology also must be flexible, open to feedback, and willing to engage with communities as equal partners.</p> <hd id="AN0174180907-16">AN EXAMPLE OF USING CBPR TO ASSESS AN MBI IN SCHOOL</hd> <p>Two faculty in a Midwest University received a grant to employ a mindfulness intervention with seventh and eigth grade students. They reached out to one school's psychologist to ask about interest in participation in the study. The school's population was a mix of white students and students of color, many of whom were from immigrant families. The faculty had a well‐researched mindfulness program in mind but were unsure whether it would be appropriate for the diverse student body. The school psychologist recommended the faculty researchers hold focus groups with potential participant families to discuss the intervention. In this discussion, faculty were receptive to individual parent feedback that would potentially change the intervention to address cultural and contextual factors that may impact participation. For example, parents recommend the program take place during the school day rather than after school given family demands after school hours. They also recommend that the children learned what mindfulness was before they opting in; for example, they could view videos, see live examples, and so forth, and then make an informed decision about participation. Families also recommend students be able to provide ongoing anonymous feedback to researchers about what is and is not working during the mindfulness intervention.</p> <p>The university faculty initially wanted the children and their parents to complete a battery of assessments pre‐ and postintervention. The teachers said assessments were fine, as long as they were not too long and were translated into the family's home languages. They also recommended the assessments be reviewed by families before administration to ensure the questions were culturally sensitive and relevant. The school personnel recommended faculty interview participants to learn their impressions about what worked and did not work regarding the intervention itself and contextual factors around implementation (inside vs. outside, time of day, length, process time afterwards, etc.). The teachers recommended participants have a say in how the intervention was implemented and that changes be made in light of feedback received.</p> <p>At the conclusion of the intervention, the university faculty offered to have the program extended. They suggested teachers learn the mindfulness intervention and incorporate it into the curriculum for all students who wish to participate. The faculty then offered to continue engagement with the school personnel for ongoing consultation. They also proposed training teachers in neighboring communities who would want to start the intervention in their schools.</p> <hd id="AN0174180907-17">CONCLUSION</hd> <p>MBIs are increasingly being implemented in schools across the country. While there is ample research to support its effectiveness, there remains individual, intervention, and systems‐level limitations to this body of empirical work. CBPR methodology is one way to address these limitations that respects the contextual issues surrounding MBI implementation in schools. While CBPR is not without its own limitations, it is worth consideration as we seek to increase implementation of empirically supported interventions within our increasingly diverse school systems.</p> <hd id="AN0174180907-18">CONFLICT OF INTEREST STATEMENT</hd> <p>The authors declare no conflict of interest.</p> <hd id="AN0174180907-19">DATA AVAILABILITY STATEMENT</hd> <p>Data sharing is not applicable to this article as no data sets were generated or analyzed during the current study.</p> <ref id="AN0174180907-20"> <title> REFERENCES </title> <blist> <bibl id="bib1" idref="ref23" type="bt">1</bibl> <bibtext> Bakosh, L. S., Tobias Mortlock, J. M., Querstret, D., & Morison, L. (2018). Audio‐guided mindfulness training in schools and its effect on academic attainment: Contributing to theory and practice. 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  Data: Exploring the Utility of Community-Based Participatory Research to Investigate Mindfulness-Based Interventions in Schools
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  Data: <searchLink fieldCode="AR" term="%22Mathur+Grunewald%2C+Nikki%22">Mathur Grunewald, Nikki</searchLink> (ORCID <externalLink term="http://orcid.org/0000-0003-0118-9557">0000-0003-0118-9557</externalLink>)<br /><searchLink fieldCode="AR" term="%22Foley-Nicpon%2C+Megan%22">Foley-Nicpon, Megan</searchLink>
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  Data: <searchLink fieldCode="SO" term="%22Psychology+in+the+Schools%22"><i>Psychology in the Schools</i></searchLink>. 2024 61(1):398-412.
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  Data: Wiley. Available from: John Wiley & Sons, Inc. 111 River Street, Hoboken, NJ 07030. Tel: 800-835-6770; e-mail: cs-journals@wiley.com; Web site: https://www.wiley.com/en-us
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  Data: 15
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  Data: 2024
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  Data: Journal Articles<br />Reports - Evaluative
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  Data: <searchLink fieldCode="DE" term="%22Metacognition%22">Metacognition</searchLink><br /><searchLink fieldCode="DE" term="%22Program+Effectiveness%22">Program Effectiveness</searchLink><br /><searchLink fieldCode="DE" term="%22Intervention%22">Intervention</searchLink><br /><searchLink fieldCode="DE" term="%22Participatory+Research%22">Participatory Research</searchLink><br /><searchLink fieldCode="DE" term="%22Cooperation%22">Cooperation</searchLink><br /><searchLink fieldCode="DE" term="%22Context+Effect%22">Context Effect</searchLink><br /><searchLink fieldCode="DE" term="%22Program+Implementation%22">Program Implementation</searchLink><br /><searchLink fieldCode="DE" term="%22Children%22">Children</searchLink><br /><searchLink fieldCode="DE" term="%22Adolescents%22">Adolescents</searchLink>
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  Data: 10.1002/pits.23059
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  Data: 0033-3085<br />1520-6807
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  Label: Abstract
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  Data: Mindfulness-based programs have become popular, empirically supported treatment modalities for increasing positive psychological outcomes for children and adolescents, with an overall effect size of 0.4. We argue for implementing community-based participatory research (CBPR) methodology to investigate the specific effects of mindfulness-based intervention (MBI) programs within schools. While interest in MBIs in schools has resulted in their increased application, research based on CBPR methodology can fill several gaps in the existing literature by collaborating with school personnel and viewing teachers, students, and staff members as equal research partners. A CBPR approach could help recognize individual differences and contextual factors that often inhibit MBI success, as well as address implementation issues, interventionist factors, and fill the science-to-practice gap. We end by providing practical information to help translate CBPR approaches into the school setting.
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  Data: 2023
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  Data: EJ1403827
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        StartPage: 398
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      – SubjectFull: Metacognition
        Type: general
      – SubjectFull: Program Effectiveness
        Type: general
      – SubjectFull: Intervention
        Type: general
      – SubjectFull: Participatory Research
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      – SubjectFull: Cooperation
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      – SubjectFull: Context Effect
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      – SubjectFull: Program Implementation
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      – SubjectFull: Children
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      – SubjectFull: Adolescents
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      – TitleFull: Exploring the Utility of Community-Based Participatory Research to Investigate Mindfulness-Based Interventions in Schools
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