Kids in crisis: The whole health learning solution

From crisis to crisis

In 2020, we introduced our whole health learning (WHL) approach to address the badly deteriorating health of children, just as the COVID-19 pandemic was wreaking havoc on society, healthcare, civic life, and education across the planet.¹ In our call-to-action, we cited a 1997 Institute of Medicine report which noted that “a strong interconnected infrastructure will be essential if [coordinated school health programs] are to become established and flourish…. schools will not be able to provide solutions without the cooperation and support of families, community institutions, the healthcare enterprise, and the political system.”² We called for urgent action to realize this unmet need.

As we emerge from this three-year ground-shifting period, the consequences of the pandemic on learning and life - compounded by growing socioeconomic inequities, climate change, school shootings, racism, and social conflict - have shaken families, educators, and healthcare professionals profoundly. The accelerated deterioration of children's mental health, particularly for those already traumatized by Adverse Childhood Experiences (ACEs), has created what can only be described as an existential and pervasive challenge to their daily lives and to the process of developing a healthy sense of wellbeing as they grow and mature.

• •The prevalence of poor current mental health and past-year suicide attempts among adolescents reporting four or more ACEs during the COVID-19 pandemic were four and 25 times as high as those without ACEs, respectively.³
• •Nearly half (47%) of young adults under 30 report “feeling down, depressed, or hopeless,” and 24% have had thoughts that they would be “better off dead,” or of hurting themselves in some way at least several days in the last two weeks.⁴

A National Emergency in Child and Adolescent Health was declared in 2021 by several leading pediatric organizations.⁵ U.S. Surgeon General Vivek Murthy, MD, has been the Nation's most vocal advocate for addressing child and adolescent mental health. In the 2021 “Surgeon General's Advisory: Protecting Youth Mental Health” he wrote:

“Our obligation to act is not just medical – it’s moral. I believe that, coming out of the COVID-19 pandemic, we have an unprecedented opportunity as a country to rebuild in a way that refocuses our identity and common values, puts people first, and strengthens our connections with each other.”⁶

The Advisory includes a chart entitled “Factors That Can Shape the Mental Health of Young People.” It organizes crucial factors within Societal, Environmental, Community, Family, and Individual categories. The only mentions of schools, where young people can spend most of their weekday time, are “school climate” and “academic pressure” as Community factors. This extremely limited view of the role schools can play in strengthening mental, emotional, and physical health of young people – and therefore their academic, social, and personal potential – reflects the powerful historic separation and tension between K-12 educators and healthcare. “School climate” and “academic pressure” are dealt with as behavioral problems rather than cultural issues rooted in structural inequity. Nor are any proven supportive practices mentioned. That so many of our children are anxious and depressed reflects a persistent existential dread that immediately requires a radical shift to investing in community health and wellbeing.

Fulfilling the Surgeon General's call to meet this unprecedented opportunity to rebuild will take significant re-alignment of assumptions and partnerships while embracing a broader view of what can be done immediately to strengthen children's mental health and wellbeing. Such re-framing will be necessary to create the conditions that can truly empower children with the academic knowledge and experience that encourages them to think of wellbeing in the same way they think about other essential skills learned in school like reading, writing and arithmetic. Furthermore, we must support the wellbeing of teachers as front-line workers in the battle to mitigate the impact of ACEs and other social determinants on our children's health.

Current governmental, educational, and healthcare programs designed to respond to the massive impact of COVID do not take into account the mature presence of well-established, effective and cost-effective community-based activities already available in schools: school gardens and teaching kitchens, nature-based education, mindfulness practices and social skills, and cognition-bolstering physical activities already exist in thousands of schools. These WHL components reinforce two core pediatric integrative health principles in that they are preventive (focused on health promotion and creation, favoring proactive strategies versus reactive solutions) and participatory (creating health as a collaborative process). Whole health learning activities are inherently collaborative, creative, and hands-on, building for students a sense of agency and ownership in the process. They lay the foundation for children to take charge of their own health and wellbeing from a very young age.

Schoolyard ingenuity

In 2020, the American Academy of Pediatrics (AAP) issued detailed guidelines designed to help educators prepare for the time when children would be returning to the classroom. Noting then what had already become the great fear of learning loss, the AAP counseled:

“The impacts of lost instructional time and social emotional development on children should be anticipated and schools will need to be prepared to adjust curricula and instructional practices accordingly without the expectation that all lost academic progress can be caught up. … It is also critical to maintain a balanced curriculum with continued physical education and other learning experiences rather than an exclusive emphasis on core subject areas.”⁷

Physical education and those “other learning experiences” have been in place and serving children in schools across the Nation for many years. Yet as primarily ancillary “nice-to-have” supplemental programs, they are rarely viewed in a coherent, inter-related fashion to realize optimal mental, emotional, and behavioral health potential. In the wake of the COVID pandemic, educators already deeply skilled in their implementation began finding new opportunities to meet students’ needs during the era of school-closings and remote learning. An inspiring wave of innovation is re-shaping school grounds and programs, much of it built on well-established WHL activities.

• •Green Schoolyards America (GSA) created a weekly series of virtual forums in which educators from all over the country could share their innovative approaches to teaching and learning outdoors, greatly amplifying what had already been a national green schoolyard movement. GSA and the Green Schools National Network helped support legislation, the Living Schoolyards Act, to provide grants to help schools develop outdoor learning environments.⁸
• •Inner Explorer, a leading national provider of mindfulness programs for K-12, now counts more than 5000 partner schools, serving two million students.⁹
• •Wellness in the Schools, a leading exponent of school-based teaching kitchens, has been enlisted by the New York City Public Schools to educate its food directors about “scratch cooking” - in more than 1200 schools.¹⁰

The urgency of the moment, the availability of proven practices, and eager educators call for significant expansion of these programs, as well as a primary place in policy conversations and sustainable financing. Federal agencies can help. In addition to the Department of Education, the USDA Farm-to-School program, the CDC Healthy Schools Branch, the NOAA, the EPA, and the Department of the Interior's Park Service all have existing relationships with school districts. Large-scale public investment in community health is critical to transforming our health future. Funding and school-directed financing are readily available; it's a matter of investing a solid proportion of the tremendous sums we are already paying in a much more impactful manner. As David Erickson, author of The Fifth Freedom: Guaranteeing an Opportunity-Rich Childhood for All, notes, “The status quo in the United States is unfair and expensive. We spend too much on downstream consequences of people living in poverty rather than spending money on the upstream conditions that would guarantee an opportunity-rich childhood for all. A strong foundation in childhood is the best predictor of a healthy and productive adulthood.”¹¹

Whole health for the whole child

Innovative healthcare providers and organizations, too, are shifting focus to health promotion. As a result, schools, families, and pediatricians can respond not only to learning loss but more importantly to the equally consequential wellbeing loss that underlies the ongoing stress and trauma that are driving adolescents into emergency rooms at alarming rates. Exponents of integrative, whole health, and lifestyle medicine have begun supporting children's health in school, emphasizing health promoting practices that have led to new kinds of relationships with schools.

• The Whole Health Institute, in collaboration with WholeHealthED, produced 60 videos in which youth embodied whole health principles by growing and making nutritious meals, creating art, expressing gratitude and compassion, moving their bodies, spending time outdoors, and connecting to what matters most to them - all while at home.¹²

• The Hackensack Meridian School of Medicine, through its community-centered Human Dimension curriculum, partnered faculty and medical students with New Jersey schools to support K-12 health and wellbeing efforts during the height of the COVID pandemic.¹³

• The American College of Lifestyle Medicine (ACLM) partnered with the non-profit Big Picture Learning, already serving adolescents in schools, to develop the Big Picture Living program based on its “Six Lifestyle Elements” to help schools educate teens about health promoting behaviors.¹⁴

• The National Center for Complementary and Integrative Health (NCCIH) developed the collaborative Consortium of Emotional Wellbeing Networks and in spring 2023 provided grants for its program, “Fostering Mental, Emotional, and Behavioral Health Among Children in School Settings: Opportunities for Complementary and Integrative Health.” ¹⁵

• The Institute for Natural Medicine collaborated with youth service organizations in local at-risk communities to promote health promotion behaviors via the Naturally Well Program.¹⁶

Promoting children's adoption of healthy lifelong habits, these partnerships with schools represent the most potent, cost-effective, equitable and near-term means to mitigate the impact of negative social determinants of health that have amplified and sustained the adolescent mental health crisis.

The wellbeing imperative

Despite unprecedented and dispiriting trends, the U.S. is in position to leverage its power and ingenuity to address - at scale - the stupefying tower of challenges confronting the health and wellbeing of its youth. New forms of collaboration in health-education partnerships, grounded in school-based whole health learning practices, portray a willingness within these individual entities to stretch beyond their usual ways and form new alliances. Whether it is a pediatrician planting a garden outside her clinic and using her produce in a teaching kitchen for new parents; medical educators modifying their courses to bring whole health principles to teens in nearby schools; teachers having the agency to collaborate and innovate with their district grounds-and-facilities director to develop gardens and green spaces; a large urban city educating its school food service directors to competency in scratch cooking; or an entire state piloting a system-wide mindfulness model in its schools - there are many fresh takes on what really improves kids’ health and wellbeing.

What is needed to propel and expand these new relationships is a freshly stated purpose for schools; one that directly addresses the current adolescent mental health crisis, enables new forms of empowerment for students, and can be readily and eagerly embraced by educators. In their groundbreaking book “Well-being in Schools,” ¹⁷ co-authors Dennis Shirley and Andy Hargreaves observe the unfolding of new social and community values and corresponding potentials arising from the COVID experience. “The world is waking up,” they write, and “…more and more people and their governments are addressing how schools and other organizations can enrich our collective quality of life.”

The authors challenge and focus us:

“How do schools help young people develop a sense of purpose in life, treat others with dignity, form friendships, build positive identities, become responsible citizens, live healthy and fulfilling lives, experience enjoyment, exercise leadership, feel senses of awe in spirituality or nature, stand up to injustice, and so on?”

Their answer? “They move well-being to the very center of them.”

Agreed. And, we would add, in order to develop the knowledge, skills and attitudes that foster such adult civic and social sensibilities, we must intentionally create learning environments in which routine practices nurture those mindsets from the beginning of school. The “proofs of concept” related to WHL activities have been thoroughly established over the last 20 years. No more research is needed to determine if children benefit from growing and eating healthy food, spending time in nature, moving their bodies or learning to be kind, compassionate and resilient humans. The time has come to accept these factors, particularly in light of the adolescent mental health crisis, and commit fully to investments that equitably strengthen communities by nurturing the wellbeing and resilience of children during their formative years in school. The tools, talents, methods, practices, experience, pedagogy, research, and partnerships are ready to “move to the very center” of our Nation's schools.

Biographies

Lawrence Rosen, MD is an integrative pediatrician and founder of the Whole Child Center. Dr. Rosen is Associate Professor in Pediatrics and Assistant Director of the Human Dimension Course at the Hackensack Meridian School of Medicine. He also serves as Chair of the Health Advisory Board for WholeHealthED.

Kate Tumelty Felice, EdD is an education and psychology professor at Rowan College of South Jersey. She began her career in law enforcement in major crimes and narcotics, then transitioned into education with a proactive focus on kids’ wellness. She trains in and incorporates trauma-informed mindfulness with nutrition, nature, and movement, for kids, veterans, and first responders to increase long-term resiliency.

Taylor Walsh founded and directs the Center for Whole Health Learning in K-12 (WholeHealthED.org). A writer and journalist, he was a pioneer in the early years of Internet publishing and the earliest forms of online community and social media. In 2008, he began media and project consulting for integrative health organizations which led to the development of WholeHealthED.