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Effectiveness, Acceptability, and Feasibility of the Soles of the Feet Mindfulness-Based Intervention with Elementary School Students

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Children with high rates of disruptive behavior in elementary school are at-risk for future psychosocial difficulties. Professionals who work in today's schools are in need of effective interventions to reduce rates of disruptive behaviors in schools in order to ensure optimal outcomes for students. This manuscript details a pilot study of a brief mindfulness-based intervention, Soles of the Feet (SOF), for elementary school students. Three non-disabled students with high-rates of off-task behavior during general education periods were selected taught the SOF intervention. Using a multiple baseline single-subject study design, results suggest that SOF may be an effective intervention to reduce off-task behavior and increase academically engaged behavior for behaviorally challenging students. Questionnaires administered to these students and their teachers suggest that SOF is socially valid and acceptable for use in public schools.
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ORIGINAL PAPER
Effectiveness, Acceptability, and Feasibility of the Soles
of the Feet Mindfulness-Based Intervention with Elementary
School Students
Joshua C. Felver & Jennifer L. Frank & Amber D. McEachern
Published online: 14 August 2013
#
Springer Science+Business Media New York 2013
Abstract Children with high rates of disruptive behavior in
elementary school are at risk for future psychosocial difficul-
ties. Professionals who work in today's schools are in need of
effective interventions to reduce rates of disruptive behaviors
in schools in order to ensure optimal outcomes for students. We
detail a pilot study of a brief mindfulness-based intervention,
Soles of the Feet (SOF), for elementary school students. Three
non-disabled students with high rates of off-task behavior
during general education periods were selected and taught
the SOF intervention. SOF took place over the course of five
2030-min sessions in a public school setting. Using a
multiple-baseline single-subject study design, results obtained
via direct observation of student behavior during general edu-
cation instructional time in the classroom suggest that SOF
may be an effective intervention to reduce off-task behavior
and increase academically engaged behavior for behaviorally
challenging students. Questionnaires administered to these
students and their teachers suggest that SOF is socially valid,
feasible, and acceptable intervention for use in public schools.
Conclusions extend the research of the effectiveness of SOF,
and suggest that SOF is an effective short-term, resource non-
intensive, and socially valid intervention for use with typically
developing students with disruptive behavior in a public school
setting.
Keywords Mindfulness
.
Children
.
Schools
.
Teachers
.
Students
Introduction
The types of behaviors a student engages in during school
have serious long-term implications. Academically engaged
behavior in the classroom is related to prosocial psychosocial
adjustment. Longitudinal research suggests that students who
display more academically engaged behavior have better out-
comes on measures of academic achievement and are less
likely to drop out of high school (Greenwood et al. 2002;
Fredricks et al. 2004). Conversely, disruptive and aggressive
behaviors in school can lead to deleterious psychosocial out-
comes. Disruptive behavior in youth frequently increases in
severity throughout childhood (Silver et al. 2005), is correlated
with later academic difficulties (Kim-Cohen et al. 2005), pre-
dicts later adolescent delinquent behavior (Broidy et al. 2003;
Tremblay et al. 1992), and can result in adult psychopathology
and incarceration (Schaeffer et al. 2003). Children who are
more academically engaged during the school day are more
likely to be met with long-term success, whereas children who
have more disruptive behavior during the school day are at risk
for long-term psychosocial difficulties. Specialized interven-
tions which increase academic engagement and reduce prob-
lem behavior are therefore needed in today's classrooms.
Among the armamentarium of interventions used in
schools to address student behavior, mindfulness-based inter-
ventions have received relatively little attention from school-
based intervention scientists. Mindfulness, or the self-
regulation of attention so that it is maintained on immediate
experience [and] is characterized by curiosity, openness,
and acceptance (Bishop et al. 2004, p. 232) has in recent
years become increasingly popular as a method of psychoso-
cial intervention (Brown et al. 2007). Over the last decade,
mindfulness-based interventions have become an increasingly
J. C. Felver (*)
Department of Psychiatry, Harvard Medical School, Boston,
MA 02115, USA
e-mail: jfelverg@uoregon.edu
J. C. Felver
Department of Special Education and Clinical Sciences,
University of Oregon, Eugene, OR 97403, USA
J. L. Frank
Prevention Research Center, Pennsylvania State University,
University Park, PA 16802, USA
A. D. McEachern
Mid America Health, Greenwood, IN 46142, USA
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DOI 10.1007/s12671-013-0238-2
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popular method of psychosocial intervention for children
(Burke 2009) and have been suggested as a viable treatment
approach in educational settings (Felver et al. 2013). Indeed,
there is an emerging body of evidence demonstrating the
effectiveness of mindfulness-based interventions for school-
age populations (Greco et al. 2008; Lee et al. 2008; Semple
et al. 2010) and in educational settings (Napoli et al. 2005;
Saltzman and Goldin 2008; Singh et al. 2003). Although there
continues to be a high amount of interest in mindfulness-based
interventions for youth among intervention scientists and cli-
nicians, more research is needed to document the effectiveness
of these approaches in naturalistic settings, such as schools.
Of the existing manualized mindfulness-based intervention
available for implementation and study, Soles of the Feet
(SOF; Singh et al. 2003, 2011) is particularly promising for
use in school settings given its focus on observable behaviors,
established record of clinical effectiveness, time and cost
efficiency, effectiveness with individuals with and without
cognitive disabilities, and ease of use across multiple settings
and contexts. SOF is an empirically supported manualized
intervention protocol, consisting of five sessions lasting ap-
proximately 2030 min. The goal of the SOF intervention is to
teach individuals (a) how to recognize the antecedent condi-
tions to their aggressive behavior, (b) disengage their attention
from those precursors, (c) reorient their attention to a neutral
point on the body, thereby discontinuing the escalation of
problematic behavior, and (d) return to the activity taking
place calmly (Singh et al. 2003). Once SOF is mastered to
the point of automaticity in the setting it is initially taught,
individuals are then encouraged to practice SOF in different
contexts in order to support generalization across settings.
SOF has been found effective in reducing aggression
among adults with disabilities, mental illness (Singh et al.
2008a, b, 2007c, b, 2003), obsessive compulsive disorder
(Singh et al. 2004), and adolescents with conduct disorder
(Singh et al. 2007a). A recently published randomized control
trial of SOF demonstrated a reduction of aggressive behavior
in adolescents and adults with intellectual disabilities (Singh
et al. 2013). Other studies have found parents and clinical
staff who utilize these techniques engage in more sensitive
and responsive interactions with children and adults with
disabilities, resulting in decreases in aggressive behavior
(Singh et al. 2006a, b). Although the results of these efficacy
trials show promise for SOF as an intervention for behavioral
disruptions, the social validity, feasibility, and effectiveness of
SOF with children in naturalistic school settings has not been
established.
The objective of this research is to replicate and extend
previous findings by delivering a pilot application of SOF to
non-disabled elementary school students in a non-clinical, pub-
lic school setting. This work expands on previous research by (a)
pilot testing the effectiveness of SOF on reducing the disruptive
behavior of elementary-age students, and (b) examining the
feasibility, social validity and acceptability of this intervention
when delivered in school settings.
Method
Participants and Settings
Approval for this study was initially obtained from the au-
thor's affiliated university institutional review board and the
local education agency. General education teachers were then
recruited from an elementary school within the school district
to participate in this study. Consent was obtained from three
third grade teachers who elected to participate in the study
following a brief study of the procedures and recruitment
presentation given at a teacher faculty meeting. These teachers
were each asked to subjectively identify two students they felt
had high levels of disruptive behavior and low levels of
academic engagement during core instructional periods (e.g.,
mathematics or reading). Parental consent and student assent
was obtained for all six students prior to student data collec-
tion or intervention procedures.
To objectively identify and confirm rates of student behavior,
teacher interviews and direct observations were conducted.
Teacher interviews involved study interventionists completing
the Functional Assessment Checklist for Teachers and Staff
(FACTS; March et al. 2000) with teachers. The FACTS is a
brief semi-structured interview designed to identify the specific
topography, frequency, duration, and intensity of a problematic
behavior , and to identify the contexts in which the behavior is
most likely to occur (e.g., antecedents, consequences, setting
events, environmental factors). For the purposes of this study,
the FACTS was used to identify each student's disruptive or
academically off-task behaviors, and to identify the instructional
period when these behaviors were most likely to occur. T e achers
also received a brief introduction to SOF techniques and were
provided a general orientation to the program by research study
personnel at this time.
Following the identification of disruptive and off-task be-
havior of the identified students, study coordinators conducted
preliminary direct observations of focal students' behavior
were conducted to confirm teacher report. The criteria used
to confirm high rates of student disruptive behavior were the
occurrence of five or more instances of discrete off-task be-
havior (e.g., talking during silent reading) and low rates of task
engagement (i.e., less than 50 % of time following teacher's
specific instructional request) during a single 20-min observa-
tion period. All six students were confirmed to have high rates
of disruptive behavior and low rates of academic engagement
using these criteria. Although all six students would eventually
receive the SOF intervention, only half (i.e., one student from
each teacher's classroom) were randomly assigned to data
collection and analysis. The decision to collect data on half
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of the students was made due to a lack of necessary resources
and personnel to complete data collection on all students; six
students were initially recruited in the event that some of these
students did not have high enough rates of disruptive behavior
confirmed through preliminary observations. Study interven-
tionists were not informed as to which students had been
assigned to direct observation data collection and analysis so
as not to bias their clinical efforts toward certain participants, in
effect blinding interventionists to participants assignment to
data collection or no-data collection conditions.
The three students selected for data collection were all en-
rolled in third grade, and received general education curricula.
According to archival record review, no student was identified
as having a disability according to federal IDEA standards.
Zachary was a European-American boy who had high rates of
disruptive behavior during language arts periods. FACTS anal-
ysis determined that he would become angry and defiant to-
wards teachers when asked to complete independent seat work,
refusing to comply with adult directives, tearing his assign-
ments, and knocking over his chair . The function of Zachary's
behavior was identified as escape from his school work and
recruitment of adult attention. Dominick was a European-
American boy who would refuse to complete school work and
was disruptive throughout his school day. FACTS analysis
determined that he was more likely to become disruptive during
unstructured periods of the day, at which point he would get out
of his seat, make noises, and drum his fingers loudly on his desk.
The function of Dominick's behavior was identified as recruit-
ment of peer attention. Caleb was a European-American boy
who would become frustrated and noncompliant during lan-
guage arts periods. FACTS analysis determined that when
Caleb was asked to complete language arts assignments, he
would refuse to complete his work, and would eventually esca-
late to yelling and pushing over his desk. The function of Caleb's
behavior was identified as escaping a non-preferred activity.
Interventionists
Study interventionists were authors of the current manuscript.
The first author was a masters level doctoral student with
training in child and family therapy and mindfulness-based
interventions; the third author was a post-doctoral level inter-
vention scientist with training in both clinical psychology and
mindfulness-based interventions.
Measures
Direct Observation of Student Behavior Three students were
selected for direct observation of disruptive behavior.
Observations lasted for 20 min during the class period when
they were most likely to display disruptive and non-academically
engaged behavior. Intervals were 15-s in duration. Coders
recorded two independent classes of behavior during each
interval. Academically engaged time was operationalized as
either actively or passively attending to assigned classwork or
instruction (e.g., completing worksheets, listening to teacher
instruction, and silently reading). Academically engaged instruc-
tion was recorded using a momentary-interval method, whereby
an occurrence of the behavior was recorded if it lasted for the first
3 s of every 15-s interval. Off-task behavior was operationalized
as either motor activity not directly associated with an assigned
academic task (e.g., playing with a toy underneath the desk,
getting out of the seat to walk around the room), verbalizations
not related to an assigned academic task (e.g., making noises
during silent reading, talking to another student during a quiz), or
passively not attending to an assigned academic task for at least
three consecutive seconds within a given 15-s interval (e.g.,
staring out the window, watching other students talk). Off-task
behavior was recorded using a partial interval system, whereby
an occurrence of the behavior was recorded if it occurred at any
time during each 15-s recording interval.
Fidelity of Direct Observations Direct observations were
conducted by trained research assistants who remained blind
to each student's phase throughout the study. Research assis-
tants were trained to an inter-observer agreement (IOA) level
of 80 % accuracy prior to data collection. IOA was measured
periodically with the study coordinator; IOA levels for each
research assistant did not fall below 80 % accuracy for the
duration of the study.
Post-Intervention Social Validity Questionnaires Students
and their teachers completed a post-intervention questionnaire
following completion of the intervention which was used to
assess for feasibility, social validity, and acceptability of SOF.
Participants were asked questions such as how effective the
intervention activities were, frequency and contexts in which
they were used (generalization), and whether or not they
experienced any unintended positive or negative side effects
resulting from their participation in the intervention or use of
intervention strategies. Student social validity and acceptabil-
ity was measured using an adapted version of the Children's
Intervention Rating Profile (CIRP; Witt and Elliott 1985), a
seven-item measure using six-point Likert-type scale, in
which children responded to how much they agreed or
disagreed with statements about the fairness, acceptability,
and potential side effects of SOF. Internal consistency reliabil-
ity estimates of the CIRP range from 0.750.89 (Witt and
Elliott 1985). Teacher feasibility , social validity , and accept-
ability were measured by an eight-item social validity ques-
tionnaire constructed for this study (see Appendix).
Experimental Design and Procedure
This study employed a multiple-baseline across subjects de-
sign with three phases: baseline, SOF tra ining, and post-
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intervention. Following conventional multiple-baseline proce-
dures, baseline data collection began simultaneously for all
three students until a stable level behavior was observed.
Students were randomly assigned to their SOF training phase
order (i.e., receiving the intervention first, second, or third),
and after 1 week of baseline data collection, the first student
Zachary began the SOF intervention. The other students be-
gan the SOF intervention only after the preceding student had
finished, with start dates staggered at least 1 week apart, with
accommodations made based on school schedule and student
attendance.
Baseline Baseline data collection commenced simultaneously
for all students. At least three observations were collected in
the week immediately prior to the first student, Zachary,
beginning the intervention phase in order to establish a stable
measurement of student behavior. Baseline data collection
continued for the other two students until they began their
own SOF intervention phases.
SOF Intervention During the intervention phase, students met
with their assigned interventionist for five 2030-min sessions
during consecutive school days in a private room reserved for
the school psychologist at their elementary school. At least
one direct observation data point was collected during this
phase. Sessions were scheduled to minimize disruption of
classroom activities and student instruction.
Intervention activities followed the scope and sequence of
the established manualized procedure (Singh et al. 2003,
2007a, b, c, 2011). During the first session, students were
explained that the purpose of SOF is to learn a technique to
stay calm when feeling upset so that one does not get in
trouble in the classroom, followed by an explanation and
guided practice of the technique. In the second, third, and
fourth sessions, students practiced the SOF intervention when
they were feeling happy, angry, and frustrated, respectively.
Students had the feelings elicited by first describing to the
interventionist a recent situation when the specified emotion
occurred (e.g., getting teased at recess and becoming angry),
and then the interventionist w ould induce the feeling by
verbally recounting the experience back to the student. Once
the student evidenced behavioral expression of the emotion
(e.g., a scowl on their face at having the experience of being
teased described to them), the student was instructed to prac-
tice the SOF routine to interrupt the emotional response. In
this way, students developed an effective routine to discontin-
ue a response cycle that could lead to further emotional
arousal (e.g., increased anger and frustration) and/or associat-
ed escalated behavior (e.g., aggressive and disruptive behav-
ior). The fifth session was used to further practice the routine
and plan for practice during school and at home to increase
generalization to other settings.
Post-intervention During the weeks following the SOF inter-
vention phase, data collection of disruptive and academically
engaged behavior continued for as many days as possible until
the end of the school year.
SOF Fidelity of Implementation
Intervention fidelity was monitored using a short form follow-
ing each of the five sessions. Key components of the inter-
vention were detailed in the form of a checklist, which the
interventionist then used to record whether they implemented
each step of the SOF intervention.
Results
Collected data for total academically engaged and off-task
behavior for each of the three students across baseline, SOF
intervention, and follow-up phases of the study are displayed in
Figs. 1 and 2 (respectively). Clinicians were able to implement
the SOF intervention with 100 % fidelity for all students in this
study according to intervention component checklist completed
after every session. Table 1 presents mean behavioral occur-
rence for each of the coded behaviors for each student across
study phases.
In analyzing these data SOF, appears to increase student
academic engagement. Zachary had an initially low and stable
rate of academically engaged behavior at a mean level of 37 %
of the observation period. His amount of observed academic
engagement initially declined at the onset of the SOF inter-
vention, but adjusted to a high and stable level of over 90 %
for the remainder of his observations, providing the most
compelling data among the three students for the effectiveness
of the intervention. Dominick displayed a stable baseline level
of academically engaged behavior prior to beginning the SOF
intervention. During and following his learning SOF, he had
generally high rates of academic engagement, with the excep-
tion of one observation. This observation point appears to be an
outlier given his generally high rates of behavior during other
observations. Caleb's rate of baseline behavior was less stable
than the other two boys, with most observations falling between
10 % and 40 % of time spent academically engaged, and one
observation period of high academic engagement above 80 %.
During and following his learning the SO F intervention,
Caleb's observed academically engaged behavior was generally
high (i.e., above 79 %), however given the instability of his data
during baseline and the limited number of observations, these
findings are less compelling than the other students.
Post-intervention social validity data show that SOF was
acceptable for both students and teachers. Table
2
details
student responses to the CIRP. Students answered that they
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agreed that SOF was an acceptable intervention, reporting that
they believed it was a useful method to help them at school, and
that they enjoyed learning the technique. When asked what
they thought should be changed about the way students are
taught SOF in schools, every student reported that nothing
should be changed. Students also reported that they do not
believe SOF causes any problems with their friends, suggesting
that SOF is a socially valid practice for these students in school.
On the post-implementation questionnaire completed by
teachers (see Appendix), the SOF intervention was reported
to be an acceptable and socially valid practice to be used with
students in their classroom and responses were uniformly pos-
itive. T eachers reported that they did not have any immediate
concerns about the intervention prior to it beginning (e.g.,
sounded like a great idea), that they felt that SOF was
effective for their students (e.g., he calmed down when frus-
trated), and that they would recommend it for other teachers
(e.g., students really need this type of training, it's easy for
teachers and students).
Post-implementation data also suggests that SOF is a fea-
sible intervention. Student responses on the CIRP (see
Table 2) indicate that they did not believe SOF was difficult
to use, that they felt SOF was a fair technique to learn during
school, and that they did not believe that anything should be
changed about the existing intervention. Teacher responses to
the post-implementation questionnaire also suggest that SOF
Baseline SOF
Caleb
Follow-Up
Zachary
Dominick
Fig. 1 Average total
academically engaged
behavior per observation
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was a feasible practice, as teachers all answered yes to the
open ended question Overall, is the amount of time teachers
invest in implementation reasonable?.
Discussion
The data from this study suggests that elementary school
students with high rates of disruptive behavior who complete
the SOF intervention spend more time being academically
engaged in the classroom and less time displaying off-task
behavior. These findings extend previous research that has
documented SOF being an effective intervention for reducing
problematic behavior in adults with disabilities by demonstrat-
ing clinical effectiveness with typically developing children in
a naturalistic school setting. It can be postulated that with
student's reduction in disruptive behavior, they were more
able to be engaged with, and perhaps learn, the academic
material presented in the classroom. This is important given
the deleterious long-term outcomes of disruptive behavior,
and successful outcomes of academically engaged behavior
in grade school. Today's schools are in need of simple, cost-
effective interventions to improve the outcomes of students,
and SOF appears to offer a viable option to meet this need.
Beyond the effectiveness of SOF in improving student be-
havior in this study, the intervention was reported to be socially
valid for use in schools. Students and teachers indicated that
they felt that SOF was appropriate, effective, and acceptable for
use in classrooms, suggesting that public school are open and
willing to implement mindfulness-based programming with
Baseline
SOF
Caleb
Follow-Up
Zachary
Dominick
Fig. 2 Average total off-task
behavior per observation
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their students. It is also worth noting that clinicians were able to
implementSOFwith100%fidelityafteronly5hoftraining,
and that clinicians spent only 2.5 h of actual face-to-face direct
interaction with students. Given the tight economic climate of
today's schools, effective and time-limited interventions such as
SOF are needed to meet studen t's behaviora l needs without
taxing a school district's already limited financial resources.
This work lends further evidence to the growing body of
research showing that youth can benefit from mindfulness-
based interventions (Burke 2009). It also lends evidence to the
postulation that mindfulness-based interventions can be effec-
tive in public school settings (Felver et al. 2013). Furthermore,
the intervention was found to be acceptable in this particular
context, suggesting that mindfulness-based interventions are a
viable treatment in a secular educational context. It is worth
noting that the researchers in this study were careful to present
this intervention in a secular fashion, detailing exactly what
SOF entailed and what SOF teaches children to do precisely.
In this way, we worked to ensure that teachers and adminis-
trative personnel understood that this mindfulness-based in-
tervention was specifically designed to teach children a skill to
control their behavior and emotions and not to teach them
meditation or anything connoting an Eastern religious tra-
dition (e.g., Buddhism). We believe that presenting the SOF
intervention in this manner increased buy-in and acceptability
ratings among the public school staff by pre-correcting any
misconceptions that mindfulness-based intervention are non-
secular in nature.
Study Limitations
There are several limitations to the current work which should
be noted and addressed in future studies of SOF in school-aged
populations. First, in our work we did not measure if children
were actually using the SOF routine during the school day. As
the SOF routine, and indeed many mindfulness practices, is a
largely covert behavior, we did not employ an observational
method to capture student practice. Although this was not
measured in the current study , students reported to intervention-
ists and observers that the SOF techniques had been employed
during classroom instructional time. Future work may employ a
measurement, either via self-report or observation, of the fre-
quency of student use of the SOF routine. Second, our study
focused on a demographic category. Although participation in
the intervention was open to the entire elementary school,
participants were only selected from third grade classrooms,
and all participants were males. Future work may recruit a more
diverse group of participants. Third, several of our participants
had limited data collected on their behavior during the follow-
up phase. Best-practice in single-subject research suggests the
gathering of at least three data points in each study phase to
establish a stable level of behavior (Horner et al. 2005). The
conclusion of the school year limited the number of data
collection points used in this study, and althou gh these data
points suggest an effect of the intervention, more data would
have been useful to definitively confirm a functional relation
between the intervention and observed behavior.
Table 1 Average percentage of time across observations student engaged
in a behavior
Student Study phase
Baseline SOF intervention Follow-up
Zachary
Total academically engaged 37.0 53.1 93.1
Actively engaged 20.3 23.4 74.7
Passively engaged 16.7 29.7 18.4
Total off-task 61.5 46.9 9.7
Off-task motor 50.5 14.8 4.1
Off-task verbal 10.9 14.1 1.3
Off-task passive 7.2 24.2 4.4
Dominick
Total academically engaged 52.5 95.3 71.9
Actively engaged 28.6 64.1 54.2
Passively engaged 23.9 31.3 17.7
Total off-task 50.6 4.7 32.8
Off-task motor 28.9 4.7 18.8
Off-task verbal 13.8 0.0 11.5
Off-task passive 17.9 0.0 7.3
Caleb
Total academically engaged 36.5 79.7 87.5
Actively engaged 22.8 12.5 45.3
Passively engaged 13.7 67.2 42.2
T otal off-task 60.0 20.3 10.9
Off-task motor 40.3 20.3 3.1
Off-task verbal 21.9 0.0 7.8
Off-task passive 5.0 0.0 0.0
Table 2 Mean student responses to social validity questionnaire (CIRP)
Item Mean response
a
1. Soles of the Feet is fair 6.0
2. Doing Soles of the Feet is too hard 1.0
3. Doing Soles of the Feet might cause problems
with my friends
1.0
4. There are better ways to deal with feelings than
SolesoftheFeet
3.0
5. Soles of the Feet would be good to use with
other students
6.0
6. I liked doing Soles of the Feet 5.7
7. I think Soles of the Feet will help me do better
in school
5.3
a
Student responses to CIRP items anchored as: 1 = I do not agree and 6 =
Iagree
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Future Research Directions
Results of this study revealed potential benefits in terms of
using SOF among non-disabled elementary school-aged chil-
dren. Future research should seek to replicate these findings
and to pilot similar work with older students in middle and
high schools. Our pilot revealed a relatively high degree of
acceptability among teachers and students in using these
practices. Real-world implementation revealed meaningful
improvements in student behavior. This study used general
education students to pilot the SOF intervention. In future
work, it may be useful to study special education students to
see if similar results could be achieved. SOF may be an
extremely helpful intervention for students in a special edu-
cation setting, as some of these students have higher rates of
disruptive and academically disengaged behavior, and SOF
has been found to be helpful with adults with disabilities in
other studies (Singh et al. 2003). Future work may also mea-
sure whether the SOF routine learned in the classroom gener-
alized to other contexts. Two students in the current study
anecdotally reported that they used the SOF routine at home to
calm down when in stressful situations, suggesting that SOF
may generalize to other contexts. Studies may also wish to
examine the efficacy of a teacher led SOF intervention, as this
could potentially bolster the generalization of the behavior to
other settings throughout the school day.
Implications for Practice
Clinicians who work in public school may note that this is a
relatively low-cost intervention, taking place over five 2030-
min sessions, thus minimizing both interventionist and student
time. Further, this intervention is manualized and easy to im-
plement based on teacher and student report. Clinicians in our
study reviewed, practiced, and implemented the intervention
with high fidelity after only approximately 5 h of training, and
several weeks of personal practice, further indicating that SOF
is easy to implement in public schools. Interventionists wishing
to employ a mindfulness-based intervention should base their
clinical work on a firm grounding of personal experience with
the intervention, as it is our experience that the effective deliv-
ery SOF occurred only after we found that we could use the
technique with fluency in our own lives. Clinicians interested in
integrating mindfulness-based interventions into their existing
armamentarium or behavioral interventions should consider
utilizing SOF in their school-based practice.
SOF has been found to be effective among a variety of
individuals with different levels of functioning. This study
suggests that SOF is an acceptable and useful intervention for
children in public school settings, and should be considered a
promising approach to addressing the needs of today's youth in
educational settings.
Acknowledgments This work was supported by the National Institutes
of Mental Health grant #T32MH20012 to Elizabeth Stormshak, PhD.
Appendix
Post-implementation social validity interview for teacher
1. What were your initial thoughts regarding this interven-
tion when you first began to learn about it? Did you have
any immediate concerns or questions?
2. Are the types of problems addressed by the SOF program
important?
3. Overall, is the amount of time teachers invest in imple-
mentation reasonable?
4. What elements of implementation did you find most
challenging?
5. Do you feel the SOF program was effective for this
student?
6. Would you recommend this intervention to other teachers?
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... Frequency and duration are two variables that researchers have altered as part of the intervention delivery, ranging from delivery multiple times each day (Schonert-Reichl et al., 2015) to bi-monthly (Napoli et al., 2005) and for as little as 3 min (Britton et al., 2014) to as long as 90 min sessions (Wright et al., 2019). Though results from the reviewed literature were overall suggestive of a positive effect of mindfulness on student attention there were findings that warranted a more cautious interpretation of such an effect (e.g., there was a lack of consistency in demonstration of an effect across participants and use of a less rigorous ABA design in Su and Swank [2019], a limited number of data points were collected during the intervention phase of a single-case design study in Felver et al. [2014], no statistically significant group × time interaction in Britton et al. [2014], and the use of comparisons between different age groups and lack of withingrade randomization for intervention-control group comparisons [Tarrasch, 2018]). ...
... The current study differed from previous studies by using an application to deliver the intervention-with minimal input from an interventionist. Previous studies that have found an effect of mindfulness on attention used instructors to deliver the intervention (Carboni et al., 2013;Crescentini et al., 2016;Felver et al., 2014;Frank et al., 2021;Napoli et al., 2005;Ricarte et al., 2015;Schonert-Reichl & Lawlor, 2010;Schonert-Reichl et al., 2015;Su & Swank, 2019;Tarrasch, 2018;Thomas & Atkinson, 2016). Perhaps this flaw in the design (i.e., limited adult input for delivering the intervention) impacted the degree to which students engaged with the intervention and therefore the intervention did not produce a conclusive effect. ...
... Although previous single-case experimental designs have shown an impact of MBIs on attention, the convincing establishment of a functional relation was not always evident (Carboni et al., 2013;Felver et al., 2014;Su & Swank, 2019). School-based research can pose challenges regardless of whether the study is a group or single-case experimental design. ...
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... Rights reserved. Felver et al. (2014) characterized the intervention as secular and not meditation or Eastern religion. ...
... None of the interventions were function-based, though several MBP studies discussed the function (as in the maintaining reinforcer) of problem behavior. Two (7%) included a functional assessment to identify functions of target behaviors such as escape and attention (Felver et al., 2014(Felver et al., , 2017. In the participant sections, three other studies reported outcomes of recent functional assessments or functional-assessment questionnaires, such as the Questionnaire About Behavior Function (Singh et al., 2017a(Singh et al., , 2017b(Singh et al., , 2019a(Singh et al., , 2019bSingh et al., 2017aSingh et al., , 2017b. ...
... Results suggested various functions maintained respective behaviors, including access to attention or tangibles, escape, demand avoidance, nonsocial motivation, and automatic reinforcement. Soles of the Feet may, therefore, work across different maintaining functions (e.g., Felver et al., 2014Felver et al., , 2017. ...
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... In the present study, functional assessment suggested mixed motivations that gave rise to the clients' challenging behaviors. The current finding that positive changes occurred in the clients due to mindfulness-based training of caregivers, regardless of the assessed motivations for specific client behaviors, is in line with findings from previous studies that showed similar outcomes (e.g., Felver et al., 2014Felver et al., , 2017Shah et al., 2022;Singh et al., 2017Singh et al., , 2019Wilson et al., 2015). There have been various speculations regarding the reasons why MBPs may override the behavioral functions of challenging behaviors (e.g., Singh et al., 2019). ...
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