The epidemic of obesity and inactivity in our youth population is a profound one and demands immediate attention from medical and mental health providers alike. Since the 1960s, the prevalence of overweight or obese children has tripled, and is currently estimated at 15% (WHO, 2001; Ogden et al., 2003). The comorbid health problems of this phenomenon are undeniable: insulin resistance, type 2 diabetes, hypertension, sleep apnea, poor self-esteem, and a lower quality of life (AAP, 2006). Add to this the high prevalence of childhood behavioral problems and the strong correlation with physical health, and the picture is ominously clear. This proposed Youth-Psychotherapy and Exercise Program (Y-PEP) is designed to simultaneously address these issues by integrating evidence-based psychotherapy and moderate exercise into one session. Our pilot program has used a closed 0.4 mile walking circuit but would ideally need treadmill and exercise bike access to establish consistency and fidelity.
Access to healthcare and behavioral healthcare specifically, especially in more rural and less affluent areas, is a real concern. Particularly in this northeastern area of Connecticut, where poverty and physical and mental health issues are a serious concern, anything that can make engagement more feasible and attractive is important. By simultaneously integrating a physiologist-monitored moderate exercise program with evidence-based psychotherapy, we have found a mutually-enhancing enterprise. Counseling becomes more fun and interactive, and less threatening, and phsycial exercise less daunting. Moreover, as opposed to going to a therapy sessionand then visiting the gym separately, at least one of these sessions per week can be a "two for one" deal and thus more time- and cost-effective.
The positive impact of regular and at least moderate physical exercise on mental wellbeing is obvious and well-documented. So, by combining effective psychosocial intervention/support techniques with an established and monitored exercise regimen, Y-PEP maximizes the potential efficacy of each modality, while likely enhancing the therapeutic relationship (e.g. "humanizing" the counselor, joining in a common pursuit, etc) which we know to be crucial in positive behavioral health outcomes. Of ourse,, the session would not represent the sole opportunity for the client to engage in physical exercise during the week, and would reinforce the need for ongoing, consistent activity at least every other day. Moreover, with concerning rates of anxiety, depression, executive functioning problems (e.g. ADHD), and the epidemic of interpersonal fragility and self-harm among our young population, this modality could serve to mitigate what seems to be a growing trend of such problems.
With rising health care costs, the tendency of insurance carriers toward denying less evidence-based protocols, and covering fewer necessary services, behavioral health costs are gravely concerning. Again, by combining psychotherapy with exercise, gains in physical and emotional/social health could potentially be more robust and come about more quickly, thus obviating the need for longer-term treatment. Ultimately, return to optimal functioning level with maximal independence, is the goal here, and Y-PEP could very well be an ideal efficient intervention. Likewise, simultaneous therapy and exercise in one session could mean fewer transportation challenges for parents/caregivers.
Our most recent literature review reveals that while programs and research exist concerning integrated therapy-exercise programs for adults (e.g. Hays, 2006; Jacquart et al., 2014) there seem to be no such programs addressing the needs of our younger and most vulnerable populations (e.g. urban/rural youth, obesity, poverty, medically complex).The Y-PEP could conceivably be the only program of its kind nationally, and especially valuable in an area of profound need such as northeastern CT. Our current hospital setting and available medical staff consultation (pediatricians, nutritionists, cardiology) also make for an ideal model which would necessarily incorporate medical/kinesiology oversight. What is also unique to this program is the concurrent addressing of barriers to the therapeutic alliance and to engaging in an exercise regimen alike.
The assertive and active engagement of our peer behavioral health organizations in this area will be crucial to the viability of the Y-PEP program. If Y-PEP is to have the broad positive impact that is possible, we will need to have "critical mass' investment and partnering from our colleague agencies. The tight-knit community of organization leaders in this are of CT is truly unique and encouraging, and has led to a number of effective inter-agency initiatives over the past 5-10 years. As the proposed Y-PEP program leader, I would see it as my charge to engage these partners, solidify their commitment to it, and help them replicate it effectively. Additionally, my valuable relationships and respected standing in this community as a leader should be helpful to this end.
Due to the rather straightforward nature and modest infrastructure of the Y-PEP program, the profound need in this particular northeast Connecticut area, and the tremendous commitment to collaboration already demonstrated within Day Kimball and our community partners, we have determined that sustainability is likely to be easily maintained. While no formal commitment has yet been established, organizations such as our own Day Kimball Healthcare, the Northeast District Department of Health (NDDH), CT Department of Children and Families (DCF), the Greater Hartford YMCA, Northeast Opportunities for Wellness (NOW), Thompson Ecumenical Empowerment Group (TEEG), and area school districts are likely to be enthusiastic partners. We also anticipate that our peer behavioral health programs in this area will follow suit and adopt such a program.
The Y-PEP program is a simple, intuitive, and easily replicable model, utilizing the simultaneous integration of evidence-based psychosocial techniques (i.e. a clinician's existing skill set) with a conventional and moderate aerobic exercise protocol. This can be carried out in any reasonably accessible outpatient facility with either available treadmill and/or exercise bicycle equipment, and during more seasonable weather, access to a safe walking/jogging path. Moreover, this can be adapted to a range of physical abilities, clinical populations, in both urban and more rural settings, with no inherent demographic or cultural barriers. The more physiological aspects of the program would be informed and overseen by our relevant medical staff.
Although Y-PEP is in its nascent stages, we have identified preliminary interim progress and outcome measures, looking at both physiological and psychological/emotional adjustment indicators. This protocol will include baseline demographic and adaptive functioning data (e.g. Ohio Scales), physiological history and assessment (family health, BMI, vitals), and general and symptom-specific (e.g. BASC-2, Achenbach, anxiety, depression, behavioral regulation) tools. We would also be consulting with our medical/kinesiology staff on these measures. We plan to assess progress in all of these areas on a quarterly basis and share these data with clinical staff, consulting practitioners, and consumers.