crim fitness foundation mindfulness initiative

CrimFitnessFoundationMindfulnessInitiative

BGraceBullock,PhD

FortheCrimFitnessFoundation


BGraceBullock,PhD–FortheCrimFitnessFoundation 2

ExecutiveSummary

TheCrimFitnessFoundationisdedicatedtocreatingaviableandvibrantcommunityby

offeringprogramsthatenhancehealthandwellbeing.TheorganizationisuniquelypositionedtobenefittheFlintcommunitybecauseofahighdegreeofcommunitytrust,andareputationforproviding40yearsofexceptionalservicetoGeneseeCounty,including10yearsofphysicalactivity,nutritionand,morerecently,mindfulnessprogrammingtoGreaterFlintSchools.IntheadventoftheFlintWaterCrisis,leadinghealthexperts,includingDr.MonaHanna-Attisha,haveindicatedthattheseprogramsandserviceswillbecrucialintheefforttomitigatetheeffectsofleadexposure,particularlyforyoungchildren.

MindfulnessprogrammingiscentraltoCrim’sprogrammaticoutreach.Mindfulnessskillsholdpromiseforincreasingkeycognitiveandbehavioralcapacitiesandsocialcompetenciesthatarelikelymostaffectedbyleadexposure.In2016,CrimlaunchedaninitiativetoexpanditsmindfulnesstrainingtoincludechildreninFlintCommunitySchools,andtoextendthattrainingtotheGeneseeIndependentSchoolDistrict.Thisinvolvesincreasingtrainingandsupportforteachers,students,andfamilies,andraisingcommunityawarenessofthebenefitsofmindfulnesspractices,particularlyinthecontextofstressresiliency.

Thisreportaddresses4keyareasrelatedtothiseffort:

(1)Theimpactofleadexposure;(2)Thebenefitsofmindfulness-basedpracticesonmarkersofhealthandwellbeing;(3)Theeffectsofmindfulnessprogramsinschoolsettings;and(4)Crim’suniquepositionandvisiontodelivertheseprograms.

(1)ImpactofLeadExposure:ThereisstrongevidencethatmanyFlintchildrenhadelevatedbloodleadlevelsfollowingthewatersourcechange.Thiswasparticularlytrueforchildrenfromeconomicallydisadvantagedneighborhoods.Thesechildrennowfacenumerousthreatstotheirimmediateandlong-termflourishing.Forexample:• ManyFlintchildrenareathighriskforpoordevelopmentaloutcomesduetohighratesof

poverty,crime,andpoornutrition,compromisedrearingenvironments,domesticviolenceandracialdiscrimination.Leadexposurewillonlyservetomagnifytheseeffects.

• Decadesofresearchlinkleadexposureinchildhoodtoabreadthofdevelopmentalproblemsincludingcognitivedeficitssuchaspoorattentionanddecision-making,limitedself-regulation,impairedinformationprocessing,lowmotivation,andanincreasedriskforantisocialbehavior,substanceuse,aggression,andcriminalactivity.Emergingstudiessuggestthattheseeffectsmaybemulti-generational.

• Alongitudinalstudyoftheeffectsofprenatalandearlychildhoodleadexposureonlong-termneuraldevelopmentrevealsadirectassociationbetweenchildhoodbloodleadconcentrationsandearlyadultbrainvolumelossintheprefrontalcortex-aregionresponsibleforexecutivefunctioning,finemotorcontrol,andbehavioralregulation.Thisisparticularlytrueformen,whichmayexplainthehigherincidenceofantisocialbehaviorsamongmencomparedtowomen.

• Thereissignificantevidencethatchildrenandadultswithahistoryofleadexposurehavelong-term,potentiallyirreversiblelearning,behavioral,andsocialdifficulties,andrequireintensiveandongoingsupport.



(2)BenefitsofMindfulness-BasedPractices:Mindfulness-basedprogramsandpracticesareassociatedwithanumberofimportantbenefitsthatmaybeparticularlyrelevanttothosefacingtheimpactofleadexposureincluding:• Reducingphysiologicalandpsychologicalstressandrelatedsymptomsincludinganxiety.• Increasingcognitivefunctioningincludingenhancedattention,self-regulation,andexecutive

functioning.• Amelioratingmentalandphysicalhealth,and the impactof stress-relatedconditions. • Lesseningdepressionandanxiety,andreducingtheriskfordepressiverelapse.• Alleviatingpain.• Improvingqualityoflifeandsubjectivewellbeing.

Mindfulnessstudiesshowadirectassociationbetweenregularpracticeandchangesinbrainstructureandfunctionalconnectivityincluding:• Increasingvolumeandactivationoftheprefrontalcortex(PFC)-aregionnegativelyimpactedby

leadexposureandrelatedtoattention,decision-making,planning,andprosocialbehavior.• Enhancingfunctionalefficiencyoftheanteriorcingulatecortex(ACC).TheACCisassociatedwith

directingattention,self-regulation,impulsecontrol,andfocusedproblemsolving,andisadverselyaffectedbyleadexposure.

• Reducingamygdalaactivityanddensity,suggestingincreasesinemotionregulation,anddecreasesinemotionalreactivity.

• Changingthedefaultmodenetwork(DMN)-aPFCstructureimportantforexecutivecontrolfunctions,socialinformationprocessing,self-referencing,andthinkingaboutothers.Thisregionisalsouniquelysusceptibletostressandleadexposure.

• Affectingneurobiologicalchangesrelatedtoimprovedmood,decreasedanxiety,anddecreasedaggression,antisocialbehaviorandsubstanceuse.

(3)BenefitsofMindfulnessProgramsinSchoolSettings:Althoughmindfulness-basedprogrammaticresearchinschoolsisemerging,initialstudiesshowthatprogramsforstudentsandteachersyieldnumerousbenefitsincluding:• Increasingstressresilienceandstressreduction.• Improvingself-regulation,emotionmodulation,andsubjectivewellbeing.• Enhancingattention,academicsuccess,andcognitiveperformance.• Decreasinganxiety,moodproblems,andantisocialbehavior.• Enhancingprosocialbehavior.• Lesseningteacherstressandburnout,andamplifyingteacherhealthandwellbeing.

(4)TheCrim’sUniquePositiontoDeliverPrograms:Crimisinauniquepositiontodeliverhighquality,evidence-basedinterventionsduetoitslonghistoryofprovidingexceptionaleducationalprogramstoFlintschools,includingmindfulnesseducation.Thiscapacityincludes:• Integrationofmindfulnesseducationwithnutritionandfitnessinstructiontoprovideholisticlife-

skillstraining.• Awell-establishedrelationshipandproventrackrecordworkingwithschooldistrictleaders,

administrators,andeducators.• Ahighlevelofcommunitytrustandgoodwill.• Theabilitytocollaboratewithmedical,researchandeducationpartnerstocomprehensively

evaluateprogrameffectiveness.



ImpactofLeadExposure

Background

GreaterFlintisapost-industrialareaofapproximately500,000inhabitantsfacedwithadecliningqualityoflifeafterGeneralMotorscloseditsautomanufacturingplantsinthe1980sand1990s.Intheinterveningyears,populationhassteadilydeclined,unemploymentrateshaveconsistentlyexceededthenationalaverage,andtheregionhasfacedhighlevelsofpoverty,violentcrime,housinginstability,domesticviolence,substanceuse/abuse,racialdiscrimination,andpoorhealthoutcomesincludinginfantmortality(UnitedStatesCensusBureau,2015).In2011,Flintwasdeclaredtobeinafinancialstateofemergency,atwhichtimethestateofMichiganassumedbudgetarycontrol,andbeganaseriesofcost-cuttingmeasures.TheseincludedtheApril25,2014switchoftheFlintwatersupplyfromLakeHurontotheFlintRiver-amovebystate-appointedofficialsintendedtodecreasewatercostswhileanewpipelinetoLakeHuron,scheduledtobecompletedin2016,wasunderconstruction(Kennedy,2016).ThecombinationofFlint’saginginfrastructureandcorrosive,untreatedwaterfromthepollutedrivercreatedarecipefordisaster.

TheFlintwaterdeliverysystemcontainsahighpercentageofleadinbothitspipesandplumbing(Fonger,2015).Moreover,FlintRiverwatercontainshighchloride,ahighchloride-to-sulfatemassratio,andnocorrosioninhibitor.TheinteractionoftheFlintwaterandaginginfrastructureresultedinsignificantamountsoflead,awater-solublemetal,beingleachedintotheFlintwatersupplyformorethan18months(Edwardsetal.,2005).Thispersisteddespiterepeatedcomplaintsofthewater’staste,color,andsmellbyresidents,andreportsofrashesandhairloss(AssociatedPress,2015).

ThankstoateamofresearchersfromVirginiaTechUniversity,thetruthofFlint’swatersupplywasfinallyrevealed.Theirindependentassessmentofthewaterin252areahomesdetectedleadlevelsof13,200ppb,fargreaterthanthelevelof5,000ppbatwhichwaterisdeclaredhazardouswaste(Roy,2015).Shortlythereafter,astudyreleasedbyDr.MonaHanna-AttishaandcolleaguesatthelocalHurleyMedicalCentershowedlargenumbersofareachildrenages5andunderwithsignificantlyelevatedbloodleadlevelsfollowingthewatersourcechange(Hanna-Attishaetal.2016).Thisnewslaunchedafirestormofpoliticalcontroversy,andarisingtideoffearthatFlintareachildrenmayhavesufferedirreversiblebraindamageduetonearly18monthsofexposuretocontaminatedwater(Adams,2016).

Leadisaneurotoxin,knowntosignificantlyimpactchildhooddevelopment,andinitiatelong-termdeficitsinintelligence,behavioralproblems,andpoorachievementacrossthelifespan(CentersforDiseaseControlandPrevention,2005).Itisparticularlyperniciousbecauseitremainsinthebrainforatleast2yearsandinbonefordecades,anddisruptsmanyneuralandphysiologicalfunctionsduetoitsabilitytosubstituteforcalciumionsinthebody(Lidsky&Schneider,2003).

Sadly,Flintisnotalone.CommunitiesfromWashington,DC,Baltimore,Cincinnati,andChicagotoOregonandFirstNationspeoplesofCanadaareexperiencingthedevastatingeffectsofleadpoisoningfrombuildings,pipes,andcontaminatedsoil.Theseeffectsincludethehighprobabilitylong-term,irreparableneurologicaldamage.Thefamiliesinthesecommunities,andtheschoolsandcommunityresourcesthatservethem,needimmediate,sustainedfinancial,psychological,educational,andhealthsupporttoassistthemindealingwiththeacutetraumaandpotentiallylastingimpactofleadexposure.TheCrimFitnessFoundation,whichhasservedthepeopleofFlintanditsschoolsfor40years,isinauniqueandunprecedentedpositiontoleadthateffort.



DeleteriousEffectsofLeadExposure

Thescientific,medical,publichealth,andbusinesscommunitieshavelongknownofthepoisonousandneurotoxiceffectsoflead(Denworth,2009).Decadesofinvestigationprovideindisputableevidencethatleadexposurehasdeleteriousandpotentiallyirreversibleconsequencesforachild’sdevelopmentaltrajectoryandlong-termsuccess(CentersforDiseaseControlandPrevention,2005;Lidsky&Schneider,2003).Studiesshowthatleadindrinkingwaterisparticularlydamagingtodevelopmentallyvulnerablechildrenandpregnantmothers.Thisisbecausechildrenabsorbhigherproportionsofwater-solubleleadwheningestedorally(40-50%)comparedtoadults(3-10%)(USDepartmentOfHealthandHumanServices,2007).Forchildren,every1partperbillionincreaseinwaterleadresultsina35%increaseinbloodlead(Nguetaetal.,2015).Theriskisevengreaterforinfantsconsumingreconstitutedformula.

ForthechildrenofFlint,Dr.Hanna-Attisha’sstudyfoundstatisticallysignificantincreasesinbloodleadconcentrationsfollowingthewatersourcechange.Thiswasparticularlytrueforchildrenlivinginpoverty,exacerbatinganalreadypronouncedriskfordisadvantagedandminoritypopulations.“Flintchildrenalreadysufferfromriskfactorsthatinnatelyincreasetheirleadexposure:poornutrition,concentratedpoverty,andolderhousingstock.Withlimitedprotectivemeasures,suchaslowratesofbreast-feeding,andscarceresourcesforwateralternatives,leadinwaterfurtherexacerbatespreexistingriskfactors.Increasedlead-poisoningrateshaveprofoundimplicationsforthelifecoursepotentialoftheentirecohortofFlintchildrenalreadyrattledwithtoxicstresscontributors…”(Hanna-Attishaetal.,2016,p.286).What’smore,recentstudiessuggestthattheseeffectsmaybecross-generational(Senetal.,2015).

LeadExposureandChangesinBrainStructureandFunction

Therearefewstudiesexaminingthespecificbrainstructures,mechanisms,andprocessesthataredirectlyaffectedbyleadexposure.Researchshowssignificantreductionsinintelligence,cognitivefunctioning,andbehavioralskillsrelatedtoself-regulation(Bellingeretal.,1987;Aizeretal.,2016;Reyes,2014),andsuggeststhattoxiclevelsofleadexposureinchildhoodmaydirectlyimpactthepre-frontalcortex(PFC),whichiscentraltotheexecutivecontrolsystem.Thissystemisimplicatedinkeycapacitiesincludingplanning,decision-making,emotionalregulation,problemsolving,andthemoderationofsocialbehavior(Frith&Dolan,1996).

Onelongitudinalstudyoftheeffectsofleadexposureonbrainchangesuggeststhatleadmayexertalong-termimpactontheexecutivecontrolsystem(Ceciletal.,2008).ThestudyincludedasubsampleofadultsfromtheCincinnatiLeadStudy(CLS),anurban,inner-citycohortofindividualswithdetailedprenatalandpost-natalhistoriesofmildtomoderateleadexposure,anddocumentedcognitiveandbehavioraloutcomesovera25-yearperiod.TheCLSincludedasampleofpregnantwomenrecruitedbetween1979and1984wholivedinneighborhoodswithhighratesofchildhoodleadpoisoning.Theirchildrenwereassessedbeginningatbirth,thenquarterlyupuntil5yearsofage,semi-annuallyfromages5to6½,thenagainatage10,andbetweentheagesof15and17.Atotalof157ofthechildreninthatsample(83male)consentedtoparticipateinabrainimagingstudyinearlyadulthood(ages19-24,mean20.9yrs,SD.90).Wholebrainimagingwasconductedusingahigh-resolution,Teslamagneticresonanceimaging(MRI)scannertoassessglobalandregionalchangesinbraintissue.Brainscansshowedasignificant,directrelationshipbetweenchildhoodbloodleadconcentrationsand“considerable”decreasesingraymattervolumeinseveralkeyregionsoftheprefrontalcortex(PFC)includingtheanteriorcingulatecortex(ACC)andventrolateralprefrontalcortex(VLPFC).Thiseffectwasparticularlypronouncedformale



participants.FurtheranalysescomparingimagingresultstoneuropsychologicaltestingscoresrevealedastronglinkbetweenPFCchangesanddeficitsinfinemotorskills(Ceciletal.,2008).

TheACC,acorticalcomponentofthebrain’slimbicsystem,isassociatedwithanumberofimportantfunctionsincludingprocessingemotionalandcognitiveinformation,attentionmodulation,motivation,emotionregulation,decision-making,processingcomplexinformation,andfinemotorcontrol.TheVLPFCisknowntobeassociatedwithregulationofmood,whichisanessentialcomponentofsuccessfulsocialfunctioning.“Volumelossin[these]frontalbrainregions,includingboththecognitiveandemotionalterritoriesoftheACCisconsistentwith,andpotentiallyexplanatoryforcognitiveandbehavioralproblemspreviouslyassociatedwithleadexposure,“theCLSauthorsconcluded.“Theseproblemsincludegeneralintellectualandexecutivefunctioning,antisocialbehaviors,andattentiondeficithyperactivitydisorder(ADHD)”(Ceciletal.,2008,p.744).

Findingsofthisstudybuildontheexistingliteraturethatshowsthatchildhoodleadexposureisassociatedwithnumerous,significantoutcomesincludinginfantmortality(Troesken,2003),childmortality(Clayetal.,2006),poorchilddevelopment(Bellingeretal.,1987),elevatedlevelsofchildandadolescentantisocialandriskybehavior(Reyes,2014),andviolentcrime(Reyes,2007),andthatleadpoisoningmaybeoneofthecausesofongoinggapsinacademictestscoresbetweenpoor,minoritychildrenandnon-disadvantagedchildren(Aizeretal.,2016).

SummaryThereisstrongevidencethatFlintchildrenhadsignificantlyelevatedbloodleadlevelsfollowingthewatersourcechange.Thiswasparticularlytrueforchildrenfromeconomicallydisadvantagedneighborhoods.Thesechildrennowfacenumerousthreatstotheirimmediateandlong-termflourishing.Forexample:• ManyFlintchildrenareathighriskforpoordevelopmentaloutcomesduetohighratesof

poverty,crime,poornutrition,compromisedrearingenvironments,housinginstability,domesticviolence,andracialdiscrimination.Leadexposurewillonlyservetomagnifytheseeffects.

• Decadesofresearchlinkleadexposureinchildhoodtoabreadthofnegativedevelopmentalproblemsincludingcognitivedeficitssuchaspoorattentionanddecision-making,limitedself-regulation,impairedinformationprocessing,lowmotivation,aswellasanincreasedriskforantisocialbehavior,substanceuse,aggression,andcriminalactivity.Emergingstudiessuggestthattheseeffectsmaybemulti-generational.

• Alongitudinalstudyoftheeffectsofchildhoodleadexposureonlong-termoutcomesfindsthatleadexposureinearlychildhoodisassociatedwithbrainvolumelossinadulthoodinregionsresponsibleforexecutivefunctioning,finemotorcontrol,andbehavioralregulation.Thisisparticularlytrueformen,whichmayexplainthehigherincidenceofantisocialbehaviorsamongmenthanwomen.

• Overall,thesefindingssupporttheargumentthatchildrenandadultswithahistoryofleadexposurehavelong-term,potentiallyirreversiblelearning,behavioral,andsocialdifficulties,andrequireintensiveandongoingsupport.



BenefitsofMindfulness-BasedPractices

Mindfulnessgenerallyreferstoa“qualityofconsciousness”(Brown&Ryan,2003). Researchshows that mindfulness-oriented practices may enhance ourwellbeing by grounding ourmindsand bodies in the presentmoment, allowing us toexaminecarefullythethoughts,feelings,sensations,andbeliefsthatinfluenceour experience(Davis&Hayes,2011;Kabat-Zinn,1990).Astateofmindfulnesscreates discriminantawareness,anabilitytoconsideralternativeexplanations,strategies,and responses to life’s circumstances rather than reactingmindlessly.This capacity can beparticularlybeneficialwhenwearenegotiatingdifficultorstressfulterraininourlives,ourrelationshipsandourcommunities.MindfulnessResearch Althoughtheword“mind”isemphasizedinthewordmindfulness,mindfulnessrepresentsaholisticstateordispositionthatincludesthemindandbody.Thismaybeonereasonwhycontemplativescientists findthatmindfulness-orientedpracticesyield bothphysicalandpsychologicalbenefits.Emergingresearchshowsthatmindfulnesspractices likemeditationandyogamay help to reduce the impactof stress-relatedconditions, lessendepressionandanxiety,amelioratedepressive relapse, alleviatepain,improvequalityoflife,attenuateHIVprogression,andincreaseemotion regulationand subjectivewell-being (e.g.Baer,2003; Brown,Ryan,&Crewsell,2007;Cherkinetal.,2016;Chisea&Serretti,2009;Creswelletal., 2016;Davis&Hayes,2011;Goyaletal.,2014;Grossmanetal.,2004;Khouryetal.,2013; Khouryetal.,2015;Pascoe&Bauer,2015). Alargebodyofevidencealsodocuments theefficacyofmindfulness-basedpsychotherapeuticinterventionsinthetreatmentofdepression(Hofmannetal.,2010;Segaletal.,2010;Teasdaleetal.,2000),anxiety(Goldin&Gross,2010;Hofmannetal.,2010),eatingdisorders(Tapperetal.,2009),andchronic pain(Grossmanetal.,2007).Thismaybedue,inpart,topositivechangesinautonomic nervoussystem(ANS)functioning,includingtheregulationofheartrateandrespiration(Goyaletal.,2014;Streeteretal.,2010,2012;Tellesetal.,2013),aswellaschanges inbrain regionsassociatedwithattention, self-regulation, self-control, focusedproblem-solving,adaptivebehavioralcoping,interoception,inadditiontoenhancedmemory, reduced emotionalinterference, and increased cognitive efficiency (Lazar et al., 2005;Gardetal.,2014;Vago&Silbersweig,2012;seeBoccia,Piccardi,&Guariglia,2015, forareview).MeditationandBrain-RelatedChange During the past several decades, contemplative neuroscientists have explored howmindfulnesspractices likemeditationmayalterbrain structureandconnectivity,and enhancementalfunction(e.g.Breweretal.,2011;Creswelletal.,2016;Hölzeletal.,2010, 2011a;Jha,Krompinger,&Baine,2007;Lazaretal.,2005;Tang,Hölzel,&Posner,2015). Usingbrain-imagingtechniqueslikeEEG (Davidsonetal.,2003),andfMRI(Farbetal.,2010;Lazaretal.,2005;Lutzetal.,2008) researchershavediscoveredthatexperiencedmeditatorsshowincreasedvolumeandactivationintheprefrontalcortex(PFC),aregionlargelyresponsibleforjudgment,decision-making,andplanning (Lazaretal.,2005).IncreasedactivityinthePFCislinkedtoprosocialbehaviorsuch asempathy,compassion,andkindness. ThePFCisparticularly susceptibletostress(Arnstein1999,2009).Evenmildlyacute,uncontrollable stresscanleadtoadramaticdeclineinprefrontalcognitiveabilities,andprolongedstresscanresultinalterationstothePFC’sneuralpathways.ThismaybeonepossibleexplanationwhyindividualswithleadexposureearlyinlifeshowstructuralchangestothePFCinadulthood(Ceciletal.,



2008).Assuch,enhancingPFCvolumeandactivationmayservetobuffertheeffectsofstressandtheneurotoxiceffectsoflead,andincreasecognitive capacitiesessentialforlifelongflourishing. Researchalsoshowsarelationshipbetweensustainedmeditationpracticeandchangeintheanteriorcingulatecortex(ACC) andmid-cingulatecortex(MCC).Collectively,theACCandMCCareimplicatedin self-regulation: the capacity to purposefully direct attention, control impulses,behavethoughtfullyandintentionally,engageinfocusedproblem-solving,andenact adaptivebehavioralresponsesunderchallengingconditions.Peoplewithdamageto theACCtendtobeaggressive,impulsive,rigidintheirthinking,andpersistinusingineffectiveproblem-solvingstrategiesevenwhentheydon’twork. A2014systematic reviewandmeta-analysisofpublishedneuroimaging studiesof meditatorsfoundthatthosepracticingmeditationshoweddifferentialactivationinthe ACCandMCC(Foxetal.,2014).Specifically,meditatorsdevelopedincreasedACCand MCC functionality,whichmay augment self-regulation, attention,learning,memory, and self-awareness.Indeed,astudyof16adultsfollowinganeight-weekmindfulness-basedstress reduction(MBSR)coursedemonstratedincreasesingraymatterinthebrainregionsassociatedwithperspective-taking,emotionregulation,learning,memory,andself-referentialprocessing.Participantsalsoreportedfeelinglessstress(Hölzeletal.,2011a). Meditation isalsothoughttobeassociatedwithchanges in the limbicsystem–theregionofthebrainthatprocessesemotion(Hölzeletal.,2010;Desbordesetal.,2012).Thelimbicsystem,whichincludesthe amygdala,isparticularlysusceptibletostress.Stress-inducedchangestotheamygdalaarethoughttobeassociatedwithlong-termdeficitsincognitive performance,increasedemotional–reactivity,aswellaspathologicallevelsofanxiety.Earlystudiespointtochangesinamygdalafunctionandvolumefollowingmeditationtraining.Forinstance,onestudyfoundthataslittleaseightweeksofmindful attentiontrainingorcognitively-basedcompassiontrainingresultedindecreasesin rightamygdalaactivation(Desbordesetal.,2012).InalongitudinalMRIstudyinvestigatingtheassociationbetweenchangesinperceivedstressandchangesinamygdala graymatterdensity,participantsreportedsignificantlylessperceivedstressfollowing eightweeksofmindfulness-basedstressreductiontraining.Inaddition,changesin perceivedstresscorrelatedsignificantlywithdecreasedrightbasolateralamygdala graymatterdensity.Themoreperceivedstresswasreduced,thelessgraymatterdensityintherightamygdala(Hölzeletal.,2010).Thisimpliesthatregularmeditationmaydirectlysafeguardagainsttheimpactofstress,and increaseemotionalresilience. Thedefaultmodenetwork(DMN),thepartofthebrainassociatedwithmindwandering,isanotherstructurethatappearstobeimpactedbymeditationpractice(Brewer etal.,2011;Garrisonetal.,2015;Jangetal.,2011;Tomasinoetal.,2013).TheDMNis represented by anumber of highly interconnected structures including the posterior cingulatecortex(PCC),dorsolateral(dlPFC)andmedialprefrontalcortex(mPFC),angulargyrus,precuneus,andhippocampus.TheDMNisassociatedwiththreeprimary functions:self-referencing,thinkingaboutothers,andrecallingthepastandanticipatingfutureevents.Researchshowsthatthisnetworkisvulnerabletofearandstress,and may play an important role in depression, chronic pain,schizophrenia, autism spectrumdisorders,andAlzheimer’sdisease(Buckner,Andrews-Hanna,&Schacter,2008). TheDMNisincreasinglygainingattentionbecauseofitsroleinsocialinformationprocessing. AhighlyactiveDMNmaybeamarkerofperseverativerumination,ahallmarkofanxietydisordersanddepression.Inonestudy,JudsonBrewer,DirectorofResearchatthe CenterforMindfulnessattheUniversityofMassachusetts,foundthattheDMNwas “relativelydeactivated”inexperienced



meditators,suggestingthatmeditationmay helptoreducemindwanderingandpossiblyrumination(Breweretal.,2011). J.DavidCreswellandcolleaguesatCarnegieMellonUniversityexaminedtherelationshipbetweentheDMNandphysiologicalstressmarkersinahighlystressed populationofjob-seekingadults(Creswelletal.,2009).Thirty-fiveparticipantswererandomlyassignedtoanintensive,3-day,residentialmindfulnessmeditationretreatorarelaxationretreat.Restingbrainscansandbloodtestsweretakenimmediatelybeforeandaftertheintervention,andbloodwasagaindrawnatafour-month follow-up.Post-interventionscansshowedincreasedrestingstatefunctionalconnectivityofregionsoftheDMNassociatedwithattentionandexecutivecontrol(dlPFC) inthemeditationgrouponly.Themeditationgroupalsohadreducedinterleukin-6 levels,whichsuggestsanattenuated inflammatoryresponse.These findingsshow thatmeditationmayenhanceexecutivecontrolandstressregulation,inadditiontoaffectingstress-relatedhealthindicatorslikeinflammation.Furthermore,ameta-analysis ofneuroimagingstudies that includeddata from24experiments foundconsistent evidencethatmeditationisassociatedwithchangesinexecutiveattentionfunction, includingfunctionalalterationsinthedefaultmodenetwork(Tomasinoetal.,2013). Neurobiologicalchangeshavealsobeendetectedfollowingregularyogapractice(Streeteretal.,2010,2012).Ina2010study,Dr.ChrisStreeterandcolleaguesrandomlyassignedadultparticipantstoeitherayogainterventionor anactivewalkinggroup.Bothyogaandwalkinggroupmembersparticipatedinthree 60-minutesessionsperweekfor12weeks.Greaterimprovementsinself-reportedmood andanxietyratingswerefoundintheyogagroupcomparedtothewalkinggroupfollowingtheintervention.Yogaparticipantsalsoshowedapositivecorrelationamongimproved mood,decreasedanxiety,andincreasedthalamicGABAlevels(Streeteretal.,2010). Oneof themostpromisingand impactfulbenefitsofmindfulnesspracticemay beinitsabilitytoreducestress.AccordingtotheWorldHealthOrganization,stresscostsAmericanbusinessesapproximately$300billionperyear,predominantly intheformofhigherhealthcarecosts,employeeabsence,andreducedproductivity. Areviewof25randomizedcontrolledtrialsexaminedthepublishedevidenceofthe effectsofbreathingexercises,yoga,meditation,andothermindfulnesspractices(or theircombination)onthesympatheticnervoussystemandhypothalamicpituitary adrenal(HPA)-axis,bothofwhicharewell-knownindicatorsofstress(Pascoe&Bauer,2015).Itincludedstudiesthatmeasuredstructuraland/orfunctionalbrainregions associatedwithstressandmoodregulation,aswellasotherphysiologicalindicators likeheartrate,bloodpressure,andcortisollevels.Mindfulnesspractices wereassociatedwithimprovedSNSandHPA-axisregulation,aswellas decreasedsymptomsofanxietyanddepressionacrossadiverserangeofparticipants. Similarly,areviewandmeta-analysisof7controlledandrandomizedcontrolled trialswhereMBSRwascomparedtootherformsoftreatmentinthereliefofstress andstress-relatedsymptomsinhealthyindividuals,foundthatMBSRparticipantsreportedreducedstressandfewersymptomsofruminativethinkingandanxiety,aswell asincreasedself-compassionandempathy(Chisea&Seretti,2009).SummaryMindfulness-basedprogramsandpracticesareknowntobeassociatedwithanumberofimportantbenefitsthatmaybeparticularlyrelevanttothosefacingtheimpactofleadexposureincluding:• Reducingphysiologicalandpsychologicalstressandrelatedsymptomsincludinganxiety.• Increasingcognitivefunctioningincludingenhancedattention,self-regulation,andexecutive

functioning.



• Amelioratingmentalandphysicalhealthand the impactof stress-relatedconditions. • Lesseningdepressionandanxiety,andreducingtheriskfordepressiverelapse.• Alleviatingpain.• Improvingqualityoflifeandsubjectivewellbeing.

Mindfulnessstudiesshowadirectassociationbetweenregularpracticeandchangesinbrainstructureandfunctionalconnectivityincluding:• Increasingvolumeandactivationoftheprefrontalcortex(PFC)-aregionnegativelyimpactedby

leadexposureandrelatedtoattention,decision-making,planning,andprosocialbehavior.• Enhancingfunctionalefficiencyoftheanteriorcingulatecortex(ACC).• Reducingamygdalaactivityanddensity,suggestingincreasesinemotionregulation,and

decreasesinemotionalreactivity.• Changingthedefaultmodenetwork(DMN),aPFCstructureimportantforexecutivecontrol

functions,socialinformationprocessing,self-referencing,andthinkingaboutothers.• Affectingneurobiologicalchangesrelatedtoimprovedmood,decreasedanxiety,anddecreased

aggression,antisocialbehavior,andsubstanceuse.Evidencealsosuggeststhatregularyogapracticeislinkedtoneurobiologicalchangesrelatedtoimprovedmoodandstressresilience,decreasedanxiety,aggression,antisocialbehavior,andsubstanceuse.



BenefitsofMindfulnessEducationinSchoolSettings

ThecommunitiesofGreaterFlinthavelongstruggledtoovercomealegacyofchallengingsocio-political,economic,andenvironmentalconditions.Poverty,unstablehousing,deficitsinnutrition,exercise,andsleep,racialdiscrimination,neighborhoodcrimeandviolence,andahostofotherfactorshavemadeitdifficultforchildren,families,andeducatorstoproviderearingandacademicenvironmentsthatpermitchildrentothrive.Compoundtheseissueswiththeveryrealprobabilityoftoxicleadexposure,andthescenarioismadeexponentiallyworse. Problemsrelatedtochildhoodstressandpsychologicalproblemshaveescalatedinrecentyears.Thismaybeduetothefactthatstressimpactsbrainstructuresinvolvedinbothcognitionandmentalhealth(Lupienetal.,2009).Schoolsprovidestable,safe,structuredenvironmentsthataredesignedtoscaffoldchilddevelopment.Althoughthefocushaslargelybeenonacademicachievement,youthinFlintschoolsarenowinevengreaterneedofprogramstosupportkeycompetenciesrelatedtosocioemotionallearning.Thesecompetencies,includingsustainedattention,present-focusedawareness,acceptance,self-awarenessandself-regulation,kindnessandcompassion,and,mostimportantly,stressresilience,arecornerstonesofmindfulnesseducation(Davidsonetal.,2012). A2012articlebyTheMindandLifeEducationResearchNetwork(MLERN)outlinestheprospectsandpotentialfunctionsofmindfulness-basedpracticesandmentaltraininginAmericaneducation(Davidsonetal.,2012). Thearticlesynthesizedresearchfromneuroscience,cognitivescience,developmentalpsychology,education,andcontemplativestudiestoadvocateforpracticessuchasmeditation,yoga,relaxation,andcompassiontrainingasessentialtoinculcatethedevelopmentskillsandsocioemotionalcompetenciesnecessaryforchildflourishing.Itsauthorsconcludedthatmindfulnesspracticesstrengthenacademicandpsychosocialqualities(e.g.focusedattention,self-regulatoryskills,andprosocialbehaviors)thatareessentialforbothacademicsuccessandlong-termpositiveadjustmentincludinghealth,financialstability,andeducationalattainment(Moffittetal.,2011). Studiesexaminingmindfulness-basedtrainingforschoolchildrenhavecontinuedtoproliferateinrecentyears,withfindingssuggestingbenefitsacrossmanydomainsofyouthfunctioning.A2016systemicreviewandmeta-analysisoftheexistingpublishedandunpublishedresearchexaminingtheimpactofmindfulness-basedtrainingsforelementary,middleschoolandhighschoolyouthsidentifiedsignificantimprovementsincognitiveperformance,resilience,stressreduction,andemotionalproblems.Theseprogramswerefoundtobewellaccepted,andweregenerallyimplementedwithfewdifficultiesoradverseeffects(Zenneretal.,2016).Student-CenteredProgramsPre-SchoolandElementarySchool Researchexaminingtheeffectsofmindfulnesspracticesonpreschoolandelementaryschoolchildrenhasfocusedontheireffectsonexecutivefunction,social-perspectivetaking,andself-care.Inonerandomizedcontrolledtrial,68preschoolchildrenwereassignedtoeithera12-week,mindfulness-basedKindnessCurriculumdeliveredinpublicschoolsoracontrolgroup.Childreninthemindfulnessgroupshowedgreaterimprovementsinsocialcompetence,andreceivedhigherreportcardgradesonmeasuresoflearning,social-emotionaldevelopment,andhealth.Conversely,controlgroupchildrendemonstratedincreasedselfishbehavior(Flooketal.,2015). Inanotherstudy,preschool-aged childrenwhowererandomlyassignedto5weeksofmindfulness-basedtrainingdemonstratedimprovementsinsustainedattentionandperspective-takingcomparedtocontrols(Johnsonetal.,2011).Astudyofsecondandthirdgradestudentswithpoor



executivefunctionfoundthat8weeksofmindfulness-basedtrainingwaslinkedtosignificant increasesinparentandteacherratingsofstudents’abilitiestodirect,sustain,andmonitortheir attention,comparedtocontrols(Flooketal.,2010).Similarstudiesinwhichyoungerchildrenreceivedmindfulness-basedtrainingfoundimprovementsinbehavioralmeasuresofselectiveattention,decreasedself-reportedanxiety,anddecreasedteacher-ratedattentionproblems,relativeto controls(Napoli,Krech&Holley,2005). Althoughevidenceregardingtheeffectivenessandsafetyofthesepracticesforchildrenisstilllimited,preliminaryresearchfindsthatdevelopmentally-appropriatemindfulnesspracticesarefeasible(Zelazo&Lyons,2012). Therealsomaybeanadvantagetoofferingmindfulnessskillstoyoungchildren,becauseofthe relativeplasticityoftheircognitiveandaffectiveneuralnetworks(Carlson,etal.,2013). MiddleandHighSchool Thereareanumberofstudiesassessingtheimpactofmindfulness-basededucationonadolescentfunctioning(Schonert-Reichl&Lawlor,2010).Onesuchstudyexaminedtheeffectsof10weeksofmindfulnesstrainingonstudents’social-emotionalwellbeingandsociallyresponsiblebehavior.Attheendoftraining,teachersratedstudentswhoreceivedmindfulnesseducationaslessaggressiveandlessoppositional,betterabletofocusattention,andmorelikelytoactprosociallytowardsotherscomparedtoteacherratingsofcontrolgroupstudents.School-basedYogaPrograms

Yogaisamindfulness-basedpracticethatemphasizesintegrationofthemind,body,andbreaththroughmovement,breathingexercises,guidedrelaxationandmeditation.Itisparticularlyimpactfulforchildrenandadolescentsbecauseitincorporatesphysicalactivitywiththeprinciplesofmindfulawareness.Overthepastdecade,anincreasingnumberofschoolshaveincorporatedyogaeducationintotheirregularorafter-schoolcurricula(Khalsa&Butzer,2016).Likewise,therehasbeenasharpincreaseinthenumberofstudiesdevotedtoexaminingtheeffectsofyogaprogramsonstudentandeducatorwellnessintheschools.

Researchalsoshowsthatschool-basedyogaprogramsmaysupportchildren’sdevelopmentofcompetenciesthatmayhavebeenalteredbyleadexposure.Arecentsystematicreviewof47peerreviewedscientificarticlesfoundthatparticipationinaschool-basedyogaprogramwasassociatedwithimprovementsacrossawidevarietyofstudentdomainsincludingstressreduction,mood,self-regulation,self-esteem,workingmemory,andpositivehealth,anddecreasesindepression,anxiety,aggression,psychologicalproblems,andalcoholuse.Severalstudiesalsoindicatedpositivechangesinstudentphysiologicaloutcomesincludingincreasedheartratevariability,decreasedcortisolconcentrationanddeclinesinphysiologicalstressreactivity,improvedrespiratorymuscleandabdominalstrength,andgreaterflexibility(Khalsa&Butzer,2016).Teacher-CenteredPrograms Teachersarekeypointsofcontactforchildrenandyouths,andhaveprovedtobeimportantbeneficiariesofmindfulnesseducation.Studiessuggestthatteacher-centeredmindfulness-basedinterventionsmaybeparticularlyimpactful,asmanyeducatorsexperiencehighlevelsofstress,andareofferedfewresourcestoenhancetheirresilience(Montgomery&Rupp,2005).Researchassessingtheeffectsofmindfulnesseducationforteacherssuggeststhatregularmindfulnesspracticemayenhancetheiremotional-andself-regulation,promotecognitiveflexibility,increaseself-efficacy,health,andsubjectivewell-being,andsupportteacher’sabilitytocreatenurturingrelationshipswithstudentsand



effectivelymanageclassroombehavior(Meiklejohnetal.,2012).Mindfulness-basedpracticesmayalsoreduceteacher’soccupationalstress,burnout,andemotionaldistress(Benn,Akiva,Arel&Roeser,2012;Kemenyetal.,2011;Roeseretal.,2013).

Althoughmostyogaprogramsinschoolsareofferedtostudents,severalhaveincludedteachersandschoolstaff.Inonestudyofastressmanagementprogramforschoolemployees,resultsshowedsignificantdecreasesinteachermentalandphysicalstressandincreasesincheerfulness,calmness,andcomfort(Nosaka&Okamura,2015).Astudyofmiddleschoolteachersnotedself-reportedincreasesinmindfulness,positivemood,classroommanagement,distresstolerance,andseveralphysicalindicatorsofstressfollowingabrief,dailyintervention(Harrisetal.,2016).Anotherstudyfoundatrendtowardloweredperceivedstressandemotionalexhaustionamongeducators(Ancona&Mendelson,2014).Ingeneral,studiesshowthatmindfulness-basedpracticeslikemeditation,yoga,breathexercises,andguidedrelaxationarefeasibleandbeneficialforbothstudentsandteachers.SummaryAlthoughmindfulness-basedprogrammaticresearchinschoolsisemerging,initialstudiesshowthatprogramsforstudentsandteachersyieldnumerousbenefitsincluding:• Increasingstressresilienceandstressreduction.• Improvingself-regulation,emotionmodulation,andsubjectivewellbeing.• Enhancingattention,academicsuccess,andcognitiveperformance.• Decreasinganxiety,moodproblems,andantisocialbehavior.• Enhancingprosocialbehavior.• Lesseningteacherstressandburnout,andamplifyingteacherhealthandwellbeing.



Crim'sStrengthofPositioning

TheCrimFitnessFoundationisdedicatedtocreatingaviableandvibrantcommunitybyofferingprogramsthatfocusonhealthandwellbeing.TheorganizationisuniquelypositionedtobenefittheFlintcommunitybecauseofahighdegreeofcommunitytrust,areputationbuiltonproviding40yearsofexceptionalservicetoschoolsthroughoutGeneseeCounty,andoveradecadeofofferingsuccessfulphysicalactivity,nutritionand,morerecently,mindfulnessprogrammingtoFlintCommunitySchools.IntheadventoftheFlintWaterCrisis,leadinghealthexperts,includingDr.MonaHanna-Attisha,haveindicatedthattheseprogramsandservicesmaybecrucialinmitigatingtheeffectsoftheWaterCrisisandcommunityleadexposure.

MindfulnessprogrammingiscentraltoCrim’sprogrammaticoutreach.Asnotedpreviously,mindfulnessskillsholdpromiseforincreasingkeycognitive,behavioral,andsocialcompetenciesthatarelikelymostaffectedbyleadexposure.CrimintendstocontinueitsworkwiththecommunitytoexpanditsmindfulnesstrainingforchildreninFlintCommunitySchoolsandtheGeneseeIndependentSchoolDistrict,increaseeducationandsupportforteachers,andraisecommunityawarenessofthebenefitsofmindfulnesspractices,particularlyinthecontextofstressresiliency.

Crim'sschool-basedMindfulnessInitiativeisalreadyyieldingbeneficialresults.Preliminarydataexaminingtheoutcomesofarandomizedpilotstudyof8weeksofmindfulnesseducationfor4thand5thgradestudentssuggeststhatchildreninthemindfulnesseducationgroupreportedhigherlevelsofmindfulnessatprogramcompletionaftercontrollingforbaselinemindfulnessscores(Diltz,Clevenger,Florida,Barkman,Sellers&Pfeiffer,2016).Further,oneoftheschools’teachersreported,"Wenoticedamarkeddifferenceinstudentswhopracticedmindfulness.Theydidmorework,atebetter,andwerehappier.Wehavehadfewerreferralstotheoffice,resultinginmoreinstructionaltimeandincreasedstudentachievement."Anothercommented,"Ourstudentshavealotofstressandtensionathome.Mindfulnessgivesthematooltousetodealwiththeirhomelife."

Conclusion

ThecitizensofFlintandtheoutlyingcommunities,aswellasschools,healthproviders,businesses,andcivicorganizationsarecopingwithanabundanceofnegativeconsequencesprecipitatedbytheleadcrisis.Businesseshavelostconsiderablerevenue,andindividualsandtheentitiesthatservethemhavebeentraumatizedbythepersistentrealityleadexposure,andtheongoingfearanduncertaintyaboutitslong-termconsequencesandresolution.Mindfulnesspractices,whichemphasizeempowerment,mayhelptomitigatesomeoftheseeffects.Indeed,byprovidingeducatorsandstudentswithpsychoemotionalandbehavioralsupport,wemaybeabletoallaysomeofthenegativeconsequencesofleadexposureandimpoverishmentthathaveplaguedFlintcitizensforgenerations.

Astheimpactsoftheleadcrisisemerge,enhancingthescopeanddepthofmindfulnesstrainingforstudents,educatorsandthecommunitywillbecomeevenmorecrucial.Sustainedandfrequentmindfulnesspracticewillhelpchildrenincreasetheirawarenessofothersinsocialsituations,andprovidetoolsforimpulsecontrol,andemotionandbehavioralregulation.Thiswillsupportthecultivationoflessstressfulclassroomenvironmentsthataremoreconducivetoacademicsuccess,socialemotionallearningandchildflourishing.

ThereisgreatdemandfromtheteachersandadministratorsoftheFlintCommunitySchoolsandGeneseeIndependentSchoolDistricttoexpandCrim'smindfulnessprogrammingtomeettheneedsofstudents,teachers,families,andthecommunityatlarge.AsFlintteachersarecontinually



facedwithpaycuts,layoffs,andworkingwithchildrenwhohavemanypreexistingemotional,physical,andenvironmentalissuesthatarebarrierstolearning,theyhaveevengreaterneedforsupport.ForGreaterFlint,theimpactoftheWaterCrisisisvastandcomplex.Thoseofusworkinginthecommunityrecognizethatmindfulnesseducationaddressesbutone,smallpieceofamultifacetedpuzzle.Butweareoptimisticthatthesestepswillenhanceresilience,strengthencognitiveandbehavioralcapacities,andpromotekindness,andcompassion,whichwillconsiderablybenefitthecommunityandtheregionduringthedecadesofhealingtocome.



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Footnote1TheCentersforDiseaseControlandPreventionguidelinesclassifybloodlevel(BLL)toxicityat10microgramsperdeciliterofleadorgreater.Theseguidelineshavebeenunderattack.StudiesbyDruceLanphear,MD,MPH,directoroftheCincinnatiChildren’sEnvironmentalHealthCenterattheCincinnatiChildren’sHospitalMedicalCenter,oneofthecountry’stoppediatricleadresearchers,findthatconsiderablysmallerlevelsoflead,lessthan10mg/dl,putchildrenatriskforcognitivedamage.StudiesconductedattheUniversityofRochesterSchoolofMedicine,andCornellUniversityalsofoundthatchildrenwithBLLsbelow



10mg/dlshowedintellectualimpairment,withtheamountofimpairmentbeingmorepronouncedatlowerlevels.

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