Here is an idea for a non-profit that has been banging around in my cavernous skull. While I think many of the problems that afflict people who live in poverty are systemic, the presence of stress can exacerbate and amplify particular situations. Providing stress relief and teaching coping skills, I believe, can help people to deal with their problems with more cognizance and more cogently.
I. Problem Formulation: The Presence of Stress
Stress is a complex interaction between the mind, body and the external environment that begins with the release of adrenaline and Cortisol in the brain which raises blood sugar levels as part of the fight-or-flight mechanism. As such, stress is a natural reaction of the body to its environment that has worked historically to protect us from danger.
But in a more complex environment, such as the contemporary world, potential fight-or-flight triggers are ubiquitous. According to Brad Lichtenstein, dangers lurk around every bend. “Twenty-four/seven access to information,” he says, “long work hours, traffic jams, tough marriages, errant kids…even seemingly innocuous aspects of our lives are stressors.” The response in our society is often chronic, nearly omnipresent, stress. “You produce so much Cortisol that your adrenal glands – the factories that produce and regulate our stress hormones – poop out,” says Lichtenstein. “The result? Constant fatigue, emotional chaos and decreased immunity” (Foltz-Gray).
To put it another way, a biological reaction meant for a more primitive environment operates on overload, and the negative effects are numerous, including diminished immune systems, significantly increased rates of aging (as evidenced by the study of telomeres) and deterioration of the cardiovascular system as well as the potential for developing newfound mental health and behavioral issues. (Foltz-Gray)
People who live in poverty (particularly children) are more vulnerable to the consequences of stress for two reasons: they have more stressors that combine to affect their lives more significantly, and they do not have the resources to develop appropriate ways to cope or relieve symptoms. Karen Seccombe lists stress as a primary pathway from poverty to adverse child outcomes, and finds that stress manifests in “adult depression, parental conflict, less social support, child abuse/neglect, and child depression/behavioral problems” (66). Stress acts both as a depressant and a suppressant; it both further depresses those who are living in adverse circumstances, as well as exacerbating situations in a way that prevents pathways out of poverty.
As a fight-or-flight mechanism, stress can lead adults to maladjusted ways of coping that have reifying consequences for their children, which show up as domestic violence, child abuse or neglect (less parental investment and response), more television and less positive stimulation, fewer educational opportunities and success in school, less exercise, poor nutrition and diet, and methods of flight such as alcohol and drug addiction (Evans, G.W, and Kim, P, 2013). Studies suggest that children in poverty cultivate chronic stress that follows them into adulthood, which includes physical ramifications, such as the development of asthma, which is common in impoverished neighborhoods (Evans and Kim). Other research strongly indicates that poorly-managed stress is not only passed on to one’s children, but can lead to addiction, terminal disease and premature death. (Mate, G.)
II. Program Objectives: Health and Vitality
A common assumption may be that changing the conditions of poverty, such as substantial stressors like homelessness, violence in the home, unemployment, food insecurity and other factors that contribute to poverty may of itself alleviate stress. Common sense would indicate that on a pragmatic level, satisfying basic needs may or may not relieve stress but all that it really does is alleviate apparent need; there is no indication that it will alleviate stress. Sufferers of Post-Traumatic Stress Disorder (PTSD), for example, continue to struggle with intense stress and anxiety when they are removed from the traumatic stressors that have impacted them, even decades later. Unlearning maladjusted coping mechanisms to deal with stressors involves more than meeting basic needs, and these mechanisms may continue to contribute to poverty in the future, particularly if one relies upon fight or flight mechanisms such as violence, criminal activity or drug and alcohol abuse in order to cope with stress.
Stress is also ubiquitous among all social classes, so while meeting basic needs is an imperative, a more pertinent and immediate solution to dealing with stress is to provide resources that contribute to optimal health and vitality, even amid difficult or adverse circumstances. An assumption that implementing appropriate methods for managing stress and encouraging people to maximize the health of their bodies, minds and environments inasmuch as possible with whatever resources are available to them is central to the concept of optimal health and vitality.
Our nonprofit stress reduction center serves the purpose of helping people who are living in adverse circumstances to optimize their health and vitality in regard to the impact of stress in their lives through a three-pronged practical and educative approach. First, participants are educated in direct and proven methods for coping with stress, primarily by way of mindfulness techniques. The medical model developed by Jon Kabat-Zinn has been shown in studies to be effective in significantly helping people suffering from terminal illnesses to cope with pain and other medical symptoms, as well as people suffering from anxiety disorders (Zinn, et al)). Secondly, as part of the program ways to achieve cardiovascular exercise through aerobics as well as other possible physical activities are explored, and participants are encouraged to develop a regimen suited to their specific physical needs. Thirdly, nutritional education is made available to participants on ways to maximize physical health by eating appropriate foods, and learning how to resist bad foods, within a sometimes severely limited budget.
The main objective of the program is to teach people who live in any circumstance, including people who live in poverty, healthy methods for coping that energize rather than enervate, and that lead to problem solving rather than fight-or-flight responses, the latter of which often exacerbate problematic situations. Experiencing less stress may result in less domestic violence, less addiction, more parental responsiveness to children, fewer incidences of disease (such as asthma), less hopelessness, less shame and depression, more optimism, more energy and more creativity as individuals begin to redress their own circumstances without as much anxiety, and with more determination, confidence and ambition.
III. Modes of Implementation: Education and Practice
A participant at the non-profit stress reduction center most often comes on a volunteer basis, but she may be referred through another agency, such as DHS or through the advisement of a case worker from another program or organization. Other methods of advertisement occasionally include paid ads, as well as community involvement through teaching relaxation and mindfulness methods for free on an occasional basis in the schools or in work environments, as well as other venues. Books and literature published by the organization also help to propagate knowledge about its existence both to generate interest among those who want to take advantage of the program, as well as among potential donors.
Learning how to manage stress requires some level of volition. Initial intake consists of a class educating participants about stress and the role it plays in their lives, followed by one-on-one meetings with participants facilitated by staff trained in motivational interviewing in order to assess and encourage further participation in the program. General information about exercise and nutrition is provided during intake as well. Brief follow-up meetings are organized by class instructors throughout the tenure of the participant’s progress through the program.
The emphasis of the program, however, is to provide methods of coping through mindfulness and relaxation techniques that are not reliant upon a social support system in order to succeed. A typical mindfulness class usually lasts for about six to eight weeks, two times a week, and includes the option of taking home books and audio recordings to assist in practicing at home. Classes are organized to accommodate the time needs of participants as well, and ongoing drop-in classes are also available at the facility. Other techniques for centering and stress management are sometimes implemented on a case by case basis for people who find it difficult to apprehend the material.
Lastly, the program serves to augment therapies for some participants who are concurrently in mental health counseling through another agency for other related issues, such as those who are addicted to substance abuse, for example, or others who are referred to the program due to anxiety disorders or other mental health issues. Likewise, when fitting, some participants are encouraged to seek additional support through other agencies for related assistance.
IV. Program Evaluation: Outcomes
Three methods are used to evaluate the stress reduction program: public hearings, program measures and theoretical evaluation.
a) Public hearings. Published reports, both formal and informal, highlight the successes of the program and how it has been shown to help participants manage stress, helping them to cope in the adverse conditions of poverty. Participants who have made progress in managing stress are showcased for the public, which is advantageous in advertising the efficacy of the program. On the negative side, this form of evaluation does not address inefficiencies well, or aspects of the program that might not be functioning as well as they should.
b) Program measures. During initial intake, participants are given stress tests that measure levels of stress. Upon completing of a class, as well as at other milestones, test scores indicate whether or not stress has been alleviated. Tests are administered for follow-up for some participants six months later, and a year later. The stress test can show whether or not those who complete the program experience less stress, but it cannot show definitely whether or not the decrease is due to the content of mindfulness practice, coupled with exercise and nutritional counseling.
c) Theoretical evaluation. The assumption is that a decreased level of stress leads to increased optimal health, and therefore revitalizes one’s capacity for coping and problem-solving in a way that avoids maladjusted methods of coping. A theoretical evaluation compares the correlation between levels of stress and one’s economic condition, as well as other factors related to poverty, upon entry into the program, then compares it again five years after completing the program through hypothesis testing in order to see if there is a positive correlation between stress reduction and various outcomes related to poverty. Hypothesis testing can show whether or not there is a correlation between graduating from the program and experiencing an economic shift, as well as comparing other outcomes, within a certain level of confidence, while accounting for numerous other, often arbitrary outliers that may play a role in perpetuating poverty or even making conditions worse (such as, for instance, a sudden death of a loved one, a disabling injury, an unexpected job loss, etc.). The problem with this method, however, is that it is time-consuming and costly, and requires numerous statistical studies which necessitate using other agencies to come to the best results. Moreover, while we can see positive trends that keep us motivated, it takes a long time to come to conclusions.