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Intervention Summary

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Early HeartSmarts Program for Preschool Children

The Early HeartSmarts Program for Preschool Children is designed to facilitate the social, emotional, physical (i.e., motor skills), cognitive, and language development of children ages 3-6. The program is based on over a decade of research on the role that positive emotions play in the functioning of the body, brain, and nervous system and the subsequent positive impact of these emotions on cognitive development.

Teachers deliver the curriculum-based program, which is composed of 11 core lessons intended to help children recognize and better understand basic emotional states, self-regulate their emotions, strengthen their expression of positive feelings, improve peer relations, and develop problem-solving skills. Each lesson lasts 15-20 minutes and is delivered twice weekly, with different examples and responses incorporated into the lesson's second delivery. Lessons focus on the heart, both physically and symbolically, and lesson content is based on psychophysiological coherence (i.e., the facilitation of emotional self-regulation by making an intentional shift to a specific psychophysiological state), neurobiology, and heart-brain communications. Objectives of lesson activities include caring for others, ability to express the span of emotions, development of empathy, and cooperative play. A puppet (Bear Heart), heartbeat dance, stethoscopes, puzzles, singing and dancing, acting out of dramatic roles, photographs, and picture cards are used in the lessons.

Implementation of the program requires a teacher who has a preschool or primary school teaching certificate, license, or permit and a teaching assistant who supports lesson activities within the classroom.

The study reviewed for this summary was designed to assess the effectiveness of the intervention with preschool youth who were ethnic minorities and were of lower socioeconomic status.

Descriptive Information

Areas of Interest Mental health promotion
Outcomes Review Date: April 2012
1: Social and emotional development
2: Motor skills
3: Cognitive development
4: Language development
Outcome Categories Education
Social functioning
Ages 0-5 (Early childhood)
Genders Male
Female
Races/Ethnicities American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino
Native Hawaiian or other Pacific Islander
White
Race/ethnicity unspecified
Settings School
Geographic Locations Urban
Implementation History Since fall 2008, more than 500 schools in Arizona, California, Colorado, Florida, Hawaii, Illinois, Michigan, New Jersey, New Mexico, New York, Oregon, Utah, and Wisconsin have implemented the Early HeartSmarts Program for Preschool Children. The program also has been used in more than 30 classrooms in Great Britain, in more than 30 primary classrooms in Mexico, and in more than 70 kindergarten and preschool classrooms in Northern Ireland. The program has been delivered to an estimated 25,000 students worldwide.
NIH Funding/CER Studies Partially/fully funded by National Institutes of Health: No
Evaluated in comparative effectiveness research studies: No
Adaptations Program materials are available in Spanish.
Adverse Effects No adverse effects, concerns, or unintended consequences were identified by the developer.
IOM Prevention Categories Universal
Selective

Quality of Research
Review Date: April 2012

Documents Reviewed

The documents below were reviewed for Quality of Research. The research point of contact can provide information regarding the studies reviewed and the availability of additional materials, including those from more recent studies that may have been conducted.

Study 1

Bradley, R. T., Atkinson, M., Tomasino, D., Rees, R. A., & Galvin, P. (2009). Facilitating emotional self-regulation in preschool children: Efficacy of the Early HeartSmarts Program in promoting social, emotional, and cognitive development. Boulder, CA: Institute of HeartMath.

Supplementary Materials

Lambert, R. G. (n.d.). The Developmental Continuum Assessment System for ages 3 to 5: The assessment component of The Creative Curriculum for Preschool--Technical report. Charlotte: University of North Carolina. Retrieved from http://www.teachingstrategies.com/content/pageDocs/Dev_Continuum_Technical_Report.pdf

Outcomes

Outcome 1: Social and emotional development
Description of Measures This outcome was assessed with the 13-item social/emotional development dimension of The Creative Curriculum Assessment (TCCA). The 50-item TCCA measures a child's growth in four dimensions: social/emotional development, physical development, cognitive development, and language development. Items composing the social/emotional development dimension are organized into three categories: (1) sense of self (e.g., "demonstrates appropriate trust in adults," "stands up for rights"), (2) responsibility for self and others (e.g., "takes responsibility for own well-being," "follows classroom routines"), and (3) prosocial behavior (e.g., "plays well with other children," "uses thinking skills to resolve conflicts"). Teachers rate each item in regard to the child's development, using a 4-point scale ranging from 0 (behaviors that may indicate a developmental delay or skills that a child has not previously been exposed to) to 3 (complete mastery). Higher scores indicate better social and emotional development.
Key Findings Preschool students from 19 urban schools in Utah were assigned to the intervention group (3 schools), which received the Early HeartSmarts Program for Preschool Children in addition to regular classroom instruction, or the control group (16 schools), which received regular classroom instruction without the intervention. Assessments occurred at baseline (in October, at the beginning of the academic year), preintervention (in January, before the intervention was implemented), and "postintervention" (in April, 1 month before the end of the intervention). At the postintervention assessment, children in the intervention group had higher scores than children in the control group for the social/emotional development dimension (p < .001) and for the categories of sense of self (p < .001), responsibility for self and others (p < .001), and prosocial behavior (p < .001), after controlling for baseline and preintervention scores.
Studies Measuring Outcome Study 1
Study Designs Quasi-experimental
Quality of Research Rating 2.4 (0.0-4.0 scale)
Outcome 2: Motor skills
Description of Measures Motor skills of children were assessed with the 8-item physical development dimension of The Creative Curriculum Assessment (TCCA). The 50-item TCCA measures a child's growth in four dimensions: social/emotional development, physical development, cognitive development, and language development. Items composing the physical development dimension are organized into two categories: (1) gross motor (e.g., "shows balance while moving," "demonstrates throwing, kicking, and catching skills") and (2) fine motor (e.g., "coordinates eye-hand movement," "uses tools for writing and drawing"). Teachers rate each item in regard to the child's development, using a 4-point scale ranging from 0 (behaviors that may indicate a developmental delay or skills that a child has not previously been exposed to) to 3 (complete mastery). Higher scores indicate better motor skills.
Key Findings Preschool students from 19 urban schools in Utah were assigned to the intervention group (3 schools), which received the Early HeartSmarts Program for Preschool Children in addition to regular classroom instruction, or the control group (16 schools), which received regular classroom instruction without the intervention. Assessments occurred at baseline (in October, at the beginning of the academic year), preintervention (in January, before the intervention was implemented), and "postintervention" (in April, 1 month before the end of the intervention). At the postintervention assessment, children in the intervention group had higher scores than children in the control group for the physical development dimension (p < .001) and for the categories of gross motor (p < .01) and fine motor (p < .001), after controlling for baseline and preintervention scores.
Studies Measuring Outcome Study 1
Study Designs Quasi-experimental
Quality of Research Rating 2.4 (0.0-4.0 scale)
Outcome 3: Cognitive development
Description of Measures This outcome was assessed with the 16-item cognitive development dimension of The Creative Curriculum Assessment (TCCA). The 50-item TCCA measures a child's growth in four dimensions: social/emotional development, physical development, cognitive development, and language development. Items composing the cognitive development dimension are organized into three categories: (1) learning and problem solving (e.g., "approaches problems flexibly," "explores cause and effect"), (2) logical thinking (e.g., "classifies objects," "shows awareness of time concepts and sequence"), and (3) representation and symbolic thinking (e.g., "takes on pretend roles and situations," "makes believe with objects"). Teachers rate each item in regard to the child's development, using a 4-point scale ranging from 0 (behaviors that may indicate a developmental delay or skills that a child has not previously been exposed to) to 3 (complete mastery). Higher scores indicate better cognitive development.
Key Findings Preschool students from 19 urban schools in Utah were assigned to the intervention group (3 schools), which received the Early HeartSmarts Program for Preschool Children in addition to regular classroom instruction, or the control group (16 schools), which received regular classroom instruction without the intervention. Assessments occurred at baseline (in October, at the beginning of the academic year), preintervention (in January, before the intervention was implemented), and "postintervention" (in April, 1 month before the end of the intervention). At the postintervention assessment, children in the intervention group had higher scores than children in the control group for the cognitive development dimension (p < .01) and for the categories of learning and problem solving (p < .001), logical thinking (p < .05), and representation and symbolic thinking (p < .05), after controlling for baseline and preintervention scores.
Studies Measuring Outcome Study 1
Study Designs Quasi-experimental
Quality of Research Rating 2.4 (0.0-4.0 scale)
Outcome 4: Language development
Description of Measures This outcome was assessed with the 13-item language development dimension of The Creative Curriculum Assessment (TCCA). The 50-item TCCA measures a child's growth in four dimensions: social/emotional development, physical development, cognitive development, and language development. Items composing the language development dimension are organized into two categories: (1) listening and speaking (e.g., "hears and discriminates the sound of language," "asks questions") and (2) reading and writing (e.g., "enjoys and values reading," "uses emerging reading skills to make meaning from print"). Teachers rate each item in regard to the child's development, using a 4-point scale ranging from 0 (behaviors that may indicate a developmental delay or skills that a child has not previously been exposed to) to 3 (complete mastery). Higher scores indicate better language development.
Key Findings Preschool students from 19 urban schools in Utah were assigned to the intervention group (3 schools), which received the Early HeartSmarts Program for Preschool Children in addition to regular classroom instruction, or the control group (16 schools), which received regular classroom instruction without the intervention. Assessments occurred at baseline (in October, at the beginning of the academic year), preintervention (in January, before the intervention was implemented), and "postintervention" (in April, 1 month before the end of the intervention). At the postintervention assessment, children in the intervention group had higher scores than children in the control group for the language development dimension (p < .001) and for the categories of listening and speaking (p < .01) and reading and writing (p < .001), after controlling for baseline and preintervention scores.
Studies Measuring Outcome Study 1
Study Designs Quasi-experimental
Quality of Research Rating 2.4 (0.0-4.0 scale)

Study Populations

The following populations were identified in the studies reviewed for Quality of Research.

Study Age Gender Race/Ethnicity
Study 1 0-5 (Early childhood) 51% Female
49% Male
54% Hispanic or Latino
29% White
7% Race/ethnicity unspecified
5% Native Hawaiian or other Pacific Islander
3% Black or African American
2% Asian
1% American Indian or Alaska Native

Quality of Research Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the Quality of Research for an intervention's reported results using six criteria:

  1. Reliability of measures
  2. Validity of measures
  3. Intervention fidelity
  4. Missing data and attrition
  5. Potential confounding variables
  6. Appropriateness of analysis

For more information about these criteria and the meaning of the ratings, see Quality of Research.

Outcome Reliability
of Measures
Validity
of Measures
Fidelity Missing
Data/Attrition
Confounding
Variables
Data
Analysis
Overall
Rating
1: Social and emotional development 3.3 3.3 1.6 2.0 2.5 2.0 2.4
2: Motor skills 3.3 3.3 1.6 2.0 2.5 2.0 2.4
3: Cognitive development 3.3 3.3 1.6 2.0 2.5 2.0 2.4
4: Language development 3.3 3.3 1.6 2.0 2.5 2.0 2.4

Study Strengths

Internal consistency reliability for the TCCA outcome measurement instrument was high for the study sample at each of the three assessment points. The TCCA has face validity, and construct validity has been established by independent investigators and confirmed in the study by a factor analysis. Intervention teachers were trained and monitored by an early childhood specialist who was also a licensed HeartMath trainer with over 10 years of teacher training experience. To minimize an expected level of attrition in the target preschool population, the study included a school administration mandate that all participating preschoolers be interviewed with verification tracking of the number of preschoolers interviewed by each study teacher following assessments. Seventy-eight percent of the baseline study sample had complete data at all three assessment points, and statistical analysis confirmed no gender or racial bias in the final sample. The statistical modeling of the data was comprehensive in its attempt to adjust for pretest differences between groups in family socioeconomic status, ethnic composition, and class size and on all developmental progress subscales of the TCCA.

Study Weaknesses

Interrater reliability for the TCCA was not established in the study, and the subjective nature of the teacher TCCA ratings coupled with a large variance in teacher TCCA ratings weakened the instrument's validity in the absence of establishing agreement with other measures of student developmental progress (concurrent validity). Evidence of intervention fidelity was weak; no standardized fidelity measurement instrument was used. Intervention teachers were trained by one teacher who also observed delivery only five times during the year of the study; there was no other assessment of intervention teacher performance. Potential confounding factors included the use of a nonrandom design and no true postintervention outcome measurement, since the intervention was still being delivered at the time of the final assessment. Although addressed by the researchers, prior exposure of some teachers in the control group to HeartMath training and teacher rating bias on the TCCA cannot be ruled out as potential confounding variables. The statistical modeling of the data did not address the nesting of students within classrooms and schools. There was no apparent correction in the experimentwise alpha level for significant, between-group differences as recommended for the numerous statistical comparisons, and the absence of a power analysis makes it difficult to separate statistical from meaningful significance in outcome differences between groups.

Readiness for Dissemination
Review Date: April 2012

Materials Reviewed

The materials below were reviewed for Readiness for Dissemination. The implementation point of contact can provide information regarding implementation of the intervention and the availability of additional, updated, or new materials.

Early HeartSmarts Kit items:

  • Conducting a Formal Assessment [Resource list]
  • Early HeartSmarts Learning Checklist
  • Institute of HeartMath. (2008). Early HeartSmarts [Introductory program CD]. Boulder Creek, CA: Author.
  • Institute of HeartMath. (2008). Early HeartSmarts leader's guide ages 3-6. Boulder Creek, CA: Author.
  • Penn, A. (1993). The kissing hand. New York, NY: Scholastic.

Program Web site, http://store.heartmath.org/store/school-programs/Early-HeartSmarts-Ages-3-6

Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the intervention's Readiness for Dissemination using three criteria:

  1. Availability of implementation materials
  2. Availability of training and support resources
  3. Availability of quality assurance procedures

For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.

Implementation
Materials
Training and Support
Resources
Quality Assurance
Procedures
Overall
Rating
3.8 3.0 2.0 2.9

Dissemination Strengths

The high-quality implementation materials and resources are easy to use and appropriate for the intended audience. The leader's guide includes sample letters that teachers can send to students' homes to encourage parental reinforcement of the program. A PowerPoint presentation is available on CD to assist decisionmakers and implementers in quickly developing an overall understanding of the program. The clearly written implementation materials and the support offered by the developer contribute to the mastery of program delivery by new implementers. A list of resources is provided for developing formal assessment protocols to support quality assurance.

Dissemination Weaknesses

The optional training provides a general overview of the programs available through the developer and is not specific to this intervention. Although the developer provides coaching to new implementers, little information is provided in written or online materials about the accessibility and content of this support. No formal system is available to ensure adherence to the program model or to assess the quality of teacher practices.

Costs

The cost information below was provided by the developer. Although this cost information may have been updated by the developer since the time of review, it may not reflect the current costs or availability of items (including newly developed or discontinued items). The implementation point of contact can provide current information and discuss implementation requirements.

Item Description Cost Required by Developer
Early HeartSmarts Kit (includes leader's guide, introductory CD, The Kissing Hand [book], posters, resource list, and learning checklist) $179.95 each Yes
2-day, off-site implementation training $2,500 for up to 25 teachers No
Phone-, email-, or Webinar-based coaching and consultation Free No

Additional Information

The cost of the implementation training is $1,500 with the purchase of Early HeartSmarts Kits for participating teachers.

Replications

No replications were identified by the developer.

Contact Information

To learn more about implementation, contact:
Jeff Goelitz
(831) 338-8713
jgoelitz@heartmath.org

To learn more about research, contact:
Mike Atkinson
(831) 338-8735
mike@heartmath.org

Consider these Questions to Ask (PDF, 54KB) as you explore the possible use of this intervention.

Web Site(s):