Stress Reduction in a High Stress Population: A Service-Learning Project

Psychology students delivered stress and coping workshops to homeless adolescent mothers as part of a college service-learning project. In this vulnerable and underserved population, stress reduction is critical. Service-learning was used as an avenue to enhance student learning and growth while helping meet this need in our community. The psychology students developed deeper learning, professional skills, and social awareness. The adolescent mothers developed stress reduction skills that they were able to successfully implement. Challenges and recommendations for the implementation of similar service-learning projects are discussed.


Non-Technical Summary
Students in a Health Psychology and Behavioral Medicine course completed an action teaching assignment for which they taught workshops on stress and coping to homeless pregnant and parenting teens in a temporary shelter.Students visited the shelter weekly for four weeks.The primary objective of the assignment was to develop two interactive workshops, one on stress research and one on coping research, which would be tailored to the needs of the residents.
The goal of the project was to deepen student learning about health psychology through the application of research findings and to help local women who were going through challenging times in their lives.

Course Content
Stress and coping theories are commonly taught in Health Psychology courses.Stress can be very harmful for mental and physical health, especially when stress is chronic (Kemeny, 2003;Segerstrom & Miller, 2004).Stress compromises many systems of the body, leading to higher likelihood of disease and shortened lifespan (Mathur et al., 2016;Segerstrom & Miller, 2004).However, coping effectively with stress can serve to reduce the likelihood of these adverse effects.The important role of stress and coping in the human experience warrants considerable course coverage in Health Psychology courses.
A popular technique for teaching stress and coping theories is to have students apply these theories to their own lives.According to Bloom's taxonomy, application of concepts leads to a higher level of learning compared to recall or explanation of concepts (Anderson et al., 2001).We used this strategy as a foundation to design a servicelearning project that could simultaneously increase interest in the subject matter, deepen learning, foster the development of social justice values, and help meet needs in our community.

Service-Learning
Service-learning integrates service projects within academic courses to enhance student learning, civic responsibility, and professional development, while simultaneously meeting organizational and community needs through meaningful service (Bringle, Hatcher, & McIntosh, 2006;Butin, 2005;Jacoby et al., 1996).Structured and rigorous course assignments connect content with service.Unlike other forms of active learning that take place in the classroom, service-learning is situated in the community through hands-on community problem-solving, which enriches students' understanding of course content.Unlike community service and volunteerism, the service is a graded assignment that provides students with an opportunity to understand contextual issues, apply new knowledge and skills, and receive support and feedback from classroom peers and their instructor.Integral to service-learning is reflection assignments that link the experience to the learning and vice versa.Dewey (1916) and Kolb (1984) emphasized the importance of experience in fostering student growth and the combination of that experience with reflective thinking to enhance understanding of course content.
The benefits of service-learning are numerous and have been well documented (Astin et al., 2000;Eyler & Giles, 1999).Application of course content to community needs can reveal the complexities of issues encountered in the course readings and create opportunities to compare the theoretical with the practical.Understanding is deepened and belief systems are challenged.According to the grant-funded Community Colleges Broadening Horizons through Service Learning project, which measured attainment of learning outcomes, service-learning provides "varied, unique, and sometimes unexpected opportunities for [students] to practice applying their newly acquired academic knowledge to complex real-world situations and problems" (Prentice & Robinson, 2010, p. 13).
A meta-analysis of 62 studies involving 11,837 students found a difference in five outcomes as a result of servicelearning compared to a controlled group.Service-learning improved attitudes toward self, attitudes toward school and learning, civic engagement, social skills, and academic performance (Celio, Durlak, & Dymnicki, 2011).Students can also develop work-ready skills, capacities to engage with people from diverse backgrounds, and a civic orientation.
In turn, students' work fills in gaps within community organizations created by scarcity of resources such as people, time, and knowledge.More broadly, campus-community partnerships address critical issues affecting the ability of nonprofits and communities to create a more just and equitable future and strengthen the public purpose of higher education.Researchers have found that as a result of service-learning, community residents learned to become advocates for positive change and develop specific skills to overcome roadblocks (e.g., Gerstenblatt, 2014).
Two types of service-learning are indirect service and direct service (Kaye, 2004).When performing indirect service, students apply their expertise to the development of a product that enhances the capacity and behind-the-scenes work of a partner organization.Examples include conducting water analysis and creating a report for an environmental non-profit in an analytical chemistry course, and developing a promotional campaign for a small business in a management course.When performing direct service, students work one-on-one with clients, students, residents, elders, and so forth to enhance individual growth and learning.Examples include leading literacy analysis for after-school program participants in an education literacy course and providing hospice care for comfort care homes in a nursing palliative care course.The current service-learning project can be considered direct service.

The Current Project
The service-learning project was administered within a Health Psychology and Behavioral Medicine course in two separate semesters.This undergraduate course had approximately 35 students enrolled each semester and took place at a small liberal arts college in the Northeast of the United States.The college is private and located in a suburban setting.It is relatively homogeneous with regard to race/ethnicity: During the semesters that the servicelearning project was administered, the undergraduate student body was 84% White.At the time of the project, approximately 81% of students received need-based financial aid.In this relatively homogeneous context, servicelearning provides students with a unique opportunity to interact with diverse populations and foster cultural understanding.
For this particular service-learning assignment, students applied course content by leading stress and coping workshops for homeless pregnant and parenting adolescent mothers in a local shelter.This population is particularly vulnerable to stress.Homeless adolescent mothers often encounter violence, poor mental and physical health, and lower social support (Silveira & Blay, 2010).Compared to housed adolescent mothers, homeless adolescent mothers are more likely to experience increased stress with regard to housing, finances, and their personal and social lives (Meadows-Oliver, Sadler, Swartz, & Ryan-Krause, 2007).Often, homeless youth have also experienced trauma during childhood (Smid, Bourgois, & Auerswald, 2010).Thus, this population would benefit greatly from learning about stress and coping skills.
All students enrolled in the psychology course learned about stress and coping through a combination of reading, lectures, and classroom activities.Although several perspectives on stress and coping were taught, the primary theoretical approach that was emphasized was the interactionist approach put forth by Lazarus and Folkman (1984).According to this theory, stress originates from an appraisal process that involves both the person and the environment.Because individuals can continually make reappraisals, they can cope by altering their demands and/or resources, thereby reducing their stress.This theory lends itself well to application because the person is an active agent in the experience of stress and coping.For example, a stressed person can learn and act upon the benefits of seeking social support (Martin & Brantley, 2004), increasing personal control (Dickerson & Kemeny, 2004), relaxation training (Jacobs, 2001), and so on.
After this phase of the course, all students were given the opportunity to apply for the service-learning project.
Students often pursue service-learning because of the opportunity to apply learning to practice, gain experience, and enhance understanding of a field of interest.Others are motivated by an altruistic desire to better their community (Muturi, An, & Mwangi, 2013).A range of 5-10 students applied each semester.The application included questions about their class year, interest, motivation, career goals, and experience with service learning.Because the workshop dates were set in advance, the application also enquired about availability during the workshop times.Because the maximum number of students for this project was four, four students were selected for each semester based on their responses to the application.Preference was given to students whose desired careers aligned with the project (e.g., social worker for underserved populations) and/or who might be an exceptionally good fit (e.g., a young student with a newborn).
The students' first task was to design a simple survey to ascertain the stressors and coping skills used by the residents.Each semester the survey was short -less than five items -and students were directed to include a mix of open-ended and Likert-style questions.The reading level of the survey was kept low, with a Flesch-Kincaid grade level below five.An example open-ended item states, "If you use coping strategies, what strategies do you use?Do you think those strategies helped you cope with stress?"Students were given license to create the items themselves; the only parameter on content was that the survey must include items that assessed current stressors and items that assessed types and frequency of coping skills.However, the instructor provided formative assessment feedback throughout the process to enhance the learning experience.The goals of the survey were threefold: First, it gave students hands-on experience with research methodology, which met learning objectives at both the course and psychology department levels.Second, it served as a pretest of residents to help students tailor their workshops to fit residents' needs.And third, it was administered as a post-test to gauge whether the workshops were effective in teaching life skills to the residents.
During their first visit to the shelter, the students prepared, served, and joined the residents in a meal.Approximately ten residents participated in this meal and the subsequent workshops.The primary purpose of this first visit was to gain familiarity with the residents and understand the challenges they faced.The students engaged the residents in conversations about stress and administered the survey to the residents.Stressors identified included finding housing, juggling responsibilities, negotiating difficult relationships, and providing a stable environment for their children.During the second visit, students offered a workshop on the effects of stress.Students discussed different types of stressors, appraisals of stress, and how stress affects physical, psychological, and social wellbeing.During the third visit, they offered a workshop on coping skills.This included a discussion of adaptive forms of coping, the benefits of social support, and specific stress management techniques such as meditation.When developing these workshops, students were directed to use a jigsaw approach (Aronson, Blaney, Stephan, Sikes, & Snapp, 1978); that is, each student was responsible for researching and leading their own portion of each workshop, but they ultimately worked together to present a comprehensive workshop.
The major requirement of the workshop content was that the material be grounded in scientific research.For example, one student presented on the difference between perceiving a stressor as a challenge versus a threat based on research she found (Moore, Vine, Wilson, & Freeman, 2012).Specifically, she described how perceiving a stressor as a challenge can increase performance as opposed to perceiving a stressor as a threat.Students were also encouraged to base the content on the needs of the residents, to include learning activities, and to be as engaging as possible.For instance, one student used a stressful parenting situation as an example during her part of a workshop after reading about residents' stressors on the surveys.Another student led the women through a progressive muscle relaxation exercise during her part of a workshop because of research she had found showing that the technique can successfully relieve tension and improve health (McCallie, Blum, & Hood, 2006).
In order for the instructor to assess student learning and provide feedback prior to the workshops, students completed detailed outlines of their portion of the workshop in advance.The detailed outlines included citations to research that supported the content.Students worked hard to make the content understandable, relevant, and useful for residents, and they thought deeply about how to translate academic course material into presentations designed for a non-academic audience.The outlines were reviewed by both the instructor and the community partner to ensure its adequacy for presentation.
After students led the workshops, they visited the shelter a fourth and final time to prepare, serve, and join the residents in another meal.During that visit, they conducted a debriefing of the experience and administered the post-test.Students talked with the residents about stress, coping, and whether the residents found the workshops to be helpful.Once the weekly visits to the shelter were over, students completed written reflections on the servicelearning project and an anonymous evaluation survey administered through the college's service-learning center.

Implementation
Although this action teaching assignment could be implemented across a wide range of high-stress populations, we determined that a homeless shelter was the ideal location for our particular setting.When assessing our community's needs, we identified a local shelter that would benefit from life skill workshops focused on stress that could be led by Health Psychology and Behavioral Medicine students.The age range of the adolescent mothers, who were typically within five years of the students, facilitated connections between the students and residents and fostered resident interest in pursuing a college education.However, specific aspects of this shelter dictated that the project be implemented by four students rather than the entire class.Thus, an optional service-learning component was integrated into the course and students who did not participate in the service-learning project were provided an alternate assignment.
Much of the groundwork for this project was completed prior to the start of the semester in order to ensure that both student learning goals and community needs were met.To accomplish mutual benefit, a framework for reciprocal community partnerships was used, informed by contributors to the field like Barbara Jacoby et al. (2003) and Randy Stoecker (2016).This framework entails hearing the voice of the community when identifying needs, creating a shared vision and set of common goals, and understanding the resources and capacity for meeting these goals.Achieving reciprocity also means students gain equally from the community interactions as the community gains from the students.This process also acknowledges the assets of the community -the clients and organization, and their capacity for self-sufficiency when provided the resources needed.When students see that their work adds value and that they are equipped with the skills and expertise to proceed, they are more likely to feel empowered to engage fully in the experience and work towards positive community outcomes.Specific practices that were put into place with this service-learning project included holding two pre-planning meetings with the community partners and creating a written project plan.The purpose of the meetings was to identify needs and areas of mutual benefit.The written plan that followed from those meetings included: (A) a description of the project, goals, and needs of the community partner; (B) student learning objectives; and (C) a timeline that included all dates, goals, and deliverables of each visit.The completed plan was then communicated and implemented by the course instructor, the students, and the community partner prior to the start of the project.
Written communication of shared expectations and desired outcomes was essential for a smooth roll-out.
To best prepare the four service-learning students, a comprehensive orientation was provided that included an overview of the organization's mission and its assets and challenges, a discussion of expectations and desired outcomes, and an introduction to staff and clients.Students were also shown an orientation video that overviewed principles of the college's service-learning program and expectations for professional behavior, followed by the signing of a student agreement form confirming their participation in the orientation.The syllabus contained a definition of service-learning, academic goals linked to the project, and project parameters and expectations.
Most of the students who participated in this project had never previously interacted with people in shelters.To support students and help reduce their nervousness, the course instructor attended the first two shelter visits.To increase student ownership of the project, the instructor did not attend the last two visits.The instructor also held planning meetings with the students on campus to check in with the students, review their outlines, and address questions and concerns.Some of these meetings were held outside of class at a prearranged time, and some of these meetings were held during class.To protect students' time, they were also given class time to work on their projects when the rest of the students in the course were working on their alternative assignments.
Students were assessed on both the professionalism of their performance and the quality of their work.Professionalism included such aspects as the quality of their behavior at the shelter and whether they successfully met deadlines.The instructor also communicated with the community partner to get feedback on student behavior.
The quality of the students' learning was assessed through the pre-and post-survey design, workshop content (outlines and workshop delivery), research citations, and the final semester reflection.A common service-learning program reflection was used that asked student perceptions regarding the effectiveness of applying course content to service and vice versa.The assignment also asked students to reflect on their personal and professional growth, and their civic and community understanding.Assessment within service-learning should focus on students' ability to meet course learning objectives and connect the service and course content.Students should be graded for their learning, not their hours (although hours could be included within the participation portion of the grade).
Because service-learning can be a departure from what students are accustomed to, it is important to supply clear grading criteria for the assignments.

Project Learning Objectives
Civic Engagement Learning Goals, developed by the college's service-learning center and guided by the Association of American Colleges & Universities (AACU) Civic Engagement VALUE rubric (AACU, 2017), were used to provide criteria for and support best practices of service-learning (see Appendix).Four of these goals in particular were used to shape the objectives and outcomes of this service-learning project.The first goal was intellectual engagement.This project was designed so students would gain knowledge of stress and coping theories through articles, lectures, and discussions in class.The second goal was application of knowledge: Students would apply course-generated knowledge and skills and develop solutions in order to address identified community issues.
The third goal was diversity and cultural understanding: Students would increase their awareness and sensitivity to the challenges faced by a diverse group of people in their community.The fourth goal was communication: Students would develop their oral and written communication skills through translating academic theory into meaningful dialogue with others.
Through meeting these objectives, the project met course goals and department goals, which align with the American Psychological Association (APA) student goals for undergraduate psychology education (APA, 2013).Specifically, "Goal 1 -Knowledge Base in Psychology" was met through students' active learning of the workshop content."Goal 2 -Scientific Inquiry and Critical Thinking" was met through having students engage with scientific research for the workshop content and through developing the items for the pre/post-test administered to residents.
"Goal 3 -Ethical and Social Responsibility in a Diverse World" was met through students' positive interactions with the residents, who were members of an underserved population."Goal 4 -Communication" was met through having students design and present the workshops as well as their written work.Finally, "Goal 5 -Professional Development" was met through students' teamwork and the application of their professional skills to a local organization.

Evidence of Effectiveness
This action teaching project was successful on all fronts in each of the two semesters.Post-tests and feedback from the community partner indicated that the project had a positive impact on the residents.There was no negative feedback about the project.On a scale of 1 (never) to 6 (several times a day), a comparison of residents' pretest and post-test surveys indicated that they were using coping techniques more frequently after the workshops had been implemented (M = 4.38, SD = 1.33) as compared to before (M = 3.00, SD = 1.08), t(24) = 2.92, p = .007,d = 1.14.Residents' written responses indicated that they were using coping strategies that the students had taught, such as meditation and seeking social support.At the last session, many residents stated that were excited to have successfully used the techniques they learned, and overall their reports of the experience were favorable.
The student learning objectives for this action teaching project were assessed primarily through the students' detailed outlines, written reflections, and an anonymous survey used within the college's service-learning program called the Civic Engagement Student Impact Assessment.The following evidence suggests that the primary learning objectives were met: (1) On the anonymous survey, all students marked that they "strongly agreed" or "agreed" with each item related to academic learning, problem solving, civil awareness, and service learning.See Table 1 for the means and standard deviations of each item.Note.Responses ranged from 1 (Strongly Disagree) to 5 (Strongly Agree).Two items were omitted from Table 1 because they were not included on the assessment across both semesters.
(2) Student comments on the experience were overwhelmingly positive.Here are representative comments: • "I entered this service learning with a biased view because of… different television shows that show teen pregnancy.However, after meeting with the girls and learning their stories I completely changed my view.I learned that I should not judge someone based on his or her circumstances." • "I realized from this experience that others who may seem different from me really aren't → social awareness." • "[The workshops] helped me to create meaning from the course content.I never realized there were so many studies supporting different coping mechanisms." • "Personally, after this experience I feel like I have developed a better sense of maturity, leadership, and organization." • "I am thankful for the opportunity to participate… and I hope that the girls learned as much from me as I did from them." (3) Service-learning students (M = 88.56,SD = 9.56) marginally outscored their classmates (M = 83.03,SD = 10.86) on an exam that included the material they had presented in the workshops, t(66) = 1.37, p = .18,d = 0.54.

Stress Reduction Service-Learning 470
While the unequal group sizes (n = 8 vs. n = 60) made the t-test underpowered, the medium effect size underscores the difference in exam scores.Notably, they did not score higher on the exams with other content (e.g., health behavior theory, chronic illnesses, food psychology).On the second exam, the service-learning students (M = 88.00,SD = 10.35)scored equivalently to their classmates (M = 88.12,SD = 14.40), t(67) = 0.02, p = .98,d < 0.01; likewise, on the third exam the service-learning students (M = 81.81,SD = 12.11) scored equivalently to their classmates (M = 82.67,SD = 11.14),t(67) = 0.20, p = .84,d = 0.07.Overall, the difference in exam performance on only the relevant exam suggests that the project resulted in better learning of the stress and coping content.

Additional Considerations
Although the project can be considered a success, there were challenges to the project's implementation.Because the shelter residents are transient, there was some inconsistent participation by the young mothers.While some residents attended the full four weeks, others entered the experience halfway through or did not finish.This created some difficulties in forming trusting relationships and resulted in some disruption in the process and delivery of the content.Students learned how to be flexible in meeting the needs of the women that were in attendance by adapting the content when needed.In general, having only four weekly visits resulted in very little time to build trusting relationships.This is an important consideration in light of the socioeconomic, racial/ethnic, and general lifestyle gaps between the residents and the students.Thus, it may be helpful to increase the number of site visits per week.Because of the transient nature of the shelter, extending the timeline of the project is not advised in this setting.
Moreover, because the course was focused on stress and less so on cultural competencies, students came into the experience relatively ill-equipped to create sensitive, meaningful dialogue.Although there were positive results in both semesters that the service-learning project was implemented, future implementations would benefit from incorporating cultural competency training to help avoid potential issues that could arise.Cultural competency can be integrated into the curriculum in a number of ways.First, culture explains the unique ways we all think, communicate, and apply our values to our actions (Cress, Collier, & Reitenauer, 2005).Our cultural identity is the lens through which we perceive others.Integrating an understanding of cultural identity and worldview would enable the students to better understand themselves and others and the factors that influence their perceptions of others.
Introducing students to the concept of cultural humility (Guskin, 1991) would also encourage them to respect the validity of others' cultures and consider that diverse perspectives and worldviews are equally valid.Reducing fear of the unknown and increasing awareness of perceptual influences can facilitate the development of meaningful relationships.In addition, specific skills can be introduced into the course such as empathic listening which involves listening to understand and responding non-judgmentally.
An additional strategy is to capitalize on the content already present within many health psychology courses that directly addresses group differences.In the curriculum for this health psychology course, for example, students explore multiple expressions of identity such as gender, race, and ethnicity and the influence these identities have on numerous facets of health.In relation to stress and coping specifically, students learn that stress is often higher for those within marginalized groups.Students can thus be guided to consider in what ways the life skills workshops can empower, reduce isolation, and increase access to power for those in marginalized groups.While not a specific goal for the course, ethical integrity was maintained in this project through the use of best practices of service-learning and adequate preparation of students.Service-learning is a commitment to both the community needs and learning needs of students.Using this framework of reciprocity can prevent institutions of higher education from adopting a charity or "savior" approach, which reinforces inequities and disparities.Moreover, a comprehensive orientation can be given which includes an introduction to the organization's mission and its assets and challenges, a discussion of agency expectations, professional code of conduct, desired outcomes, training on cultural communication and professional behavior, and introductions to staff and clients.At the conclusion of students' orientation, they were asked to sign a Student Agreement Form which affirmed their rights and responsibilities.These expectations and standards form an ethical code of conduct for students and faculty (for more information see Chapdelaine, Ruiz, Warchal, & Wells, 2005).
Another challenge was the potential for students to become overwhelmed with all of the dates and deadlines of the project.Students had to juggle the dates of the workshops, time to meet with one another, and deadlines for the instructor to review the workshop content along with other course demands.To address these issues, the instructor met with students and provided them with a detailed timeline that was organized to maximize visual ease.Additionally, creating clear expectations for regular communication, and then following through with mid-semester check-ins, proved to be vital to the project's success.The instructor recognized that communication with the service site could be used to identify gaps between the service-learning project plan, what the students report, and what is actually occurring.While site visits can be time intensive, student observations and on-site communication with community supervisors can provide a wealth of information.Another communication strategy is to appoint one student per group to serve as "the communication leader" whose job is to bring questions or concerns to the community partner and instructor.
Although the number of student participants was limited to four at the request of the shelter, this small number ended up benefiting the instructor when it was implemented for the first time.Having only a small group of students complete the project as an optional assignment, the instructor entered the service-learning arena with a small and manageable project and achievable goals.Similarly, instructors new to service-learning can choose smallscale projects and seek out support on their campus when needed.Instructors can also adopt a mindset that hands-on, action-oriented learning requires persistence, patience, and flexibility.While changes may occur with the schedule or community partner staffing, student (and instructor) frustrations can be turned into teachable moments that are equally valuable.
Seeing tremendous student growth has led us to consider variations of this project that can accommodate participation of larger groups.One potential strategy is staggering multiple student groups across the semester.Because the shelter visits occur over a four-week period, at least three student groups could lead workshops over a single semester.Overlap of residents between each of the groups would be unlikely given the transient nature of homeless shelters.One consideration to keep in mind is the specified gender of residents at homeless shelters.
Administrators of shelters may prefer a gender match between students and residents.With the current servicelearning project, only students who identified as women applied for the experience, so this issue was not a problem, but it could easily have prevented men from an educational opportunity in a different situation.Another strategy would be to partner with more than one homeless shelter or with different organizations that hold regular group meetings for high-stress populations (such as those with chronic illnesses) so that projects could be administered at different sites simultaneously without gender restrictions.

Conclusions
This service-learning project led to positive outcomes for both the psychology students and the homeless adolescent mothers.Offering stress and coping workshops to these women fulfilled multiple learning objectives while simultaneously serving an underserved population in our community.For the students, the project fostered enriched learning, professional development, and social justice values.It helped bridge a gap between groups that may not have otherwise interacted with one another, cultivating a greater understanding of our community's needs and broadening worldviews.For the mothers, the project fostered the development of stress reduction skills, helping meet a critical need in this population.Thus, this action teaching project resulted in significant benefit for all involved.

Table 1
Means and Standard Deviations of Civic Engagement Student Impact AssessmentWriting assignments, discussions, and/or exercises helped me to reflect on my SL and create connections between SL and the academic coursework.