Product Details

Author Information

Corresponding Author
Reut Gruber
Douglas Mental Health University Institute
6875 LaSalle Boulevard
Bond Pavillion - Z-1139
Montreal, QC H4H1R3
Canada
p: 514-761-6131 x 3476
f: 514-762-3858
reut.gruber@douglas.mcgill.ca

Authors (listed in order of authorship):
Reut Gruber
Douglas Mental Health University Institute

James Stadnyk and Students
Harold Napper Elementary School (RSB)

Myra Kestler
Harold Napper Elementary School (RSB)

Deborah Angelus
Saint Lambert Elementary School (RSB)

Lana Bergmame
Douglas Mental Health University Institute

Paul Enros
Riverside School Board

Laura Fontil
Douglas Mental Health University Institute

Elizabeth Gillies-Poitras
Good Shepherd Elemenary School (RSB)

Cassandra Monette
Douglas Mental Health University Institute

Gail Somerville
Riverside School Board

Product Description and Application Narrative Submitted by Corresponding Author

What general topics does your product address?

Public Health

What specific topics does your product address?

Community health , Community-based education, Education, Health education , Community-based participatory research

Does your product focus on a specific population(s)?

Adolescents, Children

What methodological approaches were used in the development of your product, or are discussed in your product?

Community-academic partnership, Community-based participatory research , Focus group , Qualitative research, Quantitative research

What resource type(s) best describe(s) your product?

Training material

Application Narrative

1. Please provide a 1600 character abstract describing your product, its intended use and the audiences for which it would be appropriate.*

Product: The product is a film entitled "Sleep Squad: The Movie," which was developed by a class and their teacher, all of whom participated in “Sleep For Success” (SFS), a program designed to increase total sleep time and promote healthy sleep habits. This program is a joint initiative between a team of researchers from McGill University and a team of educators from the Riverside School Board (RSB) in Quebec, Canada. In this film, the students bring to life the characters of the program, a team of super heroes (“Sleep Squad”) struggling to live up to their potential while dealing with a lack of sleep. In a creative and fun way, the film highlights the importance of sleep and shows viewers the different lifestyle habits that can have a negative impact on healthy sleep hygiene.
Its use: The film can be used in several ways: 1) as an effective teaching tool in school education programs about sleep; 2) as an aid in health and science classes; 3) as a way to engage institutions in sleep education and; 4) as a tool to increase awareness of the importance of sleep in the general public.
Target audiences: Elementary school students, their teachers and parents; science teachers; decision and policy makers in schools, school-boards, and ministries or departments of health or education; and, the general public. We expect that watching this film will motivate the users to reflect on their sleep habits and to re-evaluate the priority that they give to sleep in their daily lives. It may also engage school decision-makers to integrate sleep education into their health curricula.

2. What are the goals of the product?

The ultimate goal of the "Sleep Squad" film is to increase awareness of the importance of sleep and to facilitate active dissemination and use of such information at the individual and institutional levels. The movie contributes to these goals by making the information exciting, relevant, and fun for all users.
The film will be used as a teaching tool in school education programs about sleep or as an aid in health and science classrooms in helping educate children about the importance of sleep. This will help motivate students and staff to reflect on their sleep habits and to re-evaluate the priority that they give to sleep in their daily lives, eventually changing their habits and making healthy night time habits an essential part of their lifestyles.
In order to inspire changes in children’s lifestyle and values it is critical to engage and collaborate with key stakeholders and decision makers in their environments, such as school administrators, teachers, policy makers in ministries or departments of health or education, and health care professionals. The "Sleep Squad" film will be used as an innovative and creative tool to increase the understanding of the importance of sleep and to engage key decision makers in the effort to disseminate this knowledge.
Upon watching this film, we expect that users will have a greater understanding of the benefits of sleep, will reflect on their own sleep habits, and will be motivated to make the necessary adjustments to establish or to facilitate healthy sleep habits. This will have a significant positive impact on youths’ daily functioning, health, and success.

3. Who are the intended audiences or expected users of the product?

Sleep Squad: The Movie is directed, first, to students and their families to facilitate understanding of the importance of sleep, as well as to encourage healthy sleep practices. Second, the movie is addressed to educators who are interested in discussing sleep, and in learning about sleep and the impact thereof on daily classroom functioning. Third, the movie is directed to healthcare professionals who wish to emphasize the importance of sleep. Finally, the movie targets key stakeholders (school principals, curriculum developers, and policymakers in Ministries or Departments of Health and Education). School personnel can use the movie to engage parents and teachers in sleep discussions, whereas policymakers can use the movie to inspire the creative development of sleep-friendly policies.

4. Please provide any special instructions for successful use of the product, if necessary. If your product has been previously published, please provide the appropriate citation below.

The movie can be successfully used in two ways. First, the movie can serve as a ‘standalone’ tool when it is sought to engage students and their families, educators, healthcare professionals, and decision-makers. The movie facilitates fruitful discussion of sleep, and the impact thereof, on the daily functioning of children. The original full-length version (20 min) is ideal for children, whereas an edited version (5 min) is more suitable when professionals and decision-makers are to be engaged. Second, the movie can be used as a component of a larger school-based health intervention program, such as Sleep for Success. The movie, thus, can complement pre-existing school interventions. A toolkit is provided, along with the movie, to facilitate its appropriate use.

5. Please describe how your product or the project that resulted in the product builds on a relevant field, discipline or prior work. You may cite the literature and provide a bibliography in the next question if appropriate.

A sizeable proportion of children sleep less than the recommended 9 hours [1]. A healthy amount of sleep is necessary for a healthy and productive lifestyle, whereas habitual sleep restriction is associated with adverse health effects (ie. sleepiness in children [2], poorer school performance, health, and emotional regulation).
School: Sleep restriction has negative effects on functions essential to academic success, including attention/response inhibition, memory, verbal creativity, problem solving and general cognitive abilities [3-4]. Cumulative sleep restriction has negative effects on cognitive performance [3,5-8], with evidence for an inverse relationship between sleep time and school performance [9].
Health: Changes in evening cortisol, increased sympathetic activation, decreased thyrotropin activity, and decreased glucose tolerance have been observed in individuals with restricted sleep [10]. In addition, changes in the timing of growth hormone secretory profiles, alterations in the immune response to vaccination [11], larger body mass index [12-13] and obesity[14] have been associated with sleep restriction.
Emotional Regulation: Sleep deprivation leads to increased stress and arousal, as well as to impairments in affective regulation[15].
Product: Cultural regulation of sleep patterns both encodes, and responds to, larger cultural values and social pressures. These include institutional demands, such as standardized school and work start times, as well as the need for certain sectors of society to function at specific hours. Acculturation to these broader cultural values and social demands begins in the sleep patterning of children. Poor fit between culturally normative bedtime practices and individual lifestyle may lead to sleep deprivation. Sleep restriction resulting from hectic, demanding, unbalanced lifestyles, pressure for academic success, participation in extra-curricular activities, and the low priority given to sleep, may significantly impair the health, learning, and well-being of youth. The goal of our partnership was to promote health and learning capacity among youth by extending and improving sleep. In order to achieve this goal, we developed Sleep for Success which is designed to increase total sleep and enhance individuals’ sleep habits. "Sleep Squad: The Movie" is an innovative and dynamic tool resulting from the program.

6. Please provide a bibliography for work cited above or in other parts of this application. Provide full references, in the order sited in the text (i.e. according to number order). .

1. Spilsbury JC, et al. Sleep Behavior in an Urban US Sample of School-aged Children. Arch Pediatr Adolesc Med., 2004;158:988-994.
2. Fallone, G, et al. How well do school-aged children comply with imposed sleep schedules at home? . Sleep 2002;25:739-745.
3. Sadeh, A, Gruber, R, and Raviv, A. The effects of sleep restriction/extension on school-age children: What a difference an hour makes? Child Development, 2003;74:444-455.
4. Touchette, É, et al. Associations Between Sleep Duration Patterns and Behavioral/Cognitive Functioning at School Entry. Sleep, 2007;30(9):1213-1219.
5. Dinges, DF, et al. Cumulative sleepiness, mood disturbance, and psychomotor vigilance performance decrements during a week of sleep restricted to 4–5 h per night. Sleep, 1997;20(4):267-277.
6. Peigneux P, Laureys S, and Fuchs S. Are spatial memories strengthened in the human hippocampus during slow wave sleep? Neuron 2004;44(3):535-45.
7. Wagner U, et al. Brief sleep after learning keeps emotional memories alive for years. Biol Psychiatry, 2006;60(7):788-90.
8. Drummond, S, et al. Altered brain response to verbal learning following sleep deprivation. Nature, 2000;403:655-657.
9. Gruber, R, Wiebe, ST, Wells, SA, Cassoff, J, Monson, E. Sleep and academic success: Mechanisms, empirical evidence, and interventional strategies, 2010;21:522-541.
10. Spiegel K, Leproult R, and Van Cauter E. Impact of sleep debt on metabolic and endocrine function. Lancet, 1999;354:1435-9.
11. Vgontzas AN, et al. Chronic systemic inflammation in overweight and obese adults. JAMA, 2000;283:2235.
12. Taheri S, et al. Short sleep duration is associated with reduced leptin, elevated ghrelin, and increased body mass index. PLoS Med., 2004;1:e62.
13. Gangwisch JE, et al. Inadequate sleep as a risk factor for obesity: analyses of the NHANES I. . Sleep, 2005;28:1289-96.
14. Spiegel K, et al. Brief communication: Sleep curtailment in healthy young men is associated with decreased leptin levels, elevated ghrelin levels, and increased hunger and appetite. Ann Intern Med 2004;141:846-850.
15. Dahl RE and Lewin DS. Pathways to adolescent health sleep regulation and behavior. J Adolesc Health, 2002;31(6 Suppl):175-84.

7. Please describe the project or body of work from which the submitted product developed. Describe the ways that community and academic/institutional expertise contributed to the project. Pay particular attention to demonstrating the quality or rigor of the work:

• For research-related work, describe (if relevant) study aims, design, sample, measurement instruments, and analysis and interpretation. Discuss how you verified the accuracy of your data.
• For education-related work, describe (if relevant) any needs assessment conducted, learning objectives, educational strategies incorporated, and evaluation of learning.
• For other types of work, discuss how the project was developed and reasons for the methodological choices made.

"Sleep Squad: The Movie" is a product of a larger body of work, the "Sleep for Success" (SFS) program.
Community and Academic/Institutional Contribution: SFS was developed, implemented, and evaluated using community-based participatory research, through a partnership between a team of 38 researchers, lead by Dr. Gruber of McGill University, and a team of educators led by Gail Sommerville, Director of Complementary Services, Riverside School Board (RSB).
Needs Assessment: Subcommittees were assigned to oversee needs assessment, activities development, implementation, and formative evaluation of SFS. Subcommittees conducted 12 focus group (each group consisting of 5-10 participants and two moderators) meetings and interviews with students (4), teachers (4), and parents (4) to define needs and priorities and develop activities to match needs and priorities defined by users. The goals of the focus groups were to learn barriers to healthy sleep habits and balanced lifestyles. In addition, a semi-structured interview was used to explore beliefs about, attitudes toward, and knowledge of, sleep, home decision-making processes regarding sleep habits, perceived barriers to change, and the enabling factors that might make sleep a priority. Results indicated that teachers felt that the majority of students lack sleep and, as a result, their daytime performance is compromised yet they did not teach about sleep in school. Parents reported similarly. Children shared that they did not learn about the importance of sleep at school, although they did hold some awareness of the importance of sleep. Based on these discussions, activities were developed to address their needs.
Learning Objectives:The objectives of the program, based on research findings and the focus groups, were to increase students’ total sleep duration, improve their academic performance and to integrate healthy daytime behaviours with good night time habits to produce balanced lifestyles.
Education Strategies: 1) Experiential learning; classroom materials are not lecture-based but rather consist of group projects and activities that allow students to develop their own ideas, integrate concepts highlighted in the program materials, and discuss the importance of their habits with peers; 2) diverse learning styles and critical and creative thought are encouraged; 3) developmentally appropriate material; 5) encouragement of parental involvement and role modelling; 6) curriculum-congruent activities. The goal was to create materials that can be easily integrated into conventional subjects, such as English, math, and science, in order to avoid adding increased work for teachers.
Methodology: The activities and methods of instructions integrated into the SFS program have been chosen in order to comply with the principles of effective health education and governmental Education Plan and to address needs expressed in focus groups.
Evaluation of Learning. Formative activities and self-evaluation tools allowed participating students and parents to assess their own healthy living goals. Each activity has an evaluation scheme allowing teachers to evaluate each student’s learning. Summative evaluation measures are in place to address the effectiveness of SFS in obtaining program objectives. Between 2010 and 2011, SFS was implemented and evaluated in 4 schools. To document any changes in children’s sleep knowledge, habits and daytime functioning, quantitative and qualitative assessments were carried out in 3 phases: 1) at baseline (pre-program), 2) during program (mid), and 3) post. Paired sample t-tests were used to compare the outcomes of sleep measures. Sleep duration was significantly longer and sleepiness and sleep onset delay decreased following implementation of the program. Scores on attention, anxious-depressed, somatic complaints, social problems were significantly better following the program. Program participants also demonstrated improved knowledge of sleep.

8. Please describe the process of developing the product, including the ways that community and academic/institutional expertise were integrated in the development of this product.

“Sleep Squad: The Movie” was developed in the spring of 2011 by an RSB teacher, Mr. Stadnyk, and his students, all of whom were exposed to the SFS program when they were in Grades 3 and 4 (thus in Cycle 2 of Quebec elementary schools). The elementary class took full initiative in developing this product. The movie documents their experience and understanding of the program, and a team of superheroes (the “Sleep Squad”) are creatively brought to life. The movie is both dynamic and engaging, and can be used to educate other communities about sleep. In a comic-style narrative, the “Sleep Squad” struggle to live up to their potential because of a lack of sleep. The barriers to proper sleep and the consequences of poor sleep are highlighted. Aspects of the program that the class found to be particularly important and engaging are also emphasized. The film elicited excitement from other teachers, decision-makers, and RSB administrators when screened early in 2011. A new school (97 children in five classes) was, thereby, encouraged to enter the SFS program.

9. Please discuss the significance and impact of your product. In your response, discuss ways your product has added to existing knowledge and benefited the community; ways others may have utilized your product; and any relevant evaluation data about impact, if available. If the impact of the product is not yet known, discuss its potential significance.

Significance & community benefit: Sleep education is, currently, relatively neglected. As such, effective means of communicating the importance of sleep in terms of child health and success are essential. “Sleep Squad: The Movie” helps to fill this knowledge gap. The movie is succinct, yet highly engaging and meaningful. It addresses important topics, including barriers to effective sleep and the development of healthy sleep habits, in an amusing, creative, and dynamic manner. Topics such as the impact of unhealthy dietary choices on sleep, the relationship between increased screen time (e.g., television and video gaming) and insufficient sleep, as well as the impact of insufficient sleep on daytime functioning, are covered. The movie is, thus, a practical and efficient sleep education tool for children, in addition to being creative and charmingly unpredictable. Overall, the product can serve to stimulate personal reflection and dialogue on sleep, the re-evaluation of sleep habits, as well as a broader interest in sleep education.
Community Feedback
The film was created by the community and elicited excitement from other teachers, decision makers, and administrators of the Riverside School Board who viewed it at a social gathering which was held at the Board at the beginning of the school year in 2011. The event in which the movie was presented, led to the participation of another school, with 97 children and 5 classes, in the "Sleep for Success" program.
Academic Audience Feedback
The movie has also been screened at three international conferences. Many pediatric sleep researchers and healthcare providers have asked that they might use the movie to disseminate sleep knowledge to teachers and communities. For example, at the sixth Annual Conference on Pediatric Sleep Medicine in October 2011, Dr. Gruber presented the movie to an audience of 123 professionals and recorded the following testimonials: “Great videos!”; “Very interesting video clips to illustrate how the program really works”; “Impressed by children’s comments and movies.”
Additionally, SFS was formally evaluated by 103 (83.4%) attendees. 97% to 99% age “agree” or “strongly agree” ratings in response to question related to the knowledge, preparedness and responsiveness of the presenter and the organization and quality of the presentation.

10. Please describe why you chose the presentation format you did.

The Sleep for Success program aims to disseminate research findings to key stakeholders: children, parents, and teachers. Vibrant, dynamic, and informative means to this end are necessary. ”Sleep Squad: The Movie” fulfills these criteria, stimulating necessary discussions about sleep among children, parents, and teachers. The film provides clear evidence of the students’ enjoyment of the SFS program, a critical aspect that we would like to communicate to decision-makers potentially interested in implementing it.

11. Please reflect on the strengths and limitations of your product. In what ways did community and academic/institutional collaborators provide feedback and how was such feedback used? Include relevant evaluation data about strengths and limitations if available.

Strengths:
1. Fun and brief, yet a rich source of information. The film combines on the one hand, a fun, engaging, and dynamic presentation format that makes it an attractive option for our target audiences. While the presentation format is dynamic and entertaining, the film is very thorough and covers a significant amount of critical information. In merely 20 minutes, the full version (as well as the 5 minute edited version) of the film covers a variety of key topics such as the impact of unhealthy dietary choices on sleep, the relationship between increased “screen time”and insufficient sleep, and the impact of insufficient sleep on daytime functioning.
2. Engaging and surprising. The creative and unpredictable nature of the movie elicits meaningful exchange of key information about sleep and its impact on daytime functioning, while demonstrating the excitement and enjoyment of the students that participated in its creation.
3. An easy tool for knowledge dissemination and diffusion. The presentation format is distributable internationally at no-cost, and can make a positive contribution to the effort to educate the public regarding the negative impact of sleep deprivation on children’s health and success.
Limitations:
1. Sustaining the impact of the film. While the video holds a wealth of knowledge about the importance of sleep, it must be emphasized that the film has a greater impact when employed in the context of a holistic school-based intervention such as SFS. When used as a ‘standalone’ tool, the movie may fail to trigger lasting behavioural changes. Ideally, the film would be a prelude to, or a component of. a more thorough sleep education program. When part of an existing program, watching the movie would be an effective way to facilitate meaningful discussion and self-reflection pertaining to individuals’ sleep habits and its impact on their daily lives.

12. Please describe ways that the project resulting in the product involved collaboration that embodied principles of mutual respect, shared work and shared credit. If different, describe ways that the product itself involved collaboration that embodied principles of mutual respect, shared work and shared credit. Have all collaborators on the product been notified of and approved submission of the product to CES4Health.info? If not, why not? Please indicate whether the project resulting in the product was approved by an Institutional Review Board (IRB) and/or community-based review mechanism, if applicable, and provide the name(s) of the IRB/mechanism.

Several steps have been taken to develop an equitable and transparent partnership between the RSB and the McGill/ABS Lab team. The guiding principles were: i) equal participation by all partners in all activities, ii) recognition that all partners have useful expertise, iii) recognition that community-based research is collaborative. The following steps were taken: 1. Establishment of a Community Action Board to oversee the partnership. The Community Action Board consists of the main stakeholders, including teachers, parents and students, as well as the director of complementary services of Riverside school board (Mrs. Gail Sommerville), representatives of schools (e.g., Enzo di Ioia, Elizabeth Gillies-Poitras), and a panel of experts in education, sleep, participatory research. The board has acted as an advisory committee to guide the team through the implementation of the program and the integration of the evaluation procedures. 2. Development of an effective organizational structure. The partnership have dual leadership involving academic and community partners. Subcommittees overseeing program development, evaluation and training development were assigned. A project coordinator is serving as a knowledge broker working closely with all partners, coordinating the development of activities, and developing effective means of communication with and amongst users and researchers. Board members select and prioritize mutually defined goals, and develop operating norms to facilitate equitable processes and procedures and to guide the partnership. 3. Empowering. The team of the RSB will have coached the research team in the design of educational material; the researchers have given workshops to demystify research. 4. Assessing the partnership. The Collaboration Experience Questionnaire, a 43-item survey that gathers information on individuals participating in collaborative community projects has been used to examine the ability of the collaborative group to work well together. If problems are being detected they are being addressed as needed. Scores on the Collaboration Factors Inventory (CFI) scale (Thomson et al., 2009), which measures the perspectives and needs of collaborators and identifies potential strengths or weaknesses of the partnership, have revealed that the members of the teams regarded the partnership as strong in open and frequent communications; in having concrete, attainable goals and objectives; and in mutual respect, understanding, and trust. Members of the partnership have expressed concerns regarding sufficient funds, staff, materials, and time. Collectively, the nature of the interactions between researchers and knowledge-users, sustained over 5 years, have been positive and productive, as indicated by the successful development and ongoing adoption and implementation of the SFS program in RSB.
All products give credit to all involved partners.
All collaborators have approved submission of the movie to CES4Health.info.
The SFS has been approved by the Institutional Review Boards (IRBs) of the Douglas Research Center and of the Riverside School Board.