The Push To Heal skateboarding program at Hull Services began in 2015 when Hull Services received community donations to create the Matt Banister Memorial Skatepark. The skateboarding program at Hull Services is unique because it incorporates psychoeducation using the Neurosequential Model of Therapeutics (NMT). The NMT is specifically designed to help youth affected by maltreatment. Since trauma stunts brain development in unique ways, unique approaches are required to heal the traumatized brain (Perry, 2009). The NMT is one of the only approaches that has empirical evidence to demonstrate its effectiveness among youth in foster care and adoptive care (Zarnegar et al., 2016). The NMT is not a therapy; it is an approach that integrates core principles of neurodevelopment and traumatology to inform work with children, families and the communities in which they live. The NMT approach, along with the vast majority of psychotherapy programs, are difficult to evaluate in this uniquely vulnerable population, which leads to a critical knowledge gap since evidence shows that youth in foster care do not respond to psychotherapies that are effective in the general population (Bellamy et al., 2010; Hambrick et al., 2016).
Children exposed to maltreatment have worse physical and mental health throughout their lifespan and are more prone to obesity and sedentary lifestyles (Copeland et al., 2018; Felitti et al., 1998; Flaherty et al., 2009). Participating in team sports and group activities partially protects against the negative effects of child maltreatment, likely through the combination of exercise and social bonding (Easterlin et al., 2019; Eime et al., 2013). Unfortunately, kids who experience maltreatment are less likely to participate in activities with other youth, including sports (Easterlin et al., 2019). There is a need to identify group sporting activities that are highly engaging to youth affected by child maltreatment to improve their long-term physical and mental health outcomes.
Skateboarding synergizes with the NMT since a core component of the NMT is increasing emotion regulation through rhythmic activation of the body’s sensory system and motor system (Perry, 2009), which occurs when learning to ride a skateboard and perform tricks. Indeed, there is also evidence that, among adolescents, combining psychotherapy with pleasurable physical activity enhances the beneficial effects of psychotherapy (Warner et al., 2014). Thus, Hull Services’ unique combination of skateboarding and the NMT is precisely calibrated to improve the mental and physical health of their clients who are impacted by child maltreatment.
Although there is anecdotal evidence from Hull Services to suggest skateboarding has a positive impact on the mental health of youth, there is a lack of research to support this relationship. To build knowledge around the potential relationship between skateboarding and youth mental health, the purpose of this study was to evaluate the effectiveness of a pilot project at Hull Services that combined skateboarding and NMT for youth affected by maltreatment.
In total, eight youth participated in this study. Potential participants were identified through Hull Services staff. Emails were sent to potential participants by the research team in which the study was explained, eligibility requirements were confirmed, and the informed consent process began. Participants were given $70 for completing all assessments.
Participants attended six, 2-hour sessions, twice per week from July 20, 2021, to August 5, 2021. Each session began with 15 minutes of NMT content, followed by 90 minutes of skateboarding content, and ended with another 15 minutes of NMT content. Participants were provided with a skateboard and all safety equipment which they were allowed to keep once the intervention ended.
The NMT content was split into seven different lessons as follows:
The skateboarding content was split into seven different lessons as follows:
Demographic information was collected as part of the on-boarding process. Participants completed surveys pre-intervention, post-intervention, and at 2 and 3 month follow-ups. To assess any changes in physical activity, self-efficacy, emotion regulation, loneliness, and psychological distress, the following measures were utilized:
Participants completed one-on-one interviews pre-intervention, and focus groups post-intervention. The interviews and focus groups assessed mental health needs, knowledge and interest in skateboarding, and impact on social, physical, and mental wellbeing. Notes were taken during the interviews, while focus groups were recorded. Data was transcribed and NVivo was used to support a thematic analysis.
Demographics and household composition of participants are shown in Table 1. The program was successful in recruiting adolescents who have a history of mental health problems, many of whom also deal with socio-economic marginalization.
Table 1. Participant Demographics (n = 8)
Three broad themes were identified from the qualitative data: 1) skateboarding as a sense of freedom; 2) skateboarding as an activity to get them out of the house; and 3) a sense of building a community.
It is important to note that this study took place during COVID-19 which presented unique challenges such as adhering to physical distancing protocols, isolation protocols if someone became sick, and other challenges that may have impacted participants and their families. Overall, limitations noted by the research team included: 1) delivery and design of surveys; 2) collecting data through interviews and focus groups; 3) lack of data collected from staff, family, and/or caregivers; and 4) full evaluation of program efficacy.
The following recommendations align with the limitations noted in the previous section.
Delivery and Design of Surveys
Collecting Data Through Interviews and Focus Groups
Lack of Data Collected from Staff, Family and/or Caregivers
Rigorous Evaluation of Program Efficacy
Future research is warranted as the findings from this study support the anecdotal evidence from Hull Services that skateboarding may have a positive impact on youth mental health. Incorporating the recommendations into the next phase of piloting the Push To Heal program would allow for a deeper statistical analysis and understanding of the impact of the intervention from multiple perspectives for pushing this important work forward.