32 • PART i: A ModEl foR SElf-REgulATion And EngAgEMEnT
Tribole et al., 2013; Shoshani & Steinmetz, 2013). However, research is in the early stages;
much of the evidence is based on pilot studies or short-term controlled trials as opposed to
more rigorous, randomized trials. At the universal level, there is a significant need for higher
quality research with randomized controlled trials and assessment of long-term outcomes in
areas such as yoga and mindfulness (Serwacki & Cook-Cottone, 2012; Shoshani & Steinmetz,
2013). Social–emotional learning programs may be having a documented effect. Reviews of
available research related to universal programs have identified several key factors across
programs that are believed to play a role in student well-being at the universal level, including
the cultivation of positive emotions, gratitude, hope, goal setting, and development of char-
acter strengths (Shoshani & Steinmetz, 2013). Overall, research on SEL programs indicates
that they result in an increase in student well-being (Ashdown & Bernard, 2012; Durlak et al.,
2011). Benefits include increased emotional regulation, self-awareness, stress management,
relationship skills, social awareness, and an impact on learning (Ashdown & Bernard, 2012;
Durlak et al., 2011). These larger-scale, often school- and district-wide approaches provide a
foundational context for more specific programs that focus on healthy eating and physical
health promotion. Specific mindful and yoga protocols are reviewed throughout this book.
Tier 2: Approaches to facilitate Self-Regulation and intentional,
Reflective Engagement
Tier 2 approaches are intended to serve a smaller group of students who require increased
support to enhance the core programs at the Tier 1 level (Stoiber, 2014). Tier 2 programs
often target a specific risk group (e.g., students scoring low on state exams) or students
already showing risk factors (e.g., behavioral referrals) without manifesting full diagnostic
criteria (Cook-Cottone & Vujnovic, 2016).
Programs such as Girls Growing in Wellness and Balance: Yoga and Life Skills to Empower
(GGWB), which utilize yoga and a risk-reducing curriculum, can be used as a Tier 2
intervention for girls at risk for eating disorders. To participate, students may have been
identified by a school screening program, the child study team, peer report, teacher obser-
vation, or parent report. Once referred, the student is invited to take part in the Tier 2 inter-
vention. In this case, the student takes part in a 14-week program that integrates yoga,
relaxation, and specific psycho-educational lessons and activities designed to reduce eating
disorder risk factors and increase protective factors. The GGWB program has been found,
in controlled trials, to reduce body dissatisfaction, increase self-care, and decrease drive
for thinness (Cook-Cottone, Kane, Keddie, & Haugli, 2013; Scime & Cook-Cottone, 2008;
Serwacki & Cook-Cottone, 2012). However, for this program and other Tier 2 programs,
there is still much work needed before there is an evidence base built on randomized con-
trolled trials. Mindfulness and yoga programs that meet Tier 2 intervention criteria are
reviewed throughout this text along with current outcomes and the need for future research.
Tier 3: Assessing and Supporting Students in Self-Regulation
and intentional, Reflective Engagement
Once a student is showing symptoms of a disorder (e.g., anxiety, attention, substance use),
he or she should be considered for a Tier 3 level of intervention (Cook-Cottone & Vujnovic,
2016). Tier 3 is the highest level of intensity, designed to be individualized and strategically
aligned with the student’s individual needs (Stoiber, 2014). Further, Tier 3 approaches often