Why does the hospital need so many hats? Why are so many children sick? What more can I do to help? I can stay healthy, but can I learn more about how the social determinants of health are causing us to be sick. Now that I understand the connections between the social, physical and economic environment and health, I can work with my teachers to help me guide my studies towards initiatives that interest me.
Research in Social Cognitive Theory shows the importance of an Arc of Effort to build initiative in youth. GHP is a 25 session event that engages hospital outreach efforts to motivate and sustain youth engagement. This action clearly adds value to hospital mission to improve the health of their communities. Engaging youth to be a supplier of a highly valued therapeutic resource allows health professionals regular access into groups of highly caring and responsive underserved youth. As committed partners, health mentors, and role models, hospitals can achieve progress in the important area of population health.
As regional youth share their support with sick children, their parents, and hospital staff, it is something youth own. As they progress through the 25 workshops, they build initiative and the capacity to organize, configure, set-up and run community wide workshops building their confidence and sharing awareness of the scale of children's health issues. These efforts bring both joy and healing into the sometimes emotionally charged circumstances deep within hospital treatment units while, at the same time, serve as the platform for hospitals to share their brain trust through encouragement and by delivering prevention and health information to youth.
Preliminary Research Background A preliminary qualitative pilot study was conducted to provide qualitative evaluation data about the Glories Happy HATS Program at the New Beginnings Program, Northern Virginia Juvenile Detention Center. The New Beginnings' Post-Dispositional Program is a secure, co-educational, community-based program that is designed to provide secure confinement for adolescents ages 14-17. Although the Post-Dispositional Program is a part of the Northern Virginia Juvenile Detention Center, its mission and philosophy are somewhat different. Youth entering this program have clearly stated objectives that must be attained to if they are to successfully complete the program. The programs provided include care custody, educational, medical, recreational, casework, emergency psychiatric intervention, life skills and various other volunteer programs. The program provides troubled youth with an opportunity to be successful once they leave the program. The program is based on the belief that delinquent behavior can be changed and that our youth can learn behaviors that are beneficial in their environment. Methods Nine students participated in the pilot study; eight were male, and one was female. The subjects ranged in age from 13 to 18 years old. Glories Happy HATS placed a HATS Headquarters® unit in the conference room at the Northern Virginia Juvenile Detention Center for students who were preparing to be released. Volunteers ran the ten session project. The study participants set-up an assembly line, and practiced teamwork and positive communication throughout the activity. They made fifty Glories Happy Hats, which they delivered to hospitalized children at the Georgetown Lombardi Hospital Pediatric Department, Washington, DC, and the Inova Fairfax Hospital for Children, Fairfax, Virginia. After each delivery of hats, participating students were asked to write an essay describing their feelings about the experience. The essays were analyzed to provide a preliminary evaluation concerning the influences of the GHH program on students’ perceptions about themselves, their empathy for others, their realization that they have something positive to contribute to their community, and their perceptions that they could make a difference in the lives of others. Results The following essays were written by the study participants that suggest positive and sometimes powerful influences of participation in the GHH program on these students:
Essay 1 (Male, 17 years old). Today we went to the hospital to deliver the kids their hats. It made me feel good when we saw the smile on the kids faces. It made me feel like I made a big difference in someone’s life. It felt good to me that all of our hard work made paid off. At first when we started the hats, to be honest with myself, I didn’t really see any point in the hats except community service. Then, today, when we delivered the hats and I saw the faces of the kids; I was, like man, we really did something productive to help these kids. I’m so happy that I could make a difference in someone’s life; it encourages me to make one in my own. It helps me to be thankful for the things I already have, even the small things. After going there you can’t help but to be thankful for good health and just leading a normal life. I hope I can go through life helping people and making someone’s day a little better. Essay 2 (Male, 17 years old). Today’s trip to the hospital was a very beautiful experience. When we first arrived, I was a little nervous because I really didn’t know what to expect. It was actually a lot better that I thought it would be. I know that they (kids) are not doing the best but I thought it was going to be much worse. What I imagined I was going to see turned out to be different. I was expecting to see kids with bald heads or hooked up to all different respirators. I thought they were going to see needles in their bodies. But overall I really enjoyed myself and I had a really good time. My best moment was when I walked in the room with a newly born baby. It was probably at least one or two months old. But to see a baby that young having to experience all of that at an early age, it’s devastating to see. But I hope that we do this again. I hope that it is really soon. It makes me feel good to see all of my hard work go to kids who really appreciate it. But most importantly, I hope that every single person in that facility gets better. Essay 3 (Male, 18 years old). This trip was a very fun trip and meant a lot to me. It was very sad to see all of those sick kids just sitting in their rooms looking so helpless. It made me think like my problems ain’t nothing compared to them. Every time I think of my problems, I’m just going to think of them. It was kids in there three months old just hooked up to monitors it was just sad. It felt good to see the smile on the kid’s faces when we gave the hats. When we got there everybody was talking about how some people were going to cry but we had to suck it up so we ain’t put them down. One of the most amazing parts was when the nurses and doctors was getting the hats. That trip was just a wonderful experience. I really appreciated that trip.
Essay 4 (Male, 15 years old). I really enjoyed the trip. I’m not saying I enjoy looking at kids in the hospital. I really felt like crying when I saw the girl that looked like my friends daughter. I got really sad because the girl was crying. I don’t ever want to see little kids cry. It makes me upset, but I liked it because I felt good doing something more that would help them get better. I wish I could do something more that would help them get better. This got me thinking about me. I used to joke around with (friend’s name) and them. Now, after thinking, I know I need to stop so I can get back to my family. That’s why I enjoyed this trip. I got to do something for the sick kids and did some good thinking. Essay 5 (Male, 14 years old). I think our “Happy Hats” trip went very good. I can’t think of one thing that went wrong. I also think it was the second saddest thing I’ve ever seen. I was so sad, I can’t lie. I got a little emotional but it didn’t come out. My favorite was a little girl we delivered to. She was about 5 or 6 and cute as ever. She didn’t even look sick, she looked so shy. She also has a pretty smile, she made me so happy when she smiled and waved good-bye to us. This was a real good trip because now I know I can help young kids and make them smile. If I could, I would come back for another trip. Thank you for everything that you did to make this trip a good trip. Essay 6 (Male, 15 years old). Today has been a very rewarding day for me. After working really hard on the happy hats for the kids, we were finally able to deliver them personally. I was very happy to see the faces of the little kids when I gave them a hat. They were truly happy when they received a hat and it genuinely moved me. I hope to deliver more hats again before I leave the program. Essay 7 (Female, 16 years old). I really enjoyed the field trip. It’s like now that I look at it, I am so thankful that I wake up everyday and that I am healthy. I am also very proud of myself and feel good that I did hats for other people. I am happy that I could support people with just making hats. I am very happy and thank God that my family is okay and have no problems. It was very sad. It made me think of how I would handle it if it was me or if my family was in a situation like that. It’s hard and painful how people at such a young age can have cancer that can kill them with out even enjoying the young “hood” or teenage years and won’t be able to. Essay 8 (Male, 16 years old). This New Beginnings Happy HATS delivery was a very intense experience. I had extreme conflicting emotions such as: elation, sadness, awe, and deep questionability to existence. I became very pensive and began to challenge my mindset in life. I kept saying in my head, “They don’t deserve this.” I am very hesitant to use the word “enjoy” to describe the experience. It is something that I deeply wanted to do, but again, the conflicting floods of emotion leave me at somewhat of a loss. I feel splinters of guilt lodged deep in my mind, as I have taken much advantage of the things in life I took for granted. Knowing, hearing, reading, or talking about the sorrows and existence of these children does not compare to the experience.
Essay 9 (Male, 18 years old). My experience on the trip was a good one. To give them kids in there something to smile about and to have their day center around it felt good inside even through they weren’t in the best condition they made me feel good just to give them the hat and explain about them that brightens up my day and I am always crying about being locked up and they got it worse than me. Essay 10 (gender unknown, 14 years old). Happy HATS has been the most exciting thing for me since I’ve been in the Post-D program. Happy hats have been a joy to me. It puts a smile on my face when I’m feeling down. To tell you the truth, I think Happy Hats is for more than the sick kids in the hospital. It is also for the people who are making the hats. Happy hats will always be there for the sick kids and healthy when they are down. Essay 11 (gender unknown, 16 years old). I had fun giving all those little sick kids hats. I was surprised to see all those big kids in there. When I first thought about who we were giving the hats to I thought about sick little kids. I didn’t realize that 18 year-olds were there too. At first, as we entered the first room, I was a little nervous. Then I started getting used to it. I had a BLAST. I can’t wait to do it again. PS. Next time we do go, bring bigger hats and make different boy and girl designs and sizes for babies. Essay 12 (gender unknown, 18 years old). I think Happy hats is one of the best ways to give back to the community. Kids that are sick in the hospital need things and people like happy hats to make the kids feel better. Making Happy hats for sick kids for me is one of the best ideas anybody can think of. When I make a happy hat I let the kids know that someone other than their family cares about them and how they feel. I think that happy hats should continue their project so more and more kids can have happy thoughts when they are stuck in the hospital and need something to brighten their stay. Essay 13 (gender unknown, 17 years old). Dear Happy Hats: I am writing this letter to let all of you know how I feel about this project. I feel that “happy hats” is a good project that puts a smile on sick kids. I remember first when we started doing this [project] I really didn’t care about it, but after a while I started to take it serious and now I think that I like Happy Hats more that anybody else here. I feel sad after our visitation to the hospital. I can’t see little kids sick, it makes me remember when I had a car accident and I was in there for like 7 or 8 months and saw my grandmother next to my bed with her eyes red because she didn’t want to leave me alone. I think happy hats is a good project for me because it’s going to keep me out of trouble after I leave this program because I still know I am going to participate. I don’t know where, but I am going to find a place where I can go and do hats for sick kids in the hospitals. Thank you to all of you for coming to this place all of us together are going to make a better world and we will continue to put smiles on these sick kids. Essay 14 (gender unknown, age unknown). When I first stepped in the hospital, I felt like it was about to be fun passing out Glories hats to sick kids… Then I got to see some of those kids and all of a sudden it wasn’t so fun anymore. I really didn’t like what I saw in that hospital but I had to put a smile on my face so that the patients wouldn’t get their spirits brought down. I couldn’t understand how they could live like that. It looks like they are always in pain just sitting there with all of those hypodermics in their arms and wires connected to them. It seems like they could never be comfortable. In some ways it’s kind of like being locked up because you can’t do what you want to do when you’re in their situation. It has to be really hard to see other people and know that you can’t do the things that they can do because you have an illness that will not allow you to do what other people do. I really got scared for a little boy who was about to finger paint. He had a scar from surgery on his head and it was kind of hard to look him in the face because he was so small; he couldn’t even talk yet. When I gave him his hat he smiled and I felt better instantly because I thought that there is so much that he has never seen or does not know about but to know that I made his day a whole lot better made my day even though I really didn’t want that a little boy be in that condition. We also gave a hat to a little Asian boy and he was so attached to his mom that he really couldn’t decide on a hat because he was making sure she didn’t get away from him. Essay 15 (Male, 18 years old). My experience in Happy HATS was a good experience. I had lots of fun giving the hats and painting the children’s hands and faces. The kids were enjoying the hats we made and that makes me work harder to give more hats. It’s very sad to see little kids sick. I felt sorry for their parents who go through this everything. Happy HATS is a good organization that helps kids feel better and helps them go through their problems. What makes Happy HATS different from others is that we put our feelings into it when we make the hats.
Discussion of Results This preliminary qualitative study suggests that participation in (even an abbreviated 10 session, versus 25 session) GHH positive youth development program had powerful influences on the self-images and community orientations of troubled youth. Analysis of the essays illustrates that participation in the GHH program spurred significant self-reflection by the program participants, increased their recognition that there are others (the seriously ill children) who are facing greater life challenges than they are facing, that they were able to (and actually did) help seriously ill children, and the GHH program experience encouraged them to consider seeking additional opportunities to help others. However, the results from this preliminary study do not provide a comprehensive evaluation of the GHH program. The preliminary study does not provide strong outcomes data concerning the influences of the program on participants’ levels of self-efficacy, their likelihood to adopt healthy behaviors, their abilities to resist serious health risks, and the influences on their educational and career success. The proposed experimental evaluation study is designed to generate additional rigorous quantitative data to build upon the results of the preliminary study and to address these important health and well-being related issues.
Susan Khorsand will serve as the GHH intervention project manager for this research program. Susan is the co-founder and Director of Glories Happy HATS. Since 1997 she has led the project and it’s development from designing the Glories hat pattern and having its functionality approved by staff at Children’s National Medical Center, Johns Hopkins and Inova Fairfax Hospital for Children to testing the assembly-process with adolescent groups in high-risk communities. After receiving the 1999 and 2000 DC Service Learning Project of the Year Award, the resulting interest required a program delivery design capable of meeting demand, both in the youth community and in hospitals. In 2001 Susan developed the HATS Headquarters® unit, a modular turn-key factory containing all the materials and tools necessary to construct 500 Glories hats. Susan tested this model in a grant from the US Army in five military posts with children of military personnel in support of children treated at Walter Reed Army Medical Center. At the same time, she directed youth in the DC Region through a weekly service-learning project incorporating service, soft-skills, and workforce readiness. She accompanied participating youth to local hospital’s to deliver the hats to sick children at Inova Fairfax Hospital for Children and Georgetown University Hospital Pediatrics. Susan partnered with the President’s Volunteer Service Award and the Congressional Service Award to incorporate goal setting into the program. Susan directed the project in the Northern Virginia Juvenile Detention Center to assess how incarcerated adolescents and those in Post-Detention programs responded to the program. Youth demand, across the nation, has afforded Susan to lead over 3,047 community workshops with 242,675 youth serving 728,460 hours to create and deliver 350,000 Glories hats to more than 23 children's hospitals across the United States while presenting almost 1400 President’s Volunteer Service Awards and nine Congressional Service Awards to participating youth. Since H1N1, it has become less possible to have youth deliver Glories hats to patients in the hospital; however with teleconferencing technology the potential to communicate is limitless. To that end, Susan has designed the programming aspect to incorporate medical staff to thank students; high school career technical academy’s to present their programs; and local community colleges to talk to future students about their degree programs. Susan will devote 20% of her time to this project over the course of this research program. This research project team will also include administrators and staff from the Latin American Youth Centers (including their Americorp teachers), as well as administrative, medical, and nursing staff from the National Children’s Medical Center who are graciously offering the time, expertise, and services as unpaid volunteers to evaluate this important positive youth development intervention program.