School Start Time Roadmap

by John Garcia, MD, Pediatric Sleep Specialist. Gillette Children's Specialty Healthcare

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John Garcia, MD
Pediatric Sleep Specialist
Gillette Children’s Specialty Healthcare

Many schools in Minnesota have moved from whether a later high school start time is indicated to how this can be implemented. The empirical research of Kyla Wahlstrom Ph.D. from the CAREI Center at the University of Minnesota is well-known to educators nationally. Reliable evidence links the 8:30 AM and later high school start time to decreased teen car crashes, decreased depression and improved academic performance. The insight of Dr. Wahlstrom has identified these three areas closest to the hearts of teen parents. Translating Dr. Wahlstrom’s work into change in schools has been the work of many over the past several years. This translation recognizes that each school lies upon a readiness for change continuum. Readiness for change is multifactorial. Factors include the tolerance of change in the larger community, willingness of superintendents to spend political capital, presence of support from medical and educational experts, as well as openness of parents to struggle and dialogue. The motivation for change is unique in each community. Negative outcomes imagined by opponents to change are often not borne out in reality. Two groups often resisting change are parents of younger children and athletics enthusiasts. As Mark Twain said, “I’ve had a lot of worries in my life, most of which never happened.” Strategies for implementing change are reviewed here.

When the issue of school start times was first discussed, there was some consideration of advocating for state legislation that would enact an 8:30 AM or later start time for high schools. This was in part driven by knowledge of the experience in other states. For example, in Pulaski County, Arkansas the later school start time was initiated not by local school administrators but by the State Commissioner of the Department of Education. In conversation with Twin Cities school officials, it became clear that state-level action would disregard a core value of Minnesota school systems—local control. Recognizing local control while simultaneously encouraging a later school start time in as many high schools as possible, as quickly as possible, has been a creative tension. It has required the concurrent use of diverse strategies including education through use of a tool kit, leading discussions with parents, and working collaboratively with school administrators to help craft a message specific to local needs. The strategies for changing the start time are as diverse as the schools. This is in part due to the lack of research in measuring outcomes associated with a given strategy1.

The MN Sleep Society School Start Time work group emphasizes a continuum of change model that begins with awareness supporting commitment leading to action whose ultimate fruition is leading others to move along the same continuum. A similar continuum is well known to schools. The National Association of Independent Schools (NAIS) uses very similar language in its promotion of cultural pluralism that it calls “Awareness to Commitment to Action”2. To facilitate movement along the continuum the MN Sleep Society work group is creating a Tool Kit. The Tool Kit is a valuable resource especially when encountering someone early in the continuum of change known as precontemplation. It provides foundational resources when encountering those who might endorse ineffective strategies such as trying harder to sleep or using caffeine to combat tiredness. Once these sometimes formidable cultural stumbling blocks have been patiently deconstructed, healthy science-based realities are there for the asking. One of the most powerful is none other than the Center for Disease Control arguably the most powerful voice of biomedical reason in America. The CDC’s own movement on the continuum was fostered by several of the members of the MN Sleep Society work group in 2014, leading the CDC to recommend that

“…middle and high schools push back start times to 8:30 a.m. or later. Noting insufficient sleep is common among high school students and is associated with several health risks such as being overweight, drinking alcohol, smoking tobacco, and using drugs – as well as poor academic performance.”

The early action phase is known as preparation. In the preparation phase three groups come together: first, school officials, board members and teachers; second, parents and teens; and third, experts and medical providers. Early conversations with teachers from elementary, middle schools, and high schools can quickly address concerns. Teachers may be concerned about loss of time with their own young children. Experience speaks otherwise. Teachers with a later school start time can still adjust their schedule to complete work in the morning. Others follow the lead of their students and get more sleep. In practice, teachers have not substantially resisted this change1,3. Listening sessions led by the school board are a creative strategy. Sessions give parents an opportunity to lift up issues that might not have been apparent when scenarios were drafted. Parents of younger children may emphasize issues such as after school child care since starting school earlier for younger children also means ending the day earlier. Getting up earlier means putting children to bed earlier which decreases evening family time4. While after school activities are important to some, they may not stand up in light of the biologic realities of sleep debt and its well-documented consequences. In addition, some schools have seen improved athletic performance3. Building on the pre-existing studies identifying the association between sleep deprivation and poor psychomotor coordination, recent studies have revealed that sleep deprived athletes are injured more frequently. In one example injuries were four times more common in players reporting six hours of sleep than those getting nine5. Teens talking about their own experiences of insufficient sleep and its consequences provide a “report from the trenches” point of view that can move a group of listeners from disagreement about the finer details to action energized by empathy. In the Twin Cities experience the inclusion of local pediatricians provided validity. While regional sleep experts can be helpful, the history of trust that local pediatricians provide acts as a foundation for quick and sustained action. Minnesota pediatricians are supported by both the August 2014 American Academy of Pediatrics Policy Statement and the June 2016 American Medical Association Statement on School Start Times as well as the Minnesota Sleep Society. In the planning phase, transportation issues are addressed. There are plenty of examples of changes in transportation being cost neutral or better. In fact, cost savings as a result of increasing the number of busing tiers was “the most prominent benefit (and may have been the real driver for the change in some cases)”1.

In time the listening sessions have gathered their information. Pros and cons have been weighed. Few things are more tedious than a process trapped in endless preparation phase. This is similar to a doctor ordering endless tests to be sure of a diagnosis while the patient is suffering from a debilitating disease for which effective treatments are known. In the end a leader should make a conscious public decision. This is called a go point by Michael Useem6. Dr. Chace Anderson, in his 2015 presentation to the Wayzata board, had the courage to recognize that the future has no time of 100% certainty and comfort3. The go point marks the transition from preparation to action. There has been enough success in the action phase in Minnesota to describe a timeline, with details in the Tool Kit and a summary provided as follows. Late spring through fall, a stakeholder group is formed and meetings are held. Several different scenarios should be drafted for the purpose of discussion. A recommendation is presented to the decision authority (the superintendent or the school board) by late November. In early December, the school board discusses the recommendation and/or alternative scenarios. A decision to shift/not shift the start time is made. Announcing the plan to change the school start time should be made swiftly as parents parents need to declare their amount of child care payroll deduction prior to the first of the year. The change is implemented in the fall of the upcoming school year.

Maintenance is the next step on the continuum. There is an insidious creep towards chaos to which the best of human nature stands in resistance. In the school start time ethic the creep comes in the form of apparently reasonable requests for the addition of zero hour classes and before school practices. Once we have learned the consequences of insufficient sleep these requests should be granted as temporary solutions rather than ongoing commitments.

Some say that a tipping point is approaching. Over the past several years early adopters have helped prove the benefits of a later start time. A group ethic is within reach for MASA. Can we respect local school control and simultaneously reach a consensus go point?

References

  1. Owens J, Drobnich D, Baylor A, Lewin D. Blueprint for Change School Start Time Change Report .The Children’s National Medical Center Blueprint for Change Team. April14, 2014.
  2. Katz L, Wishne B. Awareness to Commitment to Action. Knowledge Center. National Association of Independent Schools Website.
  3. Anderson C. School Start Time Recommendation Presented to the Board of Education. Wayzata Public Schools. December 5, 2015.
  4. Croman J. Wayzata Board Changes School Start Times for 2016-2017. News Leader. December 15, 2015
  5. Milewski M et al. Chronic Lack of Sleep is Associated with Increased Sports Injuries in Adolescent Athletes. J Pediatr Orthop. 34(2) 2014.
  6. Useem, Michael, The Go Point: When it is Time to Decide, Three Rivers Press, 2006
  7. John Garcia, MD, authored this article on behalf of the Minnesota Sleep Society. Garcia is a pediatric sleep specialist at Gillette Children’s Specialty Healthcare in St. Paul.
  8. Contact the Minnesota Sleep Society at secretary@mnsleep.net for more information.

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