Comfortable Cafeteria

Spend some time reading about cafeteria best practices. Invite one or more colleagues to join you so that you can generate shared interest and a commitment to running this program. Key players include occupational therapists, health educators, speech therapists, school counselors, teachers, para-educators and school nurses.

Important information about best practices in the cafeteria is synthesized in the Comfortable Cafeteria Annotated Bibliography. Based on a comprehensive literature review of cafeteria best practices, this annotated bibliography provides a summary of current monographs, descriptive articles and research studies. Key 'take aways' include:
1) Have enough adult supervisors: Schools should aim for a 1 to 50 ratio of adults to students (e.g. a minimum of 2 supervisors for 100 students). We have found, however, that adult presence in the cafeteria makes a big difference in student behavior. Schools need to be creative in increasing the number of supervisors present - e.g.  free lunches for teachers who eat in the cafeteria.
2) Provide education and support for cafeteria supervisors: Include OTs or other school personnel who have a vested interest in creating a positive cafeteria environment when interviewing potential cafeteria supervisors. Right from the start, convey how important it is for supervisors to be positive and take an interest in students. Provide an orientation to cafeteria supervisors on what 'active supervision' entails, such as 'working the crowd' (walking around and saying 'hi' to groups of students; making a point to learn one new name each day). Make sure rules and routines are established for behavior in the cafeteria and reinforced.

Other suggested reading:

Comfortable Cafeteria website material. Read the information in the About the Program section to learn the basics about the Comfortable Cafeteria program. Pay special attention to the Vision Statement & Guiding Principles as these provide an important foundation for the entire program.

Comfortable Cafeteria Information Brief provides a 2-page overview of the program. Share this two-page document with colleagues who might be interested in helping you implement the program. For example, in one of our demonstration sites, the occupational therapist and speech therapist worked together to provide the program.

Comfortable Cafeteria FAQs (Frequently Asked Questions). This document provides user-friendly information related to implementing the Comfortable Cafeteria program.

Helpful websites:

The Family Dinner Project This website offers a variety of family-friendly information and ideas for making mealtimes meaningful. The Family Dinner Project is a nonprofit organization operating from the Project Zero offices at Harvard University described as a movement of 'food, fun, and conversation' in support of family meals. Tips for dinnertime conversation (e.g. explore challenging conversations, conversation starters) and ideas for family games and between dinner and dessert activities are provided.

Whatcom Farm to School This website provides user-friendly resources on healthy eating and creating positive social and physical cafeteria environments.

Reference:
1 Bazyk, S., Demirjian, L., Horvath, F., & Doxsey, L. (2018). The Comfortable Cafeteria program for promoting student participation and enjoyment: An outcome study. American Journal of Occupational Therapy, 74 (3), 1-9, https://doi.org/10.5014/ajot2018.02379

Observe lunchtime for the grade level that you plan to implement the program with. Complete the Comfortable Cafeteria Environmental Analysis form. This is a fillable form.

Before beginning the program, it is important to stop and observe the cafeteria environment and students' lunchtime experience in order to identify what's 'right' as well as what might need to be modified in order to make improvements. Every school and grade level within a school might have different challenges and needs.

Action step: This observation can be completed in a short amount of time (~20-30 min.) by a skilled occupational therapist or other school personnel who have the ability to tune into the physical, social-emotional, and sensory aspects of the environment – each of which can influence the lunch experience in a positive or negative way. Let the cafeteria supervisors know that you'll be doing an informal observation to obtain preliminary information about the quality of the lunch experience. Reassure them that this is not being done to evaluate their performance. Use this time to start building a positive relationship with the supervisors. Obtain their input about what they perceive are strengths and challenges during lunch.

The Cafeteria Environmental Analysis involves observing the physical (layout, seating), sensory (auditory, visual, movement, an olfactory) and social-emotional aspects of the cafeteria experience. Determine what characteristics of the existing cafeteria environment contribute to successful participation and enjoyment for all students. Identify challenges and/or limitations. Consider what may need to be modified or changed both in terms of procedures (i.e. transitioning out of cafeteria after disposing of trash) as well as environmental modifications (table arrangements, placement of garbage cans, regulating noise levels, etc). Think about aspects of the social environment that might need improvements (e.g. ensuring that no students sit alone).

Summarize observations. Think about strategies for improvement.

As a part of gearing up to begin the Comfortable Cafeteria program, it is important for the program facilitators (e.g.occupational therapist and/or other school staff) to meet with 'relevant stakeholders' and begin to develop a positive, trusting relationship with them.

Relevant stakeholders include any person who has a vested interest in or may be impacted by the cafeteria program such as cafeteria supervisors, food service personnel, school custodians, teachers, and principal. All relevant stakeholders need to be informed about what the Comfortable Cafeteria program is and when it will take place.

The most important stakeholders to collaborate with are the cafeteria supervisors. It's important to find out who is assigned to 'lunch duty' which varies from school to school. Although there may be variations in who actually serves in this capacity, cafeteria supervisors are the adults responsible for overseeing the lunch session and who help the students enter and leave the cafeteria, obtain lunches (if purchased), behave in positive ways, and enjoy their lunch. Cafeteria supervisors may be paid personnel (usually part-time), parent volunteers, or teachers assigned to 'lunch duty'.

Action step: The Comfortable Cafeteria program facilitators need to make a point of introducing themselves to the cafeteria supervisors during the observation session and share a copy of the Comfortable Cafeteria Information Brief.

Emphasize that the purpose of the program is to help support them in their role as supervisors by providing information, weekly activities, and ongoing problem-solving and coaching. Cafeteria supervisors play a critical role in helping students enjoy their school day. Reinforce their importance and commit to working with them in a collaborative manner.

Although the Comfortable Cafeteria program is designed to be a universal whole school initiative, we suggest starting small to ensure initial success. The program facilitators (e.g. OT and SLP) should meet to decide what grade level to begin with. It's best to begin any new program by working with stakeholders who show interest and enthusiasm in being involved. Our motto is, 'look for the open doors' and begin there since implementation involves collaboration with any staff member or volunteer assigned to lunch duty. We have had success beginning with 2nd, 3rd, or 4th graders and expanding to the other grades.

Action steps:

Pick a grade level. In our demonstration projects, we began with 2nd or 3rd graders since students at these ages are generally adjusted to school and can follow directions. Since the program only takes 6 weeks, it can be replicated numerous times throughout the school year with different grade levels.

Select a day of the week to implement the program. The program facilitators will be embedding their services into the cafeteria one day per week for 6 consecutive weeks to run the program. Choosing the specific day of the week should be a collaborative decision between the program facilitators and cafeteria supervisors. In most instances, this will depend on the program facilitators' schedule. A benefit of holding the program mid-week is that it allows cafeteria supervisors and teachers to introduce the weekly theme to students early in the week (e.g. verbally or with books or coloring sheets).

Time commitment. Based on our experience in implementing the program in multiple school districts, OTs report needing approximately 30 minutes of preparation time and 30 minutes for implementation each week. Many related service providers (OT, SLP, school counselors) have indicated that their time implementing the program can count toward IEP minutes or as a part of a workload model. Like any new program, the first time it is implemented will take more effort. We have observed many creative ways that school professionals have collaborated to provide the program. Likely facilitators include: OTs, SLPs, school counselors, special education teachers, general education teachers, and school nurses.

Following the 6th week, it is suggested that the program facilitators provide intermittent consultation and support by stopping in the cafeteria to offer ongoing problem solving and activity suggestions.

In order to implement the program, it is essential to obtain the school principal's permission and support. We have found principals to be very interested in this program because the cafeteria tends to be a place where higher incidents of behavioral problems occur leading to office referrals. Most schools, in our experience, do not have organized programs designed to prepare and support cafeteria supervisors and students in creating a positive cafeteria environment.

Action step:
Schedule an appointment to meet with the school principal to obtain permission and support. Before the meeting, give him/her a copy of the Comfortable Cafeteria Information Brief to read so that she/he can become familiar with the program. Encourage the principal to read about the Comfortable Cafeteria program on the Every Moment Counts' website and watch the video vignette 'Here's what a Principal says about it'.

During the meeting:
1. Give a brief review of the Comfortable Cafeteria program;
2. Summarize your observations of the cafeteria environment based on the Environmental Analysis. Discuss the strengths, needs, and your suggestions for improvement.
3. Share your plan of action for implementing the program (i.e. targeted grade level, day of the week, and date to begin).
4. Agree on when to begin the program and plan a date/time for the Orientation for cafeteria supervisors (need ~ 1 hour). The principal will coordinate with the cafeteria supervisors to arrange a time and location for the Orientation session. It is critical that the principal is 'on board' and communicates her/his commitment to the success of the Comfortable Cafeteria program.

After the principal has given an official approval to implement the Comfortable Cafeteria program, it is important to let the relevant stakeholders (cafeteria supervisors, teachers, students and parents) know about the program and the start date. Ideally, it is good to get the word out about the program about 2-3 weeks ahead of time so that participants can become aware of what will take place and look forward to participating in the program.

Action steps:
1. Start talking about it ... to everyone who will be involved in the program. Be enthusiastic! Let teachers, cafeteria supervisors, students and parents know when the program will begin;
2. Share information about the program. Give cafeteria supervisors and teachers a copy of the Comfortable Cafeteria Information Brief;
3. Encourage teachers to talk about the Comfortable Cafeteria program to their students a couple times during the weeks leading up to the program in order to generate student interest and enthusiasm. Give the teacher a copy of the black and white coloring sheets for the Comfortable Cafeteria (for primary students K -4th grades) or the Cool Cafe′ (5th -8th grade). This will give students a chance to learn about the program.
4. Share the Comfortable Cafeteria Marketing Flyer with the students to take home to their parents. Encourage students to tell their parents about the program.

We recommend meeting with the cafeteria supervisors and orienting them to the Comfortable Cafeteria program the week before the 6-week program begins. This will provide the cafeteria supervisors with foundation information about what will be taking place and how they will be involved.

Orientation Action Steps:
1) Schedule orientation session. Collaborate with the principal and cafeteria supervisors to schedule a 1 hour orientation session at a mutually agreed upon time. Since supervisors work during the middle of the school day, this session will most likely occur either before or after lunch. Make sure to include all relevant stakeholders if possible, including food service personnel and teachers that assist in the cafeteria. Encourage the principal to attend.
2) Orientation Session. The purpose is to share information about the vision, guiding principles, and weekly themes of the program using the Comfortable Cafeteria Power Point presentation. (another option is to send the PPT to the supervisors to review ahead of the meeting). Try and keep the presentation to about 15-20 minutes to ensure there is time to lead a discussion with the supervisors about what their greatest challenges and needs are in the cafeteria. Briefly summarize your Cafeteria Environmental Analysis findings. Begin to problem-solve solutions to challenges.
3) Review the behavioral expectations listed on the Cafeteria Poster and Cafeteria bookmark. In our experience implementing the program in multiple schools, issues related to noise and behavior seem to be common concerns.

Suggestion: Give the cafeteria supervisors a folder with a copy of the Power Point presentation, Comfortable Cafeteria Information Brief, and bookmark. Encourage them to use the folder to hold all of the subsequent handouts that will be provided each week.

Program Facilitators need to be effective coaches. The goal is to help the cafeteria supervisors be effective in and enjoy doing their jobs.

An effective coach:

• Develops a positive relationships with the supervisors based on trust
• Promotes two-way sharing of information
• Demonstrates positive unconditional regard for the cafeteria supervisors and food service personnel – they are experts about themselves and their experiences
• Is a facilitator of the change process involving problem-solving, exploring options, trying things out, working together and maintaining a positive attitude. You are in this together!

Specific instructions for how to implement the 6-week program are provided in the section below entitled, 'Just do it!: The Six Week Lesson Plans & Materials'.

For each week, a Lesson Plan for what to do along with collateral materials are provided.

Following the 6-week program, obtain feedback from the cafeteria supervisors, students, and principal about what went well and any lingering needs.

Action Steps:
1) Provide follow up coaching on an ongoing basis as needed. Visit the cafeteria routinely (e.g. every other week) to touch base with the cafeteria supervisors and find out how things are going. Observe interactions and informally solicit student input. Provide activity suggestions and support as needed. Maintain relationships.
2) Be creative! Consider developing a 'Cafeteria Committee' that will routinely meet to reflect on the lunch experience, challenges, and needs. The goal is to collaborate with cafeteria supervisors, teachers and students to do fun activities to sustain a comfortable cafeteria!
3) Foster sustainability. Encourage the principal to involve the OT or other program facilitators to help interview and orient new cafeteria supervisors. The purpose is to ensure that positive practices and supervision are sustained.

Now that the Comfortable Cafeteria program has been implemented with one grade level, replicating the program with other grades will require less time and effort. Because this program is designed to be a whole school initiative, it's important to implement it with as many grade levels as possible. With each replication, the vision, guiding principles and weekly themes will become a natural part of the cafeteria culture that will spread to all of the grades.

Action steps:

Repeat the program with another grade. The occupational therapist(s) and/or other program facilitators should meet to decide what grade level to implement the program in next and establish a timeline for when to start the program. Follow the '10 Steps to Success' to the extent needed. However, it is likely that the process can be streamlined the 2nd and 3rd times around!

Help interview and orient new cafeteria supervisors on a yearly basis. Use the Comfortable Cafeteria PPT to orient new supervisors. Give them a folder with sample materials. 

Share success stories! Spread and share the joy! Make sure to highlight successes during morning announcements and in school newsletters or on the school website.

Success story articles:
Food Management Magazine article about Lakewood City Schools implementation by Suzanne Scott, OTR/L

Cleveland Heights/University Heights newsletter article about implementation by Cindy Rakow, MS, OTR/L