Psychosocial Wellbeing of Black Youth in the Age of Hip-Hop: From Theory to Practice

Introduction: Throngs of young people are disengaging from traditional schooling, opting instead to spend most of their waking hours engaged in an alternate reality depicted in popular youth culture (PYC) and popular youth music multimedia (PYMM), in particular. This alternative reality is graphic and disturbingly real with images, messages, and stereotypes that may be perceived as promoting highly risky, problem behaviors, often failing to present the consequences of these behaviors. School aged adolescents most at-risk for negative health and social outcomes may be particularly vulnerable to themes and messages and perceived this as promoting risky and problem behavior. Stakeholders concerned with preventing negative health outcomes must address the psychosocial wellbeing of these vulnerable youth. Leveraging the ubiquitous appeal of PYMM for health-enhancing, prosocial learning offers key stakeholders culturally-relevant and culturally-responsive content and context to prompt critical thinking and discussion about prevailing themes and messages in popular music. Objective: Two research questions were explored: 1) What are students’ perceptions about the potential influences that PYMM may have on their self-image and identity development, values, communication norms, and coping skills? and 2) What are students’ perceptions about the potential influences that faith, hope, love, and optimism may have in facilitating self-awareness, personal responsibility, social awareness, and social responsibility? Method: Students completed an onsite post-intervention survey that consisted of thirteen questions graded on a nominal scale (i.e., yes/no), indicating the degree of agreement with the statements. Results: Findings suggest black youth in Baltimore are aware of the potential influences that PYMM has on their attitudes, beliefs, values, and behaviors. These youth welcome the opportunity to have critical discussions about the role of PYMM in their lives. Discussion: This study and its results offer additional evidence supporting use of PYMM for culturally-relevant and culturally-responsive teaching and learning to promote dialogue about health and psychosocial wellbeing.


Introduction
There are significant gaps in the literature about empiricallyvalidated strategies to improve student engagement, promote health and prosocial behaviors, and purposefully use select features of popular youth culture (PYC) as context and popular youth music multimedia (PYMM) as content and text for pedagogically-driven teaching and learning. Most studies that offer evidence of improved youth engagement do not specifically address the mechanisms by which improvements were achieved and what youth engagement looks like. Discovering and understanding the mechanism to engage young people and what drives their willingness to discuss and consider prohealth, prosocial behaviors could be a significant contribution to the literature for practitioners and researchers. Young people are clearly embedded in culture that has normalized and commodified risky and problem behaviors. The need to address this issue may be especially important for vulnerable black youth living at the intersection of race and poverty, with limited socialization beyond their own race or class. concern, particularly as competition for gainful employment remains stiff. While researchers have focused their inquiries on the predictors of dropout to develop effective dropout prevention programs [3], most education-based dropout prevention programs have focused on quantitative outcome measures, such as grades, state test scores, absenteeism, and disciplinary records. These factors were found to be significant predictors of dropout [4,5]; knowledge of these predictors has helped identify target groups for prevention efforts. This knowledge, however, has not shed much light on the bigger issue of understanding a student's motivation to complete school and the process preceding a student's decision to drop out of school.
For this reason, many researchers now focus on the concept of school engagement to better understand what is believed to be a gradual process of disengagement, culminating in a student leaving school before completing the public schooling process [6,7]. Many researchers agree that, by the time a student completely disengages from traditional schooling, it is the end of a long process where the student has progressively become disengaged over time [5,8]. School engagement is necessarily the first topic on which to focus.

School engagement
Fredricks, Blumenfeld, and Paris [9] found that engagement is comprised of three key components: behavior, affect (or emotion), and cognition. They describe the behavioral component as referring to a student's participation in school activities (i.e., academic, social, and extracurricular activities); the affective component referring to a student's feelings associated with school (i.e., positive/negative attitudes and reactions toward school, teachers, learning, and peers); and the cognitive component referring to a student's efforts toward tasks requiring thought and mental mastery (i.e., thoughts/feelings about themselves and their work, their skills, and the strategies they employ to master their work) [10].
Other researchers have expanded the definition of school engagement asserting that it includes social and academic components that impact school completion or failure to complete school [7]. Social aspects, known as school membership, include a student's attachments to peers and adults in the school environment. Academic aspects address a student's beliefs that the benefits of learning-related tasks are worthy of his or her time, effort, and energy. Additionally, students need to see value in the tasks and behaviors expected and required of them in school. According to Wehlage and colleagues [7], high levels of engagement along the academic and social dimensions contribute positively to a student's decision to complete school. Conversely, without these types of engagement, a student is more likely to become disengaged in the schooling process and, eventually, leave school before graduating.

School disengagement
In addition to the theoretical perspectives on engagement, empirical studies have investigated the relationship between engagement and school dropout [5,11]. Most of these studies focus on a student's negative behaviors, interpreted as a lack of engagement [9]. In most cases, a student's decision to drop out is attributed to deficiencies within the student; however, this is not always the case. Key stakeholders may attribute this lack of engagement to young people without considering all the facts, most notably the fact that some schools lack clarity about the goals and objectives for black children [12].
Researchers often measure the behavioral aspects of disengagement, because this component is most conducive to quantitative measurement. More research is needed, however, that considers cultural engagement with students growing up in the age of digital media and hip-hop. Specifically, more research is needed to assess how prevailing themes and messages in hip-hop may influence behavior and vice versa.
Importantly, there is more than one form of disengagement. Emotional disengagement, for example, has been shown to be related to a student's decision to dropout [9], as studies have found that feelings of alienation at school [8] and negative feelings about school are significant predictors of a student's emotional disengagement and decision to dropout [4,13]. Cognitive engagement is another way a student may disengage. Few empirical studies have been conducted on cognitive engagement's relationship to school dropout [9]; however, academic competence and cognitive engagement are inter-related. When used as a guide for interventions to improve school engagement, these studies suggest the importance of cultivating a student's sense of belonging at school and helping a student see the value of school. Social and emotional engagements are also forms of engagement, and the lack thereof may lead to disengagement. Therefore, it is important to cultivate both, particularly for young people who are already at higher risk for negative school outcomes.

Cultivating school engagement
The existing research provides a foundation to understand engagement and its relationship to preventing school disengagement or dropout, however, it fails to address the question: "How does one cultivate engagement?" According to Fredericks et al. [9], studies responding to this question have highlighted autonomy, relatedness, and competence as key factors in engaging youth. Autonomy includes young people having a sense of choice in the activities they pursue [14]. In this context, choice is contrasted with being told what to do, without presenting young people with options or giving the perception of having options. Additionally, young people in school need to see that what they are being asked to do to accomplish learning-related objectives is worthy of their time and effort. These youth must see value in what they are being asked to do in school. It is important to review the known risk factors for school dropout and consider the reasons traditional schooling appears unengaging to many young people across America.
Some students are at higher risk for withdrawing from school or dropping out, based on race and class. These same factors contribute to why some youth are at higher risk for negative health and social outcomes resulting in health disparities.

Triple jeopardy: Race, class, and dis-ease
Data from the National Youth Risk Behavior Surveillance Survey (YRBSS) [15] are reported based on race and can be grouped into six categories of health risk behaviors and related health outcomes: 1) alcohol, tobacco, and other drugs; 2) media use; 3) interpersonal conflict; 4) sexual health and responsibility; 5) violence, aggression, and trauma; and 6) suicide and other mental health issues. Unintentional injury and safety are two additional topics of interest to this research team, based on the study being initiated in Baltimore, following the tragic death of Freddie Gray, a young man from Baltimore who was fatally injured while in police custody [16]. Students from low socio-economic backgrounds are more likely to attend underfunded schools with high student-to-teacher ratios. Morale in poorly-funded schools with limited resources tends to be lower than morale in well-funded schools with fewer resource limitations [17]. Negative perceptions about achievement, achievement gaps, and low morale can negatively impact a student's academic performance [18]. This is likely the case in many large urban school districts. Baltimore City Public Schools is among the largest urban school districts with high rates of low literacy.
Children from low-income families display more emotional and behavioral problems than children from middle-class families [19]. In addition, children from low-income families experience more chronic stress than children born to middle-and high-income families [20]. Frequent and sustained exposures to interpersonal conflict, crime, and violence can lead to feelings of depression, fear, anxiety, and hostility [21][22][23].
Referenced studies illustrate the need for employing innovative prevention-oriented approaches, as well as revisiting the curriculum and instruction currently considered schooling. One approach to addressing the need for more culturally-relevant schooling is to extend learning opportunities beyond the traditional school day, via afterschool or summer enrichment programs.
Such programs, when structured and cognitively stimulating, act as a protective factor in improving low-income students' academic performance [24]. Additionally, offering students a socio-cultural and psycho-social lens, through which they may view the intersection of race and class, may prove to be a culturally-relevant and culturallyresponsive approach to teaching and learning, both in formal and informal learning spaces.
Popular Youth Music Multimedia (PYMM) will likely have broad appeal among adolescents, given documented media trends among younger consumers [25]. The Kaiser Family Foundation's 2010 study on media in the lives of adolescents [25] tracked changes in children's recreational media consumption from their childhood years, through their transitional period referred to as the 'tween' years, and into their late teenage years.
According to this study, youth in this age range spend more time engaged with media than any other activity, besides (maybe) sleeping. Music and digital media dominate the lives of youth growing up in the age of hip-hop, as shown in Figure 1 [26].
In a recent study assessing the prospect of using PYMM, Owens and Smith [27] found MusicsEnergy: The Message in the Music (ME-MIM) to be acceptable to 100% of rising 9 th graders attending school in a medium sized metropolitan city in the United States. These students indicated that the use of popular youth music for critical thinking is an engaging approach to teaching and learning, and that they would recommend this program to their best friends. Owens and Smith [27] also reported that students indicated ME-MIM was helpful in reflecting on their behaviors in and out of school, as well as their attitudes and beliefs about school.

Promoting competence
Based on a thorough review of the literature, positive youth development (PYD) often takes the form of programs and approaches that seek to address many of the developmental concerns occurring during adolescence. PYD model programs seek to promote competence, specifically, academic, behavioral, emotional, moral, and social competence [28]. In recent years, there has been greater emphasis on competence, especially in relation to skills required to thrive in the 21 st century [29]. Importantly, there is research suggesting the enhancement of competence can help to prevent other negative academic and social outcomes. Perhaps of even greater importance for research purposes, competence can be specified and measured independently, serving as its own outcome and indicator of positive development [30].
Many competence promotion efforts have worked toward developing skills that integrate feelings (emotional competence) with thinking (cognitive competence) and actions (behavioral competence). This integration is thought to help children achieve specific goals; these same three competencies serve as indicators of engaged learning.
Thus far, the literature on reasons some youth disengage from school and eventually leave before completing the schooling process has been reviewed. A definition of engagement has been provided, along with examples of what school engagement looks like. Some of the factors that foster engagement have been addressed. A definition of positive youth development (PYD) has been provided, as well as a list of the five core competencies linked to PYD.
The case will now be made for reasons some students living at the intersection of racial stigma and poverty, who spend many hours in the gaze of recreational media, may be particularly vulnerable to media's negative influences. These same students may be more likely to disengage from an education that fails to address real and significant issues affecting them daily. PYMM captures young people's attention and reflects real issues via themes and messages affecting them daily, making it relevant content, context, and text for meaningful dialogue about healthy self-image and identity development, self-awareness, coping, values, and communication norms. Additionally, the prevailing themes and messages therein provide content, context, and text for discussions about faith, hope, love, and optimism's potential role in mitigating negative health and social outcomes.

Why Baltimore?
Baltimore City youth are at higher risk for a range of negative health and psychosocial outcomes. For example, regional differences in adolescent risk behaviors reveal that 1 out of every 4 males attending high school in Baltimore City carried a weapon, such as a gun, knife, or club, to school. In addition, nearly 1 out of every 8 female high school students carried a weapon to school [31].
Among large urban school districts, Baltimore City high school students lead the nation in the number of youth who carried a weapon on school property. Baltimore City Public Schools (BCPS) are in the top five school districts with students who had a weapon on school property, were in a physical fight, or were injured in a physical fight [31]. Among large urban school districts, BCPS high school students were among the top ten school districts in the United States who were in a physical fight on school property and who have not attended school because of safety concerns. Additionally, youth attending BCPS were in a school district that is among the top ten in the United States with students who have attempted suicide and whose suicide attempt resulted in an injury, poisoning, or overdose that required medical treatment [31]. These youth were among the top ten school districts of youth who had ever used marijuana, tried marijuana for the first time before the age of 13 years, currently use marijuana, used cocaine or heroin, injected illegal drugs, and were offered, sold, or given an illegal drug by someone on school property [31]. Among large urban school districts, BCPS students were among the top five school districts in the nation who ever had sexual intercourse and who had sexual intercourse for the first time before age 13 years [31]. These statistics highlight health behaviors and health concerns tracked by the CDC. They also spotlight targeted behaviors correlated with prevailing themes and messages in PYMM, thereby presenting an opportunity to address risky and problem behaviors, as well as prohealth and prosocial behaviors in the context of prevention.
Based on the extensive research presented, black students attending BCPS may be at risk for at least four adverse outcomes of interest to key stakeholders: 1) school dropout; 2) school disengagement; 3) negative health and social outcomes; and 4) negative influences linked to media. Consequently, key stakeholders responsible for promoting school completion, health education, and prosocial behavior may find it helpful to understand if there is any benefit in using PYMM in a teaching and learning setting. Additionally, stakeholders may benefit from learning students' perspectives on the potential role of faith, hope, love, and optimism in a young person's healthy development as it relates to his or her self-image, values, communication norms, and coping skills, as well as his or her self-awareness, conception of personal responsibility, social awareness, and conception of social responsibility. The reviewed literature provides a theoretical framework for this inquiry.

Methods
This was action research, as defined by Bradbury and Reason [32], building upon previous research following the Deployment-Focused Model (DF Model) of Intervention Development and Testing [33] as adapted by Molina, Smith, and Pelham [34], consisting of six steps: 1) Assessment and Planning; 2) Staff Training; 3) Supervised Implementation; 4) Monitoring Implementation; 5) Two-Way Feedback with Program Revisions; and 6) Ongoing Data Collection. This multi-phase approach starts with the assessment of the interventions' feasibility and acceptability for practitioners in natural settings. The cycle consists of three steps [35]: 1) a pre-step which is to understand context and purpose; 2) six main steps to gather feedback, analyze data, plan, implement, and evaluate; and 3) a metastep to monitor. Completing Step 1 of this action research and the DF-Model was the focus of the present study.
Action research was appropriate, because it gives voice to Baltimore youth living at the intersection of race and class, making this a highly vulnerable population. The voices of these black youth are often not included in the research process itself. Their perspectives, however, are of vital importance in this study for the purpose of informing key stakeholders about psychosocial wellbeing of black youth in the age of Hip-Hop [36].
Two theories frame this research and help inform the interpretation of the results. The Social Cognitive Theory [37] emphasizes that learning occurs in a social context; much learning occurs through observation. This theory has been applied extensively by researchers seeking to understand social behavior in schools. The Cultivation Theory [38] claims that persistent long-term exposure to media content has small but measurable effects on the perceptual beliefs, or "worlds", of audience members [39].

Research questions
The following two research questions guided this study: 1) What are the potential influences that PYMM has on students' self-image and identity development, values, communication norms, and coping skills? and 2) What potential influences does embracing faith, hope, love, and optimism have on facilitating students' self-awareness, personal responsibility, social awareness, and social responsibility?

Ethical protection of the participants
The procedures to ensure ethical protection of all participants are outlined in the sponsoring University's Institutional Review Board (IRB) application. This study took place with IRB approval from the sponsoring University and the Baltimore City Public Schools (BCPS).

Participants
Data were collected from 10 15 to 19 year old high school students (n=10) participating in the 2017 Baltimore City Youth Leadership Institute (BCYLI), a multi-site summer enrichment program cosponsored by a consortium of local philanthropists, the Center for Adolescent Health at the Bloomberg School of Public Health, and BCPS. Recruitment was based on guidance in identifying a diverse population of students, including rising 9 th graders and recently graduated seniors, demonstrating a minimum level of academic strength and facing academic, attendance, and school engagement challenges resulting from obstacles within their homes and communities.

Students from BCYLI's Academy of College and Career
Exploration site participated in a seven-session, customized pilot version of MusicsEnergy: Messages in Music (ME-MIM) over the course of five weeks. All sessions met during the first half of the students' day before lunch. Eight (n=8) of ten students completed a post-intervention survey responding to thirteen questions that were a subset of the two guiding research questions.
All ten students were black; most did not read at grade level. The sample consisted of approximately an even number of males and females. Most students lived in the East Baltimore neighborhood near the low-resources, high-needs Baltimore City school. One hundred percent of participating students qualified for free or reduced lunch. The information generated by the limited number of participants was sufficient to adequately satisfy the purpose of this pilot study.

Post-intervention survey
Students completed an onsite post-intervention survey consisting of thirteen questions graded on a nominal scale (i.e., yes/no) indicating whether they agreed with the statements. The survey was developed by a team consisting of two doctoral students, two undergraduate students, youth aged 14 and 16, and research scientists. Results were analyzed via simple reporting.

Discussion
Based on the data collected and analyzed, popular youth music multimedia (PYMM) was found to have some influence on students' self-image and identity development, values, communication norms, and coping skills. The findings suggest faith, hope, love, and optimism may play a role in enabling young people's self-awareness, personal responsibility, social awareness, and social responsibility.
The perspectives of student participants are highly regarded in this study, because they hold important information. In this study, the researcher's job was to seek a deeper understanding of the phenomenon and to serve more in the role of facilitator, working with stakeholders to peel back the layers comprising a phenomenon. This is done in an attempt to discover and/or confirm core issues under investigation. This study's primary inquiry was regarding the potential influences of PYMM on students' self-awareness in relationship to their self-image and identity development, their values, their coping strategies, and their communication norms.
Based on the results, youth in this study were very aware of the potential influences that PYMM has on them, specifically, their selfimage and identity development, values, communication norms, and

Results
Study results are presented as Table 1. Understand the link between their musical preferences and their attitudes about risky behavior. 4 (50%)

ME-MIM Responses from MusicsEnergy BCYLI
Understand the influence music has on their attitudes about problem behaviors.

Students who indicated ME-MIM did not help them:
Think critically about healthy vs. risky vs. problem behaviors.

(63%)
Understand the link between exposure to problem behavior and their perceptions of problem behavior or its consequences. 5 (63%) coping skills. When asked if ME-MIM, which uses PYMM, helped them understand if there is a link between their musical preferences and communication norms in their home, school, neighborhood, and community, all students surveyed indicated ME-MIM helped them understand there is a link. Most students surveyed also indicated that ME-MIM helped them understand the link between their musical preferences and improving their sense of self-awareness, specifically: 1) their own identity; 2) their values; 3) their attitudes about themselves and family; 4) their attitudes about their community, including their peers and others; 5) their coping strategies; 6) their views about traditional gender roles; and 7) their typical communication style with others.
When asked if ME-MIM helped them understand if there was a link between their musical preferences and their attitudes about risky behaviors, at least half of those surveyed indicated that ME-MIM helped them understand there is link. Additionally, at least half of students surveyed indicated ME-MIM helped improve their selfawareness about the potential role of faith, hope, love, and optimism as personal attributes they may embrace when dealing with moral dilemmas or stressful situations. Interestingly, most of the students surveyed indicated that ME-MIM did not help them see any relationship between their exposures to problem behaviors, either in real life or via music multimedia, and their perceptions about problem behaviors and the consequences.
These results reflect a few important takeaways that may be useful for clinicians, practitioners, and school personnel currently looking for culturally-relevant, evidence-based strategies to encourage prohealth and prosocial behaviors among adolescents. Lack of an evidence-based intervention that uses PYMM for pedagogically-driven teaching and learning and that measurably improves school, health, and youth development outcomes presents a unique and timely opportunity for ME-MIM, and similar research approaches. Outcomes linking engaged learning and school connectedness with prohealth and prosocial competencies would provide considerable insight into the dilemma of growing numbers of youth disengaging from traditional schooling.
We need to know what motivates young people to consider prohealth and prosocial behaviors, given young people are embedded in a culture that may be perceived as promoting risky and antisocial behaviors. Understanding what motivates young people to consider and adopt prohealth and prosocial behaviors is critically important, given they are embedded in a culture they may perceive as promoting the opposite. The knowledge gleaned from this study may be especially useful to scholars and practitioners working with vulnerable black youth.
Context matters. Understanding what motivates a student to complete school or stay engaged in the schooling process may differ based on race and class, which are quite likely co-factors in a students' decision to stay in school or dropout. Engagement of students consists of being engaged affectively, behaviorally, and cognitively. While this much is well-known, theories about school disengagement and engagement do not account for the lack of clarity regarding the goals and objectives of schooling that may or may not be unique to black students living in poverty. This clarification is needed based on the intersection of race and class and the known impact among poor, black youth.
A European patriarchal standard, which presumes white superiority, is problematic for growing numbers of disengaged students who bring with them greater diversity and multicultural perspectives about the role of education in their lives. Since we know that cultivating a sense of community or belonging in school is key to students staying engaged in the schooling process, it is important to include social and emotional learning given PYMM elicits these responses from all consumers. Cultivating social and emotional learning may be more important for those already at higher risk for disengaging from school or traditional schooling so that they too may find meaning in a formal education.
Concerned stakeholders should be careful not to mistake the behaviors of a disengaged youth as evidence of deficiencies within the young person. Those sincerely looking for solutions must not ignore the embedded context in which young people live, particularly the convergence of digital media and the plethora of unsavory content available to them via multiple formats. In March 2017, weekly ondemand audio streaming soared past 7 billion, and the first six months of 2017 alone, on-demand audio and video streams was near 286 billion. That represents a 36% increase over the first six months of 2016 and a 74% increase compared to just three years ago [40]. Most of the streaming data reflects younger users, as streaming is most popular among these consumers.
This study included discovering and discussing the musical preferences of young people in Baltimore. Younger listeners are the highly-prized targets and YouTube is the first choice to access music among adolescents [41]. The content, context, and 'text' of their preferred music was used to prompt rich discussions about health, hope, and healing and music's role in their young lives. Today's young people spend hours engaged in what many adults over 45 may consider an alternative reality. This, however, has become their very own reality filled with images and messages promoting highly risky, problem behaviors. Today, many young people and their young parents struggle with how to adapt to sobering realities and discern the "truth". Those most at-risk for negative school outcomes in our public schools are also at-risk for negative health and social outcomes, such as early substance use, early entrance into the criminal justice system, early exposure to violence and trauma, early sexual activity, and unhealthy relationships. Early exposure to adverse childhood experiences is highly correlated with race and economic status or class. All of this is reinforced by the statistics reported previously in this manuscript.
Regrettably, many young people in public schools may not be learning the critical thinking and inquiry skills necessary to fully participate in or benefit from a public education. They often enter the labor market ill-prepared to thrive and set up to repeat the cycle. They are increasingly disengaged in the status quo and increasingly engaged in social media and popular (youth) culture. Many of today's youth are the children of millennial parents, meaning their parents were born between 1982-2004 [42]. This period was when media entertainment and online access converged via the World Wide Web with shocking content in the name of "keeping it real". The Internet emerged and exists today with few restrictions on content, resulting in even more blurred lines regarding family values, healthy coping, communication norms, and a healthy sense of self.
These concerns are especially significant during adolescence, a critical period of development during which young people are becoming more self-aware and forming their identity, clarifying their values, learning communication norms, and grasping for healthy coping strategies. Clearly, there is a dilemma. One question that emerges is, "Should engagement be viewed solely as the personal responsibility of each student or is disengagement more evidence of the need for a different type of schooling?" The future direction of this research is to partner with school and community-engaged stakeholders to create learning opportunities using ME-MIM to assess its impact on school, health, and youth development outcomes. These discussions will also allow trained facilitators to probe further into the potential roles that faith, hope, love, and optimism may have on facilitating awareness, responsibility, and response-ability linked to attitudes, beliefs, values, norms, and choices.
Prior to this study, ME-MIM was heavily focused on health and media literacy, without lessons or activities to facilitate self-and social awareness. Prompting young people to analyze their musical preferences and discuss avoiding known risks or problem behaviors proved more challenging than anticipated, highlighting the need for four additional units of instruction. These are: 1) self-awareness; 2) social awareness; 3) relationship skills; and 4) self-management; in addition to 5) media literacy/advertising; and 6) responsible decisionmaking.
In addition to adding fidelity measures and integrating evidencebased practices and strategies, the future direction of this research includes moving on to Step 2 of the Deployment Focused Model (DF Model) of Intervention Development and Testing [33], initially developed by Weisz and adapted by Molina and colleagues [34]. This multi-phase/stage model begins with the development of an intervention that is assessed to determine its feasibility and acceptability to practitioners in their natural settings. The DF Model ends with an efficacy trial based on manualized procedures. The best outcome of the intervention development and refinement process is to have an effective and acceptable intervention in a manualized format that practitioners or para-professionals can implement with minimum training and support. ME-MIM has been assessed to be both acceptable and feasible to key stakeholders, under certain conditions [26,[43][44][45]. The next step in this process is to train facilitators and assess the effectiveness of these trained facilitators via fidelity monitoring and observing their interactions with participants.

Conclusion
In conclusion, concerned stakeholders must acknowledge that strongly held traditions in many American schools serving poor children do little to help young people understand the benefits of crossing cultural boundaries. The research is inconclusive on the topic of Ebonics; however, there are clear advantages and benefits to cultural code-switching [46], which would be in line with facilitating a student's sense of attachment to others at school, and could potentially, bolster a sense of cultural competence for young people not inspired to speak the King's English. Code-switching is the practice of alternating between two or more languages or dialects in conversation. It allows students to maintain kindred connections and familiar networks while also acquiring and practicing communication and social skills necessary to reap the full rewards and benefits in and out of school.
Deconstructing the origins of black inferiority is necessary to address social determinants of health, such as race, class, and education. Such a dialogue may go a long way toward validating the psycho-social wellbeing, the emotional pain and struggle for hope that some black people, especially traditionally marginalized youth, may experience. We must explore new pathways to health, hope, and healing.