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Promoting Health and Academic Success
The Whole School, Whole Community, Whole Child Approach
by David A. Birch and Donna M. Videto
248 Pages
There is increasing evidence that health and academic success go hand in hand. Now educators and health professionals have a new model—the Whole School, Whole Community, Whole Child (WSCC) approach—to use in promoting health and learning in the schools. This new approach, developed by leaders in education and health, is a transition from the coordinated school health (CSH) model that was introduced in 1987.
Promoting Health and Academic Success is a new resource for the transition from CSH to WSCC. Written by national leaders in education and school health, some of whom were involved in the development of WSCC, this book provides direction for education and school health professionals interested in promoting student health. It is valuable for individuals and groups interested in advocating for WSCC and for those engaged in the planning, implementation, and evaluation of this new approach.
The book also is a resource for both undergraduate and graduate students in courses that address a coordinated approach to school health. Each chapter includes application activities that engage students in translating their learning in the context of WSCC simulations. In addition, the School Health in Action feature provides case studies that demonstrate the impact school health programs are having in schools across the United States.
Applicable to both students and professionals, Promoting Health and Academic Success includes an appendix that presents a thorough guide to using school health assessment tools created by organizations such as the Centers for Disease Control and Prevention, Association for Supervision and Curriculum Development, and the National Association of State Boards of Education. Following is a partial listing of the tools:
• The School Health Index helps schools improve health and safety policies.
• The State Schools Health Policy Database facilitates sharing of policies across states.
• The Health Education Curriculum Analysis Tool encourages children to adopt and maintain health-enhancing behaviors.
• The Physical Education Curriculum Analysis Tool assists schools in analyzing their curricula and comparing it to national physical education standards.
• A Parent Engagement tool shares strategies for involving parents in school health.
The book is presented in five parts. Part I unveils the new WSCC model, explains its components, and provides a historical overview of coordinated school health. Part II offers insights into the Whole Child initiative and examines the evidence linking health and academic success. Part III explores the crucial role of school administration in ensuring success, ways to meet the diverse needs of students and their families, and methods for getting the community involved. Part IV delves into planning, implementation, and evaluation aspects of WSCC. Part V looks to the future for WSCC and provides perspectives from the field. The appendix supplies the assessment instruments and tools.
Part I: Moving From Coordinated School Health to the Whole School, Whole Community, Whole Child Approach
Chapter 1 Whole School, Whole Community, Whole Child: A New Model for Health and Academic Success
David A. Birch and Donna M. Videto
Evolution of School Health Models
Creation of WSCC
Summary
Learning Aids
Chapter 2 Historical Overview of Coordinated School Health
Diane DeMuth Allensworth
First Stage of Health Promotion: Addressing Infectious Diseases
Second Stage of Health Promotion: Addressing Individual Behaviors
Third Stage of Health Promotion: Addressing the Social Determinants of Health
Barriers to Universal Adoption of CSH
Next Evolution for School Health
Summary
Learning Aids
Chapter 3 Components of the WSCC Model
David A. Birch, Qshequilla Mitchell, and Hannah M. Priest
Health Education
Parent and Family Engagement
Physical Environment
Social and Emotional Climate
Physical Education and Physical Activity
Counseling, Psychological, and Social Services
Health Services
Nutrition Environment and Services
Employee Wellness
Summary
Learning Aids
Part II: Putting the Focus on the Child
Chapter 4 The Whole Child Initiative
Sean Slade
Whole Child Tenets
Links Between Health and Education
“Healthy” as a Key Tenet of the Whole Child Initiative
Gaining Support for the Whole Child Initiative
Nine Levers for Cultural Change
Sustainability
Relevance for Whole School, Whole Community, Whole Child
Summary
Learning Aids
Chapter 5 Linking Health and Academic Success
Michele Wallen
Health and Education in Early Childhood
Health-Risk Behaviors and Academic Achievement
Making a Difference Through the WSCC Approach
Summary
Learning Aids
Part III: Building Partnerships and Support
Chapter 6 Role of School Administration
Jeremy Lyon
Need for School Health Promotion
School Administrators as Advocates for WSCC
Embracing the Leadership Role in WSCC
Promoting Change
Schools as Centers for Employee Wellness
Identifying Health Champions
Identifying a Leader
Moving Forward
Summary
Learning Aids
Chapter 7 Meeting the Needs of Diverse Students, Families, and Communities
Angelia M. Paschal
Diverse Students and School Connectedness
Diverse Family Involvement
Diverse Community Engagement
Cultural Competence Strategies
Whole School, Whole Community, Whole Child Approach
Summary
Learning Aids
Chapter 8 Community Involvement
Bonni C. Hodges and Lisa Angermeier
Need for School–Community Collaborations
Stages of Collaboration
Barriers to Collaboration
Characteristics of Effective School–Community Collaborations
Summary
Learning Aids
Part IV: Planning, Implementation, and Evaluation
Chapter 9 Planning for WSCC
Bonni C. Hodges and Donna M. Videto
Need for Systematic Planning
Creating a Comprehensive Profile
Actions for Collecting Profile Data
Implications for WSCC
Summary
Learning Aids
Chapter 10 Implementing WSCC
Donna M. Videto and David A. Birch
1. Secure and Maintain Administrative Support and Commitment
2. Establish a District Health Council and School Teams
3. Identify a School Health Coordinator
4. Set Goals and Objectives and Then Develop a Plan
5. Implement the Plan and Strategies
ASCD and CDC Combined Strategies 5, 6, and 7
Summary
Learning Aids
Chapter 11 Evaluating WSCC
Robert Valois
Rationale for Program Evaluation
Planning for Program Evaluation
Developing an Evaluation Plan: CDC’s Framework for Program Evaluation
Internal or External Program Evaluation
Types of Evaluation
Quantitative and Qualitative Data Collection
Summary
Learning Aids
Part V: The Path Forward
Chapter 12 Building on the Past and Moving Into the Future
Sean Slade
CSH Success
Focus on Standardized Testing
Beyond Cooperation: Alignment and Integration
Healthy Learning Environment
Responding to Trends in Education
ASCD and CDC
What’s in It for Education?
What’s in It for Health?
Summary
Chapter 13 Perspectives From the Field
Sharon Murray
Karen Cottrell
Richard A. Lyons
Barb McDowell
Vanessa Booth
Rochelle Davis
Beth H. Chaney
Linda Morse
Denise M. Seabert
Deborah A. Fortune
Jill Deuink Pace
Laurence Spring
Caroline Eberle
Sharon Murray
David A. Birch, PhD, MCHES, is professor and chair of the department of health science at the University of Alabama. He is president-elect of the Society for Public Health Education (SOPHE) and is past president of the American Association for Health Education (AAHE). He has served on the board of directors of AAHE, the American School Health Association (ASHA), and the National Association of Health Education Centers (NAHEC) and on the board of trustees of the Society for Public Health Education (SOPHE). Dr. Birch is cochair of the National Implementation Task Force for Accreditation in Health Education, a member of the Governing Council of the American Public Health Association, and a member of the board of directors of the Foundation for the Advancement for Health Education. He is chair of the editorial board of the Journal of School Health and a member of the editorial boards of Pedagogy in Health Promotion: The Scholarship of Teaching and Learning and the American Journal of Health Studies. Dr. Birch is a charter fellow of AAHE and a fellow of ASHA. He has received the Eta Sigma Gamma Honor Award (2015), the SOPHE Presidential Citation (2012), the ASHA Outstanding Researcher Award (2010), AAHE Professional Service Award (2008), the AAHE Presidential Citation (2008, 2012, and 2013), and the ASHA Distinguished Service Award (1996). He was the 2008 Ann E. Nolte Scholar in Health Education at Illinois State University and a 2000 Robert D. Russell Scholar at Southern Illinois University at Carbondale. As a faculty member at Indiana University, Dr. Birch received the Trustee’s Teaching Award and the Teaching Excellence Recognition Award. His research interests include professional preparation, professional leadership, and the Whole School, Whole Community, Whole Child model.
Donna M. Videto, PhD, MCHES, is a professor of health at SUNY College at Cortland. She is a national leader in school health and has published articles on health education in several journals, written chapters in four books, and coauthored a book on assessment in health education. She has also made numerous presentations across the United States on health education and was given the 2012 New York AHPERD Amazing People Award for outstanding contributions and commitment to professional excellence. She became an American Association for Health Education fellow in 2012, and she has received several awards for her teaching. Videto is a member of the American School Health Association and the Society for Public Health Education.
Tips for Implementation of WSCC at District Level
The Cortland City (New York) school district was highlighted on the CDC website of success stories (CDC, 2013c) for the work conducted at Cortland City Schools in the CSH component of nutrition services. District initiatives included limiting student access to competitive foods, adopting marketing techniques to promote healthful choices, setting nutrition policies and standards, establishing nutrition standards for competitive foods, and making more healthy foods and beverages available.
Tips for Implementation at District Level
The Cortland City (New York) school district was highlighted on the CDC website of success stories (CDC, 2013c) for the work conducted at Cortland City Schools in the CSH component of nutrition services. District initiatives included limiting student access to competitive foods, adopting marketing techniques to promote healthful choices, setting nutrition policies and standards, establishing nutrition standards for competitive foods, and making more healthy foods and beverages available. Six factors were reported as keys to the success of Cortland City Schools. The first factor was having a vision of being committed to a Coordinated School Health program. The second factor was leadership as demonstrated by administrative support from the board of education, superintendent, and the principals from the schools in the district. The third factor, collaboration, was shown through partnerships that were established with community agencies, staff, parents, and students. Teamwork in each building as well as districtwide provided a demonstration of the fourth factor. The fifth factor, data driven, was demonstrated by collecting baseline data to demonstrate improvements after repeated assessments, which were then conducted every two to three years. Finally, the sixth factor recognized was the issue of financial support, which was apparent in the use of minigrants such as one through the Healthy Heart Coalition.
Jeannette Dippo, former Health Education and Wellness coordinator with Cortland City Schools, offered five suggestions for the implementation of CSH programs and policies:
- Districts need to get administrative support for the CSH activities and to send out consistent messages.
- Broad involvement is needed, including support from parents, school staff, and community members. This support is necessary for strong advocates to assist in getting the CSH vision and goals converted into actual programs and policy. Administrators may respond more positivity to general staff and parents than to the typical school health champion, who is generally the health educator or health coordinator.
- The most critical CSH priorities need to be converted into policy. Such a policy will help ensure that work or effort in that area will continue. A policy will help to establish the priority after the champions leave or have moved on to other initiatives because the policy will still exist.
- Each school needs to have a health coordinator to drive and pull the work of the team together. The schools and the district need someone with real passion for CSH. CSH functions best when someone with continuity who believes in what is being done is there to oversee the actions. A health coordinator is someone to help develop the structure for the work to happen.
- A healthy school team is needed for every school building, along with a separate district team. The accomplishments that were made in individual schools happened because each school building had its own team to work with, and someone to take the program or initiative and make it happen at the school level. It is critical that school principals be members of each school team. This network needs to be in place to share ideas and develop and implement districtwide policies.
Implement the Plan and Strategies
Putting the action plan into place consists of implementing the plan and strategies, which usually consists of adopting policies or programs. When implementing the plan, districts need to direct the focus of school health efforts on meeting the education and health needs of students (CDC, 2013b). In addition, providing opportunities for students to be meaningfully involved in the school and the community will help the team to focus on students. School health efforts in programming and policies should give youth the chance to develop and exercise leadership abilities, build skills, form positive relationships with caring adults, and contribute to their school and greater community (CDC, 2013a).
CDC suggests that students can promote a healthy and safe school and community through opportunities such as involvement in peer education, peer advocacy, or cross-age mentoring programs. Other opportunities include involving young people in service learning avenues and participation on school health teams' advisory committees and boards that address health and wellness, education, and youth-related issues (CDC, 2013b).
Moving into the taking-action phase of program and policy implementation, CDC suggests that school districts implement multiple strategies through multiple components. To address one school health component, a variety of efforts are needed to have an effect in that area. Because the components are often overlapping and dependent on each other, addressing multiple if not all of the components is recommended for achieving the positive health and learning outcomes desired (CDC, 2013b). Many possibilities exist for advancing each of the WSCC components, and examples of possible policies and programming efforts can be discovered in any of the CSH assessment tools or criteria (see table 10.2 for possible strategies for improvement). Tools such as the CDC School Health Index, ASCD Healthy Schools Report Card, and ASCD School Improvement Tool are some of the more well-known and commonly used tools. Any strategies pursued by a school or district should be based on an assessment conducted at the school or district.
Schools should consider implementing policies and programs to help students avoid or reduce health-risk behaviors that contribute to the leading causes of death and disability among young people as well as among adults (CDC, 2014d). CDC has identified six categories of priority health-risk behaviors as being linked to the leading causes of death and disability in the United States:
- Behaviors that contribute to unintentional injuries and violence
- Tobacco use
- Alcohol and other drug use
- Sexual behaviors that contribute to unintended pregnancy and STDs, including HIV infection
- Unhealthy eating
- Physical inactivity (CDC, 2014d)
Schools can assess health-risk behaviors among young people in these six categories as well as in general health status, overweight, and asthma through formal surveys such as the Youth Risk Behavior Survey (YRBS) (CDC, 2014d). The YRBS, available through CDC, is a national school-based survey that can provide the school and district with behavioral data for 9th through 12th graders (CDC, 2014d). Data resulting from the survey can be used to track behavioral trends at the local level for establishing priorities and for monitoring program and policy success. In addition, the local data can be used to make comparisons to state, regional, and national levels with the data available on the CDC YRBS website. For example if a school district discovers that the proportion of students who participated in at least 60 minutes of physical activity per day was lower than the proportion for students in the state and nation, the district may decide that they need to address the issue. The action could mean changing the academic schedule and requirements to include daily physical education, training teachers to incorporate physical activity into the classroom, allowing fit breaks throughout the day, or instituting a walk-to-school program. This example demonstrates how data from the YRBS system can be used to inform programming and policies as a district tries to improve the health and well-being of students and staff.
After a health-risk behavior or behaviors have been identified as a priority, the school or district faces the challenge of identifying or developing relevant policies or programs. Research-based programming that can reduce risk behaviors has been identified, and information is available through Registries of Programs Effective in Reducing Youth Risk Behaviors on the CDC website as well as through other similar sites (CDC, 2013d).
Besides selecting programming options, districts need to work to bring faculty and staff onboard with WSCC efforts. Education is important to help faculty and staff see the value of a coordinated approach and the relationship between health and academics. With proper training, teachers and school leaders can become important health champions to support and reinforce efforts of the school health education coordinator or administrator (Healthy Schools Campaign, 2012). Education is also essential for teachers, administrators, and other school employees committed to improving the health, academic success, and well-being of students. CDC stated,
Professional development can provide opportunities for school employees to identify areas for improvement, learn about and use proven practices, solve problems, develop skills, and reflect on and practice new strategies. In order to promote a Coordinated School Health approach, professional development should focus on the development of skills such as leadership, communication, and collaboration. (CDC, 2013b, para. 8)
In the 2013 document A Framework for Safe and Successful Schools,the recommendation was provided to conduct professional development for school staff and community partners that would address school climate and safety; positive behavior; and crisis prevention, preparedness, and response (NASP, 2013). As part of the professional development training, teachers and school leaders need to be provided with the information and resources they need to address student health issues and support a healthy school environment (Healthy Schools Campaign, 2012). Training might involve helping teachers to become aware of state-level health education regulations and requirements for health instruction so that those issues can be addressed outside the health education classroom and integrated into other subjects as a way to reinforce health-promoting concepts (Healthy Schools Campaign, 2012). Having more teachers and school leaders take on the role of health champion and work to support health concepts and health policies facilitates moving the district toward a more unified WSCC effort. Table 10.3 provides examples of how all teachers, not just health and physical education teachers, and school leaders can support WSCC though examples in each of the 10 components.
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Creation of WSCC
ASCD, in collaboration with CDC, moved forward in 2013 to develop a new model that builds on both the Whole Child Initiative and the original eight-component CSH approach. The development of the new model, titled Whole School, Whole Community, Whole Child (WSCC), involved a consultation group that developed the documents and frameworks related to the new model and a review group that periodically reviewed and provided feedback to the work of the consultation group.
ASCD, in collaboration with CDC, moved forward in 2013 to develop a new model that builds on both the Whole Child Initiative and the original eight-component CSH approach. The development of the new model, titled Whole School, Whole Community, Whole Child (WSCC), involved a consultation group that developed the documents and frameworks related to the new model and a review group that periodically reviewed and provided feedback to the work of the consultation group. Members of both groups were selected because of their role as leaders in both education and health. The new WSCC model was introduced at two national conferences, the ASCD conference in Los Angeles in March 2014 and the Society for Public Health Education (SOPHE) conference in Baltimore, also in March 2014. WSCC incorporates and builds on CSH and the ASCD Whole Child Initiative (ASCD, 2014).
WSCC is designed to promote alignment, integration, and collaboration between education and health and is intended to enhance health outcomes and academic success. Support and engagement of the whole community should be an important aspect of the implementation of WSCC (ASCD, 2014).
An important aspect of the new model is the expansion from 8 to 10 components. One original component, healthy and safe school environment, has been expanded to two separate components, physical environment and social and emotional climate. Another original component, family and community involvement, has been expanded to two components, community involvement and family engagement (see figure 1.1) (ASCD, 2014). The evolution of the school health models is presented in figure 1.2.
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Evolution of components in school health models.
Following are brief descriptions of all 10 WSCC components:
- Health education:Health education provides students with opportunities to acquire the knowledge, attitudes, and skills necessary for making health-promoting decisions, achieving health literacy, adopting health-enhancing behaviors, and promoting the health of others. Health education should be provided sequentially from pre-K through grade 12. Health education curricula should address important health topic areas through instruction based on the National Health Education Standards (NHES) (CDC, 2013).
- Physical education and physical activity: Physical education is a school-based instructional opportunity for students to gain the necessary skills and knowledge for lifelong participation in physical activity. Physical education is characterized by a planned, sequential K through 12 curriculum that assists students in achieving the national standards for K through 12 physical education. The outcome of a quality physical education program is a physically educated person who has the knowledge, skills, and confidence to enjoy a lifetime of healthful physical activity (CDC, 2013).
- Health services:These services are designed to ensure access or referral to primary health care services; foster appropriate use of primary health care services; prevent and control communicable disease and other health problems; provide emergency care for illness or injury; promote and provide optimum sanitary conditions for a safe school facility and school environment; and provide educational and counseling opportunities for promoting and maintaining individual, family, and community health (CDC, 2013).
- Nutrition environment and services: Schools should provide access to a variety of nutritious and appealing meals that accommodate the health and nutrition needs of all students. School nutrition programs should reflect U.S. Dietary Guidelines for Americans and other criteria to achieve nutrition integrity. The school nutrition services should offer students a learning laboratory for classroom nutrition and health education and serve as a resource for linkages with nutrition-related community services (CDC, 2013).
- Counseling, psychological, and social services: These services are provided to improve students' mental, emotional, and social health and include individual and group assessments, interventions, and referrals. Organizational assessment and consultation skills of counselors and psychologists should contribute not only to the health of students but also to the health of the school environment (CDC, 2013).
- Physical environment: The physical environment of the school includes buildings, school grounds, playground equipment, and athletic fields. The physical environment within the school includes building design, adequate space, cleanliness, noise level, heating and cooling, ventilation, and restrooms. These interior and exterior areas should be clean; safe; free from environmental hazards, tobacco, drugs, weapons, and violence; and appropriately secure from unauthorized access (Allensworth, Lawson, Nicholson, & Wyche, 1997; ASCD, 2014).
- Social and emotional climate:The social and emotional climate should provide a supportive culture conducive to enabling students, families, and staff members to feel safe, secure, accepted, and valued. Important factors in the social and emotional climate of a school include an attractive, comfortable physical environment; appreciation and respect for individual differences and cultural diversity; value placed on equity and social justice; high expectations and supportive actions for learning; size and structure of classes and organizations; and a general sense of comfort and safety (Allensworth, Lawson, Nicholson, & Wyche, 1997).
- Health promotion for staff: Schools can provide opportunities for school staff members to improve their health status through activities such as health assessments, health education, and health-related fitness activities. These opportunities should encourage staff members to pursue a healthy lifestyle that contributes to their improved health status, improved morale, and a greater personal commitment to the school's overall coordinated health approach (CDC, 2013).
- Family engagement:Epstein et al. (2009) identified six types of involvement necessary for successful school and family partnerships: (1) providing parenting support, (2) communicating with parents, (3) providing diverse volunteer opportunities, (4) supporting at-home learning, (5) encouraging parents to engage in decision-making opportunities in schools, and (6) collaborating with the community. Engaging family members often involves overcoming challenges such as family time conflicts, lack of transportation to school, and lack of comfort among family members in engaging in school activities. In addition, teachers and school staff may lack adequate time and resources to work with families.
- Community involvement:Meaningful community involvement in the WSCC approach is characterized by systematic collaboration among individuals and organizations within the school community. This systematic collaboration involves the engagement of individuals and organizations representing various segments of the community in the planning, implementation, and evaluation of programs, structures, and systems designed to create and sustain WSCC. The collaboration also involves the sharing of both community and school resources.
An Early Step Forward in Promoting WSCC at the Local Level
Upon the March 2014 unveiling of the Whole School, Whole Community, Whole Child model, a local school district in upstate New York introduced WSCC to the district's faculty and administration across their rural school district. A faculty member from a local college was asked to introduce the new WSCC model and then work with the district health and wellness coordinator to oversee 25 breakout sessions focused on the theme of incorporating wellness into learning. One goal for the day was to provide participants with knowledge and skills to adjust the physical, social, and emotional climate in their classrooms to improve the learning environment for each student. In an attempt to achieve the workshop goal, the WSCC model was introduced and compared with the CSH model. The ASCD video that provides an overview of the WSCC model was shown to the audience. Following the video a discussion was held on how a collaborative approach can have a positive effect on health and learning in the school district.
At the conclusion of the opening session, breakout sessions with small groups were held. An example of a breakout session was one titled "Healthy and Wise: Preparing Students for the World Beyond Formal Schooling." In this session, the facilitator went into detail about the collaborative WSCC approach while putting a strong focus on the ASCD Whole Child concept. The goal of this breakout session was to challenge the participants to produce a comprehensive health and academic plan in which the faculty and staff become leaders in the quest to reinvent, refocus, and recharge the health and academic status of the school district.
At the conclusion of the workshop it was decided to begin an initiative to implement the WSCC approach in the school district. The name of the first effort is "Optimize the Year with Healthy Habits: Incredible You, Incredible Year." In this effort the wellness committee will begin by addressing the wellness of the faculty and staff for the upcoming school year as a way to develop health and wellness leaders for the work to follow.
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Assessing nutrition and health services
Discover School Breakfast Toolkit - Purpose: This toolkit, from the Food and Nutrition Service of the U.S. Department of Agriculture, was developed to help schools assess current breakfast patterns and programs, calculate costs of implementing or changing breakfast programs, identify the type of meal service to provide to students, and create a marketing plan to engage and sustain a customer base.
Assessing Nutrition Services
Discover School Breakfast Toolkit
Purpose: This toolkit, from the Food and Nutrition Service of the U.S. Department of Agriculture, was developed to help schools assess current breakfast patterns and programs, calculate costs of implementing or changing breakfast programs, identify the type of meal service to provide to students, and create a marketing plan to engage and sustain a customer base. The toolkit includes the following sections:
- Introduction
- Successful use of the toolkit, which guides users through the toolkit
- An initial assessment, which provides surveys that schools can use to evaluate the interest levels of parents and students
- Cost calculator, which includes worksheets to help schools calculate the costs of implementing the School Breakfast Program
- Description of multiple methods for serving breakfast, which can help schools determine the best method for their needs
- Roadmaps to success
- Marketing efforts, which includes a marketing plan for schools to market the School Breakfast Program
- Resources
- Program evaluation, which provides information about how and what to evaluate specific to the School Breakfast Program
Audience: The toolkit is targeted toward individuals interested in increasing access to the School Breakfast Program. That might include school health councils, school nutrition staff, school administrators, parents, and community members.
Use: Toolkit users should first become familiar with the items in the toolkit and the steps to take. The next step is to use the student, parent, and administrator surveys to identify current knowledge, attitudes, and behaviors of these audiences as it relates to eating breakfast and breakfast programs. The third step is to use the tools to calculate a variety of cost-related items, such as breakfast profit/loss, revenue per reimbursable breakfast, daily revenue breakfast, and annual expenses to revenue comparisons. The remaining components of the toolkit guides users through identifying the best method for serving breakfast and developing and implementing a marketing plan to increase access and participation in the School Breakfast Program.
Access: The toolkit is found online at www.fns.usda.gov/cnd/breakfast/toolkit/.
Assessing Health Services
Body Mass Index Measurement (BMI) in Schools
Purpose: Developed by CDC researchers, with extensive input from experts from the field of school health, the BMI Measurement in Schools document, published in both full journal article (Nihiser, 2007) and executive summary formats, provides schools with an overview of what BMI is, the differences between BMI surveillance and screening, and a list of safeguards for schools choosing to implement a BMI measurement program.
Audience: The document can be used by school health councils, school nurses, and physical education and health education teachers. Any school interested in conducting BMI measurement can use the document to learn more about options for such a strategy and to identify the best option for the school.
Use: The BMI Measurement in Schools document presents both a synthesis of the science on measuring BMI in schools and safeguards to have in place when developing and implementing such a program or initiative. Leaders within the school who are interested in BMI measurement use the document to determine whether the school prefers surveillance or screening and to identify how the safeguards can be put in place.
Access: Both the full journal article and the executive summary can be found online at www.cdc.gov/healthyyouth/npao/publications.htm#10.
Safe at School and Ready to Learn: A Comprehensive Policy Guide for Protecting Students With Life-Threatening Food Allergies
Purpose: Developed by the National School Boards Association (NSBA), the Safe at School and Ready to Learn policy guide provides school boards with an overview of the prevalence of food allergies, policy guidance for school boards to consider when developing food allergy policies, and a policy checklist (National School Boards Association, 2012). The policy checklist guides the user through a process of identifying policy areas that need attention and actions that can be taken towards improvement.
Audience: The policy guide is to be used primarily by school board members. Secondary users can be school administrators, school health services staff, physical and health education teachers, parents, and school nutrition staff.
Use: In addition to providing policy guidance to school boards and other stakeholders, the guide's checklist is to be completed by identifying whether a specific policy element is included or not included and whether it is implemented or not implemented. When policy gaps are determined, a section for identifying action steps is provided. Results of the policy checklist can be used to inform and develop food allergy policies for schools.
Access: The guide is available online at http://www.nsba.org/sites/default/files/reports/Safe-at-School-and-Ready-to-Learn.pdf
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What a health education curriculum should look like
Comprehensive school health education is characterized by planned, sequential, developmentally appropriate, and culturally inclusive learning experiences taught by qualified trained teachers. The health education curriculum should be based on relevant health behavior theories; focus on the emotional, intellectual, physical, and social dimensions of health; provide students with exposure to diverse instructional techniques; and evaluate student achievement through a variety of assessment
Health Education
Comprehensive school health education is characterized by planned, sequential, developmentally appropriate, and culturally inclusive learning experiences taught by qualified trained teachers. The health education curriculum should be based on relevant health behavior theories; focus on the emotional, intellectual, physical, and social dimensions of health; provide students with exposure to diverse instructional techniques; and evaluate student achievement through a variety of assessment strategies (Joint Committee on National Health Education Standards [JCNHES], 2007). The learning experiences embedded within the curriculum should be designed to help students acquire functional health information; identify personal values that support healthy behaviors; recognize group norms that relate to a healthy lifestyle; and develop skills necessary to adopt, practice, and maintain health-enhancing behaviors (CDC, 2013a; JCNHES, 2007). Although many leaders in health and education suggest a linkage between quality health education and academic achievement, and some research verifies this linkage, many schools in the United States struggle to provide quality health education instruction (CDC, 2013b; JCNHES, 2007). Possible positive consequences of this linkage include a decrease in student absenteeism, higher academic achievement, and an increase in graduation rates (Allensworth, 2011; Basch, 2011a, 2011b; Freudenberg & Ruglis, 2007).
Healthy People 2020 includes an objective to increase the proportion of elementary, middle, and senior high schools that provide comprehensive school health education (USDHHS, 2013). Nationwide, 41.2 percent of elementary schools, 58.7 percent of middle schools, and 78.7 percent of high schools had specific time requirements for school health instruction (CDC, 2013b).
Thesecond edition of The National Health Education Standards (figure 3.1) was released in 2007. The standards were developed by a panel of health education leaders with input from professionals in both health and education, as well as parents and community members. The standards are not federally mandated or designed to define a national curriculum. Instead, they are intended to provide a framework and resource for the development of state standards and health education curricula in local school districts (American Cancer Society, 2007). The standardsinclude three distinct components: the individual health education standards, a rationale statement for each standard, and performance indicators linked to each standard for mastery by the completion of grades 4, 8, and 11 (American Cancer Society, 2007).
The standards can be applied to various health education content areas. The Centers for Disease Control and Prevention (CDC, 2011a) has identified six risk behaviors as being important focal points for instruction in school health education. These behaviors include alcohol and other drug use, physical inactivity, sexual behaviors that contribute to unintended pregnancy and sexually transmitted diseases, tobacco use, unhealthy dietary behaviors, and behaviors that contribute to unintentional injuries and violence. Other possible content areas for instruction include environmental health, human sexuality, and mental and emotional health (CDC, 2013a).
Beyond the National Health Education Standards, quality school health education should be based on quality health instruction. The following best practices have been identified by the CDC Division of Adolescent and School Health. They are based on reviews of effective programs and curricula and the positions of experts in the profession of health education (CDC, 2013d).
- Focus on clear health goals and related behavioral outcomes
- Are research-based and theory-driven
- Address individual values, attitudes, and beliefs
- Address individual and group norms that support health-enhancing behaviors
- Focus on reinforcing protective factors and increasing perceptions of personal risk and harmfulness of engaging in specific unhealthy practices and behaviors
- Address social pressures and influences
- Build personal competence, social competence, and self-efficacy by addressing skills
- Provide functional health knowledge that is basic, accurate, and directly contributes to health-promoting decisions and behaviors
- Use strategies designed to personalize information and engage students
- Provide age-appropriate and developmentally appropriate information, learning strategies, teaching methods, and materials
- Incorporate learning strategies, teaching methods, and materials that are culturally inclusive
- Provide adequate time for instruction and learning
- Provide opportunities to reinforce skills and positive health behaviors
- Provide opportunities to make positive connections with influential others
- Include teacher information and plans for professional development and training that enhance effectiveness of instruction and student learning
Learn more about Promoting Health and Academic Success.
Tips for Implementation of WSCC at District Level
The Cortland City (New York) school district was highlighted on the CDC website of success stories (CDC, 2013c) for the work conducted at Cortland City Schools in the CSH component of nutrition services. District initiatives included limiting student access to competitive foods, adopting marketing techniques to promote healthful choices, setting nutrition policies and standards, establishing nutrition standards for competitive foods, and making more healthy foods and beverages available.
Tips for Implementation at District Level
The Cortland City (New York) school district was highlighted on the CDC website of success stories (CDC, 2013c) for the work conducted at Cortland City Schools in the CSH component of nutrition services. District initiatives included limiting student access to competitive foods, adopting marketing techniques to promote healthful choices, setting nutrition policies and standards, establishing nutrition standards for competitive foods, and making more healthy foods and beverages available. Six factors were reported as keys to the success of Cortland City Schools. The first factor was having a vision of being committed to a Coordinated School Health program. The second factor was leadership as demonstrated by administrative support from the board of education, superintendent, and the principals from the schools in the district. The third factor, collaboration, was shown through partnerships that were established with community agencies, staff, parents, and students. Teamwork in each building as well as districtwide provided a demonstration of the fourth factor. The fifth factor, data driven, was demonstrated by collecting baseline data to demonstrate improvements after repeated assessments, which were then conducted every two to three years. Finally, the sixth factor recognized was the issue of financial support, which was apparent in the use of minigrants such as one through the Healthy Heart Coalition.
Jeannette Dippo, former Health Education and Wellness coordinator with Cortland City Schools, offered five suggestions for the implementation of CSH programs and policies:
- Districts need to get administrative support for the CSH activities and to send out consistent messages.
- Broad involvement is needed, including support from parents, school staff, and community members. This support is necessary for strong advocates to assist in getting the CSH vision and goals converted into actual programs and policy. Administrators may respond more positivity to general staff and parents than to the typical school health champion, who is generally the health educator or health coordinator.
- The most critical CSH priorities need to be converted into policy. Such a policy will help ensure that work or effort in that area will continue. A policy will help to establish the priority after the champions leave or have moved on to other initiatives because the policy will still exist.
- Each school needs to have a health coordinator to drive and pull the work of the team together. The schools and the district need someone with real passion for CSH. CSH functions best when someone with continuity who believes in what is being done is there to oversee the actions. A health coordinator is someone to help develop the structure for the work to happen.
- A healthy school team is needed for every school building, along with a separate district team. The accomplishments that were made in individual schools happened because each school building had its own team to work with, and someone to take the program or initiative and make it happen at the school level. It is critical that school principals be members of each school team. This network needs to be in place to share ideas and develop and implement districtwide policies.
Implement the Plan and Strategies
Putting the action plan into place consists of implementing the plan and strategies, which usually consists of adopting policies or programs. When implementing the plan, districts need to direct the focus of school health efforts on meeting the education and health needs of students (CDC, 2013b). In addition, providing opportunities for students to be meaningfully involved in the school and the community will help the team to focus on students. School health efforts in programming and policies should give youth the chance to develop and exercise leadership abilities, build skills, form positive relationships with caring adults, and contribute to their school and greater community (CDC, 2013a).
CDC suggests that students can promote a healthy and safe school and community through opportunities such as involvement in peer education, peer advocacy, or cross-age mentoring programs. Other opportunities include involving young people in service learning avenues and participation on school health teams' advisory committees and boards that address health and wellness, education, and youth-related issues (CDC, 2013b).
Moving into the taking-action phase of program and policy implementation, CDC suggests that school districts implement multiple strategies through multiple components. To address one school health component, a variety of efforts are needed to have an effect in that area. Because the components are often overlapping and dependent on each other, addressing multiple if not all of the components is recommended for achieving the positive health and learning outcomes desired (CDC, 2013b). Many possibilities exist for advancing each of the WSCC components, and examples of possible policies and programming efforts can be discovered in any of the CSH assessment tools or criteria (see table 10.2 for possible strategies for improvement). Tools such as the CDC School Health Index, ASCD Healthy Schools Report Card, and ASCD School Improvement Tool are some of the more well-known and commonly used tools. Any strategies pursued by a school or district should be based on an assessment conducted at the school or district.
Schools should consider implementing policies and programs to help students avoid or reduce health-risk behaviors that contribute to the leading causes of death and disability among young people as well as among adults (CDC, 2014d). CDC has identified six categories of priority health-risk behaviors as being linked to the leading causes of death and disability in the United States:
- Behaviors that contribute to unintentional injuries and violence
- Tobacco use
- Alcohol and other drug use
- Sexual behaviors that contribute to unintended pregnancy and STDs, including HIV infection
- Unhealthy eating
- Physical inactivity (CDC, 2014d)
Schools can assess health-risk behaviors among young people in these six categories as well as in general health status, overweight, and asthma through formal surveys such as the Youth Risk Behavior Survey (YRBS) (CDC, 2014d). The YRBS, available through CDC, is a national school-based survey that can provide the school and district with behavioral data for 9th through 12th graders (CDC, 2014d). Data resulting from the survey can be used to track behavioral trends at the local level for establishing priorities and for monitoring program and policy success. In addition, the local data can be used to make comparisons to state, regional, and national levels with the data available on the CDC YRBS website. For example if a school district discovers that the proportion of students who participated in at least 60 minutes of physical activity per day was lower than the proportion for students in the state and nation, the district may decide that they need to address the issue. The action could mean changing the academic schedule and requirements to include daily physical education, training teachers to incorporate physical activity into the classroom, allowing fit breaks throughout the day, or instituting a walk-to-school program. This example demonstrates how data from the YRBS system can be used to inform programming and policies as a district tries to improve the health and well-being of students and staff.
After a health-risk behavior or behaviors have been identified as a priority, the school or district faces the challenge of identifying or developing relevant policies or programs. Research-based programming that can reduce risk behaviors has been identified, and information is available through Registries of Programs Effective in Reducing Youth Risk Behaviors on the CDC website as well as through other similar sites (CDC, 2013d).
Besides selecting programming options, districts need to work to bring faculty and staff onboard with WSCC efforts. Education is important to help faculty and staff see the value of a coordinated approach and the relationship between health and academics. With proper training, teachers and school leaders can become important health champions to support and reinforce efforts of the school health education coordinator or administrator (Healthy Schools Campaign, 2012). Education is also essential for teachers, administrators, and other school employees committed to improving the health, academic success, and well-being of students. CDC stated,
Professional development can provide opportunities for school employees to identify areas for improvement, learn about and use proven practices, solve problems, develop skills, and reflect on and practice new strategies. In order to promote a Coordinated School Health approach, professional development should focus on the development of skills such as leadership, communication, and collaboration. (CDC, 2013b, para. 8)
In the 2013 document A Framework for Safe and Successful Schools,the recommendation was provided to conduct professional development for school staff and community partners that would address school climate and safety; positive behavior; and crisis prevention, preparedness, and response (NASP, 2013). As part of the professional development training, teachers and school leaders need to be provided with the information and resources they need to address student health issues and support a healthy school environment (Healthy Schools Campaign, 2012). Training might involve helping teachers to become aware of state-level health education regulations and requirements for health instruction so that those issues can be addressed outside the health education classroom and integrated into other subjects as a way to reinforce health-promoting concepts (Healthy Schools Campaign, 2012). Having more teachers and school leaders take on the role of health champion and work to support health concepts and health policies facilitates moving the district toward a more unified WSCC effort. Table 10.3 provides examples of how all teachers, not just health and physical education teachers, and school leaders can support WSCC though examples in each of the 10 components.
Learn more about Promoting Health and Academic Success.
Creation of WSCC
ASCD, in collaboration with CDC, moved forward in 2013 to develop a new model that builds on both the Whole Child Initiative and the original eight-component CSH approach. The development of the new model, titled Whole School, Whole Community, Whole Child (WSCC), involved a consultation group that developed the documents and frameworks related to the new model and a review group that periodically reviewed and provided feedback to the work of the consultation group.
ASCD, in collaboration with CDC, moved forward in 2013 to develop a new model that builds on both the Whole Child Initiative and the original eight-component CSH approach. The development of the new model, titled Whole School, Whole Community, Whole Child (WSCC), involved a consultation group that developed the documents and frameworks related to the new model and a review group that periodically reviewed and provided feedback to the work of the consultation group. Members of both groups were selected because of their role as leaders in both education and health. The new WSCC model was introduced at two national conferences, the ASCD conference in Los Angeles in March 2014 and the Society for Public Health Education (SOPHE) conference in Baltimore, also in March 2014. WSCC incorporates and builds on CSH and the ASCD Whole Child Initiative (ASCD, 2014).
WSCC is designed to promote alignment, integration, and collaboration between education and health and is intended to enhance health outcomes and academic success. Support and engagement of the whole community should be an important aspect of the implementation of WSCC (ASCD, 2014).
An important aspect of the new model is the expansion from 8 to 10 components. One original component, healthy and safe school environment, has been expanded to two separate components, physical environment and social and emotional climate. Another original component, family and community involvement, has been expanded to two components, community involvement and family engagement (see figure 1.1) (ASCD, 2014). The evolution of the school health models is presented in figure 1.2.
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Evolution of components in school health models.
Following are brief descriptions of all 10 WSCC components:
- Health education:Health education provides students with opportunities to acquire the knowledge, attitudes, and skills necessary for making health-promoting decisions, achieving health literacy, adopting health-enhancing behaviors, and promoting the health of others. Health education should be provided sequentially from pre-K through grade 12. Health education curricula should address important health topic areas through instruction based on the National Health Education Standards (NHES) (CDC, 2013).
- Physical education and physical activity: Physical education is a school-based instructional opportunity for students to gain the necessary skills and knowledge for lifelong participation in physical activity. Physical education is characterized by a planned, sequential K through 12 curriculum that assists students in achieving the national standards for K through 12 physical education. The outcome of a quality physical education program is a physically educated person who has the knowledge, skills, and confidence to enjoy a lifetime of healthful physical activity (CDC, 2013).
- Health services:These services are designed to ensure access or referral to primary health care services; foster appropriate use of primary health care services; prevent and control communicable disease and other health problems; provide emergency care for illness or injury; promote and provide optimum sanitary conditions for a safe school facility and school environment; and provide educational and counseling opportunities for promoting and maintaining individual, family, and community health (CDC, 2013).
- Nutrition environment and services: Schools should provide access to a variety of nutritious and appealing meals that accommodate the health and nutrition needs of all students. School nutrition programs should reflect U.S. Dietary Guidelines for Americans and other criteria to achieve nutrition integrity. The school nutrition services should offer students a learning laboratory for classroom nutrition and health education and serve as a resource for linkages with nutrition-related community services (CDC, 2013).
- Counseling, psychological, and social services: These services are provided to improve students' mental, emotional, and social health and include individual and group assessments, interventions, and referrals. Organizational assessment and consultation skills of counselors and psychologists should contribute not only to the health of students but also to the health of the school environment (CDC, 2013).
- Physical environment: The physical environment of the school includes buildings, school grounds, playground equipment, and athletic fields. The physical environment within the school includes building design, adequate space, cleanliness, noise level, heating and cooling, ventilation, and restrooms. These interior and exterior areas should be clean; safe; free from environmental hazards, tobacco, drugs, weapons, and violence; and appropriately secure from unauthorized access (Allensworth, Lawson, Nicholson, & Wyche, 1997; ASCD, 2014).
- Social and emotional climate:The social and emotional climate should provide a supportive culture conducive to enabling students, families, and staff members to feel safe, secure, accepted, and valued. Important factors in the social and emotional climate of a school include an attractive, comfortable physical environment; appreciation and respect for individual differences and cultural diversity; value placed on equity and social justice; high expectations and supportive actions for learning; size and structure of classes and organizations; and a general sense of comfort and safety (Allensworth, Lawson, Nicholson, & Wyche, 1997).
- Health promotion for staff: Schools can provide opportunities for school staff members to improve their health status through activities such as health assessments, health education, and health-related fitness activities. These opportunities should encourage staff members to pursue a healthy lifestyle that contributes to their improved health status, improved morale, and a greater personal commitment to the school's overall coordinated health approach (CDC, 2013).
- Family engagement:Epstein et al. (2009) identified six types of involvement necessary for successful school and family partnerships: (1) providing parenting support, (2) communicating with parents, (3) providing diverse volunteer opportunities, (4) supporting at-home learning, (5) encouraging parents to engage in decision-making opportunities in schools, and (6) collaborating with the community. Engaging family members often involves overcoming challenges such as family time conflicts, lack of transportation to school, and lack of comfort among family members in engaging in school activities. In addition, teachers and school staff may lack adequate time and resources to work with families.
- Community involvement:Meaningful community involvement in the WSCC approach is characterized by systematic collaboration among individuals and organizations within the school community. This systematic collaboration involves the engagement of individuals and organizations representing various segments of the community in the planning, implementation, and evaluation of programs, structures, and systems designed to create and sustain WSCC. The collaboration also involves the sharing of both community and school resources.
An Early Step Forward in Promoting WSCC at the Local Level
Upon the March 2014 unveiling of the Whole School, Whole Community, Whole Child model, a local school district in upstate New York introduced WSCC to the district's faculty and administration across their rural school district. A faculty member from a local college was asked to introduce the new WSCC model and then work with the district health and wellness coordinator to oversee 25 breakout sessions focused on the theme of incorporating wellness into learning. One goal for the day was to provide participants with knowledge and skills to adjust the physical, social, and emotional climate in their classrooms to improve the learning environment for each student. In an attempt to achieve the workshop goal, the WSCC model was introduced and compared with the CSH model. The ASCD video that provides an overview of the WSCC model was shown to the audience. Following the video a discussion was held on how a collaborative approach can have a positive effect on health and learning in the school district.
At the conclusion of the opening session, breakout sessions with small groups were held. An example of a breakout session was one titled "Healthy and Wise: Preparing Students for the World Beyond Formal Schooling." In this session, the facilitator went into detail about the collaborative WSCC approach while putting a strong focus on the ASCD Whole Child concept. The goal of this breakout session was to challenge the participants to produce a comprehensive health and academic plan in which the faculty and staff become leaders in the quest to reinvent, refocus, and recharge the health and academic status of the school district.
At the conclusion of the workshop it was decided to begin an initiative to implement the WSCC approach in the school district. The name of the first effort is "Optimize the Year with Healthy Habits: Incredible You, Incredible Year." In this effort the wellness committee will begin by addressing the wellness of the faculty and staff for the upcoming school year as a way to develop health and wellness leaders for the work to follow.
Learn more about Promoting Health and Academic Success.
Assessing nutrition and health services
Discover School Breakfast Toolkit - Purpose: This toolkit, from the Food and Nutrition Service of the U.S. Department of Agriculture, was developed to help schools assess current breakfast patterns and programs, calculate costs of implementing or changing breakfast programs, identify the type of meal service to provide to students, and create a marketing plan to engage and sustain a customer base.
Assessing Nutrition Services
Discover School Breakfast Toolkit
Purpose: This toolkit, from the Food and Nutrition Service of the U.S. Department of Agriculture, was developed to help schools assess current breakfast patterns and programs, calculate costs of implementing or changing breakfast programs, identify the type of meal service to provide to students, and create a marketing plan to engage and sustain a customer base. The toolkit includes the following sections:
- Introduction
- Successful use of the toolkit, which guides users through the toolkit
- An initial assessment, which provides surveys that schools can use to evaluate the interest levels of parents and students
- Cost calculator, which includes worksheets to help schools calculate the costs of implementing the School Breakfast Program
- Description of multiple methods for serving breakfast, which can help schools determine the best method for their needs
- Roadmaps to success
- Marketing efforts, which includes a marketing plan for schools to market the School Breakfast Program
- Resources
- Program evaluation, which provides information about how and what to evaluate specific to the School Breakfast Program
Audience: The toolkit is targeted toward individuals interested in increasing access to the School Breakfast Program. That might include school health councils, school nutrition staff, school administrators, parents, and community members.
Use: Toolkit users should first become familiar with the items in the toolkit and the steps to take. The next step is to use the student, parent, and administrator surveys to identify current knowledge, attitudes, and behaviors of these audiences as it relates to eating breakfast and breakfast programs. The third step is to use the tools to calculate a variety of cost-related items, such as breakfast profit/loss, revenue per reimbursable breakfast, daily revenue breakfast, and annual expenses to revenue comparisons. The remaining components of the toolkit guides users through identifying the best method for serving breakfast and developing and implementing a marketing plan to increase access and participation in the School Breakfast Program.
Access: The toolkit is found online at www.fns.usda.gov/cnd/breakfast/toolkit/.
Assessing Health Services
Body Mass Index Measurement (BMI) in Schools
Purpose: Developed by CDC researchers, with extensive input from experts from the field of school health, the BMI Measurement in Schools document, published in both full journal article (Nihiser, 2007) and executive summary formats, provides schools with an overview of what BMI is, the differences between BMI surveillance and screening, and a list of safeguards for schools choosing to implement a BMI measurement program.
Audience: The document can be used by school health councils, school nurses, and physical education and health education teachers. Any school interested in conducting BMI measurement can use the document to learn more about options for such a strategy and to identify the best option for the school.
Use: The BMI Measurement in Schools document presents both a synthesis of the science on measuring BMI in schools and safeguards to have in place when developing and implementing such a program or initiative. Leaders within the school who are interested in BMI measurement use the document to determine whether the school prefers surveillance or screening and to identify how the safeguards can be put in place.
Access: Both the full journal article and the executive summary can be found online at www.cdc.gov/healthyyouth/npao/publications.htm#10.
Safe at School and Ready to Learn: A Comprehensive Policy Guide for Protecting Students With Life-Threatening Food Allergies
Purpose: Developed by the National School Boards Association (NSBA), the Safe at School and Ready to Learn policy guide provides school boards with an overview of the prevalence of food allergies, policy guidance for school boards to consider when developing food allergy policies, and a policy checklist (National School Boards Association, 2012). The policy checklist guides the user through a process of identifying policy areas that need attention and actions that can be taken towards improvement.
Audience: The policy guide is to be used primarily by school board members. Secondary users can be school administrators, school health services staff, physical and health education teachers, parents, and school nutrition staff.
Use: In addition to providing policy guidance to school boards and other stakeholders, the guide's checklist is to be completed by identifying whether a specific policy element is included or not included and whether it is implemented or not implemented. When policy gaps are determined, a section for identifying action steps is provided. Results of the policy checklist can be used to inform and develop food allergy policies for schools.
Access: The guide is available online at http://www.nsba.org/sites/default/files/reports/Safe-at-School-and-Ready-to-Learn.pdf
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What a health education curriculum should look like
Comprehensive school health education is characterized by planned, sequential, developmentally appropriate, and culturally inclusive learning experiences taught by qualified trained teachers. The health education curriculum should be based on relevant health behavior theories; focus on the emotional, intellectual, physical, and social dimensions of health; provide students with exposure to diverse instructional techniques; and evaluate student achievement through a variety of assessment
Health Education
Comprehensive school health education is characterized by planned, sequential, developmentally appropriate, and culturally inclusive learning experiences taught by qualified trained teachers. The health education curriculum should be based on relevant health behavior theories; focus on the emotional, intellectual, physical, and social dimensions of health; provide students with exposure to diverse instructional techniques; and evaluate student achievement through a variety of assessment strategies (Joint Committee on National Health Education Standards [JCNHES], 2007). The learning experiences embedded within the curriculum should be designed to help students acquire functional health information; identify personal values that support healthy behaviors; recognize group norms that relate to a healthy lifestyle; and develop skills necessary to adopt, practice, and maintain health-enhancing behaviors (CDC, 2013a; JCNHES, 2007). Although many leaders in health and education suggest a linkage between quality health education and academic achievement, and some research verifies this linkage, many schools in the United States struggle to provide quality health education instruction (CDC, 2013b; JCNHES, 2007). Possible positive consequences of this linkage include a decrease in student absenteeism, higher academic achievement, and an increase in graduation rates (Allensworth, 2011; Basch, 2011a, 2011b; Freudenberg & Ruglis, 2007).
Healthy People 2020 includes an objective to increase the proportion of elementary, middle, and senior high schools that provide comprehensive school health education (USDHHS, 2013). Nationwide, 41.2 percent of elementary schools, 58.7 percent of middle schools, and 78.7 percent of high schools had specific time requirements for school health instruction (CDC, 2013b).
Thesecond edition of The National Health Education Standards (figure 3.1) was released in 2007. The standards were developed by a panel of health education leaders with input from professionals in both health and education, as well as parents and community members. The standards are not federally mandated or designed to define a national curriculum. Instead, they are intended to provide a framework and resource for the development of state standards and health education curricula in local school districts (American Cancer Society, 2007). The standardsinclude three distinct components: the individual health education standards, a rationale statement for each standard, and performance indicators linked to each standard for mastery by the completion of grades 4, 8, and 11 (American Cancer Society, 2007).
The standards can be applied to various health education content areas. The Centers for Disease Control and Prevention (CDC, 2011a) has identified six risk behaviors as being important focal points for instruction in school health education. These behaviors include alcohol and other drug use, physical inactivity, sexual behaviors that contribute to unintended pregnancy and sexually transmitted diseases, tobacco use, unhealthy dietary behaviors, and behaviors that contribute to unintentional injuries and violence. Other possible content areas for instruction include environmental health, human sexuality, and mental and emotional health (CDC, 2013a).
Beyond the National Health Education Standards, quality school health education should be based on quality health instruction. The following best practices have been identified by the CDC Division of Adolescent and School Health. They are based on reviews of effective programs and curricula and the positions of experts in the profession of health education (CDC, 2013d).
- Focus on clear health goals and related behavioral outcomes
- Are research-based and theory-driven
- Address individual values, attitudes, and beliefs
- Address individual and group norms that support health-enhancing behaviors
- Focus on reinforcing protective factors and increasing perceptions of personal risk and harmfulness of engaging in specific unhealthy practices and behaviors
- Address social pressures and influences
- Build personal competence, social competence, and self-efficacy by addressing skills
- Provide functional health knowledge that is basic, accurate, and directly contributes to health-promoting decisions and behaviors
- Use strategies designed to personalize information and engage students
- Provide age-appropriate and developmentally appropriate information, learning strategies, teaching methods, and materials
- Incorporate learning strategies, teaching methods, and materials that are culturally inclusive
- Provide adequate time for instruction and learning
- Provide opportunities to reinforce skills and positive health behaviors
- Provide opportunities to make positive connections with influential others
- Include teacher information and plans for professional development and training that enhance effectiveness of instruction and student learning
Learn more about Promoting Health and Academic Success.
Tips for Implementation of WSCC at District Level
The Cortland City (New York) school district was highlighted on the CDC website of success stories (CDC, 2013c) for the work conducted at Cortland City Schools in the CSH component of nutrition services. District initiatives included limiting student access to competitive foods, adopting marketing techniques to promote healthful choices, setting nutrition policies and standards, establishing nutrition standards for competitive foods, and making more healthy foods and beverages available.
Tips for Implementation at District Level
The Cortland City (New York) school district was highlighted on the CDC website of success stories (CDC, 2013c) for the work conducted at Cortland City Schools in the CSH component of nutrition services. District initiatives included limiting student access to competitive foods, adopting marketing techniques to promote healthful choices, setting nutrition policies and standards, establishing nutrition standards for competitive foods, and making more healthy foods and beverages available. Six factors were reported as keys to the success of Cortland City Schools. The first factor was having a vision of being committed to a Coordinated School Health program. The second factor was leadership as demonstrated by administrative support from the board of education, superintendent, and the principals from the schools in the district. The third factor, collaboration, was shown through partnerships that were established with community agencies, staff, parents, and students. Teamwork in each building as well as districtwide provided a demonstration of the fourth factor. The fifth factor, data driven, was demonstrated by collecting baseline data to demonstrate improvements after repeated assessments, which were then conducted every two to three years. Finally, the sixth factor recognized was the issue of financial support, which was apparent in the use of minigrants such as one through the Healthy Heart Coalition.
Jeannette Dippo, former Health Education and Wellness coordinator with Cortland City Schools, offered five suggestions for the implementation of CSH programs and policies:
- Districts need to get administrative support for the CSH activities and to send out consistent messages.
- Broad involvement is needed, including support from parents, school staff, and community members. This support is necessary for strong advocates to assist in getting the CSH vision and goals converted into actual programs and policy. Administrators may respond more positivity to general staff and parents than to the typical school health champion, who is generally the health educator or health coordinator.
- The most critical CSH priorities need to be converted into policy. Such a policy will help ensure that work or effort in that area will continue. A policy will help to establish the priority after the champions leave or have moved on to other initiatives because the policy will still exist.
- Each school needs to have a health coordinator to drive and pull the work of the team together. The schools and the district need someone with real passion for CSH. CSH functions best when someone with continuity who believes in what is being done is there to oversee the actions. A health coordinator is someone to help develop the structure for the work to happen.
- A healthy school team is needed for every school building, along with a separate district team. The accomplishments that were made in individual schools happened because each school building had its own team to work with, and someone to take the program or initiative and make it happen at the school level. It is critical that school principals be members of each school team. This network needs to be in place to share ideas and develop and implement districtwide policies.
Implement the Plan and Strategies
Putting the action plan into place consists of implementing the plan and strategies, which usually consists of adopting policies or programs. When implementing the plan, districts need to direct the focus of school health efforts on meeting the education and health needs of students (CDC, 2013b). In addition, providing opportunities for students to be meaningfully involved in the school and the community will help the team to focus on students. School health efforts in programming and policies should give youth the chance to develop and exercise leadership abilities, build skills, form positive relationships with caring adults, and contribute to their school and greater community (CDC, 2013a).
CDC suggests that students can promote a healthy and safe school and community through opportunities such as involvement in peer education, peer advocacy, or cross-age mentoring programs. Other opportunities include involving young people in service learning avenues and participation on school health teams' advisory committees and boards that address health and wellness, education, and youth-related issues (CDC, 2013b).
Moving into the taking-action phase of program and policy implementation, CDC suggests that school districts implement multiple strategies through multiple components. To address one school health component, a variety of efforts are needed to have an effect in that area. Because the components are often overlapping and dependent on each other, addressing multiple if not all of the components is recommended for achieving the positive health and learning outcomes desired (CDC, 2013b). Many possibilities exist for advancing each of the WSCC components, and examples of possible policies and programming efforts can be discovered in any of the CSH assessment tools or criteria (see table 10.2 for possible strategies for improvement). Tools such as the CDC School Health Index, ASCD Healthy Schools Report Card, and ASCD School Improvement Tool are some of the more well-known and commonly used tools. Any strategies pursued by a school or district should be based on an assessment conducted at the school or district.
Schools should consider implementing policies and programs to help students avoid or reduce health-risk behaviors that contribute to the leading causes of death and disability among young people as well as among adults (CDC, 2014d). CDC has identified six categories of priority health-risk behaviors as being linked to the leading causes of death and disability in the United States:
- Behaviors that contribute to unintentional injuries and violence
- Tobacco use
- Alcohol and other drug use
- Sexual behaviors that contribute to unintended pregnancy and STDs, including HIV infection
- Unhealthy eating
- Physical inactivity (CDC, 2014d)
Schools can assess health-risk behaviors among young people in these six categories as well as in general health status, overweight, and asthma through formal surveys such as the Youth Risk Behavior Survey (YRBS) (CDC, 2014d). The YRBS, available through CDC, is a national school-based survey that can provide the school and district with behavioral data for 9th through 12th graders (CDC, 2014d). Data resulting from the survey can be used to track behavioral trends at the local level for establishing priorities and for monitoring program and policy success. In addition, the local data can be used to make comparisons to state, regional, and national levels with the data available on the CDC YRBS website. For example if a school district discovers that the proportion of students who participated in at least 60 minutes of physical activity per day was lower than the proportion for students in the state and nation, the district may decide that they need to address the issue. The action could mean changing the academic schedule and requirements to include daily physical education, training teachers to incorporate physical activity into the classroom, allowing fit breaks throughout the day, or instituting a walk-to-school program. This example demonstrates how data from the YRBS system can be used to inform programming and policies as a district tries to improve the health and well-being of students and staff.
After a health-risk behavior or behaviors have been identified as a priority, the school or district faces the challenge of identifying or developing relevant policies or programs. Research-based programming that can reduce risk behaviors has been identified, and information is available through Registries of Programs Effective in Reducing Youth Risk Behaviors on the CDC website as well as through other similar sites (CDC, 2013d).
Besides selecting programming options, districts need to work to bring faculty and staff onboard with WSCC efforts. Education is important to help faculty and staff see the value of a coordinated approach and the relationship between health and academics. With proper training, teachers and school leaders can become important health champions to support and reinforce efforts of the school health education coordinator or administrator (Healthy Schools Campaign, 2012). Education is also essential for teachers, administrators, and other school employees committed to improving the health, academic success, and well-being of students. CDC stated,
Professional development can provide opportunities for school employees to identify areas for improvement, learn about and use proven practices, solve problems, develop skills, and reflect on and practice new strategies. In order to promote a Coordinated School Health approach, professional development should focus on the development of skills such as leadership, communication, and collaboration. (CDC, 2013b, para. 8)
In the 2013 document A Framework for Safe and Successful Schools,the recommendation was provided to conduct professional development for school staff and community partners that would address school climate and safety; positive behavior; and crisis prevention, preparedness, and response (NASP, 2013). As part of the professional development training, teachers and school leaders need to be provided with the information and resources they need to address student health issues and support a healthy school environment (Healthy Schools Campaign, 2012). Training might involve helping teachers to become aware of state-level health education regulations and requirements for health instruction so that those issues can be addressed outside the health education classroom and integrated into other subjects as a way to reinforce health-promoting concepts (Healthy Schools Campaign, 2012). Having more teachers and school leaders take on the role of health champion and work to support health concepts and health policies facilitates moving the district toward a more unified WSCC effort. Table 10.3 provides examples of how all teachers, not just health and physical education teachers, and school leaders can support WSCC though examples in each of the 10 components.
Learn more about Promoting Health and Academic Success.
Creation of WSCC
ASCD, in collaboration with CDC, moved forward in 2013 to develop a new model that builds on both the Whole Child Initiative and the original eight-component CSH approach. The development of the new model, titled Whole School, Whole Community, Whole Child (WSCC), involved a consultation group that developed the documents and frameworks related to the new model and a review group that periodically reviewed and provided feedback to the work of the consultation group.
ASCD, in collaboration with CDC, moved forward in 2013 to develop a new model that builds on both the Whole Child Initiative and the original eight-component CSH approach. The development of the new model, titled Whole School, Whole Community, Whole Child (WSCC), involved a consultation group that developed the documents and frameworks related to the new model and a review group that periodically reviewed and provided feedback to the work of the consultation group. Members of both groups were selected because of their role as leaders in both education and health. The new WSCC model was introduced at two national conferences, the ASCD conference in Los Angeles in March 2014 and the Society for Public Health Education (SOPHE) conference in Baltimore, also in March 2014. WSCC incorporates and builds on CSH and the ASCD Whole Child Initiative (ASCD, 2014).
WSCC is designed to promote alignment, integration, and collaboration between education and health and is intended to enhance health outcomes and academic success. Support and engagement of the whole community should be an important aspect of the implementation of WSCC (ASCD, 2014).
An important aspect of the new model is the expansion from 8 to 10 components. One original component, healthy and safe school environment, has been expanded to two separate components, physical environment and social and emotional climate. Another original component, family and community involvement, has been expanded to two components, community involvement and family engagement (see figure 1.1) (ASCD, 2014). The evolution of the school health models is presented in figure 1.2.
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Evolution of components in school health models.
Following are brief descriptions of all 10 WSCC components:
- Health education:Health education provides students with opportunities to acquire the knowledge, attitudes, and skills necessary for making health-promoting decisions, achieving health literacy, adopting health-enhancing behaviors, and promoting the health of others. Health education should be provided sequentially from pre-K through grade 12. Health education curricula should address important health topic areas through instruction based on the National Health Education Standards (NHES) (CDC, 2013).
- Physical education and physical activity: Physical education is a school-based instructional opportunity for students to gain the necessary skills and knowledge for lifelong participation in physical activity. Physical education is characterized by a planned, sequential K through 12 curriculum that assists students in achieving the national standards for K through 12 physical education. The outcome of a quality physical education program is a physically educated person who has the knowledge, skills, and confidence to enjoy a lifetime of healthful physical activity (CDC, 2013).
- Health services:These services are designed to ensure access or referral to primary health care services; foster appropriate use of primary health care services; prevent and control communicable disease and other health problems; provide emergency care for illness or injury; promote and provide optimum sanitary conditions for a safe school facility and school environment; and provide educational and counseling opportunities for promoting and maintaining individual, family, and community health (CDC, 2013).
- Nutrition environment and services: Schools should provide access to a variety of nutritious and appealing meals that accommodate the health and nutrition needs of all students. School nutrition programs should reflect U.S. Dietary Guidelines for Americans and other criteria to achieve nutrition integrity. The school nutrition services should offer students a learning laboratory for classroom nutrition and health education and serve as a resource for linkages with nutrition-related community services (CDC, 2013).
- Counseling, psychological, and social services: These services are provided to improve students' mental, emotional, and social health and include individual and group assessments, interventions, and referrals. Organizational assessment and consultation skills of counselors and psychologists should contribute not only to the health of students but also to the health of the school environment (CDC, 2013).
- Physical environment: The physical environment of the school includes buildings, school grounds, playground equipment, and athletic fields. The physical environment within the school includes building design, adequate space, cleanliness, noise level, heating and cooling, ventilation, and restrooms. These interior and exterior areas should be clean; safe; free from environmental hazards, tobacco, drugs, weapons, and violence; and appropriately secure from unauthorized access (Allensworth, Lawson, Nicholson, & Wyche, 1997; ASCD, 2014).
- Social and emotional climate:The social and emotional climate should provide a supportive culture conducive to enabling students, families, and staff members to feel safe, secure, accepted, and valued. Important factors in the social and emotional climate of a school include an attractive, comfortable physical environment; appreciation and respect for individual differences and cultural diversity; value placed on equity and social justice; high expectations and supportive actions for learning; size and structure of classes and organizations; and a general sense of comfort and safety (Allensworth, Lawson, Nicholson, & Wyche, 1997).
- Health promotion for staff: Schools can provide opportunities for school staff members to improve their health status through activities such as health assessments, health education, and health-related fitness activities. These opportunities should encourage staff members to pursue a healthy lifestyle that contributes to their improved health status, improved morale, and a greater personal commitment to the school's overall coordinated health approach (CDC, 2013).
- Family engagement:Epstein et al. (2009) identified six types of involvement necessary for successful school and family partnerships: (1) providing parenting support, (2) communicating with parents, (3) providing diverse volunteer opportunities, (4) supporting at-home learning, (5) encouraging parents to engage in decision-making opportunities in schools, and (6) collaborating with the community. Engaging family members often involves overcoming challenges such as family time conflicts, lack of transportation to school, and lack of comfort among family members in engaging in school activities. In addition, teachers and school staff may lack adequate time and resources to work with families.
- Community involvement:Meaningful community involvement in the WSCC approach is characterized by systematic collaboration among individuals and organizations within the school community. This systematic collaboration involves the engagement of individuals and organizations representing various segments of the community in the planning, implementation, and evaluation of programs, structures, and systems designed to create and sustain WSCC. The collaboration also involves the sharing of both community and school resources.
An Early Step Forward in Promoting WSCC at the Local Level
Upon the March 2014 unveiling of the Whole School, Whole Community, Whole Child model, a local school district in upstate New York introduced WSCC to the district's faculty and administration across their rural school district. A faculty member from a local college was asked to introduce the new WSCC model and then work with the district health and wellness coordinator to oversee 25 breakout sessions focused on the theme of incorporating wellness into learning. One goal for the day was to provide participants with knowledge and skills to adjust the physical, social, and emotional climate in their classrooms to improve the learning environment for each student. In an attempt to achieve the workshop goal, the WSCC model was introduced and compared with the CSH model. The ASCD video that provides an overview of the WSCC model was shown to the audience. Following the video a discussion was held on how a collaborative approach can have a positive effect on health and learning in the school district.
At the conclusion of the opening session, breakout sessions with small groups were held. An example of a breakout session was one titled "Healthy and Wise: Preparing Students for the World Beyond Formal Schooling." In this session, the facilitator went into detail about the collaborative WSCC approach while putting a strong focus on the ASCD Whole Child concept. The goal of this breakout session was to challenge the participants to produce a comprehensive health and academic plan in which the faculty and staff become leaders in the quest to reinvent, refocus, and recharge the health and academic status of the school district.
At the conclusion of the workshop it was decided to begin an initiative to implement the WSCC approach in the school district. The name of the first effort is "Optimize the Year with Healthy Habits: Incredible You, Incredible Year." In this effort the wellness committee will begin by addressing the wellness of the faculty and staff for the upcoming school year as a way to develop health and wellness leaders for the work to follow.
Learn more about Promoting Health and Academic Success.
Assessing nutrition and health services
Discover School Breakfast Toolkit - Purpose: This toolkit, from the Food and Nutrition Service of the U.S. Department of Agriculture, was developed to help schools assess current breakfast patterns and programs, calculate costs of implementing or changing breakfast programs, identify the type of meal service to provide to students, and create a marketing plan to engage and sustain a customer base.
Assessing Nutrition Services
Discover School Breakfast Toolkit
Purpose: This toolkit, from the Food and Nutrition Service of the U.S. Department of Agriculture, was developed to help schools assess current breakfast patterns and programs, calculate costs of implementing or changing breakfast programs, identify the type of meal service to provide to students, and create a marketing plan to engage and sustain a customer base. The toolkit includes the following sections:
- Introduction
- Successful use of the toolkit, which guides users through the toolkit
- An initial assessment, which provides surveys that schools can use to evaluate the interest levels of parents and students
- Cost calculator, which includes worksheets to help schools calculate the costs of implementing the School Breakfast Program
- Description of multiple methods for serving breakfast, which can help schools determine the best method for their needs
- Roadmaps to success
- Marketing efforts, which includes a marketing plan for schools to market the School Breakfast Program
- Resources
- Program evaluation, which provides information about how and what to evaluate specific to the School Breakfast Program
Audience: The toolkit is targeted toward individuals interested in increasing access to the School Breakfast Program. That might include school health councils, school nutrition staff, school administrators, parents, and community members.
Use: Toolkit users should first become familiar with the items in the toolkit and the steps to take. The next step is to use the student, parent, and administrator surveys to identify current knowledge, attitudes, and behaviors of these audiences as it relates to eating breakfast and breakfast programs. The third step is to use the tools to calculate a variety of cost-related items, such as breakfast profit/loss, revenue per reimbursable breakfast, daily revenue breakfast, and annual expenses to revenue comparisons. The remaining components of the toolkit guides users through identifying the best method for serving breakfast and developing and implementing a marketing plan to increase access and participation in the School Breakfast Program.
Access: The toolkit is found online at www.fns.usda.gov/cnd/breakfast/toolkit/.
Assessing Health Services
Body Mass Index Measurement (BMI) in Schools
Purpose: Developed by CDC researchers, with extensive input from experts from the field of school health, the BMI Measurement in Schools document, published in both full journal article (Nihiser, 2007) and executive summary formats, provides schools with an overview of what BMI is, the differences between BMI surveillance and screening, and a list of safeguards for schools choosing to implement a BMI measurement program.
Audience: The document can be used by school health councils, school nurses, and physical education and health education teachers. Any school interested in conducting BMI measurement can use the document to learn more about options for such a strategy and to identify the best option for the school.
Use: The BMI Measurement in Schools document presents both a synthesis of the science on measuring BMI in schools and safeguards to have in place when developing and implementing such a program or initiative. Leaders within the school who are interested in BMI measurement use the document to determine whether the school prefers surveillance or screening and to identify how the safeguards can be put in place.
Access: Both the full journal article and the executive summary can be found online at www.cdc.gov/healthyyouth/npao/publications.htm#10.
Safe at School and Ready to Learn: A Comprehensive Policy Guide for Protecting Students With Life-Threatening Food Allergies
Purpose: Developed by the National School Boards Association (NSBA), the Safe at School and Ready to Learn policy guide provides school boards with an overview of the prevalence of food allergies, policy guidance for school boards to consider when developing food allergy policies, and a policy checklist (National School Boards Association, 2012). The policy checklist guides the user through a process of identifying policy areas that need attention and actions that can be taken towards improvement.
Audience: The policy guide is to be used primarily by school board members. Secondary users can be school administrators, school health services staff, physical and health education teachers, parents, and school nutrition staff.
Use: In addition to providing policy guidance to school boards and other stakeholders, the guide's checklist is to be completed by identifying whether a specific policy element is included or not included and whether it is implemented or not implemented. When policy gaps are determined, a section for identifying action steps is provided. Results of the policy checklist can be used to inform and develop food allergy policies for schools.
Access: The guide is available online at http://www.nsba.org/sites/default/files/reports/Safe-at-School-and-Ready-to-Learn.pdf
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What a health education curriculum should look like
Comprehensive school health education is characterized by planned, sequential, developmentally appropriate, and culturally inclusive learning experiences taught by qualified trained teachers. The health education curriculum should be based on relevant health behavior theories; focus on the emotional, intellectual, physical, and social dimensions of health; provide students with exposure to diverse instructional techniques; and evaluate student achievement through a variety of assessment
Health Education
Comprehensive school health education is characterized by planned, sequential, developmentally appropriate, and culturally inclusive learning experiences taught by qualified trained teachers. The health education curriculum should be based on relevant health behavior theories; focus on the emotional, intellectual, physical, and social dimensions of health; provide students with exposure to diverse instructional techniques; and evaluate student achievement through a variety of assessment strategies (Joint Committee on National Health Education Standards [JCNHES], 2007). The learning experiences embedded within the curriculum should be designed to help students acquire functional health information; identify personal values that support healthy behaviors; recognize group norms that relate to a healthy lifestyle; and develop skills necessary to adopt, practice, and maintain health-enhancing behaviors (CDC, 2013a; JCNHES, 2007). Although many leaders in health and education suggest a linkage between quality health education and academic achievement, and some research verifies this linkage, many schools in the United States struggle to provide quality health education instruction (CDC, 2013b; JCNHES, 2007). Possible positive consequences of this linkage include a decrease in student absenteeism, higher academic achievement, and an increase in graduation rates (Allensworth, 2011; Basch, 2011a, 2011b; Freudenberg & Ruglis, 2007).
Healthy People 2020 includes an objective to increase the proportion of elementary, middle, and senior high schools that provide comprehensive school health education (USDHHS, 2013). Nationwide, 41.2 percent of elementary schools, 58.7 percent of middle schools, and 78.7 percent of high schools had specific time requirements for school health instruction (CDC, 2013b).
Thesecond edition of The National Health Education Standards (figure 3.1) was released in 2007. The standards were developed by a panel of health education leaders with input from professionals in both health and education, as well as parents and community members. The standards are not federally mandated or designed to define a national curriculum. Instead, they are intended to provide a framework and resource for the development of state standards and health education curricula in local school districts (American Cancer Society, 2007). The standardsinclude three distinct components: the individual health education standards, a rationale statement for each standard, and performance indicators linked to each standard for mastery by the completion of grades 4, 8, and 11 (American Cancer Society, 2007).
The standards can be applied to various health education content areas. The Centers for Disease Control and Prevention (CDC, 2011a) has identified six risk behaviors as being important focal points for instruction in school health education. These behaviors include alcohol and other drug use, physical inactivity, sexual behaviors that contribute to unintended pregnancy and sexually transmitted diseases, tobacco use, unhealthy dietary behaviors, and behaviors that contribute to unintentional injuries and violence. Other possible content areas for instruction include environmental health, human sexuality, and mental and emotional health (CDC, 2013a).
Beyond the National Health Education Standards, quality school health education should be based on quality health instruction. The following best practices have been identified by the CDC Division of Adolescent and School Health. They are based on reviews of effective programs and curricula and the positions of experts in the profession of health education (CDC, 2013d).
- Focus on clear health goals and related behavioral outcomes
- Are research-based and theory-driven
- Address individual values, attitudes, and beliefs
- Address individual and group norms that support health-enhancing behaviors
- Focus on reinforcing protective factors and increasing perceptions of personal risk and harmfulness of engaging in specific unhealthy practices and behaviors
- Address social pressures and influences
- Build personal competence, social competence, and self-efficacy by addressing skills
- Provide functional health knowledge that is basic, accurate, and directly contributes to health-promoting decisions and behaviors
- Use strategies designed to personalize information and engage students
- Provide age-appropriate and developmentally appropriate information, learning strategies, teaching methods, and materials
- Incorporate learning strategies, teaching methods, and materials that are culturally inclusive
- Provide adequate time for instruction and learning
- Provide opportunities to reinforce skills and positive health behaviors
- Provide opportunities to make positive connections with influential others
- Include teacher information and plans for professional development and training that enhance effectiveness of instruction and student learning
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Tips for Implementation of WSCC at District Level
The Cortland City (New York) school district was highlighted on the CDC website of success stories (CDC, 2013c) for the work conducted at Cortland City Schools in the CSH component of nutrition services. District initiatives included limiting student access to competitive foods, adopting marketing techniques to promote healthful choices, setting nutrition policies and standards, establishing nutrition standards for competitive foods, and making more healthy foods and beverages available.
Tips for Implementation at District Level
The Cortland City (New York) school district was highlighted on the CDC website of success stories (CDC, 2013c) for the work conducted at Cortland City Schools in the CSH component of nutrition services. District initiatives included limiting student access to competitive foods, adopting marketing techniques to promote healthful choices, setting nutrition policies and standards, establishing nutrition standards for competitive foods, and making more healthy foods and beverages available. Six factors were reported as keys to the success of Cortland City Schools. The first factor was having a vision of being committed to a Coordinated School Health program. The second factor was leadership as demonstrated by administrative support from the board of education, superintendent, and the principals from the schools in the district. The third factor, collaboration, was shown through partnerships that were established with community agencies, staff, parents, and students. Teamwork in each building as well as districtwide provided a demonstration of the fourth factor. The fifth factor, data driven, was demonstrated by collecting baseline data to demonstrate improvements after repeated assessments, which were then conducted every two to three years. Finally, the sixth factor recognized was the issue of financial support, which was apparent in the use of minigrants such as one through the Healthy Heart Coalition.
Jeannette Dippo, former Health Education and Wellness coordinator with Cortland City Schools, offered five suggestions for the implementation of CSH programs and policies:
- Districts need to get administrative support for the CSH activities and to send out consistent messages.
- Broad involvement is needed, including support from parents, school staff, and community members. This support is necessary for strong advocates to assist in getting the CSH vision and goals converted into actual programs and policy. Administrators may respond more positivity to general staff and parents than to the typical school health champion, who is generally the health educator or health coordinator.
- The most critical CSH priorities need to be converted into policy. Such a policy will help ensure that work or effort in that area will continue. A policy will help to establish the priority after the champions leave or have moved on to other initiatives because the policy will still exist.
- Each school needs to have a health coordinator to drive and pull the work of the team together. The schools and the district need someone with real passion for CSH. CSH functions best when someone with continuity who believes in what is being done is there to oversee the actions. A health coordinator is someone to help develop the structure for the work to happen.
- A healthy school team is needed for every school building, along with a separate district team. The accomplishments that were made in individual schools happened because each school building had its own team to work with, and someone to take the program or initiative and make it happen at the school level. It is critical that school principals be members of each school team. This network needs to be in place to share ideas and develop and implement districtwide policies.
Implement the Plan and Strategies
Putting the action plan into place consists of implementing the plan and strategies, which usually consists of adopting policies or programs. When implementing the plan, districts need to direct the focus of school health efforts on meeting the education and health needs of students (CDC, 2013b). In addition, providing opportunities for students to be meaningfully involved in the school and the community will help the team to focus on students. School health efforts in programming and policies should give youth the chance to develop and exercise leadership abilities, build skills, form positive relationships with caring adults, and contribute to their school and greater community (CDC, 2013a).
CDC suggests that students can promote a healthy and safe school and community through opportunities such as involvement in peer education, peer advocacy, or cross-age mentoring programs. Other opportunities include involving young people in service learning avenues and participation on school health teams' advisory committees and boards that address health and wellness, education, and youth-related issues (CDC, 2013b).
Moving into the taking-action phase of program and policy implementation, CDC suggests that school districts implement multiple strategies through multiple components. To address one school health component, a variety of efforts are needed to have an effect in that area. Because the components are often overlapping and dependent on each other, addressing multiple if not all of the components is recommended for achieving the positive health and learning outcomes desired (CDC, 2013b). Many possibilities exist for advancing each of the WSCC components, and examples of possible policies and programming efforts can be discovered in any of the CSH assessment tools or criteria (see table 10.2 for possible strategies for improvement). Tools such as the CDC School Health Index, ASCD Healthy Schools Report Card, and ASCD School Improvement Tool are some of the more well-known and commonly used tools. Any strategies pursued by a school or district should be based on an assessment conducted at the school or district.
Schools should consider implementing policies and programs to help students avoid or reduce health-risk behaviors that contribute to the leading causes of death and disability among young people as well as among adults (CDC, 2014d). CDC has identified six categories of priority health-risk behaviors as being linked to the leading causes of death and disability in the United States:
- Behaviors that contribute to unintentional injuries and violence
- Tobacco use
- Alcohol and other drug use
- Sexual behaviors that contribute to unintended pregnancy and STDs, including HIV infection
- Unhealthy eating
- Physical inactivity (CDC, 2014d)
Schools can assess health-risk behaviors among young people in these six categories as well as in general health status, overweight, and asthma through formal surveys such as the Youth Risk Behavior Survey (YRBS) (CDC, 2014d). The YRBS, available through CDC, is a national school-based survey that can provide the school and district with behavioral data for 9th through 12th graders (CDC, 2014d). Data resulting from the survey can be used to track behavioral trends at the local level for establishing priorities and for monitoring program and policy success. In addition, the local data can be used to make comparisons to state, regional, and national levels with the data available on the CDC YRBS website. For example if a school district discovers that the proportion of students who participated in at least 60 minutes of physical activity per day was lower than the proportion for students in the state and nation, the district may decide that they need to address the issue. The action could mean changing the academic schedule and requirements to include daily physical education, training teachers to incorporate physical activity into the classroom, allowing fit breaks throughout the day, or instituting a walk-to-school program. This example demonstrates how data from the YRBS system can be used to inform programming and policies as a district tries to improve the health and well-being of students and staff.
After a health-risk behavior or behaviors have been identified as a priority, the school or district faces the challenge of identifying or developing relevant policies or programs. Research-based programming that can reduce risk behaviors has been identified, and information is available through Registries of Programs Effective in Reducing Youth Risk Behaviors on the CDC website as well as through other similar sites (CDC, 2013d).
Besides selecting programming options, districts need to work to bring faculty and staff onboard with WSCC efforts. Education is important to help faculty and staff see the value of a coordinated approach and the relationship between health and academics. With proper training, teachers and school leaders can become important health champions to support and reinforce efforts of the school health education coordinator or administrator (Healthy Schools Campaign, 2012). Education is also essential for teachers, administrators, and other school employees committed to improving the health, academic success, and well-being of students. CDC stated,
Professional development can provide opportunities for school employees to identify areas for improvement, learn about and use proven practices, solve problems, develop skills, and reflect on and practice new strategies. In order to promote a Coordinated School Health approach, professional development should focus on the development of skills such as leadership, communication, and collaboration. (CDC, 2013b, para. 8)
In the 2013 document A Framework for Safe and Successful Schools,the recommendation was provided to conduct professional development for school staff and community partners that would address school climate and safety; positive behavior; and crisis prevention, preparedness, and response (NASP, 2013). As part of the professional development training, teachers and school leaders need to be provided with the information and resources they need to address student health issues and support a healthy school environment (Healthy Schools Campaign, 2012). Training might involve helping teachers to become aware of state-level health education regulations and requirements for health instruction so that those issues can be addressed outside the health education classroom and integrated into other subjects as a way to reinforce health-promoting concepts (Healthy Schools Campaign, 2012). Having more teachers and school leaders take on the role of health champion and work to support health concepts and health policies facilitates moving the district toward a more unified WSCC effort. Table 10.3 provides examples of how all teachers, not just health and physical education teachers, and school leaders can support WSCC though examples in each of the 10 components.
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Creation of WSCC
ASCD, in collaboration with CDC, moved forward in 2013 to develop a new model that builds on both the Whole Child Initiative and the original eight-component CSH approach. The development of the new model, titled Whole School, Whole Community, Whole Child (WSCC), involved a consultation group that developed the documents and frameworks related to the new model and a review group that periodically reviewed and provided feedback to the work of the consultation group.
ASCD, in collaboration with CDC, moved forward in 2013 to develop a new model that builds on both the Whole Child Initiative and the original eight-component CSH approach. The development of the new model, titled Whole School, Whole Community, Whole Child (WSCC), involved a consultation group that developed the documents and frameworks related to the new model and a review group that periodically reviewed and provided feedback to the work of the consultation group. Members of both groups were selected because of their role as leaders in both education and health. The new WSCC model was introduced at two national conferences, the ASCD conference in Los Angeles in March 2014 and the Society for Public Health Education (SOPHE) conference in Baltimore, also in March 2014. WSCC incorporates and builds on CSH and the ASCD Whole Child Initiative (ASCD, 2014).
WSCC is designed to promote alignment, integration, and collaboration between education and health and is intended to enhance health outcomes and academic success. Support and engagement of the whole community should be an important aspect of the implementation of WSCC (ASCD, 2014).
An important aspect of the new model is the expansion from 8 to 10 components. One original component, healthy and safe school environment, has been expanded to two separate components, physical environment and social and emotional climate. Another original component, family and community involvement, has been expanded to two components, community involvement and family engagement (see figure 1.1) (ASCD, 2014). The evolution of the school health models is presented in figure 1.2.
http://www.humankinetics.com/AcuCustom/Sitename/DAM/135/E6224_504973_ebook_Main.jpg
Evolution of components in school health models.
Following are brief descriptions of all 10 WSCC components:
- Health education:Health education provides students with opportunities to acquire the knowledge, attitudes, and skills necessary for making health-promoting decisions, achieving health literacy, adopting health-enhancing behaviors, and promoting the health of others. Health education should be provided sequentially from pre-K through grade 12. Health education curricula should address important health topic areas through instruction based on the National Health Education Standards (NHES) (CDC, 2013).
- Physical education and physical activity: Physical education is a school-based instructional opportunity for students to gain the necessary skills and knowledge for lifelong participation in physical activity. Physical education is characterized by a planned, sequential K through 12 curriculum that assists students in achieving the national standards for K through 12 physical education. The outcome of a quality physical education program is a physically educated person who has the knowledge, skills, and confidence to enjoy a lifetime of healthful physical activity (CDC, 2013).
- Health services:These services are designed to ensure access or referral to primary health care services; foster appropriate use of primary health care services; prevent and control communicable disease and other health problems; provide emergency care for illness or injury; promote and provide optimum sanitary conditions for a safe school facility and school environment; and provide educational and counseling opportunities for promoting and maintaining individual, family, and community health (CDC, 2013).
- Nutrition environment and services: Schools should provide access to a variety of nutritious and appealing meals that accommodate the health and nutrition needs of all students. School nutrition programs should reflect U.S. Dietary Guidelines for Americans and other criteria to achieve nutrition integrity. The school nutrition services should offer students a learning laboratory for classroom nutrition and health education and serve as a resource for linkages with nutrition-related community services (CDC, 2013).
- Counseling, psychological, and social services: These services are provided to improve students' mental, emotional, and social health and include individual and group assessments, interventions, and referrals. Organizational assessment and consultation skills of counselors and psychologists should contribute not only to the health of students but also to the health of the school environment (CDC, 2013).
- Physical environment: The physical environment of the school includes buildings, school grounds, playground equipment, and athletic fields. The physical environment within the school includes building design, adequate space, cleanliness, noise level, heating and cooling, ventilation, and restrooms. These interior and exterior areas should be clean; safe; free from environmental hazards, tobacco, drugs, weapons, and violence; and appropriately secure from unauthorized access (Allensworth, Lawson, Nicholson, & Wyche, 1997; ASCD, 2014).
- Social and emotional climate:The social and emotional climate should provide a supportive culture conducive to enabling students, families, and staff members to feel safe, secure, accepted, and valued. Important factors in the social and emotional climate of a school include an attractive, comfortable physical environment; appreciation and respect for individual differences and cultural diversity; value placed on equity and social justice; high expectations and supportive actions for learning; size and structure of classes and organizations; and a general sense of comfort and safety (Allensworth, Lawson, Nicholson, & Wyche, 1997).
- Health promotion for staff: Schools can provide opportunities for school staff members to improve their health status through activities such as health assessments, health education, and health-related fitness activities. These opportunities should encourage staff members to pursue a healthy lifestyle that contributes to their improved health status, improved morale, and a greater personal commitment to the school's overall coordinated health approach (CDC, 2013).
- Family engagement:Epstein et al. (2009) identified six types of involvement necessary for successful school and family partnerships: (1) providing parenting support, (2) communicating with parents, (3) providing diverse volunteer opportunities, (4) supporting at-home learning, (5) encouraging parents to engage in decision-making opportunities in schools, and (6) collaborating with the community. Engaging family members often involves overcoming challenges such as family time conflicts, lack of transportation to school, and lack of comfort among family members in engaging in school activities. In addition, teachers and school staff may lack adequate time and resources to work with families.
- Community involvement:Meaningful community involvement in the WSCC approach is characterized by systematic collaboration among individuals and organizations within the school community. This systematic collaboration involves the engagement of individuals and organizations representing various segments of the community in the planning, implementation, and evaluation of programs, structures, and systems designed to create and sustain WSCC. The collaboration also involves the sharing of both community and school resources.
An Early Step Forward in Promoting WSCC at the Local Level
Upon the March 2014 unveiling of the Whole School, Whole Community, Whole Child model, a local school district in upstate New York introduced WSCC to the district's faculty and administration across their rural school district. A faculty member from a local college was asked to introduce the new WSCC model and then work with the district health and wellness coordinator to oversee 25 breakout sessions focused on the theme of incorporating wellness into learning. One goal for the day was to provide participants with knowledge and skills to adjust the physical, social, and emotional climate in their classrooms to improve the learning environment for each student. In an attempt to achieve the workshop goal, the WSCC model was introduced and compared with the CSH model. The ASCD video that provides an overview of the WSCC model was shown to the audience. Following the video a discussion was held on how a collaborative approach can have a positive effect on health and learning in the school district.
At the conclusion of the opening session, breakout sessions with small groups were held. An example of a breakout session was one titled "Healthy and Wise: Preparing Students for the World Beyond Formal Schooling." In this session, the facilitator went into detail about the collaborative WSCC approach while putting a strong focus on the ASCD Whole Child concept. The goal of this breakout session was to challenge the participants to produce a comprehensive health and academic plan in which the faculty and staff become leaders in the quest to reinvent, refocus, and recharge the health and academic status of the school district.
At the conclusion of the workshop it was decided to begin an initiative to implement the WSCC approach in the school district. The name of the first effort is "Optimize the Year with Healthy Habits: Incredible You, Incredible Year." In this effort the wellness committee will begin by addressing the wellness of the faculty and staff for the upcoming school year as a way to develop health and wellness leaders for the work to follow.
Learn more about Promoting Health and Academic Success.
Assessing nutrition and health services
Discover School Breakfast Toolkit - Purpose: This toolkit, from the Food and Nutrition Service of the U.S. Department of Agriculture, was developed to help schools assess current breakfast patterns and programs, calculate costs of implementing or changing breakfast programs, identify the type of meal service to provide to students, and create a marketing plan to engage and sustain a customer base.
Assessing Nutrition Services
Discover School Breakfast Toolkit
Purpose: This toolkit, from the Food and Nutrition Service of the U.S. Department of Agriculture, was developed to help schools assess current breakfast patterns and programs, calculate costs of implementing or changing breakfast programs, identify the type of meal service to provide to students, and create a marketing plan to engage and sustain a customer base. The toolkit includes the following sections:
- Introduction
- Successful use of the toolkit, which guides users through the toolkit
- An initial assessment, which provides surveys that schools can use to evaluate the interest levels of parents and students
- Cost calculator, which includes worksheets to help schools calculate the costs of implementing the School Breakfast Program
- Description of multiple methods for serving breakfast, which can help schools determine the best method for their needs
- Roadmaps to success
- Marketing efforts, which includes a marketing plan for schools to market the School Breakfast Program
- Resources
- Program evaluation, which provides information about how and what to evaluate specific to the School Breakfast Program
Audience: The toolkit is targeted toward individuals interested in increasing access to the School Breakfast Program. That might include school health councils, school nutrition staff, school administrators, parents, and community members.
Use: Toolkit users should first become familiar with the items in the toolkit and the steps to take. The next step is to use the student, parent, and administrator surveys to identify current knowledge, attitudes, and behaviors of these audiences as it relates to eating breakfast and breakfast programs. The third step is to use the tools to calculate a variety of cost-related items, such as breakfast profit/loss, revenue per reimbursable breakfast, daily revenue breakfast, and annual expenses to revenue comparisons. The remaining components of the toolkit guides users through identifying the best method for serving breakfast and developing and implementing a marketing plan to increase access and participation in the School Breakfast Program.
Access: The toolkit is found online at www.fns.usda.gov/cnd/breakfast/toolkit/.
Assessing Health Services
Body Mass Index Measurement (BMI) in Schools
Purpose: Developed by CDC researchers, with extensive input from experts from the field of school health, the BMI Measurement in Schools document, published in both full journal article (Nihiser, 2007) and executive summary formats, provides schools with an overview of what BMI is, the differences between BMI surveillance and screening, and a list of safeguards for schools choosing to implement a BMI measurement program.
Audience: The document can be used by school health councils, school nurses, and physical education and health education teachers. Any school interested in conducting BMI measurement can use the document to learn more about options for such a strategy and to identify the best option for the school.
Use: The BMI Measurement in Schools document presents both a synthesis of the science on measuring BMI in schools and safeguards to have in place when developing and implementing such a program or initiative. Leaders within the school who are interested in BMI measurement use the document to determine whether the school prefers surveillance or screening and to identify how the safeguards can be put in place.
Access: Both the full journal article and the executive summary can be found online at www.cdc.gov/healthyyouth/npao/publications.htm#10.
Safe at School and Ready to Learn: A Comprehensive Policy Guide for Protecting Students With Life-Threatening Food Allergies
Purpose: Developed by the National School Boards Association (NSBA), the Safe at School and Ready to Learn policy guide provides school boards with an overview of the prevalence of food allergies, policy guidance for school boards to consider when developing food allergy policies, and a policy checklist (National School Boards Association, 2012). The policy checklist guides the user through a process of identifying policy areas that need attention and actions that can be taken towards improvement.
Audience: The policy guide is to be used primarily by school board members. Secondary users can be school administrators, school health services staff, physical and health education teachers, parents, and school nutrition staff.
Use: In addition to providing policy guidance to school boards and other stakeholders, the guide's checklist is to be completed by identifying whether a specific policy element is included or not included and whether it is implemented or not implemented. When policy gaps are determined, a section for identifying action steps is provided. Results of the policy checklist can be used to inform and develop food allergy policies for schools.
Access: The guide is available online at http://www.nsba.org/sites/default/files/reports/Safe-at-School-and-Ready-to-Learn.pdf
Learn more about Promoting Health and Academic Success.
What a health education curriculum should look like
Comprehensive school health education is characterized by planned, sequential, developmentally appropriate, and culturally inclusive learning experiences taught by qualified trained teachers. The health education curriculum should be based on relevant health behavior theories; focus on the emotional, intellectual, physical, and social dimensions of health; provide students with exposure to diverse instructional techniques; and evaluate student achievement through a variety of assessment
Health Education
Comprehensive school health education is characterized by planned, sequential, developmentally appropriate, and culturally inclusive learning experiences taught by qualified trained teachers. The health education curriculum should be based on relevant health behavior theories; focus on the emotional, intellectual, physical, and social dimensions of health; provide students with exposure to diverse instructional techniques; and evaluate student achievement through a variety of assessment strategies (Joint Committee on National Health Education Standards [JCNHES], 2007). The learning experiences embedded within the curriculum should be designed to help students acquire functional health information; identify personal values that support healthy behaviors; recognize group norms that relate to a healthy lifestyle; and develop skills necessary to adopt, practice, and maintain health-enhancing behaviors (CDC, 2013a; JCNHES, 2007). Although many leaders in health and education suggest a linkage between quality health education and academic achievement, and some research verifies this linkage, many schools in the United States struggle to provide quality health education instruction (CDC, 2013b; JCNHES, 2007). Possible positive consequences of this linkage include a decrease in student absenteeism, higher academic achievement, and an increase in graduation rates (Allensworth, 2011; Basch, 2011a, 2011b; Freudenberg & Ruglis, 2007).
Healthy People 2020 includes an objective to increase the proportion of elementary, middle, and senior high schools that provide comprehensive school health education (USDHHS, 2013). Nationwide, 41.2 percent of elementary schools, 58.7 percent of middle schools, and 78.7 percent of high schools had specific time requirements for school health instruction (CDC, 2013b).
Thesecond edition of The National Health Education Standards (figure 3.1) was released in 2007. The standards were developed by a panel of health education leaders with input from professionals in both health and education, as well as parents and community members. The standards are not federally mandated or designed to define a national curriculum. Instead, they are intended to provide a framework and resource for the development of state standards and health education curricula in local school districts (American Cancer Society, 2007). The standardsinclude three distinct components: the individual health education standards, a rationale statement for each standard, and performance indicators linked to each standard for mastery by the completion of grades 4, 8, and 11 (American Cancer Society, 2007).
The standards can be applied to various health education content areas. The Centers for Disease Control and Prevention (CDC, 2011a) has identified six risk behaviors as being important focal points for instruction in school health education. These behaviors include alcohol and other drug use, physical inactivity, sexual behaviors that contribute to unintended pregnancy and sexually transmitted diseases, tobacco use, unhealthy dietary behaviors, and behaviors that contribute to unintentional injuries and violence. Other possible content areas for instruction include environmental health, human sexuality, and mental and emotional health (CDC, 2013a).
Beyond the National Health Education Standards, quality school health education should be based on quality health instruction. The following best practices have been identified by the CDC Division of Adolescent and School Health. They are based on reviews of effective programs and curricula and the positions of experts in the profession of health education (CDC, 2013d).
- Focus on clear health goals and related behavioral outcomes
- Are research-based and theory-driven
- Address individual values, attitudes, and beliefs
- Address individual and group norms that support health-enhancing behaviors
- Focus on reinforcing protective factors and increasing perceptions of personal risk and harmfulness of engaging in specific unhealthy practices and behaviors
- Address social pressures and influences
- Build personal competence, social competence, and self-efficacy by addressing skills
- Provide functional health knowledge that is basic, accurate, and directly contributes to health-promoting decisions and behaviors
- Use strategies designed to personalize information and engage students
- Provide age-appropriate and developmentally appropriate information, learning strategies, teaching methods, and materials
- Incorporate learning strategies, teaching methods, and materials that are culturally inclusive
- Provide adequate time for instruction and learning
- Provide opportunities to reinforce skills and positive health behaviors
- Provide opportunities to make positive connections with influential others
- Include teacher information and plans for professional development and training that enhance effectiveness of instruction and student learning
Learn more about Promoting Health and Academic Success.
Tips for Implementation of WSCC at District Level
The Cortland City (New York) school district was highlighted on the CDC website of success stories (CDC, 2013c) for the work conducted at Cortland City Schools in the CSH component of nutrition services. District initiatives included limiting student access to competitive foods, adopting marketing techniques to promote healthful choices, setting nutrition policies and standards, establishing nutrition standards for competitive foods, and making more healthy foods and beverages available.
Tips for Implementation at District Level
The Cortland City (New York) school district was highlighted on the CDC website of success stories (CDC, 2013c) for the work conducted at Cortland City Schools in the CSH component of nutrition services. District initiatives included limiting student access to competitive foods, adopting marketing techniques to promote healthful choices, setting nutrition policies and standards, establishing nutrition standards for competitive foods, and making more healthy foods and beverages available. Six factors were reported as keys to the success of Cortland City Schools. The first factor was having a vision of being committed to a Coordinated School Health program. The second factor was leadership as demonstrated by administrative support from the board of education, superintendent, and the principals from the schools in the district. The third factor, collaboration, was shown through partnerships that were established with community agencies, staff, parents, and students. Teamwork in each building as well as districtwide provided a demonstration of the fourth factor. The fifth factor, data driven, was demonstrated by collecting baseline data to demonstrate improvements after repeated assessments, which were then conducted every two to three years. Finally, the sixth factor recognized was the issue of financial support, which was apparent in the use of minigrants such as one through the Healthy Heart Coalition.
Jeannette Dippo, former Health Education and Wellness coordinator with Cortland City Schools, offered five suggestions for the implementation of CSH programs and policies:
- Districts need to get administrative support for the CSH activities and to send out consistent messages.
- Broad involvement is needed, including support from parents, school staff, and community members. This support is necessary for strong advocates to assist in getting the CSH vision and goals converted into actual programs and policy. Administrators may respond more positivity to general staff and parents than to the typical school health champion, who is generally the health educator or health coordinator.
- The most critical CSH priorities need to be converted into policy. Such a policy will help ensure that work or effort in that area will continue. A policy will help to establish the priority after the champions leave or have moved on to other initiatives because the policy will still exist.
- Each school needs to have a health coordinator to drive and pull the work of the team together. The schools and the district need someone with real passion for CSH. CSH functions best when someone with continuity who believes in what is being done is there to oversee the actions. A health coordinator is someone to help develop the structure for the work to happen.
- A healthy school team is needed for every school building, along with a separate district team. The accomplishments that were made in individual schools happened because each school building had its own team to work with, and someone to take the program or initiative and make it happen at the school level. It is critical that school principals be members of each school team. This network needs to be in place to share ideas and develop and implement districtwide policies.
Implement the Plan and Strategies
Putting the action plan into place consists of implementing the plan and strategies, which usually consists of adopting policies or programs. When implementing the plan, districts need to direct the focus of school health efforts on meeting the education and health needs of students (CDC, 2013b). In addition, providing opportunities for students to be meaningfully involved in the school and the community will help the team to focus on students. School health efforts in programming and policies should give youth the chance to develop and exercise leadership abilities, build skills, form positive relationships with caring adults, and contribute to their school and greater community (CDC, 2013a).
CDC suggests that students can promote a healthy and safe school and community through opportunities such as involvement in peer education, peer advocacy, or cross-age mentoring programs. Other opportunities include involving young people in service learning avenues and participation on school health teams' advisory committees and boards that address health and wellness, education, and youth-related issues (CDC, 2013b).
Moving into the taking-action phase of program and policy implementation, CDC suggests that school districts implement multiple strategies through multiple components. To address one school health component, a variety of efforts are needed to have an effect in that area. Because the components are often overlapping and dependent on each other, addressing multiple if not all of the components is recommended for achieving the positive health and learning outcomes desired (CDC, 2013b). Many possibilities exist for advancing each of the WSCC components, and examples of possible policies and programming efforts can be discovered in any of the CSH assessment tools or criteria (see table 10.2 for possible strategies for improvement). Tools such as the CDC School Health Index, ASCD Healthy Schools Report Card, and ASCD School Improvement Tool are some of the more well-known and commonly used tools. Any strategies pursued by a school or district should be based on an assessment conducted at the school or district.
Schools should consider implementing policies and programs to help students avoid or reduce health-risk behaviors that contribute to the leading causes of death and disability among young people as well as among adults (CDC, 2014d). CDC has identified six categories of priority health-risk behaviors as being linked to the leading causes of death and disability in the United States:
- Behaviors that contribute to unintentional injuries and violence
- Tobacco use
- Alcohol and other drug use
- Sexual behaviors that contribute to unintended pregnancy and STDs, including HIV infection
- Unhealthy eating
- Physical inactivity (CDC, 2014d)
Schools can assess health-risk behaviors among young people in these six categories as well as in general health status, overweight, and asthma through formal surveys such as the Youth Risk Behavior Survey (YRBS) (CDC, 2014d). The YRBS, available through CDC, is a national school-based survey that can provide the school and district with behavioral data for 9th through 12th graders (CDC, 2014d). Data resulting from the survey can be used to track behavioral trends at the local level for establishing priorities and for monitoring program and policy success. In addition, the local data can be used to make comparisons to state, regional, and national levels with the data available on the CDC YRBS website. For example if a school district discovers that the proportion of students who participated in at least 60 minutes of physical activity per day was lower than the proportion for students in the state and nation, the district may decide that they need to address the issue. The action could mean changing the academic schedule and requirements to include daily physical education, training teachers to incorporate physical activity into the classroom, allowing fit breaks throughout the day, or instituting a walk-to-school program. This example demonstrates how data from the YRBS system can be used to inform programming and policies as a district tries to improve the health and well-being of students and staff.
After a health-risk behavior or behaviors have been identified as a priority, the school or district faces the challenge of identifying or developing relevant policies or programs. Research-based programming that can reduce risk behaviors has been identified, and information is available through Registries of Programs Effective in Reducing Youth Risk Behaviors on the CDC website as well as through other similar sites (CDC, 2013d).
Besides selecting programming options, districts need to work to bring faculty and staff onboard with WSCC efforts. Education is important to help faculty and staff see the value of a coordinated approach and the relationship between health and academics. With proper training, teachers and school leaders can become important health champions to support and reinforce efforts of the school health education coordinator or administrator (Healthy Schools Campaign, 2012). Education is also essential for teachers, administrators, and other school employees committed to improving the health, academic success, and well-being of students. CDC stated,
Professional development can provide opportunities for school employees to identify areas for improvement, learn about and use proven practices, solve problems, develop skills, and reflect on and practice new strategies. In order to promote a Coordinated School Health approach, professional development should focus on the development of skills such as leadership, communication, and collaboration. (CDC, 2013b, para. 8)
In the 2013 document A Framework for Safe and Successful Schools,the recommendation was provided to conduct professional development for school staff and community partners that would address school climate and safety; positive behavior; and crisis prevention, preparedness, and response (NASP, 2013). As part of the professional development training, teachers and school leaders need to be provided with the information and resources they need to address student health issues and support a healthy school environment (Healthy Schools Campaign, 2012). Training might involve helping teachers to become aware of state-level health education regulations and requirements for health instruction so that those issues can be addressed outside the health education classroom and integrated into other subjects as a way to reinforce health-promoting concepts (Healthy Schools Campaign, 2012). Having more teachers and school leaders take on the role of health champion and work to support health concepts and health policies facilitates moving the district toward a more unified WSCC effort. Table 10.3 provides examples of how all teachers, not just health and physical education teachers, and school leaders can support WSCC though examples in each of the 10 components.
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Creation of WSCC
ASCD, in collaboration with CDC, moved forward in 2013 to develop a new model that builds on both the Whole Child Initiative and the original eight-component CSH approach. The development of the new model, titled Whole School, Whole Community, Whole Child (WSCC), involved a consultation group that developed the documents and frameworks related to the new model and a review group that periodically reviewed and provided feedback to the work of the consultation group.
ASCD, in collaboration with CDC, moved forward in 2013 to develop a new model that builds on both the Whole Child Initiative and the original eight-component CSH approach. The development of the new model, titled Whole School, Whole Community, Whole Child (WSCC), involved a consultation group that developed the documents and frameworks related to the new model and a review group that periodically reviewed and provided feedback to the work of the consultation group. Members of both groups were selected because of their role as leaders in both education and health. The new WSCC model was introduced at two national conferences, the ASCD conference in Los Angeles in March 2014 and the Society for Public Health Education (SOPHE) conference in Baltimore, also in March 2014. WSCC incorporates and builds on CSH and the ASCD Whole Child Initiative (ASCD, 2014).
WSCC is designed to promote alignment, integration, and collaboration between education and health and is intended to enhance health outcomes and academic success. Support and engagement of the whole community should be an important aspect of the implementation of WSCC (ASCD, 2014).
An important aspect of the new model is the expansion from 8 to 10 components. One original component, healthy and safe school environment, has been expanded to two separate components, physical environment and social and emotional climate. Another original component, family and community involvement, has been expanded to two components, community involvement and family engagement (see figure 1.1) (ASCD, 2014). The evolution of the school health models is presented in figure 1.2.
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Evolution of components in school health models.
Following are brief descriptions of all 10 WSCC components:
- Health education:Health education provides students with opportunities to acquire the knowledge, attitudes, and skills necessary for making health-promoting decisions, achieving health literacy, adopting health-enhancing behaviors, and promoting the health of others. Health education should be provided sequentially from pre-K through grade 12. Health education curricula should address important health topic areas through instruction based on the National Health Education Standards (NHES) (CDC, 2013).
- Physical education and physical activity: Physical education is a school-based instructional opportunity for students to gain the necessary skills and knowledge for lifelong participation in physical activity. Physical education is characterized by a planned, sequential K through 12 curriculum that assists students in achieving the national standards for K through 12 physical education. The outcome of a quality physical education program is a physically educated person who has the knowledge, skills, and confidence to enjoy a lifetime of healthful physical activity (CDC, 2013).
- Health services:These services are designed to ensure access or referral to primary health care services; foster appropriate use of primary health care services; prevent and control communicable disease and other health problems; provide emergency care for illness or injury; promote and provide optimum sanitary conditions for a safe school facility and school environment; and provide educational and counseling opportunities for promoting and maintaining individual, family, and community health (CDC, 2013).
- Nutrition environment and services: Schools should provide access to a variety of nutritious and appealing meals that accommodate the health and nutrition needs of all students. School nutrition programs should reflect U.S. Dietary Guidelines for Americans and other criteria to achieve nutrition integrity. The school nutrition services should offer students a learning laboratory for classroom nutrition and health education and serve as a resource for linkages with nutrition-related community services (CDC, 2013).
- Counseling, psychological, and social services: These services are provided to improve students' mental, emotional, and social health and include individual and group assessments, interventions, and referrals. Organizational assessment and consultation skills of counselors and psychologists should contribute not only to the health of students but also to the health of the school environment (CDC, 2013).
- Physical environment: The physical environment of the school includes buildings, school grounds, playground equipment, and athletic fields. The physical environment within the school includes building design, adequate space, cleanliness, noise level, heating and cooling, ventilation, and restrooms. These interior and exterior areas should be clean; safe; free from environmental hazards, tobacco, drugs, weapons, and violence; and appropriately secure from unauthorized access (Allensworth, Lawson, Nicholson, & Wyche, 1997; ASCD, 2014).
- Social and emotional climate:The social and emotional climate should provide a supportive culture conducive to enabling students, families, and staff members to feel safe, secure, accepted, and valued. Important factors in the social and emotional climate of a school include an attractive, comfortable physical environment; appreciation and respect for individual differences and cultural diversity; value placed on equity and social justice; high expectations and supportive actions for learning; size and structure of classes and organizations; and a general sense of comfort and safety (Allensworth, Lawson, Nicholson, & Wyche, 1997).
- Health promotion for staff: Schools can provide opportunities for school staff members to improve their health status through activities such as health assessments, health education, and health-related fitness activities. These opportunities should encourage staff members to pursue a healthy lifestyle that contributes to their improved health status, improved morale, and a greater personal commitment to the school's overall coordinated health approach (CDC, 2013).
- Family engagement:Epstein et al. (2009) identified six types of involvement necessary for successful school and family partnerships: (1) providing parenting support, (2) communicating with parents, (3) providing diverse volunteer opportunities, (4) supporting at-home learning, (5) encouraging parents to engage in decision-making opportunities in schools, and (6) collaborating with the community. Engaging family members often involves overcoming challenges such as family time conflicts, lack of transportation to school, and lack of comfort among family members in engaging in school activities. In addition, teachers and school staff may lack adequate time and resources to work with families.
- Community involvement:Meaningful community involvement in the WSCC approach is characterized by systematic collaboration among individuals and organizations within the school community. This systematic collaboration involves the engagement of individuals and organizations representing various segments of the community in the planning, implementation, and evaluation of programs, structures, and systems designed to create and sustain WSCC. The collaboration also involves the sharing of both community and school resources.
An Early Step Forward in Promoting WSCC at the Local Level
Upon the March 2014 unveiling of the Whole School, Whole Community, Whole Child model, a local school district in upstate New York introduced WSCC to the district's faculty and administration across their rural school district. A faculty member from a local college was asked to introduce the new WSCC model and then work with the district health and wellness coordinator to oversee 25 breakout sessions focused on the theme of incorporating wellness into learning. One goal for the day was to provide participants with knowledge and skills to adjust the physical, social, and emotional climate in their classrooms to improve the learning environment for each student. In an attempt to achieve the workshop goal, the WSCC model was introduced and compared with the CSH model. The ASCD video that provides an overview of the WSCC model was shown to the audience. Following the video a discussion was held on how a collaborative approach can have a positive effect on health and learning in the school district.
At the conclusion of the opening session, breakout sessions with small groups were held. An example of a breakout session was one titled "Healthy and Wise: Preparing Students for the World Beyond Formal Schooling." In this session, the facilitator went into detail about the collaborative WSCC approach while putting a strong focus on the ASCD Whole Child concept. The goal of this breakout session was to challenge the participants to produce a comprehensive health and academic plan in which the faculty and staff become leaders in the quest to reinvent, refocus, and recharge the health and academic status of the school district.
At the conclusion of the workshop it was decided to begin an initiative to implement the WSCC approach in the school district. The name of the first effort is "Optimize the Year with Healthy Habits: Incredible You, Incredible Year." In this effort the wellness committee will begin by addressing the wellness of the faculty and staff for the upcoming school year as a way to develop health and wellness leaders for the work to follow.
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Assessing nutrition and health services
Discover School Breakfast Toolkit - Purpose: This toolkit, from the Food and Nutrition Service of the U.S. Department of Agriculture, was developed to help schools assess current breakfast patterns and programs, calculate costs of implementing or changing breakfast programs, identify the type of meal service to provide to students, and create a marketing plan to engage and sustain a customer base.
Assessing Nutrition Services
Discover School Breakfast Toolkit
Purpose: This toolkit, from the Food and Nutrition Service of the U.S. Department of Agriculture, was developed to help schools assess current breakfast patterns and programs, calculate costs of implementing or changing breakfast programs, identify the type of meal service to provide to students, and create a marketing plan to engage and sustain a customer base. The toolkit includes the following sections:
- Introduction
- Successful use of the toolkit, which guides users through the toolkit
- An initial assessment, which provides surveys that schools can use to evaluate the interest levels of parents and students
- Cost calculator, which includes worksheets to help schools calculate the costs of implementing the School Breakfast Program
- Description of multiple methods for serving breakfast, which can help schools determine the best method for their needs
- Roadmaps to success
- Marketing efforts, which includes a marketing plan for schools to market the School Breakfast Program
- Resources
- Program evaluation, which provides information about how and what to evaluate specific to the School Breakfast Program
Audience: The toolkit is targeted toward individuals interested in increasing access to the School Breakfast Program. That might include school health councils, school nutrition staff, school administrators, parents, and community members.
Use: Toolkit users should first become familiar with the items in the toolkit and the steps to take. The next step is to use the student, parent, and administrator surveys to identify current knowledge, attitudes, and behaviors of these audiences as it relates to eating breakfast and breakfast programs. The third step is to use the tools to calculate a variety of cost-related items, such as breakfast profit/loss, revenue per reimbursable breakfast, daily revenue breakfast, and annual expenses to revenue comparisons. The remaining components of the toolkit guides users through identifying the best method for serving breakfast and developing and implementing a marketing plan to increase access and participation in the School Breakfast Program.
Access: The toolkit is found online at www.fns.usda.gov/cnd/breakfast/toolkit/.
Assessing Health Services
Body Mass Index Measurement (BMI) in Schools
Purpose: Developed by CDC researchers, with extensive input from experts from the field of school health, the BMI Measurement in Schools document, published in both full journal article (Nihiser, 2007) and executive summary formats, provides schools with an overview of what BMI is, the differences between BMI surveillance and screening, and a list of safeguards for schools choosing to implement a BMI measurement program.
Audience: The document can be used by school health councils, school nurses, and physical education and health education teachers. Any school interested in conducting BMI measurement can use the document to learn more about options for such a strategy and to identify the best option for the school.
Use: The BMI Measurement in Schools document presents both a synthesis of the science on measuring BMI in schools and safeguards to have in place when developing and implementing such a program or initiative. Leaders within the school who are interested in BMI measurement use the document to determine whether the school prefers surveillance or screening and to identify how the safeguards can be put in place.
Access: Both the full journal article and the executive summary can be found online at www.cdc.gov/healthyyouth/npao/publications.htm#10.
Safe at School and Ready to Learn: A Comprehensive Policy Guide for Protecting Students With Life-Threatening Food Allergies
Purpose: Developed by the National School Boards Association (NSBA), the Safe at School and Ready to Learn policy guide provides school boards with an overview of the prevalence of food allergies, policy guidance for school boards to consider when developing food allergy policies, and a policy checklist (National School Boards Association, 2012). The policy checklist guides the user through a process of identifying policy areas that need attention and actions that can be taken towards improvement.
Audience: The policy guide is to be used primarily by school board members. Secondary users can be school administrators, school health services staff, physical and health education teachers, parents, and school nutrition staff.
Use: In addition to providing policy guidance to school boards and other stakeholders, the guide's checklist is to be completed by identifying whether a specific policy element is included or not included and whether it is implemented or not implemented. When policy gaps are determined, a section for identifying action steps is provided. Results of the policy checklist can be used to inform and develop food allergy policies for schools.
Access: The guide is available online at http://www.nsba.org/sites/default/files/reports/Safe-at-School-and-Ready-to-Learn.pdf
Learn more about Promoting Health and Academic Success.
What a health education curriculum should look like
Comprehensive school health education is characterized by planned, sequential, developmentally appropriate, and culturally inclusive learning experiences taught by qualified trained teachers. The health education curriculum should be based on relevant health behavior theories; focus on the emotional, intellectual, physical, and social dimensions of health; provide students with exposure to diverse instructional techniques; and evaluate student achievement through a variety of assessment
Health Education
Comprehensive school health education is characterized by planned, sequential, developmentally appropriate, and culturally inclusive learning experiences taught by qualified trained teachers. The health education curriculum should be based on relevant health behavior theories; focus on the emotional, intellectual, physical, and social dimensions of health; provide students with exposure to diverse instructional techniques; and evaluate student achievement through a variety of assessment strategies (Joint Committee on National Health Education Standards [JCNHES], 2007). The learning experiences embedded within the curriculum should be designed to help students acquire functional health information; identify personal values that support healthy behaviors; recognize group norms that relate to a healthy lifestyle; and develop skills necessary to adopt, practice, and maintain health-enhancing behaviors (CDC, 2013a; JCNHES, 2007). Although many leaders in health and education suggest a linkage between quality health education and academic achievement, and some research verifies this linkage, many schools in the United States struggle to provide quality health education instruction (CDC, 2013b; JCNHES, 2007). Possible positive consequences of this linkage include a decrease in student absenteeism, higher academic achievement, and an increase in graduation rates (Allensworth, 2011; Basch, 2011a, 2011b; Freudenberg & Ruglis, 2007).
Healthy People 2020 includes an objective to increase the proportion of elementary, middle, and senior high schools that provide comprehensive school health education (USDHHS, 2013). Nationwide, 41.2 percent of elementary schools, 58.7 percent of middle schools, and 78.7 percent of high schools had specific time requirements for school health instruction (CDC, 2013b).
Thesecond edition of The National Health Education Standards (figure 3.1) was released in 2007. The standards were developed by a panel of health education leaders with input from professionals in both health and education, as well as parents and community members. The standards are not federally mandated or designed to define a national curriculum. Instead, they are intended to provide a framework and resource for the development of state standards and health education curricula in local school districts (American Cancer Society, 2007). The standardsinclude three distinct components: the individual health education standards, a rationale statement for each standard, and performance indicators linked to each standard for mastery by the completion of grades 4, 8, and 11 (American Cancer Society, 2007).
The standards can be applied to various health education content areas. The Centers for Disease Control and Prevention (CDC, 2011a) has identified six risk behaviors as being important focal points for instruction in school health education. These behaviors include alcohol and other drug use, physical inactivity, sexual behaviors that contribute to unintended pregnancy and sexually transmitted diseases, tobacco use, unhealthy dietary behaviors, and behaviors that contribute to unintentional injuries and violence. Other possible content areas for instruction include environmental health, human sexuality, and mental and emotional health (CDC, 2013a).
Beyond the National Health Education Standards, quality school health education should be based on quality health instruction. The following best practices have been identified by the CDC Division of Adolescent and School Health. They are based on reviews of effective programs and curricula and the positions of experts in the profession of health education (CDC, 2013d).
- Focus on clear health goals and related behavioral outcomes
- Are research-based and theory-driven
- Address individual values, attitudes, and beliefs
- Address individual and group norms that support health-enhancing behaviors
- Focus on reinforcing protective factors and increasing perceptions of personal risk and harmfulness of engaging in specific unhealthy practices and behaviors
- Address social pressures and influences
- Build personal competence, social competence, and self-efficacy by addressing skills
- Provide functional health knowledge that is basic, accurate, and directly contributes to health-promoting decisions and behaviors
- Use strategies designed to personalize information and engage students
- Provide age-appropriate and developmentally appropriate information, learning strategies, teaching methods, and materials
- Incorporate learning strategies, teaching methods, and materials that are culturally inclusive
- Provide adequate time for instruction and learning
- Provide opportunities to reinforce skills and positive health behaviors
- Provide opportunities to make positive connections with influential others
- Include teacher information and plans for professional development and training that enhance effectiveness of instruction and student learning
Learn more about Promoting Health and Academic Success.
Tips for Implementation of WSCC at District Level
The Cortland City (New York) school district was highlighted on the CDC website of success stories (CDC, 2013c) for the work conducted at Cortland City Schools in the CSH component of nutrition services. District initiatives included limiting student access to competitive foods, adopting marketing techniques to promote healthful choices, setting nutrition policies and standards, establishing nutrition standards for competitive foods, and making more healthy foods and beverages available.
Tips for Implementation at District Level
The Cortland City (New York) school district was highlighted on the CDC website of success stories (CDC, 2013c) for the work conducted at Cortland City Schools in the CSH component of nutrition services. District initiatives included limiting student access to competitive foods, adopting marketing techniques to promote healthful choices, setting nutrition policies and standards, establishing nutrition standards for competitive foods, and making more healthy foods and beverages available. Six factors were reported as keys to the success of Cortland City Schools. The first factor was having a vision of being committed to a Coordinated School Health program. The second factor was leadership as demonstrated by administrative support from the board of education, superintendent, and the principals from the schools in the district. The third factor, collaboration, was shown through partnerships that were established with community agencies, staff, parents, and students. Teamwork in each building as well as districtwide provided a demonstration of the fourth factor. The fifth factor, data driven, was demonstrated by collecting baseline data to demonstrate improvements after repeated assessments, which were then conducted every two to three years. Finally, the sixth factor recognized was the issue of financial support, which was apparent in the use of minigrants such as one through the Healthy Heart Coalition.
Jeannette Dippo, former Health Education and Wellness coordinator with Cortland City Schools, offered five suggestions for the implementation of CSH programs and policies:
- Districts need to get administrative support for the CSH activities and to send out consistent messages.
- Broad involvement is needed, including support from parents, school staff, and community members. This support is necessary for strong advocates to assist in getting the CSH vision and goals converted into actual programs and policy. Administrators may respond more positivity to general staff and parents than to the typical school health champion, who is generally the health educator or health coordinator.
- The most critical CSH priorities need to be converted into policy. Such a policy will help ensure that work or effort in that area will continue. A policy will help to establish the priority after the champions leave or have moved on to other initiatives because the policy will still exist.
- Each school needs to have a health coordinator to drive and pull the work of the team together. The schools and the district need someone with real passion for CSH. CSH functions best when someone with continuity who believes in what is being done is there to oversee the actions. A health coordinator is someone to help develop the structure for the work to happen.
- A healthy school team is needed for every school building, along with a separate district team. The accomplishments that were made in individual schools happened because each school building had its own team to work with, and someone to take the program or initiative and make it happen at the school level. It is critical that school principals be members of each school team. This network needs to be in place to share ideas and develop and implement districtwide policies.
Implement the Plan and Strategies
Putting the action plan into place consists of implementing the plan and strategies, which usually consists of adopting policies or programs. When implementing the plan, districts need to direct the focus of school health efforts on meeting the education and health needs of students (CDC, 2013b). In addition, providing opportunities for students to be meaningfully involved in the school and the community will help the team to focus on students. School health efforts in programming and policies should give youth the chance to develop and exercise leadership abilities, build skills, form positive relationships with caring adults, and contribute to their school and greater community (CDC, 2013a).
CDC suggests that students can promote a healthy and safe school and community through opportunities such as involvement in peer education, peer advocacy, or cross-age mentoring programs. Other opportunities include involving young people in service learning avenues and participation on school health teams' advisory committees and boards that address health and wellness, education, and youth-related issues (CDC, 2013b).
Moving into the taking-action phase of program and policy implementation, CDC suggests that school districts implement multiple strategies through multiple components. To address one school health component, a variety of efforts are needed to have an effect in that area. Because the components are often overlapping and dependent on each other, addressing multiple if not all of the components is recommended for achieving the positive health and learning outcomes desired (CDC, 2013b). Many possibilities exist for advancing each of the WSCC components, and examples of possible policies and programming efforts can be discovered in any of the CSH assessment tools or criteria (see table 10.2 for possible strategies for improvement). Tools such as the CDC School Health Index, ASCD Healthy Schools Report Card, and ASCD School Improvement Tool are some of the more well-known and commonly used tools. Any strategies pursued by a school or district should be based on an assessment conducted at the school or district.
Schools should consider implementing policies and programs to help students avoid or reduce health-risk behaviors that contribute to the leading causes of death and disability among young people as well as among adults (CDC, 2014d). CDC has identified six categories of priority health-risk behaviors as being linked to the leading causes of death and disability in the United States:
- Behaviors that contribute to unintentional injuries and violence
- Tobacco use
- Alcohol and other drug use
- Sexual behaviors that contribute to unintended pregnancy and STDs, including HIV infection
- Unhealthy eating
- Physical inactivity (CDC, 2014d)
Schools can assess health-risk behaviors among young people in these six categories as well as in general health status, overweight, and asthma through formal surveys such as the Youth Risk Behavior Survey (YRBS) (CDC, 2014d). The YRBS, available through CDC, is a national school-based survey that can provide the school and district with behavioral data for 9th through 12th graders (CDC, 2014d). Data resulting from the survey can be used to track behavioral trends at the local level for establishing priorities and for monitoring program and policy success. In addition, the local data can be used to make comparisons to state, regional, and national levels with the data available on the CDC YRBS website. For example if a school district discovers that the proportion of students who participated in at least 60 minutes of physical activity per day was lower than the proportion for students in the state and nation, the district may decide that they need to address the issue. The action could mean changing the academic schedule and requirements to include daily physical education, training teachers to incorporate physical activity into the classroom, allowing fit breaks throughout the day, or instituting a walk-to-school program. This example demonstrates how data from the YRBS system can be used to inform programming and policies as a district tries to improve the health and well-being of students and staff.
After a health-risk behavior or behaviors have been identified as a priority, the school or district faces the challenge of identifying or developing relevant policies or programs. Research-based programming that can reduce risk behaviors has been identified, and information is available through Registries of Programs Effective in Reducing Youth Risk Behaviors on the CDC website as well as through other similar sites (CDC, 2013d).
Besides selecting programming options, districts need to work to bring faculty and staff onboard with WSCC efforts. Education is important to help faculty and staff see the value of a coordinated approach and the relationship between health and academics. With proper training, teachers and school leaders can become important health champions to support and reinforce efforts of the school health education coordinator or administrator (Healthy Schools Campaign, 2012). Education is also essential for teachers, administrators, and other school employees committed to improving the health, academic success, and well-being of students. CDC stated,
Professional development can provide opportunities for school employees to identify areas for improvement, learn about and use proven practices, solve problems, develop skills, and reflect on and practice new strategies. In order to promote a Coordinated School Health approach, professional development should focus on the development of skills such as leadership, communication, and collaboration. (CDC, 2013b, para. 8)
In the 2013 document A Framework for Safe and Successful Schools,the recommendation was provided to conduct professional development for school staff and community partners that would address school climate and safety; positive behavior; and crisis prevention, preparedness, and response (NASP, 2013). As part of the professional development training, teachers and school leaders need to be provided with the information and resources they need to address student health issues and support a healthy school environment (Healthy Schools Campaign, 2012). Training might involve helping teachers to become aware of state-level health education regulations and requirements for health instruction so that those issues can be addressed outside the health education classroom and integrated into other subjects as a way to reinforce health-promoting concepts (Healthy Schools Campaign, 2012). Having more teachers and school leaders take on the role of health champion and work to support health concepts and health policies facilitates moving the district toward a more unified WSCC effort. Table 10.3 provides examples of how all teachers, not just health and physical education teachers, and school leaders can support WSCC though examples in each of the 10 components.
Learn more about Promoting Health and Academic Success.
Creation of WSCC
ASCD, in collaboration with CDC, moved forward in 2013 to develop a new model that builds on both the Whole Child Initiative and the original eight-component CSH approach. The development of the new model, titled Whole School, Whole Community, Whole Child (WSCC), involved a consultation group that developed the documents and frameworks related to the new model and a review group that periodically reviewed and provided feedback to the work of the consultation group.
ASCD, in collaboration with CDC, moved forward in 2013 to develop a new model that builds on both the Whole Child Initiative and the original eight-component CSH approach. The development of the new model, titled Whole School, Whole Community, Whole Child (WSCC), involved a consultation group that developed the documents and frameworks related to the new model and a review group that periodically reviewed and provided feedback to the work of the consultation group. Members of both groups were selected because of their role as leaders in both education and health. The new WSCC model was introduced at two national conferences, the ASCD conference in Los Angeles in March 2014 and the Society for Public Health Education (SOPHE) conference in Baltimore, also in March 2014. WSCC incorporates and builds on CSH and the ASCD Whole Child Initiative (ASCD, 2014).
WSCC is designed to promote alignment, integration, and collaboration between education and health and is intended to enhance health outcomes and academic success. Support and engagement of the whole community should be an important aspect of the implementation of WSCC (ASCD, 2014).
An important aspect of the new model is the expansion from 8 to 10 components. One original component, healthy and safe school environment, has been expanded to two separate components, physical environment and social and emotional climate. Another original component, family and community involvement, has been expanded to two components, community involvement and family engagement (see figure 1.1) (ASCD, 2014). The evolution of the school health models is presented in figure 1.2.
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Evolution of components in school health models.
Following are brief descriptions of all 10 WSCC components:
- Health education:Health education provides students with opportunities to acquire the knowledge, attitudes, and skills necessary for making health-promoting decisions, achieving health literacy, adopting health-enhancing behaviors, and promoting the health of others. Health education should be provided sequentially from pre-K through grade 12. Health education curricula should address important health topic areas through instruction based on the National Health Education Standards (NHES) (CDC, 2013).
- Physical education and physical activity: Physical education is a school-based instructional opportunity for students to gain the necessary skills and knowledge for lifelong participation in physical activity. Physical education is characterized by a planned, sequential K through 12 curriculum that assists students in achieving the national standards for K through 12 physical education. The outcome of a quality physical education program is a physically educated person who has the knowledge, skills, and confidence to enjoy a lifetime of healthful physical activity (CDC, 2013).
- Health services:These services are designed to ensure access or referral to primary health care services; foster appropriate use of primary health care services; prevent and control communicable disease and other health problems; provide emergency care for illness or injury; promote and provide optimum sanitary conditions for a safe school facility and school environment; and provide educational and counseling opportunities for promoting and maintaining individual, family, and community health (CDC, 2013).
- Nutrition environment and services: Schools should provide access to a variety of nutritious and appealing meals that accommodate the health and nutrition needs of all students. School nutrition programs should reflect U.S. Dietary Guidelines for Americans and other criteria to achieve nutrition integrity. The school nutrition services should offer students a learning laboratory for classroom nutrition and health education and serve as a resource for linkages with nutrition-related community services (CDC, 2013).
- Counseling, psychological, and social services: These services are provided to improve students' mental, emotional, and social health and include individual and group assessments, interventions, and referrals. Organizational assessment and consultation skills of counselors and psychologists should contribute not only to the health of students but also to the health of the school environment (CDC, 2013).
- Physical environment: The physical environment of the school includes buildings, school grounds, playground equipment, and athletic fields. The physical environment within the school includes building design, adequate space, cleanliness, noise level, heating and cooling, ventilation, and restrooms. These interior and exterior areas should be clean; safe; free from environmental hazards, tobacco, drugs, weapons, and violence; and appropriately secure from unauthorized access (Allensworth, Lawson, Nicholson, & Wyche, 1997; ASCD, 2014).
- Social and emotional climate:The social and emotional climate should provide a supportive culture conducive to enabling students, families, and staff members to feel safe, secure, accepted, and valued. Important factors in the social and emotional climate of a school include an attractive, comfortable physical environment; appreciation and respect for individual differences and cultural diversity; value placed on equity and social justice; high expectations and supportive actions for learning; size and structure of classes and organizations; and a general sense of comfort and safety (Allensworth, Lawson, Nicholson, & Wyche, 1997).
- Health promotion for staff: Schools can provide opportunities for school staff members to improve their health status through activities such as health assessments, health education, and health-related fitness activities. These opportunities should encourage staff members to pursue a healthy lifestyle that contributes to their improved health status, improved morale, and a greater personal commitment to the school's overall coordinated health approach (CDC, 2013).
- Family engagement:Epstein et al. (2009) identified six types of involvement necessary for successful school and family partnerships: (1) providing parenting support, (2) communicating with parents, (3) providing diverse volunteer opportunities, (4) supporting at-home learning, (5) encouraging parents to engage in decision-making opportunities in schools, and (6) collaborating with the community. Engaging family members often involves overcoming challenges such as family time conflicts, lack of transportation to school, and lack of comfort among family members in engaging in school activities. In addition, teachers and school staff may lack adequate time and resources to work with families.
- Community involvement:Meaningful community involvement in the WSCC approach is characterized by systematic collaboration among individuals and organizations within the school community. This systematic collaboration involves the engagement of individuals and organizations representing various segments of the community in the planning, implementation, and evaluation of programs, structures, and systems designed to create and sustain WSCC. The collaboration also involves the sharing of both community and school resources.
An Early Step Forward in Promoting WSCC at the Local Level
Upon the March 2014 unveiling of the Whole School, Whole Community, Whole Child model, a local school district in upstate New York introduced WSCC to the district's faculty and administration across their rural school district. A faculty member from a local college was asked to introduce the new WSCC model and then work with the district health and wellness coordinator to oversee 25 breakout sessions focused on the theme of incorporating wellness into learning. One goal for the day was to provide participants with knowledge and skills to adjust the physical, social, and emotional climate in their classrooms to improve the learning environment for each student. In an attempt to achieve the workshop goal, the WSCC model was introduced and compared with the CSH model. The ASCD video that provides an overview of the WSCC model was shown to the audience. Following the video a discussion was held on how a collaborative approach can have a positive effect on health and learning in the school district.
At the conclusion of the opening session, breakout sessions with small groups were held. An example of a breakout session was one titled "Healthy and Wise: Preparing Students for the World Beyond Formal Schooling." In this session, the facilitator went into detail about the collaborative WSCC approach while putting a strong focus on the ASCD Whole Child concept. The goal of this breakout session was to challenge the participants to produce a comprehensive health and academic plan in which the faculty and staff become leaders in the quest to reinvent, refocus, and recharge the health and academic status of the school district.
At the conclusion of the workshop it was decided to begin an initiative to implement the WSCC approach in the school district. The name of the first effort is "Optimize the Year with Healthy Habits: Incredible You, Incredible Year." In this effort the wellness committee will begin by addressing the wellness of the faculty and staff for the upcoming school year as a way to develop health and wellness leaders for the work to follow.
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Assessing nutrition and health services
Discover School Breakfast Toolkit - Purpose: This toolkit, from the Food and Nutrition Service of the U.S. Department of Agriculture, was developed to help schools assess current breakfast patterns and programs, calculate costs of implementing or changing breakfast programs, identify the type of meal service to provide to students, and create a marketing plan to engage and sustain a customer base.
Assessing Nutrition Services
Discover School Breakfast Toolkit
Purpose: This toolkit, from the Food and Nutrition Service of the U.S. Department of Agriculture, was developed to help schools assess current breakfast patterns and programs, calculate costs of implementing or changing breakfast programs, identify the type of meal service to provide to students, and create a marketing plan to engage and sustain a customer base. The toolkit includes the following sections:
- Introduction
- Successful use of the toolkit, which guides users through the toolkit
- An initial assessment, which provides surveys that schools can use to evaluate the interest levels of parents and students
- Cost calculator, which includes worksheets to help schools calculate the costs of implementing the School Breakfast Program
- Description of multiple methods for serving breakfast, which can help schools determine the best method for their needs
- Roadmaps to success
- Marketing efforts, which includes a marketing plan for schools to market the School Breakfast Program
- Resources
- Program evaluation, which provides information about how and what to evaluate specific to the School Breakfast Program
Audience: The toolkit is targeted toward individuals interested in increasing access to the School Breakfast Program. That might include school health councils, school nutrition staff, school administrators, parents, and community members.
Use: Toolkit users should first become familiar with the items in the toolkit and the steps to take. The next step is to use the student, parent, and administrator surveys to identify current knowledge, attitudes, and behaviors of these audiences as it relates to eating breakfast and breakfast programs. The third step is to use the tools to calculate a variety of cost-related items, such as breakfast profit/loss, revenue per reimbursable breakfast, daily revenue breakfast, and annual expenses to revenue comparisons. The remaining components of the toolkit guides users through identifying the best method for serving breakfast and developing and implementing a marketing plan to increase access and participation in the School Breakfast Program.
Access: The toolkit is found online at www.fns.usda.gov/cnd/breakfast/toolkit/.
Assessing Health Services
Body Mass Index Measurement (BMI) in Schools
Purpose: Developed by CDC researchers, with extensive input from experts from the field of school health, the BMI Measurement in Schools document, published in both full journal article (Nihiser, 2007) and executive summary formats, provides schools with an overview of what BMI is, the differences between BMI surveillance and screening, and a list of safeguards for schools choosing to implement a BMI measurement program.
Audience: The document can be used by school health councils, school nurses, and physical education and health education teachers. Any school interested in conducting BMI measurement can use the document to learn more about options for such a strategy and to identify the best option for the school.
Use: The BMI Measurement in Schools document presents both a synthesis of the science on measuring BMI in schools and safeguards to have in place when developing and implementing such a program or initiative. Leaders within the school who are interested in BMI measurement use the document to determine whether the school prefers surveillance or screening and to identify how the safeguards can be put in place.
Access: Both the full journal article and the executive summary can be found online at www.cdc.gov/healthyyouth/npao/publications.htm#10.
Safe at School and Ready to Learn: A Comprehensive Policy Guide for Protecting Students With Life-Threatening Food Allergies
Purpose: Developed by the National School Boards Association (NSBA), the Safe at School and Ready to Learn policy guide provides school boards with an overview of the prevalence of food allergies, policy guidance for school boards to consider when developing food allergy policies, and a policy checklist (National School Boards Association, 2012). The policy checklist guides the user through a process of identifying policy areas that need attention and actions that can be taken towards improvement.
Audience: The policy guide is to be used primarily by school board members. Secondary users can be school administrators, school health services staff, physical and health education teachers, parents, and school nutrition staff.
Use: In addition to providing policy guidance to school boards and other stakeholders, the guide's checklist is to be completed by identifying whether a specific policy element is included or not included and whether it is implemented or not implemented. When policy gaps are determined, a section for identifying action steps is provided. Results of the policy checklist can be used to inform and develop food allergy policies for schools.
Access: The guide is available online at http://www.nsba.org/sites/default/files/reports/Safe-at-School-and-Ready-to-Learn.pdf
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What a health education curriculum should look like
Comprehensive school health education is characterized by planned, sequential, developmentally appropriate, and culturally inclusive learning experiences taught by qualified trained teachers. The health education curriculum should be based on relevant health behavior theories; focus on the emotional, intellectual, physical, and social dimensions of health; provide students with exposure to diverse instructional techniques; and evaluate student achievement through a variety of assessment
Health Education
Comprehensive school health education is characterized by planned, sequential, developmentally appropriate, and culturally inclusive learning experiences taught by qualified trained teachers. The health education curriculum should be based on relevant health behavior theories; focus on the emotional, intellectual, physical, and social dimensions of health; provide students with exposure to diverse instructional techniques; and evaluate student achievement through a variety of assessment strategies (Joint Committee on National Health Education Standards [JCNHES], 2007). The learning experiences embedded within the curriculum should be designed to help students acquire functional health information; identify personal values that support healthy behaviors; recognize group norms that relate to a healthy lifestyle; and develop skills necessary to adopt, practice, and maintain health-enhancing behaviors (CDC, 2013a; JCNHES, 2007). Although many leaders in health and education suggest a linkage between quality health education and academic achievement, and some research verifies this linkage, many schools in the United States struggle to provide quality health education instruction (CDC, 2013b; JCNHES, 2007). Possible positive consequences of this linkage include a decrease in student absenteeism, higher academic achievement, and an increase in graduation rates (Allensworth, 2011; Basch, 2011a, 2011b; Freudenberg & Ruglis, 2007).
Healthy People 2020 includes an objective to increase the proportion of elementary, middle, and senior high schools that provide comprehensive school health education (USDHHS, 2013). Nationwide, 41.2 percent of elementary schools, 58.7 percent of middle schools, and 78.7 percent of high schools had specific time requirements for school health instruction (CDC, 2013b).
Thesecond edition of The National Health Education Standards (figure 3.1) was released in 2007. The standards were developed by a panel of health education leaders with input from professionals in both health and education, as well as parents and community members. The standards are not federally mandated or designed to define a national curriculum. Instead, they are intended to provide a framework and resource for the development of state standards and health education curricula in local school districts (American Cancer Society, 2007). The standardsinclude three distinct components: the individual health education standards, a rationale statement for each standard, and performance indicators linked to each standard for mastery by the completion of grades 4, 8, and 11 (American Cancer Society, 2007).
The standards can be applied to various health education content areas. The Centers for Disease Control and Prevention (CDC, 2011a) has identified six risk behaviors as being important focal points for instruction in school health education. These behaviors include alcohol and other drug use, physical inactivity, sexual behaviors that contribute to unintended pregnancy and sexually transmitted diseases, tobacco use, unhealthy dietary behaviors, and behaviors that contribute to unintentional injuries and violence. Other possible content areas for instruction include environmental health, human sexuality, and mental and emotional health (CDC, 2013a).
Beyond the National Health Education Standards, quality school health education should be based on quality health instruction. The following best practices have been identified by the CDC Division of Adolescent and School Health. They are based on reviews of effective programs and curricula and the positions of experts in the profession of health education (CDC, 2013d).
- Focus on clear health goals and related behavioral outcomes
- Are research-based and theory-driven
- Address individual values, attitudes, and beliefs
- Address individual and group norms that support health-enhancing behaviors
- Focus on reinforcing protective factors and increasing perceptions of personal risk and harmfulness of engaging in specific unhealthy practices and behaviors
- Address social pressures and influences
- Build personal competence, social competence, and self-efficacy by addressing skills
- Provide functional health knowledge that is basic, accurate, and directly contributes to health-promoting decisions and behaviors
- Use strategies designed to personalize information and engage students
- Provide age-appropriate and developmentally appropriate information, learning strategies, teaching methods, and materials
- Incorporate learning strategies, teaching methods, and materials that are culturally inclusive
- Provide adequate time for instruction and learning
- Provide opportunities to reinforce skills and positive health behaviors
- Provide opportunities to make positive connections with influential others
- Include teacher information and plans for professional development and training that enhance effectiveness of instruction and student learning
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Tips for Implementation of WSCC at District Level
The Cortland City (New York) school district was highlighted on the CDC website of success stories (CDC, 2013c) for the work conducted at Cortland City Schools in the CSH component of nutrition services. District initiatives included limiting student access to competitive foods, adopting marketing techniques to promote healthful choices, setting nutrition policies and standards, establishing nutrition standards for competitive foods, and making more healthy foods and beverages available.
Tips for Implementation at District Level
The Cortland City (New York) school district was highlighted on the CDC website of success stories (CDC, 2013c) for the work conducted at Cortland City Schools in the CSH component of nutrition services. District initiatives included limiting student access to competitive foods, adopting marketing techniques to promote healthful choices, setting nutrition policies and standards, establishing nutrition standards for competitive foods, and making more healthy foods and beverages available. Six factors were reported as keys to the success of Cortland City Schools. The first factor was having a vision of being committed to a Coordinated School Health program. The second factor was leadership as demonstrated by administrative support from the board of education, superintendent, and the principals from the schools in the district. The third factor, collaboration, was shown through partnerships that were established with community agencies, staff, parents, and students. Teamwork in each building as well as districtwide provided a demonstration of the fourth factor. The fifth factor, data driven, was demonstrated by collecting baseline data to demonstrate improvements after repeated assessments, which were then conducted every two to three years. Finally, the sixth factor recognized was the issue of financial support, which was apparent in the use of minigrants such as one through the Healthy Heart Coalition.
Jeannette Dippo, former Health Education and Wellness coordinator with Cortland City Schools, offered five suggestions for the implementation of CSH programs and policies:
- Districts need to get administrative support for the CSH activities and to send out consistent messages.
- Broad involvement is needed, including support from parents, school staff, and community members. This support is necessary for strong advocates to assist in getting the CSH vision and goals converted into actual programs and policy. Administrators may respond more positivity to general staff and parents than to the typical school health champion, who is generally the health educator or health coordinator.
- The most critical CSH priorities need to be converted into policy. Such a policy will help ensure that work or effort in that area will continue. A policy will help to establish the priority after the champions leave or have moved on to other initiatives because the policy will still exist.
- Each school needs to have a health coordinator to drive and pull the work of the team together. The schools and the district need someone with real passion for CSH. CSH functions best when someone with continuity who believes in what is being done is there to oversee the actions. A health coordinator is someone to help develop the structure for the work to happen.
- A healthy school team is needed for every school building, along with a separate district team. The accomplishments that were made in individual schools happened because each school building had its own team to work with, and someone to take the program or initiative and make it happen at the school level. It is critical that school principals be members of each school team. This network needs to be in place to share ideas and develop and implement districtwide policies.
Implement the Plan and Strategies
Putting the action plan into place consists of implementing the plan and strategies, which usually consists of adopting policies or programs. When implementing the plan, districts need to direct the focus of school health efforts on meeting the education and health needs of students (CDC, 2013b). In addition, providing opportunities for students to be meaningfully involved in the school and the community will help the team to focus on students. School health efforts in programming and policies should give youth the chance to develop and exercise leadership abilities, build skills, form positive relationships with caring adults, and contribute to their school and greater community (CDC, 2013a).
CDC suggests that students can promote a healthy and safe school and community through opportunities such as involvement in peer education, peer advocacy, or cross-age mentoring programs. Other opportunities include involving young people in service learning avenues and participation on school health teams' advisory committees and boards that address health and wellness, education, and youth-related issues (CDC, 2013b).
Moving into the taking-action phase of program and policy implementation, CDC suggests that school districts implement multiple strategies through multiple components. To address one school health component, a variety of efforts are needed to have an effect in that area. Because the components are often overlapping and dependent on each other, addressing multiple if not all of the components is recommended for achieving the positive health and learning outcomes desired (CDC, 2013b). Many possibilities exist for advancing each of the WSCC components, and examples of possible policies and programming efforts can be discovered in any of the CSH assessment tools or criteria (see table 10.2 for possible strategies for improvement). Tools such as the CDC School Health Index, ASCD Healthy Schools Report Card, and ASCD School Improvement Tool are some of the more well-known and commonly used tools. Any strategies pursued by a school or district should be based on an assessment conducted at the school or district.
Schools should consider implementing policies and programs to help students avoid or reduce health-risk behaviors that contribute to the leading causes of death and disability among young people as well as among adults (CDC, 2014d). CDC has identified six categories of priority health-risk behaviors as being linked to the leading causes of death and disability in the United States:
- Behaviors that contribute to unintentional injuries and violence
- Tobacco use
- Alcohol and other drug use
- Sexual behaviors that contribute to unintended pregnancy and STDs, including HIV infection
- Unhealthy eating
- Physical inactivity (CDC, 2014d)
Schools can assess health-risk behaviors among young people in these six categories as well as in general health status, overweight, and asthma through formal surveys such as the Youth Risk Behavior Survey (YRBS) (CDC, 2014d). The YRBS, available through CDC, is a national school-based survey that can provide the school and district with behavioral data for 9th through 12th graders (CDC, 2014d). Data resulting from the survey can be used to track behavioral trends at the local level for establishing priorities and for monitoring program and policy success. In addition, the local data can be used to make comparisons to state, regional, and national levels with the data available on the CDC YRBS website. For example if a school district discovers that the proportion of students who participated in at least 60 minutes of physical activity per day was lower than the proportion for students in the state and nation, the district may decide that they need to address the issue. The action could mean changing the academic schedule and requirements to include daily physical education, training teachers to incorporate physical activity into the classroom, allowing fit breaks throughout the day, or instituting a walk-to-school program. This example demonstrates how data from the YRBS system can be used to inform programming and policies as a district tries to improve the health and well-being of students and staff.
After a health-risk behavior or behaviors have been identified as a priority, the school or district faces the challenge of identifying or developing relevant policies or programs. Research-based programming that can reduce risk behaviors has been identified, and information is available through Registries of Programs Effective in Reducing Youth Risk Behaviors on the CDC website as well as through other similar sites (CDC, 2013d).
Besides selecting programming options, districts need to work to bring faculty and staff onboard with WSCC efforts. Education is important to help faculty and staff see the value of a coordinated approach and the relationship between health and academics. With proper training, teachers and school leaders can become important health champions to support and reinforce efforts of the school health education coordinator or administrator (Healthy Schools Campaign, 2012). Education is also essential for teachers, administrators, and other school employees committed to improving the health, academic success, and well-being of students. CDC stated,
Professional development can provide opportunities for school employees to identify areas for improvement, learn about and use proven practices, solve problems, develop skills, and reflect on and practice new strategies. In order to promote a Coordinated School Health approach, professional development should focus on the development of skills such as leadership, communication, and collaboration. (CDC, 2013b, para. 8)
In the 2013 document A Framework for Safe and Successful Schools,the recommendation was provided to conduct professional development for school staff and community partners that would address school climate and safety; positive behavior; and crisis prevention, preparedness, and response (NASP, 2013). As part of the professional development training, teachers and school leaders need to be provided with the information and resources they need to address student health issues and support a healthy school environment (Healthy Schools Campaign, 2012). Training might involve helping teachers to become aware of state-level health education regulations and requirements for health instruction so that those issues can be addressed outside the health education classroom and integrated into other subjects as a way to reinforce health-promoting concepts (Healthy Schools Campaign, 2012). Having more teachers and school leaders take on the role of health champion and work to support health concepts and health policies facilitates moving the district toward a more unified WSCC effort. Table 10.3 provides examples of how all teachers, not just health and physical education teachers, and school leaders can support WSCC though examples in each of the 10 components.
Learn more about Promoting Health and Academic Success.
Creation of WSCC
ASCD, in collaboration with CDC, moved forward in 2013 to develop a new model that builds on both the Whole Child Initiative and the original eight-component CSH approach. The development of the new model, titled Whole School, Whole Community, Whole Child (WSCC), involved a consultation group that developed the documents and frameworks related to the new model and a review group that periodically reviewed and provided feedback to the work of the consultation group.
ASCD, in collaboration with CDC, moved forward in 2013 to develop a new model that builds on both the Whole Child Initiative and the original eight-component CSH approach. The development of the new model, titled Whole School, Whole Community, Whole Child (WSCC), involved a consultation group that developed the documents and frameworks related to the new model and a review group that periodically reviewed and provided feedback to the work of the consultation group. Members of both groups were selected because of their role as leaders in both education and health. The new WSCC model was introduced at two national conferences, the ASCD conference in Los Angeles in March 2014 and the Society for Public Health Education (SOPHE) conference in Baltimore, also in March 2014. WSCC incorporates and builds on CSH and the ASCD Whole Child Initiative (ASCD, 2014).
WSCC is designed to promote alignment, integration, and collaboration between education and health and is intended to enhance health outcomes and academic success. Support and engagement of the whole community should be an important aspect of the implementation of WSCC (ASCD, 2014).
An important aspect of the new model is the expansion from 8 to 10 components. One original component, healthy and safe school environment, has been expanded to two separate components, physical environment and social and emotional climate. Another original component, family and community involvement, has been expanded to two components, community involvement and family engagement (see figure 1.1) (ASCD, 2014). The evolution of the school health models is presented in figure 1.2.
http://www.humankinetics.com/AcuCustom/Sitename/DAM/135/E6224_504973_ebook_Main.jpg
Evolution of components in school health models.
Following are brief descriptions of all 10 WSCC components:
- Health education:Health education provides students with opportunities to acquire the knowledge, attitudes, and skills necessary for making health-promoting decisions, achieving health literacy, adopting health-enhancing behaviors, and promoting the health of others. Health education should be provided sequentially from pre-K through grade 12. Health education curricula should address important health topic areas through instruction based on the National Health Education Standards (NHES) (CDC, 2013).
- Physical education and physical activity: Physical education is a school-based instructional opportunity for students to gain the necessary skills and knowledge for lifelong participation in physical activity. Physical education is characterized by a planned, sequential K through 12 curriculum that assists students in achieving the national standards for K through 12 physical education. The outcome of a quality physical education program is a physically educated person who has the knowledge, skills, and confidence to enjoy a lifetime of healthful physical activity (CDC, 2013).
- Health services:These services are designed to ensure access or referral to primary health care services; foster appropriate use of primary health care services; prevent and control communicable disease and other health problems; provide emergency care for illness or injury; promote and provide optimum sanitary conditions for a safe school facility and school environment; and provide educational and counseling opportunities for promoting and maintaining individual, family, and community health (CDC, 2013).
- Nutrition environment and services: Schools should provide access to a variety of nutritious and appealing meals that accommodate the health and nutrition needs of all students. School nutrition programs should reflect U.S. Dietary Guidelines for Americans and other criteria to achieve nutrition integrity. The school nutrition services should offer students a learning laboratory for classroom nutrition and health education and serve as a resource for linkages with nutrition-related community services (CDC, 2013).
- Counseling, psychological, and social services: These services are provided to improve students' mental, emotional, and social health and include individual and group assessments, interventions, and referrals. Organizational assessment and consultation skills of counselors and psychologists should contribute not only to the health of students but also to the health of the school environment (CDC, 2013).
- Physical environment: The physical environment of the school includes buildings, school grounds, playground equipment, and athletic fields. The physical environment within the school includes building design, adequate space, cleanliness, noise level, heating and cooling, ventilation, and restrooms. These interior and exterior areas should be clean; safe; free from environmental hazards, tobacco, drugs, weapons, and violence; and appropriately secure from unauthorized access (Allensworth, Lawson, Nicholson, & Wyche, 1997; ASCD, 2014).
- Social and emotional climate:The social and emotional climate should provide a supportive culture conducive to enabling students, families, and staff members to feel safe, secure, accepted, and valued. Important factors in the social and emotional climate of a school include an attractive, comfortable physical environment; appreciation and respect for individual differences and cultural diversity; value placed on equity and social justice; high expectations and supportive actions for learning; size and structure of classes and organizations; and a general sense of comfort and safety (Allensworth, Lawson, Nicholson, & Wyche, 1997).
- Health promotion for staff: Schools can provide opportunities for school staff members to improve their health status through activities such as health assessments, health education, and health-related fitness activities. These opportunities should encourage staff members to pursue a healthy lifestyle that contributes to their improved health status, improved morale, and a greater personal commitment to the school's overall coordinated health approach (CDC, 2013).
- Family engagement:Epstein et al. (2009) identified six types of involvement necessary for successful school and family partnerships: (1) providing parenting support, (2) communicating with parents, (3) providing diverse volunteer opportunities, (4) supporting at-home learning, (5) encouraging parents to engage in decision-making opportunities in schools, and (6) collaborating with the community. Engaging family members often involves overcoming challenges such as family time conflicts, lack of transportation to school, and lack of comfort among family members in engaging in school activities. In addition, teachers and school staff may lack adequate time and resources to work with families.
- Community involvement:Meaningful community involvement in the WSCC approach is characterized by systematic collaboration among individuals and organizations within the school community. This systematic collaboration involves the engagement of individuals and organizations representing various segments of the community in the planning, implementation, and evaluation of programs, structures, and systems designed to create and sustain WSCC. The collaboration also involves the sharing of both community and school resources.
An Early Step Forward in Promoting WSCC at the Local Level
Upon the March 2014 unveiling of the Whole School, Whole Community, Whole Child model, a local school district in upstate New York introduced WSCC to the district's faculty and administration across their rural school district. A faculty member from a local college was asked to introduce the new WSCC model and then work with the district health and wellness coordinator to oversee 25 breakout sessions focused on the theme of incorporating wellness into learning. One goal for the day was to provide participants with knowledge and skills to adjust the physical, social, and emotional climate in their classrooms to improve the learning environment for each student. In an attempt to achieve the workshop goal, the WSCC model was introduced and compared with the CSH model. The ASCD video that provides an overview of the WSCC model was shown to the audience. Following the video a discussion was held on how a collaborative approach can have a positive effect on health and learning in the school district.
At the conclusion of the opening session, breakout sessions with small groups were held. An example of a breakout session was one titled "Healthy and Wise: Preparing Students for the World Beyond Formal Schooling." In this session, the facilitator went into detail about the collaborative WSCC approach while putting a strong focus on the ASCD Whole Child concept. The goal of this breakout session was to challenge the participants to produce a comprehensive health and academic plan in which the faculty and staff become leaders in the quest to reinvent, refocus, and recharge the health and academic status of the school district.
At the conclusion of the workshop it was decided to begin an initiative to implement the WSCC approach in the school district. The name of the first effort is "Optimize the Year with Healthy Habits: Incredible You, Incredible Year." In this effort the wellness committee will begin by addressing the wellness of the faculty and staff for the upcoming school year as a way to develop health and wellness leaders for the work to follow.
Learn more about Promoting Health and Academic Success.
Assessing nutrition and health services
Discover School Breakfast Toolkit - Purpose: This toolkit, from the Food and Nutrition Service of the U.S. Department of Agriculture, was developed to help schools assess current breakfast patterns and programs, calculate costs of implementing or changing breakfast programs, identify the type of meal service to provide to students, and create a marketing plan to engage and sustain a customer base.
Assessing Nutrition Services
Discover School Breakfast Toolkit
Purpose: This toolkit, from the Food and Nutrition Service of the U.S. Department of Agriculture, was developed to help schools assess current breakfast patterns and programs, calculate costs of implementing or changing breakfast programs, identify the type of meal service to provide to students, and create a marketing plan to engage and sustain a customer base. The toolkit includes the following sections:
- Introduction
- Successful use of the toolkit, which guides users through the toolkit
- An initial assessment, which provides surveys that schools can use to evaluate the interest levels of parents and students
- Cost calculator, which includes worksheets to help schools calculate the costs of implementing the School Breakfast Program
- Description of multiple methods for serving breakfast, which can help schools determine the best method for their needs
- Roadmaps to success
- Marketing efforts, which includes a marketing plan for schools to market the School Breakfast Program
- Resources
- Program evaluation, which provides information about how and what to evaluate specific to the School Breakfast Program
Audience: The toolkit is targeted toward individuals interested in increasing access to the School Breakfast Program. That might include school health councils, school nutrition staff, school administrators, parents, and community members.
Use: Toolkit users should first become familiar with the items in the toolkit and the steps to take. The next step is to use the student, parent, and administrator surveys to identify current knowledge, attitudes, and behaviors of these audiences as it relates to eating breakfast and breakfast programs. The third step is to use the tools to calculate a variety of cost-related items, such as breakfast profit/loss, revenue per reimbursable breakfast, daily revenue breakfast, and annual expenses to revenue comparisons. The remaining components of the toolkit guides users through identifying the best method for serving breakfast and developing and implementing a marketing plan to increase access and participation in the School Breakfast Program.
Access: The toolkit is found online at www.fns.usda.gov/cnd/breakfast/toolkit/.
Assessing Health Services
Body Mass Index Measurement (BMI) in Schools
Purpose: Developed by CDC researchers, with extensive input from experts from the field of school health, the BMI Measurement in Schools document, published in both full journal article (Nihiser, 2007) and executive summary formats, provides schools with an overview of what BMI is, the differences between BMI surveillance and screening, and a list of safeguards for schools choosing to implement a BMI measurement program.
Audience: The document can be used by school health councils, school nurses, and physical education and health education teachers. Any school interested in conducting BMI measurement can use the document to learn more about options for such a strategy and to identify the best option for the school.
Use: The BMI Measurement in Schools document presents both a synthesis of the science on measuring BMI in schools and safeguards to have in place when developing and implementing such a program or initiative. Leaders within the school who are interested in BMI measurement use the document to determine whether the school prefers surveillance or screening and to identify how the safeguards can be put in place.
Access: Both the full journal article and the executive summary can be found online at www.cdc.gov/healthyyouth/npao/publications.htm#10.
Safe at School and Ready to Learn: A Comprehensive Policy Guide for Protecting Students With Life-Threatening Food Allergies
Purpose: Developed by the National School Boards Association (NSBA), the Safe at School and Ready to Learn policy guide provides school boards with an overview of the prevalence of food allergies, policy guidance for school boards to consider when developing food allergy policies, and a policy checklist (National School Boards Association, 2012). The policy checklist guides the user through a process of identifying policy areas that need attention and actions that can be taken towards improvement.
Audience: The policy guide is to be used primarily by school board members. Secondary users can be school administrators, school health services staff, physical and health education teachers, parents, and school nutrition staff.
Use: In addition to providing policy guidance to school boards and other stakeholders, the guide's checklist is to be completed by identifying whether a specific policy element is included or not included and whether it is implemented or not implemented. When policy gaps are determined, a section for identifying action steps is provided. Results of the policy checklist can be used to inform and develop food allergy policies for schools.
Access: The guide is available online at http://www.nsba.org/sites/default/files/reports/Safe-at-School-and-Ready-to-Learn.pdf
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What a health education curriculum should look like
Comprehensive school health education is characterized by planned, sequential, developmentally appropriate, and culturally inclusive learning experiences taught by qualified trained teachers. The health education curriculum should be based on relevant health behavior theories; focus on the emotional, intellectual, physical, and social dimensions of health; provide students with exposure to diverse instructional techniques; and evaluate student achievement through a variety of assessment
Health Education
Comprehensive school health education is characterized by planned, sequential, developmentally appropriate, and culturally inclusive learning experiences taught by qualified trained teachers. The health education curriculum should be based on relevant health behavior theories; focus on the emotional, intellectual, physical, and social dimensions of health; provide students with exposure to diverse instructional techniques; and evaluate student achievement through a variety of assessment strategies (Joint Committee on National Health Education Standards [JCNHES], 2007). The learning experiences embedded within the curriculum should be designed to help students acquire functional health information; identify personal values that support healthy behaviors; recognize group norms that relate to a healthy lifestyle; and develop skills necessary to adopt, practice, and maintain health-enhancing behaviors (CDC, 2013a; JCNHES, 2007). Although many leaders in health and education suggest a linkage between quality health education and academic achievement, and some research verifies this linkage, many schools in the United States struggle to provide quality health education instruction (CDC, 2013b; JCNHES, 2007). Possible positive consequences of this linkage include a decrease in student absenteeism, higher academic achievement, and an increase in graduation rates (Allensworth, 2011; Basch, 2011a, 2011b; Freudenberg & Ruglis, 2007).
Healthy People 2020 includes an objective to increase the proportion of elementary, middle, and senior high schools that provide comprehensive school health education (USDHHS, 2013). Nationwide, 41.2 percent of elementary schools, 58.7 percent of middle schools, and 78.7 percent of high schools had specific time requirements for school health instruction (CDC, 2013b).
Thesecond edition of The National Health Education Standards (figure 3.1) was released in 2007. The standards were developed by a panel of health education leaders with input from professionals in both health and education, as well as parents and community members. The standards are not federally mandated or designed to define a national curriculum. Instead, they are intended to provide a framework and resource for the development of state standards and health education curricula in local school districts (American Cancer Society, 2007). The standardsinclude three distinct components: the individual health education standards, a rationale statement for each standard, and performance indicators linked to each standard for mastery by the completion of grades 4, 8, and 11 (American Cancer Society, 2007).
The standards can be applied to various health education content areas. The Centers for Disease Control and Prevention (CDC, 2011a) has identified six risk behaviors as being important focal points for instruction in school health education. These behaviors include alcohol and other drug use, physical inactivity, sexual behaviors that contribute to unintended pregnancy and sexually transmitted diseases, tobacco use, unhealthy dietary behaviors, and behaviors that contribute to unintentional injuries and violence. Other possible content areas for instruction include environmental health, human sexuality, and mental and emotional health (CDC, 2013a).
Beyond the National Health Education Standards, quality school health education should be based on quality health instruction. The following best practices have been identified by the CDC Division of Adolescent and School Health. They are based on reviews of effective programs and curricula and the positions of experts in the profession of health education (CDC, 2013d).
- Focus on clear health goals and related behavioral outcomes
- Are research-based and theory-driven
- Address individual values, attitudes, and beliefs
- Address individual and group norms that support health-enhancing behaviors
- Focus on reinforcing protective factors and increasing perceptions of personal risk and harmfulness of engaging in specific unhealthy practices and behaviors
- Address social pressures and influences
- Build personal competence, social competence, and self-efficacy by addressing skills
- Provide functional health knowledge that is basic, accurate, and directly contributes to health-promoting decisions and behaviors
- Use strategies designed to personalize information and engage students
- Provide age-appropriate and developmentally appropriate information, learning strategies, teaching methods, and materials
- Incorporate learning strategies, teaching methods, and materials that are culturally inclusive
- Provide adequate time for instruction and learning
- Provide opportunities to reinforce skills and positive health behaviors
- Provide opportunities to make positive connections with influential others
- Include teacher information and plans for professional development and training that enhance effectiveness of instruction and student learning
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Tips for Implementation of WSCC at District Level
The Cortland City (New York) school district was highlighted on the CDC website of success stories (CDC, 2013c) for the work conducted at Cortland City Schools in the CSH component of nutrition services. District initiatives included limiting student access to competitive foods, adopting marketing techniques to promote healthful choices, setting nutrition policies and standards, establishing nutrition standards for competitive foods, and making more healthy foods and beverages available.
Tips for Implementation at District Level
The Cortland City (New York) school district was highlighted on the CDC website of success stories (CDC, 2013c) for the work conducted at Cortland City Schools in the CSH component of nutrition services. District initiatives included limiting student access to competitive foods, adopting marketing techniques to promote healthful choices, setting nutrition policies and standards, establishing nutrition standards for competitive foods, and making more healthy foods and beverages available. Six factors were reported as keys to the success of Cortland City Schools. The first factor was having a vision of being committed to a Coordinated School Health program. The second factor was leadership as demonstrated by administrative support from the board of education, superintendent, and the principals from the schools in the district. The third factor, collaboration, was shown through partnerships that were established with community agencies, staff, parents, and students. Teamwork in each building as well as districtwide provided a demonstration of the fourth factor. The fifth factor, data driven, was demonstrated by collecting baseline data to demonstrate improvements after repeated assessments, which were then conducted every two to three years. Finally, the sixth factor recognized was the issue of financial support, which was apparent in the use of minigrants such as one through the Healthy Heart Coalition.
Jeannette Dippo, former Health Education and Wellness coordinator with Cortland City Schools, offered five suggestions for the implementation of CSH programs and policies:
- Districts need to get administrative support for the CSH activities and to send out consistent messages.
- Broad involvement is needed, including support from parents, school staff, and community members. This support is necessary for strong advocates to assist in getting the CSH vision and goals converted into actual programs and policy. Administrators may respond more positivity to general staff and parents than to the typical school health champion, who is generally the health educator or health coordinator.
- The most critical CSH priorities need to be converted into policy. Such a policy will help ensure that work or effort in that area will continue. A policy will help to establish the priority after the champions leave or have moved on to other initiatives because the policy will still exist.
- Each school needs to have a health coordinator to drive and pull the work of the team together. The schools and the district need someone with real passion for CSH. CSH functions best when someone with continuity who believes in what is being done is there to oversee the actions. A health coordinator is someone to help develop the structure for the work to happen.
- A healthy school team is needed for every school building, along with a separate district team. The accomplishments that were made in individual schools happened because each school building had its own team to work with, and someone to take the program or initiative and make it happen at the school level. It is critical that school principals be members of each school team. This network needs to be in place to share ideas and develop and implement districtwide policies.
Implement the Plan and Strategies
Putting the action plan into place consists of implementing the plan and strategies, which usually consists of adopting policies or programs. When implementing the plan, districts need to direct the focus of school health efforts on meeting the education and health needs of students (CDC, 2013b). In addition, providing opportunities for students to be meaningfully involved in the school and the community will help the team to focus on students. School health efforts in programming and policies should give youth the chance to develop and exercise leadership abilities, build skills, form positive relationships with caring adults, and contribute to their school and greater community (CDC, 2013a).
CDC suggests that students can promote a healthy and safe school and community through opportunities such as involvement in peer education, peer advocacy, or cross-age mentoring programs. Other opportunities include involving young people in service learning avenues and participation on school health teams' advisory committees and boards that address health and wellness, education, and youth-related issues (CDC, 2013b).
Moving into the taking-action phase of program and policy implementation, CDC suggests that school districts implement multiple strategies through multiple components. To address one school health component, a variety of efforts are needed to have an effect in that area. Because the components are often overlapping and dependent on each other, addressing multiple if not all of the components is recommended for achieving the positive health and learning outcomes desired (CDC, 2013b). Many possibilities exist for advancing each of the WSCC components, and examples of possible policies and programming efforts can be discovered in any of the CSH assessment tools or criteria (see table 10.2 for possible strategies for improvement). Tools such as the CDC School Health Index, ASCD Healthy Schools Report Card, and ASCD School Improvement Tool are some of the more well-known and commonly used tools. Any strategies pursued by a school or district should be based on an assessment conducted at the school or district.
Schools should consider implementing policies and programs to help students avoid or reduce health-risk behaviors that contribute to the leading causes of death and disability among young people as well as among adults (CDC, 2014d). CDC has identified six categories of priority health-risk behaviors as being linked to the leading causes of death and disability in the United States:
- Behaviors that contribute to unintentional injuries and violence
- Tobacco use
- Alcohol and other drug use
- Sexual behaviors that contribute to unintended pregnancy and STDs, including HIV infection
- Unhealthy eating
- Physical inactivity (CDC, 2014d)
Schools can assess health-risk behaviors among young people in these six categories as well as in general health status, overweight, and asthma through formal surveys such as the Youth Risk Behavior Survey (YRBS) (CDC, 2014d). The YRBS, available through CDC, is a national school-based survey that can provide the school and district with behavioral data for 9th through 12th graders (CDC, 2014d). Data resulting from the survey can be used to track behavioral trends at the local level for establishing priorities and for monitoring program and policy success. In addition, the local data can be used to make comparisons to state, regional, and national levels with the data available on the CDC YRBS website. For example if a school district discovers that the proportion of students who participated in at least 60 minutes of physical activity per day was lower than the proportion for students in the state and nation, the district may decide that they need to address the issue. The action could mean changing the academic schedule and requirements to include daily physical education, training teachers to incorporate physical activity into the classroom, allowing fit breaks throughout the day, or instituting a walk-to-school program. This example demonstrates how data from the YRBS system can be used to inform programming and policies as a district tries to improve the health and well-being of students and staff.
After a health-risk behavior or behaviors have been identified as a priority, the school or district faces the challenge of identifying or developing relevant policies or programs. Research-based programming that can reduce risk behaviors has been identified, and information is available through Registries of Programs Effective in Reducing Youth Risk Behaviors on the CDC website as well as through other similar sites (CDC, 2013d).
Besides selecting programming options, districts need to work to bring faculty and staff onboard with WSCC efforts. Education is important to help faculty and staff see the value of a coordinated approach and the relationship between health and academics. With proper training, teachers and school leaders can become important health champions to support and reinforce efforts of the school health education coordinator or administrator (Healthy Schools Campaign, 2012). Education is also essential for teachers, administrators, and other school employees committed to improving the health, academic success, and well-being of students. CDC stated,
Professional development can provide opportunities for school employees to identify areas for improvement, learn about and use proven practices, solve problems, develop skills, and reflect on and practice new strategies. In order to promote a Coordinated School Health approach, professional development should focus on the development of skills such as leadership, communication, and collaboration. (CDC, 2013b, para. 8)
In the 2013 document A Framework for Safe and Successful Schools,the recommendation was provided to conduct professional development for school staff and community partners that would address school climate and safety; positive behavior; and crisis prevention, preparedness, and response (NASP, 2013). As part of the professional development training, teachers and school leaders need to be provided with the information and resources they need to address student health issues and support a healthy school environment (Healthy Schools Campaign, 2012). Training might involve helping teachers to become aware of state-level health education regulations and requirements for health instruction so that those issues can be addressed outside the health education classroom and integrated into other subjects as a way to reinforce health-promoting concepts (Healthy Schools Campaign, 2012). Having more teachers and school leaders take on the role of health champion and work to support health concepts and health policies facilitates moving the district toward a more unified WSCC effort. Table 10.3 provides examples of how all teachers, not just health and physical education teachers, and school leaders can support WSCC though examples in each of the 10 components.
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Creation of WSCC
ASCD, in collaboration with CDC, moved forward in 2013 to develop a new model that builds on both the Whole Child Initiative and the original eight-component CSH approach. The development of the new model, titled Whole School, Whole Community, Whole Child (WSCC), involved a consultation group that developed the documents and frameworks related to the new model and a review group that periodically reviewed and provided feedback to the work of the consultation group.
ASCD, in collaboration with CDC, moved forward in 2013 to develop a new model that builds on both the Whole Child Initiative and the original eight-component CSH approach. The development of the new model, titled Whole School, Whole Community, Whole Child (WSCC), involved a consultation group that developed the documents and frameworks related to the new model and a review group that periodically reviewed and provided feedback to the work of the consultation group. Members of both groups were selected because of their role as leaders in both education and health. The new WSCC model was introduced at two national conferences, the ASCD conference in Los Angeles in March 2014 and the Society for Public Health Education (SOPHE) conference in Baltimore, also in March 2014. WSCC incorporates and builds on CSH and the ASCD Whole Child Initiative (ASCD, 2014).
WSCC is designed to promote alignment, integration, and collaboration between education and health and is intended to enhance health outcomes and academic success. Support and engagement of the whole community should be an important aspect of the implementation of WSCC (ASCD, 2014).
An important aspect of the new model is the expansion from 8 to 10 components. One original component, healthy and safe school environment, has been expanded to two separate components, physical environment and social and emotional climate. Another original component, family and community involvement, has been expanded to two components, community involvement and family engagement (see figure 1.1) (ASCD, 2014). The evolution of the school health models is presented in figure 1.2.
http://www.humankinetics.com/AcuCustom/Sitename/DAM/135/E6224_504973_ebook_Main.jpg
Evolution of components in school health models.
Following are brief descriptions of all 10 WSCC components:
- Health education:Health education provides students with opportunities to acquire the knowledge, attitudes, and skills necessary for making health-promoting decisions, achieving health literacy, adopting health-enhancing behaviors, and promoting the health of others. Health education should be provided sequentially from pre-K through grade 12. Health education curricula should address important health topic areas through instruction based on the National Health Education Standards (NHES) (CDC, 2013).
- Physical education and physical activity: Physical education is a school-based instructional opportunity for students to gain the necessary skills and knowledge for lifelong participation in physical activity. Physical education is characterized by a planned, sequential K through 12 curriculum that assists students in achieving the national standards for K through 12 physical education. The outcome of a quality physical education program is a physically educated person who has the knowledge, skills, and confidence to enjoy a lifetime of healthful physical activity (CDC, 2013).
- Health services:These services are designed to ensure access or referral to primary health care services; foster appropriate use of primary health care services; prevent and control communicable disease and other health problems; provide emergency care for illness or injury; promote and provide optimum sanitary conditions for a safe school facility and school environment; and provide educational and counseling opportunities for promoting and maintaining individual, family, and community health (CDC, 2013).
- Nutrition environment and services: Schools should provide access to a variety of nutritious and appealing meals that accommodate the health and nutrition needs of all students. School nutrition programs should reflect U.S. Dietary Guidelines for Americans and other criteria to achieve nutrition integrity. The school nutrition services should offer students a learning laboratory for classroom nutrition and health education and serve as a resource for linkages with nutrition-related community services (CDC, 2013).
- Counseling, psychological, and social services: These services are provided to improve students' mental, emotional, and social health and include individual and group assessments, interventions, and referrals. Organizational assessment and consultation skills of counselors and psychologists should contribute not only to the health of students but also to the health of the school environment (CDC, 2013).
- Physical environment: The physical environment of the school includes buildings, school grounds, playground equipment, and athletic fields. The physical environment within the school includes building design, adequate space, cleanliness, noise level, heating and cooling, ventilation, and restrooms. These interior and exterior areas should be clean; safe; free from environmental hazards, tobacco, drugs, weapons, and violence; and appropriately secure from unauthorized access (Allensworth, Lawson, Nicholson, & Wyche, 1997; ASCD, 2014).
- Social and emotional climate:The social and emotional climate should provide a supportive culture conducive to enabling students, families, and staff members to feel safe, secure, accepted, and valued. Important factors in the social and emotional climate of a school include an attractive, comfortable physical environment; appreciation and respect for individual differences and cultural diversity; value placed on equity and social justice; high expectations and supportive actions for learning; size and structure of classes and organizations; and a general sense of comfort and safety (Allensworth, Lawson, Nicholson, & Wyche, 1997).
- Health promotion for staff: Schools can provide opportunities for school staff members to improve their health status through activities such as health assessments, health education, and health-related fitness activities. These opportunities should encourage staff members to pursue a healthy lifestyle that contributes to their improved health status, improved morale, and a greater personal commitment to the school's overall coordinated health approach (CDC, 2013).
- Family engagement:Epstein et al. (2009) identified six types of involvement necessary for successful school and family partnerships: (1) providing parenting support, (2) communicating with parents, (3) providing diverse volunteer opportunities, (4) supporting at-home learning, (5) encouraging parents to engage in decision-making opportunities in schools, and (6) collaborating with the community. Engaging family members often involves overcoming challenges such as family time conflicts, lack of transportation to school, and lack of comfort among family members in engaging in school activities. In addition, teachers and school staff may lack adequate time and resources to work with families.
- Community involvement:Meaningful community involvement in the WSCC approach is characterized by systematic collaboration among individuals and organizations within the school community. This systematic collaboration involves the engagement of individuals and organizations representing various segments of the community in the planning, implementation, and evaluation of programs, structures, and systems designed to create and sustain WSCC. The collaboration also involves the sharing of both community and school resources.
An Early Step Forward in Promoting WSCC at the Local Level
Upon the March 2014 unveiling of the Whole School, Whole Community, Whole Child model, a local school district in upstate New York introduced WSCC to the district's faculty and administration across their rural school district. A faculty member from a local college was asked to introduce the new WSCC model and then work with the district health and wellness coordinator to oversee 25 breakout sessions focused on the theme of incorporating wellness into learning. One goal for the day was to provide participants with knowledge and skills to adjust the physical, social, and emotional climate in their classrooms to improve the learning environment for each student. In an attempt to achieve the workshop goal, the WSCC model was introduced and compared with the CSH model. The ASCD video that provides an overview of the WSCC model was shown to the audience. Following the video a discussion was held on how a collaborative approach can have a positive effect on health and learning in the school district.
At the conclusion of the opening session, breakout sessions with small groups were held. An example of a breakout session was one titled "Healthy and Wise: Preparing Students for the World Beyond Formal Schooling." In this session, the facilitator went into detail about the collaborative WSCC approach while putting a strong focus on the ASCD Whole Child concept. The goal of this breakout session was to challenge the participants to produce a comprehensive health and academic plan in which the faculty and staff become leaders in the quest to reinvent, refocus, and recharge the health and academic status of the school district.
At the conclusion of the workshop it was decided to begin an initiative to implement the WSCC approach in the school district. The name of the first effort is "Optimize the Year with Healthy Habits: Incredible You, Incredible Year." In this effort the wellness committee will begin by addressing the wellness of the faculty and staff for the upcoming school year as a way to develop health and wellness leaders for the work to follow.
Learn more about Promoting Health and Academic Success.
Assessing nutrition and health services
Discover School Breakfast Toolkit - Purpose: This toolkit, from the Food and Nutrition Service of the U.S. Department of Agriculture, was developed to help schools assess current breakfast patterns and programs, calculate costs of implementing or changing breakfast programs, identify the type of meal service to provide to students, and create a marketing plan to engage and sustain a customer base.
Assessing Nutrition Services
Discover School Breakfast Toolkit
Purpose: This toolkit, from the Food and Nutrition Service of the U.S. Department of Agriculture, was developed to help schools assess current breakfast patterns and programs, calculate costs of implementing or changing breakfast programs, identify the type of meal service to provide to students, and create a marketing plan to engage and sustain a customer base. The toolkit includes the following sections:
- Introduction
- Successful use of the toolkit, which guides users through the toolkit
- An initial assessment, which provides surveys that schools can use to evaluate the interest levels of parents and students
- Cost calculator, which includes worksheets to help schools calculate the costs of implementing the School Breakfast Program
- Description of multiple methods for serving breakfast, which can help schools determine the best method for their needs
- Roadmaps to success
- Marketing efforts, which includes a marketing plan for schools to market the School Breakfast Program
- Resources
- Program evaluation, which provides information about how and what to evaluate specific to the School Breakfast Program
Audience: The toolkit is targeted toward individuals interested in increasing access to the School Breakfast Program. That might include school health councils, school nutrition staff, school administrators, parents, and community members.
Use: Toolkit users should first become familiar with the items in the toolkit and the steps to take. The next step is to use the student, parent, and administrator surveys to identify current knowledge, attitudes, and behaviors of these audiences as it relates to eating breakfast and breakfast programs. The third step is to use the tools to calculate a variety of cost-related items, such as breakfast profit/loss, revenue per reimbursable breakfast, daily revenue breakfast, and annual expenses to revenue comparisons. The remaining components of the toolkit guides users through identifying the best method for serving breakfast and developing and implementing a marketing plan to increase access and participation in the School Breakfast Program.
Access: The toolkit is found online at www.fns.usda.gov/cnd/breakfast/toolkit/.
Assessing Health Services
Body Mass Index Measurement (BMI) in Schools
Purpose: Developed by CDC researchers, with extensive input from experts from the field of school health, the BMI Measurement in Schools document, published in both full journal article (Nihiser, 2007) and executive summary formats, provides schools with an overview of what BMI is, the differences between BMI surveillance and screening, and a list of safeguards for schools choosing to implement a BMI measurement program.
Audience: The document can be used by school health councils, school nurses, and physical education and health education teachers. Any school interested in conducting BMI measurement can use the document to learn more about options for such a strategy and to identify the best option for the school.
Use: The BMI Measurement in Schools document presents both a synthesis of the science on measuring BMI in schools and safeguards to have in place when developing and implementing such a program or initiative. Leaders within the school who are interested in BMI measurement use the document to determine whether the school prefers surveillance or screening and to identify how the safeguards can be put in place.
Access: Both the full journal article and the executive summary can be found online at www.cdc.gov/healthyyouth/npao/publications.htm#10.
Safe at School and Ready to Learn: A Comprehensive Policy Guide for Protecting Students With Life-Threatening Food Allergies
Purpose: Developed by the National School Boards Association (NSBA), the Safe at School and Ready to Learn policy guide provides school boards with an overview of the prevalence of food allergies, policy guidance for school boards to consider when developing food allergy policies, and a policy checklist (National School Boards Association, 2012). The policy checklist guides the user through a process of identifying policy areas that need attention and actions that can be taken towards improvement.
Audience: The policy guide is to be used primarily by school board members. Secondary users can be school administrators, school health services staff, physical and health education teachers, parents, and school nutrition staff.
Use: In addition to providing policy guidance to school boards and other stakeholders, the guide's checklist is to be completed by identifying whether a specific policy element is included or not included and whether it is implemented or not implemented. When policy gaps are determined, a section for identifying action steps is provided. Results of the policy checklist can be used to inform and develop food allergy policies for schools.
Access: The guide is available online at http://www.nsba.org/sites/default/files/reports/Safe-at-School-and-Ready-to-Learn.pdf
Learn more about Promoting Health and Academic Success.
What a health education curriculum should look like
Comprehensive school health education is characterized by planned, sequential, developmentally appropriate, and culturally inclusive learning experiences taught by qualified trained teachers. The health education curriculum should be based on relevant health behavior theories; focus on the emotional, intellectual, physical, and social dimensions of health; provide students with exposure to diverse instructional techniques; and evaluate student achievement through a variety of assessment
Health Education
Comprehensive school health education is characterized by planned, sequential, developmentally appropriate, and culturally inclusive learning experiences taught by qualified trained teachers. The health education curriculum should be based on relevant health behavior theories; focus on the emotional, intellectual, physical, and social dimensions of health; provide students with exposure to diverse instructional techniques; and evaluate student achievement through a variety of assessment strategies (Joint Committee on National Health Education Standards [JCNHES], 2007). The learning experiences embedded within the curriculum should be designed to help students acquire functional health information; identify personal values that support healthy behaviors; recognize group norms that relate to a healthy lifestyle; and develop skills necessary to adopt, practice, and maintain health-enhancing behaviors (CDC, 2013a; JCNHES, 2007). Although many leaders in health and education suggest a linkage between quality health education and academic achievement, and some research verifies this linkage, many schools in the United States struggle to provide quality health education instruction (CDC, 2013b; JCNHES, 2007). Possible positive consequences of this linkage include a decrease in student absenteeism, higher academic achievement, and an increase in graduation rates (Allensworth, 2011; Basch, 2011a, 2011b; Freudenberg & Ruglis, 2007).
Healthy People 2020 includes an objective to increase the proportion of elementary, middle, and senior high schools that provide comprehensive school health education (USDHHS, 2013). Nationwide, 41.2 percent of elementary schools, 58.7 percent of middle schools, and 78.7 percent of high schools had specific time requirements for school health instruction (CDC, 2013b).
Thesecond edition of The National Health Education Standards (figure 3.1) was released in 2007. The standards were developed by a panel of health education leaders with input from professionals in both health and education, as well as parents and community members. The standards are not federally mandated or designed to define a national curriculum. Instead, they are intended to provide a framework and resource for the development of state standards and health education curricula in local school districts (American Cancer Society, 2007). The standardsinclude three distinct components: the individual health education standards, a rationale statement for each standard, and performance indicators linked to each standard for mastery by the completion of grades 4, 8, and 11 (American Cancer Society, 2007).
The standards can be applied to various health education content areas. The Centers for Disease Control and Prevention (CDC, 2011a) has identified six risk behaviors as being important focal points for instruction in school health education. These behaviors include alcohol and other drug use, physical inactivity, sexual behaviors that contribute to unintended pregnancy and sexually transmitted diseases, tobacco use, unhealthy dietary behaviors, and behaviors that contribute to unintentional injuries and violence. Other possible content areas for instruction include environmental health, human sexuality, and mental and emotional health (CDC, 2013a).
Beyond the National Health Education Standards, quality school health education should be based on quality health instruction. The following best practices have been identified by the CDC Division of Adolescent and School Health. They are based on reviews of effective programs and curricula and the positions of experts in the profession of health education (CDC, 2013d).
- Focus on clear health goals and related behavioral outcomes
- Are research-based and theory-driven
- Address individual values, attitudes, and beliefs
- Address individual and group norms that support health-enhancing behaviors
- Focus on reinforcing protective factors and increasing perceptions of personal risk and harmfulness of engaging in specific unhealthy practices and behaviors
- Address social pressures and influences
- Build personal competence, social competence, and self-efficacy by addressing skills
- Provide functional health knowledge that is basic, accurate, and directly contributes to health-promoting decisions and behaviors
- Use strategies designed to personalize information and engage students
- Provide age-appropriate and developmentally appropriate information, learning strategies, teaching methods, and materials
- Incorporate learning strategies, teaching methods, and materials that are culturally inclusive
- Provide adequate time for instruction and learning
- Provide opportunities to reinforce skills and positive health behaviors
- Provide opportunities to make positive connections with influential others
- Include teacher information and plans for professional development and training that enhance effectiveness of instruction and student learning
Learn more about Promoting Health and Academic Success.
Tips for Implementation of WSCC at District Level
The Cortland City (New York) school district was highlighted on the CDC website of success stories (CDC, 2013c) for the work conducted at Cortland City Schools in the CSH component of nutrition services. District initiatives included limiting student access to competitive foods, adopting marketing techniques to promote healthful choices, setting nutrition policies and standards, establishing nutrition standards for competitive foods, and making more healthy foods and beverages available.
Tips for Implementation at District Level
The Cortland City (New York) school district was highlighted on the CDC website of success stories (CDC, 2013c) for the work conducted at Cortland City Schools in the CSH component of nutrition services. District initiatives included limiting student access to competitive foods, adopting marketing techniques to promote healthful choices, setting nutrition policies and standards, establishing nutrition standards for competitive foods, and making more healthy foods and beverages available. Six factors were reported as keys to the success of Cortland City Schools. The first factor was having a vision of being committed to a Coordinated School Health program. The second factor was leadership as demonstrated by administrative support from the board of education, superintendent, and the principals from the schools in the district. The third factor, collaboration, was shown through partnerships that were established with community agencies, staff, parents, and students. Teamwork in each building as well as districtwide provided a demonstration of the fourth factor. The fifth factor, data driven, was demonstrated by collecting baseline data to demonstrate improvements after repeated assessments, which were then conducted every two to three years. Finally, the sixth factor recognized was the issue of financial support, which was apparent in the use of minigrants such as one through the Healthy Heart Coalition.
Jeannette Dippo, former Health Education and Wellness coordinator with Cortland City Schools, offered five suggestions for the implementation of CSH programs and policies:
- Districts need to get administrative support for the CSH activities and to send out consistent messages.
- Broad involvement is needed, including support from parents, school staff, and community members. This support is necessary for strong advocates to assist in getting the CSH vision and goals converted into actual programs and policy. Administrators may respond more positivity to general staff and parents than to the typical school health champion, who is generally the health educator or health coordinator.
- The most critical CSH priorities need to be converted into policy. Such a policy will help ensure that work or effort in that area will continue. A policy will help to establish the priority after the champions leave or have moved on to other initiatives because the policy will still exist.
- Each school needs to have a health coordinator to drive and pull the work of the team together. The schools and the district need someone with real passion for CSH. CSH functions best when someone with continuity who believes in what is being done is there to oversee the actions. A health coordinator is someone to help develop the structure for the work to happen.
- A healthy school team is needed for every school building, along with a separate district team. The accomplishments that were made in individual schools happened because each school building had its own team to work with, and someone to take the program or initiative and make it happen at the school level. It is critical that school principals be members of each school team. This network needs to be in place to share ideas and develop and implement districtwide policies.
Implement the Plan and Strategies
Putting the action plan into place consists of implementing the plan and strategies, which usually consists of adopting policies or programs. When implementing the plan, districts need to direct the focus of school health efforts on meeting the education and health needs of students (CDC, 2013b). In addition, providing opportunities for students to be meaningfully involved in the school and the community will help the team to focus on students. School health efforts in programming and policies should give youth the chance to develop and exercise leadership abilities, build skills, form positive relationships with caring adults, and contribute to their school and greater community (CDC, 2013a).
CDC suggests that students can promote a healthy and safe school and community through opportunities such as involvement in peer education, peer advocacy, or cross-age mentoring programs. Other opportunities include involving young people in service learning avenues and participation on school health teams' advisory committees and boards that address health and wellness, education, and youth-related issues (CDC, 2013b).
Moving into the taking-action phase of program and policy implementation, CDC suggests that school districts implement multiple strategies through multiple components. To address one school health component, a variety of efforts are needed to have an effect in that area. Because the components are often overlapping and dependent on each other, addressing multiple if not all of the components is recommended for achieving the positive health and learning outcomes desired (CDC, 2013b). Many possibilities exist for advancing each of the WSCC components, and examples of possible policies and programming efforts can be discovered in any of the CSH assessment tools or criteria (see table 10.2 for possible strategies for improvement). Tools such as the CDC School Health Index, ASCD Healthy Schools Report Card, and ASCD School Improvement Tool are some of the more well-known and commonly used tools. Any strategies pursued by a school or district should be based on an assessment conducted at the school or district.
Schools should consider implementing policies and programs to help students avoid or reduce health-risk behaviors that contribute to the leading causes of death and disability among young people as well as among adults (CDC, 2014d). CDC has identified six categories of priority health-risk behaviors as being linked to the leading causes of death and disability in the United States:
- Behaviors that contribute to unintentional injuries and violence
- Tobacco use
- Alcohol and other drug use
- Sexual behaviors that contribute to unintended pregnancy and STDs, including HIV infection
- Unhealthy eating
- Physical inactivity (CDC, 2014d)
Schools can assess health-risk behaviors among young people in these six categories as well as in general health status, overweight, and asthma through formal surveys such as the Youth Risk Behavior Survey (YRBS) (CDC, 2014d). The YRBS, available through CDC, is a national school-based survey that can provide the school and district with behavioral data for 9th through 12th graders (CDC, 2014d). Data resulting from the survey can be used to track behavioral trends at the local level for establishing priorities and for monitoring program and policy success. In addition, the local data can be used to make comparisons to state, regional, and national levels with the data available on the CDC YRBS website. For example if a school district discovers that the proportion of students who participated in at least 60 minutes of physical activity per day was lower than the proportion for students in the state and nation, the district may decide that they need to address the issue. The action could mean changing the academic schedule and requirements to include daily physical education, training teachers to incorporate physical activity into the classroom, allowing fit breaks throughout the day, or instituting a walk-to-school program. This example demonstrates how data from the YRBS system can be used to inform programming and policies as a district tries to improve the health and well-being of students and staff.
After a health-risk behavior or behaviors have been identified as a priority, the school or district faces the challenge of identifying or developing relevant policies or programs. Research-based programming that can reduce risk behaviors has been identified, and information is available through Registries of Programs Effective in Reducing Youth Risk Behaviors on the CDC website as well as through other similar sites (CDC, 2013d).
Besides selecting programming options, districts need to work to bring faculty and staff onboard with WSCC efforts. Education is important to help faculty and staff see the value of a coordinated approach and the relationship between health and academics. With proper training, teachers and school leaders can become important health champions to support and reinforce efforts of the school health education coordinator or administrator (Healthy Schools Campaign, 2012). Education is also essential for teachers, administrators, and other school employees committed to improving the health, academic success, and well-being of students. CDC stated,
Professional development can provide opportunities for school employees to identify areas for improvement, learn about and use proven practices, solve problems, develop skills, and reflect on and practice new strategies. In order to promote a Coordinated School Health approach, professional development should focus on the development of skills such as leadership, communication, and collaboration. (CDC, 2013b, para. 8)
In the 2013 document A Framework for Safe and Successful Schools,the recommendation was provided to conduct professional development for school staff and community partners that would address school climate and safety; positive behavior; and crisis prevention, preparedness, and response (NASP, 2013). As part of the professional development training, teachers and school leaders need to be provided with the information and resources they need to address student health issues and support a healthy school environment (Healthy Schools Campaign, 2012). Training might involve helping teachers to become aware of state-level health education regulations and requirements for health instruction so that those issues can be addressed outside the health education classroom and integrated into other subjects as a way to reinforce health-promoting concepts (Healthy Schools Campaign, 2012). Having more teachers and school leaders take on the role of health champion and work to support health concepts and health policies facilitates moving the district toward a more unified WSCC effort. Table 10.3 provides examples of how all teachers, not just health and physical education teachers, and school leaders can support WSCC though examples in each of the 10 components.
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Creation of WSCC
ASCD, in collaboration with CDC, moved forward in 2013 to develop a new model that builds on both the Whole Child Initiative and the original eight-component CSH approach. The development of the new model, titled Whole School, Whole Community, Whole Child (WSCC), involved a consultation group that developed the documents and frameworks related to the new model and a review group that periodically reviewed and provided feedback to the work of the consultation group.
ASCD, in collaboration with CDC, moved forward in 2013 to develop a new model that builds on both the Whole Child Initiative and the original eight-component CSH approach. The development of the new model, titled Whole School, Whole Community, Whole Child (WSCC), involved a consultation group that developed the documents and frameworks related to the new model and a review group that periodically reviewed and provided feedback to the work of the consultation group. Members of both groups were selected because of their role as leaders in both education and health. The new WSCC model was introduced at two national conferences, the ASCD conference in Los Angeles in March 2014 and the Society for Public Health Education (SOPHE) conference in Baltimore, also in March 2014. WSCC incorporates and builds on CSH and the ASCD Whole Child Initiative (ASCD, 2014).
WSCC is designed to promote alignment, integration, and collaboration between education and health and is intended to enhance health outcomes and academic success. Support and engagement of the whole community should be an important aspect of the implementation of WSCC (ASCD, 2014).
An important aspect of the new model is the expansion from 8 to 10 components. One original component, healthy and safe school environment, has been expanded to two separate components, physical environment and social and emotional climate. Another original component, family and community involvement, has been expanded to two components, community involvement and family engagement (see figure 1.1) (ASCD, 2014). The evolution of the school health models is presented in figure 1.2.
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Evolution of components in school health models.
Following are brief descriptions of all 10 WSCC components:
- Health education:Health education provides students with opportunities to acquire the knowledge, attitudes, and skills necessary for making health-promoting decisions, achieving health literacy, adopting health-enhancing behaviors, and promoting the health of others. Health education should be provided sequentially from pre-K through grade 12. Health education curricula should address important health topic areas through instruction based on the National Health Education Standards (NHES) (CDC, 2013).
- Physical education and physical activity: Physical education is a school-based instructional opportunity for students to gain the necessary skills and knowledge for lifelong participation in physical activity. Physical education is characterized by a planned, sequential K through 12 curriculum that assists students in achieving the national standards for K through 12 physical education. The outcome of a quality physical education program is a physically educated person who has the knowledge, skills, and confidence to enjoy a lifetime of healthful physical activity (CDC, 2013).
- Health services:These services are designed to ensure access or referral to primary health care services; foster appropriate use of primary health care services; prevent and control communicable disease and other health problems; provide emergency care for illness or injury; promote and provide optimum sanitary conditions for a safe school facility and school environment; and provide educational and counseling opportunities for promoting and maintaining individual, family, and community health (CDC, 2013).
- Nutrition environment and services: Schools should provide access to a variety of nutritious and appealing meals that accommodate the health and nutrition needs of all students. School nutrition programs should reflect U.S. Dietary Guidelines for Americans and other criteria to achieve nutrition integrity. The school nutrition services should offer students a learning laboratory for classroom nutrition and health education and serve as a resource for linkages with nutrition-related community services (CDC, 2013).
- Counseling, psychological, and social services: These services are provided to improve students' mental, emotional, and social health and include individual and group assessments, interventions, and referrals. Organizational assessment and consultation skills of counselors and psychologists should contribute not only to the health of students but also to the health of the school environment (CDC, 2013).
- Physical environment: The physical environment of the school includes buildings, school grounds, playground equipment, and athletic fields. The physical environment within the school includes building design, adequate space, cleanliness, noise level, heating and cooling, ventilation, and restrooms. These interior and exterior areas should be clean; safe; free from environmental hazards, tobacco, drugs, weapons, and violence; and appropriately secure from unauthorized access (Allensworth, Lawson, Nicholson, & Wyche, 1997; ASCD, 2014).
- Social and emotional climate:The social and emotional climate should provide a supportive culture conducive to enabling students, families, and staff members to feel safe, secure, accepted, and valued. Important factors in the social and emotional climate of a school include an attractive, comfortable physical environment; appreciation and respect for individual differences and cultural diversity; value placed on equity and social justice; high expectations and supportive actions for learning; size and structure of classes and organizations; and a general sense of comfort and safety (Allensworth, Lawson, Nicholson, & Wyche, 1997).
- Health promotion for staff: Schools can provide opportunities for school staff members to improve their health status through activities such as health assessments, health education, and health-related fitness activities. These opportunities should encourage staff members to pursue a healthy lifestyle that contributes to their improved health status, improved morale, and a greater personal commitment to the school's overall coordinated health approach (CDC, 2013).
- Family engagement:Epstein et al. (2009) identified six types of involvement necessary for successful school and family partnerships: (1) providing parenting support, (2) communicating with parents, (3) providing diverse volunteer opportunities, (4) supporting at-home learning, (5) encouraging parents to engage in decision-making opportunities in schools, and (6) collaborating with the community. Engaging family members often involves overcoming challenges such as family time conflicts, lack of transportation to school, and lack of comfort among family members in engaging in school activities. In addition, teachers and school staff may lack adequate time and resources to work with families.
- Community involvement:Meaningful community involvement in the WSCC approach is characterized by systematic collaboration among individuals and organizations within the school community. This systematic collaboration involves the engagement of individuals and organizations representing various segments of the community in the planning, implementation, and evaluation of programs, structures, and systems designed to create and sustain WSCC. The collaboration also involves the sharing of both community and school resources.
An Early Step Forward in Promoting WSCC at the Local Level
Upon the March 2014 unveiling of the Whole School, Whole Community, Whole Child model, a local school district in upstate New York introduced WSCC to the district's faculty and administration across their rural school district. A faculty member from a local college was asked to introduce the new WSCC model and then work with the district health and wellness coordinator to oversee 25 breakout sessions focused on the theme of incorporating wellness into learning. One goal for the day was to provide participants with knowledge and skills to adjust the physical, social, and emotional climate in their classrooms to improve the learning environment for each student. In an attempt to achieve the workshop goal, the WSCC model was introduced and compared with the CSH model. The ASCD video that provides an overview of the WSCC model was shown to the audience. Following the video a discussion was held on how a collaborative approach can have a positive effect on health and learning in the school district.
At the conclusion of the opening session, breakout sessions with small groups were held. An example of a breakout session was one titled "Healthy and Wise: Preparing Students for the World Beyond Formal Schooling." In this session, the facilitator went into detail about the collaborative WSCC approach while putting a strong focus on the ASCD Whole Child concept. The goal of this breakout session was to challenge the participants to produce a comprehensive health and academic plan in which the faculty and staff become leaders in the quest to reinvent, refocus, and recharge the health and academic status of the school district.
At the conclusion of the workshop it was decided to begin an initiative to implement the WSCC approach in the school district. The name of the first effort is "Optimize the Year with Healthy Habits: Incredible You, Incredible Year." In this effort the wellness committee will begin by addressing the wellness of the faculty and staff for the upcoming school year as a way to develop health and wellness leaders for the work to follow.
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Assessing nutrition and health services
Discover School Breakfast Toolkit - Purpose: This toolkit, from the Food and Nutrition Service of the U.S. Department of Agriculture, was developed to help schools assess current breakfast patterns and programs, calculate costs of implementing or changing breakfast programs, identify the type of meal service to provide to students, and create a marketing plan to engage and sustain a customer base.
Assessing Nutrition Services
Discover School Breakfast Toolkit
Purpose: This toolkit, from the Food and Nutrition Service of the U.S. Department of Agriculture, was developed to help schools assess current breakfast patterns and programs, calculate costs of implementing or changing breakfast programs, identify the type of meal service to provide to students, and create a marketing plan to engage and sustain a customer base. The toolkit includes the following sections:
- Introduction
- Successful use of the toolkit, which guides users through the toolkit
- An initial assessment, which provides surveys that schools can use to evaluate the interest levels of parents and students
- Cost calculator, which includes worksheets to help schools calculate the costs of implementing the School Breakfast Program
- Description of multiple methods for serving breakfast, which can help schools determine the best method for their needs
- Roadmaps to success
- Marketing efforts, which includes a marketing plan for schools to market the School Breakfast Program
- Resources
- Program evaluation, which provides information about how and what to evaluate specific to the School Breakfast Program
Audience: The toolkit is targeted toward individuals interested in increasing access to the School Breakfast Program. That might include school health councils, school nutrition staff, school administrators, parents, and community members.
Use: Toolkit users should first become familiar with the items in the toolkit and the steps to take. The next step is to use the student, parent, and administrator surveys to identify current knowledge, attitudes, and behaviors of these audiences as it relates to eating breakfast and breakfast programs. The third step is to use the tools to calculate a variety of cost-related items, such as breakfast profit/loss, revenue per reimbursable breakfast, daily revenue breakfast, and annual expenses to revenue comparisons. The remaining components of the toolkit guides users through identifying the best method for serving breakfast and developing and implementing a marketing plan to increase access and participation in the School Breakfast Program.
Access: The toolkit is found online at www.fns.usda.gov/cnd/breakfast/toolkit/.
Assessing Health Services
Body Mass Index Measurement (BMI) in Schools
Purpose: Developed by CDC researchers, with extensive input from experts from the field of school health, the BMI Measurement in Schools document, published in both full journal article (Nihiser, 2007) and executive summary formats, provides schools with an overview of what BMI is, the differences between BMI surveillance and screening, and a list of safeguards for schools choosing to implement a BMI measurement program.
Audience: The document can be used by school health councils, school nurses, and physical education and health education teachers. Any school interested in conducting BMI measurement can use the document to learn more about options for such a strategy and to identify the best option for the school.
Use: The BMI Measurement in Schools document presents both a synthesis of the science on measuring BMI in schools and safeguards to have in place when developing and implementing such a program or initiative. Leaders within the school who are interested in BMI measurement use the document to determine whether the school prefers surveillance or screening and to identify how the safeguards can be put in place.
Access: Both the full journal article and the executive summary can be found online at www.cdc.gov/healthyyouth/npao/publications.htm#10.
Safe at School and Ready to Learn: A Comprehensive Policy Guide for Protecting Students With Life-Threatening Food Allergies
Purpose: Developed by the National School Boards Association (NSBA), the Safe at School and Ready to Learn policy guide provides school boards with an overview of the prevalence of food allergies, policy guidance for school boards to consider when developing food allergy policies, and a policy checklist (National School Boards Association, 2012). The policy checklist guides the user through a process of identifying policy areas that need attention and actions that can be taken towards improvement.
Audience: The policy guide is to be used primarily by school board members. Secondary users can be school administrators, school health services staff, physical and health education teachers, parents, and school nutrition staff.
Use: In addition to providing policy guidance to school boards and other stakeholders, the guide's checklist is to be completed by identifying whether a specific policy element is included or not included and whether it is implemented or not implemented. When policy gaps are determined, a section for identifying action steps is provided. Results of the policy checklist can be used to inform and develop food allergy policies for schools.
Access: The guide is available online at http://www.nsba.org/sites/default/files/reports/Safe-at-School-and-Ready-to-Learn.pdf
Learn more about Promoting Health and Academic Success.
What a health education curriculum should look like
Comprehensive school health education is characterized by planned, sequential, developmentally appropriate, and culturally inclusive learning experiences taught by qualified trained teachers. The health education curriculum should be based on relevant health behavior theories; focus on the emotional, intellectual, physical, and social dimensions of health; provide students with exposure to diverse instructional techniques; and evaluate student achievement through a variety of assessment
Health Education
Comprehensive school health education is characterized by planned, sequential, developmentally appropriate, and culturally inclusive learning experiences taught by qualified trained teachers. The health education curriculum should be based on relevant health behavior theories; focus on the emotional, intellectual, physical, and social dimensions of health; provide students with exposure to diverse instructional techniques; and evaluate student achievement through a variety of assessment strategies (Joint Committee on National Health Education Standards [JCNHES], 2007). The learning experiences embedded within the curriculum should be designed to help students acquire functional health information; identify personal values that support healthy behaviors; recognize group norms that relate to a healthy lifestyle; and develop skills necessary to adopt, practice, and maintain health-enhancing behaviors (CDC, 2013a; JCNHES, 2007). Although many leaders in health and education suggest a linkage between quality health education and academic achievement, and some research verifies this linkage, many schools in the United States struggle to provide quality health education instruction (CDC, 2013b; JCNHES, 2007). Possible positive consequences of this linkage include a decrease in student absenteeism, higher academic achievement, and an increase in graduation rates (Allensworth, 2011; Basch, 2011a, 2011b; Freudenberg & Ruglis, 2007).
Healthy People 2020 includes an objective to increase the proportion of elementary, middle, and senior high schools that provide comprehensive school health education (USDHHS, 2013). Nationwide, 41.2 percent of elementary schools, 58.7 percent of middle schools, and 78.7 percent of high schools had specific time requirements for school health instruction (CDC, 2013b).
Thesecond edition of The National Health Education Standards (figure 3.1) was released in 2007. The standards were developed by a panel of health education leaders with input from professionals in both health and education, as well as parents and community members. The standards are not federally mandated or designed to define a national curriculum. Instead, they are intended to provide a framework and resource for the development of state standards and health education curricula in local school districts (American Cancer Society, 2007). The standardsinclude three distinct components: the individual health education standards, a rationale statement for each standard, and performance indicators linked to each standard for mastery by the completion of grades 4, 8, and 11 (American Cancer Society, 2007).
The standards can be applied to various health education content areas. The Centers for Disease Control and Prevention (CDC, 2011a) has identified six risk behaviors as being important focal points for instruction in school health education. These behaviors include alcohol and other drug use, physical inactivity, sexual behaviors that contribute to unintended pregnancy and sexually transmitted diseases, tobacco use, unhealthy dietary behaviors, and behaviors that contribute to unintentional injuries and violence. Other possible content areas for instruction include environmental health, human sexuality, and mental and emotional health (CDC, 2013a).
Beyond the National Health Education Standards, quality school health education should be based on quality health instruction. The following best practices have been identified by the CDC Division of Adolescent and School Health. They are based on reviews of effective programs and curricula and the positions of experts in the profession of health education (CDC, 2013d).
- Focus on clear health goals and related behavioral outcomes
- Are research-based and theory-driven
- Address individual values, attitudes, and beliefs
- Address individual and group norms that support health-enhancing behaviors
- Focus on reinforcing protective factors and increasing perceptions of personal risk and harmfulness of engaging in specific unhealthy practices and behaviors
- Address social pressures and influences
- Build personal competence, social competence, and self-efficacy by addressing skills
- Provide functional health knowledge that is basic, accurate, and directly contributes to health-promoting decisions and behaviors
- Use strategies designed to personalize information and engage students
- Provide age-appropriate and developmentally appropriate information, learning strategies, teaching methods, and materials
- Incorporate learning strategies, teaching methods, and materials that are culturally inclusive
- Provide adequate time for instruction and learning
- Provide opportunities to reinforce skills and positive health behaviors
- Provide opportunities to make positive connections with influential others
- Include teacher information and plans for professional development and training that enhance effectiveness of instruction and student learning
Learn more about Promoting Health and Academic Success.
Tips for Implementation of WSCC at District Level
The Cortland City (New York) school district was highlighted on the CDC website of success stories (CDC, 2013c) for the work conducted at Cortland City Schools in the CSH component of nutrition services. District initiatives included limiting student access to competitive foods, adopting marketing techniques to promote healthful choices, setting nutrition policies and standards, establishing nutrition standards for competitive foods, and making more healthy foods and beverages available.
Tips for Implementation at District Level
The Cortland City (New York) school district was highlighted on the CDC website of success stories (CDC, 2013c) for the work conducted at Cortland City Schools in the CSH component of nutrition services. District initiatives included limiting student access to competitive foods, adopting marketing techniques to promote healthful choices, setting nutrition policies and standards, establishing nutrition standards for competitive foods, and making more healthy foods and beverages available. Six factors were reported as keys to the success of Cortland City Schools. The first factor was having a vision of being committed to a Coordinated School Health program. The second factor was leadership as demonstrated by administrative support from the board of education, superintendent, and the principals from the schools in the district. The third factor, collaboration, was shown through partnerships that were established with community agencies, staff, parents, and students. Teamwork in each building as well as districtwide provided a demonstration of the fourth factor. The fifth factor, data driven, was demonstrated by collecting baseline data to demonstrate improvements after repeated assessments, which were then conducted every two to three years. Finally, the sixth factor recognized was the issue of financial support, which was apparent in the use of minigrants such as one through the Healthy Heart Coalition.
Jeannette Dippo, former Health Education and Wellness coordinator with Cortland City Schools, offered five suggestions for the implementation of CSH programs and policies:
- Districts need to get administrative support for the CSH activities and to send out consistent messages.
- Broad involvement is needed, including support from parents, school staff, and community members. This support is necessary for strong advocates to assist in getting the CSH vision and goals converted into actual programs and policy. Administrators may respond more positivity to general staff and parents than to the typical school health champion, who is generally the health educator or health coordinator.
- The most critical CSH priorities need to be converted into policy. Such a policy will help ensure that work or effort in that area will continue. A policy will help to establish the priority after the champions leave or have moved on to other initiatives because the policy will still exist.
- Each school needs to have a health coordinator to drive and pull the work of the team together. The schools and the district need someone with real passion for CSH. CSH functions best when someone with continuity who believes in what is being done is there to oversee the actions. A health coordinator is someone to help develop the structure for the work to happen.
- A healthy school team is needed for every school building, along with a separate district team. The accomplishments that were made in individual schools happened because each school building had its own team to work with, and someone to take the program or initiative and make it happen at the school level. It is critical that school principals be members of each school team. This network needs to be in place to share ideas and develop and implement districtwide policies.
Implement the Plan and Strategies
Putting the action plan into place consists of implementing the plan and strategies, which usually consists of adopting policies or programs. When implementing the plan, districts need to direct the focus of school health efforts on meeting the education and health needs of students (CDC, 2013b). In addition, providing opportunities for students to be meaningfully involved in the school and the community will help the team to focus on students. School health efforts in programming and policies should give youth the chance to develop and exercise leadership abilities, build skills, form positive relationships with caring adults, and contribute to their school and greater community (CDC, 2013a).
CDC suggests that students can promote a healthy and safe school and community through opportunities such as involvement in peer education, peer advocacy, or cross-age mentoring programs. Other opportunities include involving young people in service learning avenues and participation on school health teams' advisory committees and boards that address health and wellness, education, and youth-related issues (CDC, 2013b).
Moving into the taking-action phase of program and policy implementation, CDC suggests that school districts implement multiple strategies through multiple components. To address one school health component, a variety of efforts are needed to have an effect in that area. Because the components are often overlapping and dependent on each other, addressing multiple if not all of the components is recommended for achieving the positive health and learning outcomes desired (CDC, 2013b). Many possibilities exist for advancing each of the WSCC components, and examples of possible policies and programming efforts can be discovered in any of the CSH assessment tools or criteria (see table 10.2 for possible strategies for improvement). Tools such as the CDC School Health Index, ASCD Healthy Schools Report Card, and ASCD School Improvement Tool are some of the more well-known and commonly used tools. Any strategies pursued by a school or district should be based on an assessment conducted at the school or district.
Schools should consider implementing policies and programs to help students avoid or reduce health-risk behaviors that contribute to the leading causes of death and disability among young people as well as among adults (CDC, 2014d). CDC has identified six categories of priority health-risk behaviors as being linked to the leading causes of death and disability in the United States:
- Behaviors that contribute to unintentional injuries and violence
- Tobacco use
- Alcohol and other drug use
- Sexual behaviors that contribute to unintended pregnancy and STDs, including HIV infection
- Unhealthy eating
- Physical inactivity (CDC, 2014d)
Schools can assess health-risk behaviors among young people in these six categories as well as in general health status, overweight, and asthma through formal surveys such as the Youth Risk Behavior Survey (YRBS) (CDC, 2014d). The YRBS, available through CDC, is a national school-based survey that can provide the school and district with behavioral data for 9th through 12th graders (CDC, 2014d). Data resulting from the survey can be used to track behavioral trends at the local level for establishing priorities and for monitoring program and policy success. In addition, the local data can be used to make comparisons to state, regional, and national levels with the data available on the CDC YRBS website. For example if a school district discovers that the proportion of students who participated in at least 60 minutes of physical activity per day was lower than the proportion for students in the state and nation, the district may decide that they need to address the issue. The action could mean changing the academic schedule and requirements to include daily physical education, training teachers to incorporate physical activity into the classroom, allowing fit breaks throughout the day, or instituting a walk-to-school program. This example demonstrates how data from the YRBS system can be used to inform programming and policies as a district tries to improve the health and well-being of students and staff.
After a health-risk behavior or behaviors have been identified as a priority, the school or district faces the challenge of identifying or developing relevant policies or programs. Research-based programming that can reduce risk behaviors has been identified, and information is available through Registries of Programs Effective in Reducing Youth Risk Behaviors on the CDC website as well as through other similar sites (CDC, 2013d).
Besides selecting programming options, districts need to work to bring faculty and staff onboard with WSCC efforts. Education is important to help faculty and staff see the value of a coordinated approach and the relationship between health and academics. With proper training, teachers and school leaders can become important health champions to support and reinforce efforts of the school health education coordinator or administrator (Healthy Schools Campaign, 2012). Education is also essential for teachers, administrators, and other school employees committed to improving the health, academic success, and well-being of students. CDC stated,
Professional development can provide opportunities for school employees to identify areas for improvement, learn about and use proven practices, solve problems, develop skills, and reflect on and practice new strategies. In order to promote a Coordinated School Health approach, professional development should focus on the development of skills such as leadership, communication, and collaboration. (CDC, 2013b, para. 8)
In the 2013 document A Framework for Safe and Successful Schools,the recommendation was provided to conduct professional development for school staff and community partners that would address school climate and safety; positive behavior; and crisis prevention, preparedness, and response (NASP, 2013). As part of the professional development training, teachers and school leaders need to be provided with the information and resources they need to address student health issues and support a healthy school environment (Healthy Schools Campaign, 2012). Training might involve helping teachers to become aware of state-level health education regulations and requirements for health instruction so that those issues can be addressed outside the health education classroom and integrated into other subjects as a way to reinforce health-promoting concepts (Healthy Schools Campaign, 2012). Having more teachers and school leaders take on the role of health champion and work to support health concepts and health policies facilitates moving the district toward a more unified WSCC effort. Table 10.3 provides examples of how all teachers, not just health and physical education teachers, and school leaders can support WSCC though examples in each of the 10 components.
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Creation of WSCC
ASCD, in collaboration with CDC, moved forward in 2013 to develop a new model that builds on both the Whole Child Initiative and the original eight-component CSH approach. The development of the new model, titled Whole School, Whole Community, Whole Child (WSCC), involved a consultation group that developed the documents and frameworks related to the new model and a review group that periodically reviewed and provided feedback to the work of the consultation group.
ASCD, in collaboration with CDC, moved forward in 2013 to develop a new model that builds on both the Whole Child Initiative and the original eight-component CSH approach. The development of the new model, titled Whole School, Whole Community, Whole Child (WSCC), involved a consultation group that developed the documents and frameworks related to the new model and a review group that periodically reviewed and provided feedback to the work of the consultation group. Members of both groups were selected because of their role as leaders in both education and health. The new WSCC model was introduced at two national conferences, the ASCD conference in Los Angeles in March 2014 and the Society for Public Health Education (SOPHE) conference in Baltimore, also in March 2014. WSCC incorporates and builds on CSH and the ASCD Whole Child Initiative (ASCD, 2014).
WSCC is designed to promote alignment, integration, and collaboration between education and health and is intended to enhance health outcomes and academic success. Support and engagement of the whole community should be an important aspect of the implementation of WSCC (ASCD, 2014).
An important aspect of the new model is the expansion from 8 to 10 components. One original component, healthy and safe school environment, has been expanded to two separate components, physical environment and social and emotional climate. Another original component, family and community involvement, has been expanded to two components, community involvement and family engagement (see figure 1.1) (ASCD, 2014). The evolution of the school health models is presented in figure 1.2.
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Evolution of components in school health models.
Following are brief descriptions of all 10 WSCC components:
- Health education:Health education provides students with opportunities to acquire the knowledge, attitudes, and skills necessary for making health-promoting decisions, achieving health literacy, adopting health-enhancing behaviors, and promoting the health of others. Health education should be provided sequentially from pre-K through grade 12. Health education curricula should address important health topic areas through instruction based on the National Health Education Standards (NHES) (CDC, 2013).
- Physical education and physical activity: Physical education is a school-based instructional opportunity for students to gain the necessary skills and knowledge for lifelong participation in physical activity. Physical education is characterized by a planned, sequential K through 12 curriculum that assists students in achieving the national standards for K through 12 physical education. The outcome of a quality physical education program is a physically educated person who has the knowledge, skills, and confidence to enjoy a lifetime of healthful physical activity (CDC, 2013).
- Health services:These services are designed to ensure access or referral to primary health care services; foster appropriate use of primary health care services; prevent and control communicable disease and other health problems; provide emergency care for illness or injury; promote and provide optimum sanitary conditions for a safe school facility and school environment; and provide educational and counseling opportunities for promoting and maintaining individual, family, and community health (CDC, 2013).
- Nutrition environment and services: Schools should provide access to a variety of nutritious and appealing meals that accommodate the health and nutrition needs of all students. School nutrition programs should reflect U.S. Dietary Guidelines for Americans and other criteria to achieve nutrition integrity. The school nutrition services should offer students a learning laboratory for classroom nutrition and health education and serve as a resource for linkages with nutrition-related community services (CDC, 2013).
- Counseling, psychological, and social services: These services are provided to improve students' mental, emotional, and social health and include individual and group assessments, interventions, and referrals. Organizational assessment and consultation skills of counselors and psychologists should contribute not only to the health of students but also to the health of the school environment (CDC, 2013).
- Physical environment: The physical environment of the school includes buildings, school grounds, playground equipment, and athletic fields. The physical environment within the school includes building design, adequate space, cleanliness, noise level, heating and cooling, ventilation, and restrooms. These interior and exterior areas should be clean; safe; free from environmental hazards, tobacco, drugs, weapons, and violence; and appropriately secure from unauthorized access (Allensworth, Lawson, Nicholson, & Wyche, 1997; ASCD, 2014).
- Social and emotional climate:The social and emotional climate should provide a supportive culture conducive to enabling students, families, and staff members to feel safe, secure, accepted, and valued. Important factors in the social and emotional climate of a school include an attractive, comfortable physical environment; appreciation and respect for individual differences and cultural diversity; value placed on equity and social justice; high expectations and supportive actions for learning; size and structure of classes and organizations; and a general sense of comfort and safety (Allensworth, Lawson, Nicholson, & Wyche, 1997).
- Health promotion for staff: Schools can provide opportunities for school staff members to improve their health status through activities such as health assessments, health education, and health-related fitness activities. These opportunities should encourage staff members to pursue a healthy lifestyle that contributes to their improved health status, improved morale, and a greater personal commitment to the school's overall coordinated health approach (CDC, 2013).
- Family engagement:Epstein et al. (2009) identified six types of involvement necessary for successful school and family partnerships: (1) providing parenting support, (2) communicating with parents, (3) providing diverse volunteer opportunities, (4) supporting at-home learning, (5) encouraging parents to engage in decision-making opportunities in schools, and (6) collaborating with the community. Engaging family members often involves overcoming challenges such as family time conflicts, lack of transportation to school, and lack of comfort among family members in engaging in school activities. In addition, teachers and school staff may lack adequate time and resources to work with families.
- Community involvement:Meaningful community involvement in the WSCC approach is characterized by systematic collaboration among individuals and organizations within the school community. This systematic collaboration involves the engagement of individuals and organizations representing various segments of the community in the planning, implementation, and evaluation of programs, structures, and systems designed to create and sustain WSCC. The collaboration also involves the sharing of both community and school resources.
An Early Step Forward in Promoting WSCC at the Local Level
Upon the March 2014 unveiling of the Whole School, Whole Community, Whole Child model, a local school district in upstate New York introduced WSCC to the district's faculty and administration across their rural school district. A faculty member from a local college was asked to introduce the new WSCC model and then work with the district health and wellness coordinator to oversee 25 breakout sessions focused on the theme of incorporating wellness into learning. One goal for the day was to provide participants with knowledge and skills to adjust the physical, social, and emotional climate in their classrooms to improve the learning environment for each student. In an attempt to achieve the workshop goal, the WSCC model was introduced and compared with the CSH model. The ASCD video that provides an overview of the WSCC model was shown to the audience. Following the video a discussion was held on how a collaborative approach can have a positive effect on health and learning in the school district.
At the conclusion of the opening session, breakout sessions with small groups were held. An example of a breakout session was one titled "Healthy and Wise: Preparing Students for the World Beyond Formal Schooling." In this session, the facilitator went into detail about the collaborative WSCC approach while putting a strong focus on the ASCD Whole Child concept. The goal of this breakout session was to challenge the participants to produce a comprehensive health and academic plan in which the faculty and staff become leaders in the quest to reinvent, refocus, and recharge the health and academic status of the school district.
At the conclusion of the workshop it was decided to begin an initiative to implement the WSCC approach in the school district. The name of the first effort is "Optimize the Year with Healthy Habits: Incredible You, Incredible Year." In this effort the wellness committee will begin by addressing the wellness of the faculty and staff for the upcoming school year as a way to develop health and wellness leaders for the work to follow.
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Assessing nutrition and health services
Discover School Breakfast Toolkit - Purpose: This toolkit, from the Food and Nutrition Service of the U.S. Department of Agriculture, was developed to help schools assess current breakfast patterns and programs, calculate costs of implementing or changing breakfast programs, identify the type of meal service to provide to students, and create a marketing plan to engage and sustain a customer base.
Assessing Nutrition Services
Discover School Breakfast Toolkit
Purpose: This toolkit, from the Food and Nutrition Service of the U.S. Department of Agriculture, was developed to help schools assess current breakfast patterns and programs, calculate costs of implementing or changing breakfast programs, identify the type of meal service to provide to students, and create a marketing plan to engage and sustain a customer base. The toolkit includes the following sections:
- Introduction
- Successful use of the toolkit, which guides users through the toolkit
- An initial assessment, which provides surveys that schools can use to evaluate the interest levels of parents and students
- Cost calculator, which includes worksheets to help schools calculate the costs of implementing the School Breakfast Program
- Description of multiple methods for serving breakfast, which can help schools determine the best method for their needs
- Roadmaps to success
- Marketing efforts, which includes a marketing plan for schools to market the School Breakfast Program
- Resources
- Program evaluation, which provides information about how and what to evaluate specific to the School Breakfast Program
Audience: The toolkit is targeted toward individuals interested in increasing access to the School Breakfast Program. That might include school health councils, school nutrition staff, school administrators, parents, and community members.
Use: Toolkit users should first become familiar with the items in the toolkit and the steps to take. The next step is to use the student, parent, and administrator surveys to identify current knowledge, attitudes, and behaviors of these audiences as it relates to eating breakfast and breakfast programs. The third step is to use the tools to calculate a variety of cost-related items, such as breakfast profit/loss, revenue per reimbursable breakfast, daily revenue breakfast, and annual expenses to revenue comparisons. The remaining components of the toolkit guides users through identifying the best method for serving breakfast and developing and implementing a marketing plan to increase access and participation in the School Breakfast Program.
Access: The toolkit is found online at www.fns.usda.gov/cnd/breakfast/toolkit/.
Assessing Health Services
Body Mass Index Measurement (BMI) in Schools
Purpose: Developed by CDC researchers, with extensive input from experts from the field of school health, the BMI Measurement in Schools document, published in both full journal article (Nihiser, 2007) and executive summary formats, provides schools with an overview of what BMI is, the differences between BMI surveillance and screening, and a list of safeguards for schools choosing to implement a BMI measurement program.
Audience: The document can be used by school health councils, school nurses, and physical education and health education teachers. Any school interested in conducting BMI measurement can use the document to learn more about options for such a strategy and to identify the best option for the school.
Use: The BMI Measurement in Schools document presents both a synthesis of the science on measuring BMI in schools and safeguards to have in place when developing and implementing such a program or initiative. Leaders within the school who are interested in BMI measurement use the document to determine whether the school prefers surveillance or screening and to identify how the safeguards can be put in place.
Access: Both the full journal article and the executive summary can be found online at www.cdc.gov/healthyyouth/npao/publications.htm#10.
Safe at School and Ready to Learn: A Comprehensive Policy Guide for Protecting Students With Life-Threatening Food Allergies
Purpose: Developed by the National School Boards Association (NSBA), the Safe at School and Ready to Learn policy guide provides school boards with an overview of the prevalence of food allergies, policy guidance for school boards to consider when developing food allergy policies, and a policy checklist (National School Boards Association, 2012). The policy checklist guides the user through a process of identifying policy areas that need attention and actions that can be taken towards improvement.
Audience: The policy guide is to be used primarily by school board members. Secondary users can be school administrators, school health services staff, physical and health education teachers, parents, and school nutrition staff.
Use: In addition to providing policy guidance to school boards and other stakeholders, the guide's checklist is to be completed by identifying whether a specific policy element is included or not included and whether it is implemented or not implemented. When policy gaps are determined, a section for identifying action steps is provided. Results of the policy checklist can be used to inform and develop food allergy policies for schools.
Access: The guide is available online at http://www.nsba.org/sites/default/files/reports/Safe-at-School-and-Ready-to-Learn.pdf
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What a health education curriculum should look like
Comprehensive school health education is characterized by planned, sequential, developmentally appropriate, and culturally inclusive learning experiences taught by qualified trained teachers. The health education curriculum should be based on relevant health behavior theories; focus on the emotional, intellectual, physical, and social dimensions of health; provide students with exposure to diverse instructional techniques; and evaluate student achievement through a variety of assessment
Health Education
Comprehensive school health education is characterized by planned, sequential, developmentally appropriate, and culturally inclusive learning experiences taught by qualified trained teachers. The health education curriculum should be based on relevant health behavior theories; focus on the emotional, intellectual, physical, and social dimensions of health; provide students with exposure to diverse instructional techniques; and evaluate student achievement through a variety of assessment strategies (Joint Committee on National Health Education Standards [JCNHES], 2007). The learning experiences embedded within the curriculum should be designed to help students acquire functional health information; identify personal values that support healthy behaviors; recognize group norms that relate to a healthy lifestyle; and develop skills necessary to adopt, practice, and maintain health-enhancing behaviors (CDC, 2013a; JCNHES, 2007). Although many leaders in health and education suggest a linkage between quality health education and academic achievement, and some research verifies this linkage, many schools in the United States struggle to provide quality health education instruction (CDC, 2013b; JCNHES, 2007). Possible positive consequences of this linkage include a decrease in student absenteeism, higher academic achievement, and an increase in graduation rates (Allensworth, 2011; Basch, 2011a, 2011b; Freudenberg & Ruglis, 2007).
Healthy People 2020 includes an objective to increase the proportion of elementary, middle, and senior high schools that provide comprehensive school health education (USDHHS, 2013). Nationwide, 41.2 percent of elementary schools, 58.7 percent of middle schools, and 78.7 percent of high schools had specific time requirements for school health instruction (CDC, 2013b).
Thesecond edition of The National Health Education Standards (figure 3.1) was released in 2007. The standards were developed by a panel of health education leaders with input from professionals in both health and education, as well as parents and community members. The standards are not federally mandated or designed to define a national curriculum. Instead, they are intended to provide a framework and resource for the development of state standards and health education curricula in local school districts (American Cancer Society, 2007). The standardsinclude three distinct components: the individual health education standards, a rationale statement for each standard, and performance indicators linked to each standard for mastery by the completion of grades 4, 8, and 11 (American Cancer Society, 2007).
The standards can be applied to various health education content areas. The Centers for Disease Control and Prevention (CDC, 2011a) has identified six risk behaviors as being important focal points for instruction in school health education. These behaviors include alcohol and other drug use, physical inactivity, sexual behaviors that contribute to unintended pregnancy and sexually transmitted diseases, tobacco use, unhealthy dietary behaviors, and behaviors that contribute to unintentional injuries and violence. Other possible content areas for instruction include environmental health, human sexuality, and mental and emotional health (CDC, 2013a).
Beyond the National Health Education Standards, quality school health education should be based on quality health instruction. The following best practices have been identified by the CDC Division of Adolescent and School Health. They are based on reviews of effective programs and curricula and the positions of experts in the profession of health education (CDC, 2013d).
- Focus on clear health goals and related behavioral outcomes
- Are research-based and theory-driven
- Address individual values, attitudes, and beliefs
- Address individual and group norms that support health-enhancing behaviors
- Focus on reinforcing protective factors and increasing perceptions of personal risk and harmfulness of engaging in specific unhealthy practices and behaviors
- Address social pressures and influences
- Build personal competence, social competence, and self-efficacy by addressing skills
- Provide functional health knowledge that is basic, accurate, and directly contributes to health-promoting decisions and behaviors
- Use strategies designed to personalize information and engage students
- Provide age-appropriate and developmentally appropriate information, learning strategies, teaching methods, and materials
- Incorporate learning strategies, teaching methods, and materials that are culturally inclusive
- Provide adequate time for instruction and learning
- Provide opportunities to reinforce skills and positive health behaviors
- Provide opportunities to make positive connections with influential others
- Include teacher information and plans for professional development and training that enhance effectiveness of instruction and student learning
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