The School Health Portfolio System: a new tool for planning and evaluating coordinated school health programs

The School Health Portfolio System (SHPS), developed originally to evaluate the Florida Coordinated School Health Program Pilot Schools Project, offers a new and innovative system for planning and evaluating a coordinated school health program at the individual school level. The SHPS provides practitioners a detailed but easy-to-use system that enables schools to create new programs or modify existing programs across all eight components of the CSHP model, as well as administrative support critical to sustainability. The System comes packaged as a self-contained, notebook-style manual divided into 15 sections. It includes electronic templates of key documents to guide school teams in creating a customized portfolio, and a list of sample goals and artifacts that confirm achievement of a goal related to the school's coordinated school health program. An evaluation rubric provides a structured method to assess a program portfolio's contents, and the extent to which the contents document achievement of program goals. The rubric produces both a qualitative assessment, such as a narrative summary of program strengths and areas for improvement, and a quantitative assessment, such as a numerical score (0-100), letter grade (A-F), or 5-star system (*-*****). The physical structure, function, and scoring of the rubric depend on the method of assessment. The SHPS enables schools to set goals based on individual school needs, and incorporate CSHP goals into school improvement plans--a critical factor in sustainability and accountability. The System also offers teams the option of coordinating their efforts with CDC's School Health Index as a companion assessment measure. This article outlines the process a team would follow in developing a portfolio, and includes a sample assessment for the area of School Health Education.     

Position of the American Dietetic Association: Local Support for Nutrition Integrity in Schools

It is the position of the American Dietetic Association (ADA) that schools and communities have a shared responsibility to provide students with access to high-quality, affordable, nutritious foods and beverages. School-based nutrition services, including the provision of meals through the National School Lunch Program and the School Breakfast Program, are an integral part of the total education program. Strong wellness policies promote environments that enhance nutrition integrity and help students to develop lifelong healthy behaviors. ADA actively supported the 2004 and proposed 2010 Child Nutrition reauthorization which determines school nutrition policy. ADA believes that the Dietary Guidelines for Americans should serve as the foundation for all food and nutrition assistance programs and should apply to all foods and beverages sold or served to students during the school day. Local wellness policies are mandated by federal legislation for all school districts participating in the National School Lunch Program. These policies support nutrition integrity, including a healthy school environment. Nutrition integrity also requires coordinating nutrition education and promotion and funding research on program outcomes. Registered dietitians and dietetic technicians, registered, and other credentialed staff, are essential for nutrition integrity in schools to perform in policy-making, management, education, and community-building roles. A healthy school environment can be achieved through adequate funding of school meals programs and through implementation and evaluation of strong local wellness policies.     

Developing an Evaluation Plan for School Health Programs in Nebraska

ABSTRACT: This article describes a unique plan for comprehensive evaluation of school health programs. With property tax caps threatening Nebraska's school health programs, the Nebraska Dept. of Health and Human Services initiated an evaluation plan to answer the question, “What is the value of school health?” The plan used the “Targeting Outcomes of Program” (TOP) framework to measure impact indicators of a comprehensive school health program. To customize the plan for Nebraska schools, community input was sought from stakeholders identified from a small rural school district. Following a series of focus group meetings, the final evaluation plan was developed and implemented as a statewide evaluation of comprehensive school health services. The resulting plan addressed several deficiencies previously identified in the literature by including community input, attention to multiple roles, and measurable outcomes documenting effectiveness, or value.     

An evaluation of client satisfaction with training programs and technical assistance provided by Florida's Coordinated School Health Program Office

Client or customer satisfaction surveys assess the perceived quality of programs, products, services, and employee performance. Such assessments prove beneficial for evaluation and planning purposes. This survey examined the satisfaction of clients using the programs, services, and technical assistance provided through the Coordinated School Health Program Office (CSHPO) in the Florida Department of Education. Using the 42-item Client Satisfaction Survey, data were collected in summer 1999 from 300 of 574 clients (52.3%) who attended training sessions or sought technical assistance from CSHPO during 1996-1999. More than two-thirds (67.2%) of clients rated the training program as "very good" or "excellent" at increasing their understanding about the concept of a coordinated school health program. Overall, 69.7% of clients rated the training programs they attended as "very good" or "excellent." Resource materials and staff effectiveness rated positively as well. Findings confirmed client satisfaction with CSHPO's training programs, technical assistance, and staff. Information obtained through the client satisfaction survey can be used by CSHPO to assist in future program planning and resource allocations.     

Evaluation of the West Australian School Development in Health Education Project

ABSTRACT: In December 1990, the National Centre for Research into the Prevention of Drug Abuse was invited to evaluate the School Development in Health Education Project (SDHE), a national program tested in Western Australia (WA) in 1991. A formative evaluation indicated the project was moderately successful in achieving the objectives in the operational plan. Schools involved reported the project was successful, and they agreed to continue health planning meetings during 1992. The evaluation also indicated that while most schools achieved macro-level change, they achieved little at the micro level. A significant outcome for SDHE WA was the successful application for three-year funding to continue and expand the project as the West Australian School Health program (WASH). Recommendations generated from the SDHE evaluation produced a shift in emphasis for the WASH program from the "action research" orientation of the national program to more content-based professional development. This study highlights the important role formative evaluation can play in developing and refining health education programs.     

Assessing organizational support for school health promotion

The Western Australian School Health Project (WASH Project)is an intervention that encourages schools to develop comprehensivehealth promotion programs. The WASH Project works with self-selectedschool communities and uses community development strategiesto support participating schools in identifying and respondingto health concerns relevant to their students. The study reportedhere was designed to assess the impact of the WASH Project interventionon changes to a school's structural commitment to comprehensivelypromote health. School structural factors include both managementfactors, which identify a schools commitment to health promotion,and health promotion factors, which help to identify the breadthof a school's health promotion program. The study employed aquasi-experimental research design with pre-test, post-testand a control group. In this instance the WASH Project has demonstratedan ability to involve the school in health promotion to theextent that it is willing to provide both monetary and humanresources to the development of school health promotion, andto adopt policy to reinforce this change. These structural improvementsindicate that relatively modest external interventions, suchas the WASH Project, can influence the way a school operatesto increase adoption and development of comprehensive healthpromotion programs.     

Coordinated school health program and dietetics professionals: partners in promoting healthful eating

Although research indicates that school meal programs contribute to improved academic performance and healthier eating behaviors for students who participate, fewer than 60% of students choose the National School Lunch Program or School Breakfast Program. School meal programs have a difficult time competing with foods that are marketed to young people through sophisticated advertising campaigns. Youth's preferences for fast foods, soft drinks, and salty snacks; mixed messages sent by school personnel; school food preparation and serving space limitations; inadequate meal periods; and lack of education standards for school foodservice directors challenge school meal programs as well. A coordinated school health program offers a framework for meeting these challenges and provides children and adolescents with the knowledge and skills necessary for healthful eating. This article identifies challenges facing school foodservice directors in delivering healthful meals and acquaints dietetics professionals with the coordinated school health program to be used as a tool for addressing unhealthful weight gain and promoting healthful eating.     

Health promoting schools

Promoting the health of children through schools has long been an important task of the WHO. Guided by the recommendations of the Expert Committee on Comprehensive School Health Education and Promotion, the Initiative seeks to strengthen health promotion and education activities at the local, national, regional, and global levels. It aims to increase the number of schools that can truly be called "Health-Promoting Schools". The four strategies undertaken by WHO in creating Health-Promoting Schools are: 1) strengthening the ability to advocate for improved school health programs, 2) creating networks and alliances for the development of Health-Promoting Schools, 3) strengthening national capacities, and 4) research to improve school health program. Finally, WHO recognizes that the success of the Global School Health Initiative lies on the extent to which partnerships can be formed at local, national, and international levels.     

Bridging the gap between community health and K-12 schools

The topic of this article is program planning for K-12 school health programs collaborating with community agencies, businesses, colleges, and organizations. Community involvement was listed as one of the weakest areas of school health efforts in a national coordinated school health study [1]. This article presents the 5-year results demonstrating the outcomes of K-12 schools program planning aimed at community involvement in the coordinated school health model. Directors of the Departments of Education and Health in South Dakota initiated training for school personnel in the coordinated school health model through development of councils in the schools starting in 2000. The expectations of the councils were to design a program plan to support the health of students and staff in their school. The short-term results of a 5-year evaluation indicated the greatest area of gain was in community health involvement to improve student and staff health.     

Encouraging Schools to Promote Health: Impact of the Western Australian School Health Project (1992 — 1995)

The Western Australian School Health (WASH) Project, a school health promotion intervention operating over a four-year period (1992-1995), provided a comprehensive, year-long intervention to help successive groups of schools develop health promotion programs. The WASH Project worked with self-selected school communities and used community development strategies to support participating schools in identifying and responding to health concerns relevant to their students. This paper reports the school impact results of the WASH Project. School impact data involved 24 variables categorized into two areas: school organizational factors supportive of health promotion, and school health promotion factors. Two methods of analysis were used: logistic regression indicating the direction of change, and linear regression indicating the magnitude of change. Results demonstrated that schools successfully made organizational changes, such as the allocation of additional time, personnel, and monetary resources, to support health promotion.     

Implementation of a school environment intervention to increase physical activity in high school girls

Physical activity levels begin to decline in childhood and continue falling throughout adolescence, with girls being at greatest risk for inactivity. Schools are ideal settings for helping girls develop and maintain a physically active lifestyle. This paper describes the design and implementation of 'Lifestyle Education for Activity Program', or LEAP. LEAP used a health team approach with participatory strategies to provide training and support, instructional capacity building and opportunities to adapt school instructional program and environmental supports to local needs. The social-ecological model, based on social cognitive theory, served as the organizing framework for the LEAP intervention and elements of the coordinated school health program model as intervention channels. For the 12 intervention schools, LEAP staff documented 191 visits and interactions with 850 individuals over the 2-year period. Teachers reported successful implementation of most components of the intervention and demonstrated optimism for sustainability. These results indicate that a facilitative approach to intervention implementation can be used successfully to engage school personnel, and to change instructional programs and school environments to increase the physical activity level of high school girls.     

Parent Expectations of the School Health Program in Nebraska

This article presents findings from the first phase of a comprehensive evaluation plan for the school health program in Nebraska public schools. The evaluation utilized the Targeting Outcomes of Programs (TOP) framework to gather parents' perspectives about the benefits of the school health program, and a ranking of important health activities and role providers. A survey was distributed to 1,200 parents randomly selected from 60 school districts. Of these, 450 (38%) were returned: 96% supported funding of health programs; 88% believed families benefited from school health; 92% viewed the health programs as "essential" to the educational mission; 64% preferred a ratio of 1 nurse/500 students; and 89% believed all students needed access to a professional school nurse. The nurse was the only clearly defined role in the health program and had activities rated as "extremely important." Results were reported to the Nebraska legislature for support of state funding for school health nursing.     

The relationship between school health councils and school health policies and programs in US schools

ABSTRACT: This study analyzed data from the School Health Policies and Programs Study (SHPPS) 2000 to examine the relationship between school health councils and selected school health policies and programs. SHPPS 2000 collected data from faculty and staff in a nationally representative sample of schools. About two-thirds (65.7%) of US schools have school health councils. Schools with councils were significantly more likely than schools without councils to report policies and programs related to health services. mental health and social services; faculty and staff health promotion, and family and community involvement. Schools with councils were as likely as schools without councils to report policies and programs related to health education, physical education, and food service. Although school health councils are associated with the presence of some key school health policies and programs, a council does not guarantee a school will have all important school health policies and programs in place.     

Faculty and staff health promotion: results from the School Health Policies and Programs Study 2006

BACKGROUND: US schools employ an estimated 6.7 million workers and are thus an ideal setting for employee wellness programs. This article describes the characteristics of school employee wellness programs in the United States, including state-, district-, and school-level policies and programs. METHODS: The Centers for Disease Control and Prevention conducts the School Health Policies and Programs Study every 6 years. In 2006, computer-assisted telephone interviews or self-administered mail questionnaires were completed by state education agency personnel in 49 states plus the District of Columbia and among a nationally representative sample of school districts (n=445). Computer-assisted personal interviews were conducted with personnel in a nationally representative sample of elementary, middle, and high schools (n=873). RESULTS: During the 2 years preceding the study, 67.3% of states provided assistance to districts or schools on how to develop or implement faculty and staff health promotion activities or services. Although nearly all schools offered at least 1 health promotion service or activity, few schools offered coordinated activities and services within a comprehensive employee wellness program. During the 12 months preceding the study, none of the health screenings were offered by more than one third of schools; only a few of the health promotion activities and services were offered by more than one third of schools; about one third of schools offered physical activity programs, employee assistance programs, and subsidies or discounts for off-site health promotion activities; and only 1 in 10 schools provided health-risk appraisals for faculty and staff. CONCLUSIONS: More schools should implement comprehensive employee wellness programs to improve faculty and staff health behaviors and health status.     

Subjective outcome evaluation of the Project P.A.T.H.S.: findings based on different datasets

A total of 216 schools participated in the Project P.A.T.H.S. in the 2008/2009 school year. After completion of the Tier 1 Program, subjective outcome evaluation data were collected from 3274 program implementers. Based on the consolidated data with schools as units, results showed that participants had positive perceptions of the program, implementers and benefits of the program. More than four-fifths of the implementers regarded the program as helpful to the program participants. Multiple regression analysis revealed that perceived qualities of the program and the program implementers predicted perceived effectiveness of the program. Grade differences were not significant, except in the perception of the program for the Secondary 1 and Secondary 3 programs. The present study provides additional support for the effectiveness of the Tier 1 Program of the Project P.A.T.H.S. in Hong Kong.     

Influence of Funding Cuts on Texas School Tobacco Programs*

BACKGROUND: Following the Master Settlement Agreement, state tobacco prevention spending peaked in 2002, but has subsequently been diminishing annually. This study compared the influence of 2004 Texas tobacco program budget cuts on school practices a year after funding loss. METHODS: Three school groups were compared: continuously funded for a 2‐year minimum (n = 109), funded but discontinued (n = 123), and never funded (n = 70). Among the 123 schools with discontinued funding, differences were examined based on funding cut decision level (state or local). Written responses to surveys based on the Centers for Disease Control and Prevention (CDC) School Health Education Profile Tobacco Module were received from 49% of health coordinators and 58% of principals. RESULTS: Principals and health coordinators from continuously funded schools reported more 1) tobacco instrunctional activities; 2) teacher training; 3) student cessation support; 4) program leadership; 5) a district advocate; 6) interest in tobacco use prevention education; 7) use of evidence‐based programs and CDC‐recommended teaching methods; 8) involvement of school staff; 9) student tobacco cessation programs at school and community; 10) family involvement; and 11) staff development funding. Previously funded schools approached profiles of those never funded. Few differences were noted among schools with funding loss due to state or local decisions. CONCLUSION: The continuously funded schools consistently were better positioned to positively reach their students with effective tobacco programs. Funding reductions were associated with rapid reductions in programming. Results emphasize the need for early programmatic initiation of capacity building skill development to ensure implementation and retention of health programs during fiscally challenging circumstances.     

A journey into school health promotion: district implementation of the health promoting schools approach

The health-promoting schools approach has gained momentum in the last decade with many jurisdictions providing guidelines and frameworks for general implementation. Although general agreement exists as to the broad strokes needed for effectiveness, less apparent are local implementation designs and models. The Battle River Project was designed to explore one such local implementation strategy for a provincial (Alberta, Canada) health promoting schools program. Located in the Battle River School Division, the project featured a partnership between Ever Active Schools, the school division and the local health authority. Case study was used to come to a greater understanding of how the health promoting schools approach worked in this particular school authority and model. Three themes emerged: participation, coordination and, integration.     

Policies and opportunities for physical activity in middle school environments

BACKGROUND: This study examined physical activity opportunities and barriers at 36 geographically diverse middle schools participating in the Trial of Activity for Adolescent Girls. METHODS: Principals, physical education and health education department heads, and program leaders were interviewed to assess policies and instructional practices that support physical activity. RESULTS: Schools provided approximately 110 hours per year in physical education instruction. Approximately 20% of students walked or bicycled to school. Eighty-three percent of schools offered interscholastic sports and 69% offered intramural sports. Most schools offered programs for girls, but on average, only 24 girls ( approximately 5%) in the schools attended any programs. Only 25% of schools allowed after school free play. An overall score created to assess school environmental support for physical activity indicated that, on average, schools met 6.7 items of 10 items. Free/reduced lunch program participation versus not (p = .04), perceived priority of physical education instruction over coaching (p = .02), and safety for walking/bicycling to school (p = .02) predicted environmental support score. CONCLUSIONS: Schools have policies and practices that support physical activity, although unfavorable practices exist. Schools must work with community partners and officials to provide environments that optimally support physical activity, especially schools that serve low-income students.