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.     

The School Health Innovative Programs: Integrating School Health and Managed Care in San Diego

ABSTRACT: Managed care organizations (MCOs) are being recruited to support school health services delivered in school clinics. Schools without clinics already provide numerous health services and could provide more if they had support from managed care organizations. This article describes the first two years of a San Diego-based collaborative consisting of MCOs, school districts, and other health care agencies. By establishing trust, developing overriding principles, and creating an interagency communication infrastructure, this collaborative has encouraged shared management of many student health issues. Because the agreements apply to all schools, programs can reduce high rates of absenteeism district-wide and avoid unnecessary doctor appointments for common health problems. These collaborative agreements are designed to be financially self-sustaining. However, data collection, the logistics of obtaining parental consent, and getting health professionals to communicate with each other in new ways remain to be significant challenges.     

Program Management: A Necessary Component for the Comprehensive School Health Program

ABSTRACT: The definition of a comprehensive school health program changed dramatically in the 20th century: Publication of the book Health Education, in the 1920s, provided a vision of health education as an instructional experience. In the 1950s, the concept of school health programs grew with addition of components in health services and a healthy school environment. An expanded concept of comprehensive school health programs now includes the components of physical education, food services, counseling, staff health promotion programs, and involvement of parents and the community. The next step involves inclusion of a "focusing' or "integrating" component that unifies elements of the comprehensive school health model. This component provides leadership and management to ensure that potential benefits of a comprehensive school health program are fully realized.     

A Comprehensive Approach to School Health Program Needs Assessments

ABSTRACT: An assessment of health promotion needs represents a fundamental step for developing comprehensive school health programs. This project developed and tested an approach for school districts to use when conducting a district-wide needs assessment of school health programs. The approach assumes a needs assessment should be multidimensional and comprehensive. Seven priority health-related behaviors were included as well as eight components of a school health program identified by Kolbe. This paper describes each aspect of the needs assessment, discusses the importance of perspectives provided by each component, and provides recommendations for districts interested in conducting an assessment.     

ACCESS: Keystones for School Health Promotion

This article provides a perspective on the three elements that traditionally constitute school health programs in the U.S. and describes a new model called ACCESS. Consisting of five major keystones, ACCESS provides an organizational structure for planning, implementing, and evaluating school health promotion programs. In addition, the model provides a reference point for international comparisons of school health.     

Position of the American Dietetic Association, School Nutrition Association, and Society for Nutrition Education: comprehensive school nutrition services

It is the position of the American Dietetic Association (ADA), School Nutrition Association (SNA), and Society for Nutrition Education (SNE) that comprehensive, integrated nutrition services in schools, kindergarten through grade 12, are an essential component of coordinated school health programs and will improve the nutritional status, health, and academic performance of our nation's children. Local school wellness policies may strengthen comprehensive nutrition services by encouraging multidisciplinary wellness teams, composed of school and community members, to work together in identifying local school needs, developing feasible strategies to address priority areas, and integrating comprehensive nutrition services with a coordinated school health program. This joint position paper affirms schools as an important partner in health promotion. To maximize the impact of school wellness policies on strengthening comprehensive, integrated nutrition services in schools nationwide, ADA, SNA, and SNE recommend specific strategies in the following key areas: nutrition education and promotion, food and nutrition programs available on the school campus, school-home-community partnerships, and nutrition-related health services.     

Position of the American Dietetic Association,Society for Nutrition Education,and American School Food Service Association--Nutrition services: an essential component of comprehensive school health programs

It is the position of the American Dietetic Association (ADA), the Society for Nutrition Education (SNE), and the American School Food Service Association (ASFSA) that comprehensive nutrition services must be provided to all of the nation's preschool through grade twelve students. These nutrition services shall be integrated with a coordinated, comprehensive school health program and implemented through a school nutrition policy. The policy should link comprehensive, sequential nutrition education; access to and promotion of child nutrition programs providing nutritious meals and snacks in the school environment; and family, community, and health services' partnerships supporting positive health outcomes for all children. Childhood obesity has reached epidemic proportions and is directly attributed to physical inactivity and diet. Schools can play a key role in reversing this trend through coordinated nutrition services that promote policies linking comprehensive, sequential nutrition education programs, access to and marketing of child nutrition programs, a school environment that models healthy food choices, and community partnerships. This position paper provides information and resources for nutrition professionals to use in developing and supporting comprehensive school health programs. J Am Diet Assoc. 2003;103:505-514.     

Position of the American Dietetic Association, School Nutrition Association, and Society for Nutrition Education: comprehensive school nutrition services

It is the position of the American Dietetic Association (ADA), School Nutrition Association (SNA), and Society for Nutrition Education (SNE) that comprehensive, integrated nutrition services in schools, kindergarten through grade 12, are an essential component of coordinated school health programs and will improve the nutritional status, health, and academic performance of our nation's children. Local school wellness policies may strengthen comprehensive nutrition services by encouraging multidisciplinary wellness teams, composed of school and community members, to work together in identifying local school needs, developing feasible strategies to address priority areas, and integrating comprehensive nutrition services with a coordinated school health program. This joint position paper affirms schools as an important partner in health promotion. To maximize the impact of school wellness policies on strengthening comprehensive, integrated nutrition services in schools nationwide, ADA, SNA, and SNE recommend specific strategies in the following key areas: nutrition education and promotion, food and nutrition programs available on the school campus, school-home-community partnerships, and nutrition-related health services.     

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.     

Ten Unanswered Questions Regarding Comprehensive School Health Promotion

ABSTRACT: The past two decades witnessed dramatic growth in support for comprehensive school health promotion. Yet, many questions about its effectiveness and feasibility remain unanswered. This article poses several research and policy questions, the answers to which may help to shape the future of school health programs in this country.     

Position of the American Dietetic Association,Society for Nutrition Education,and American School Food Service Association: Nutrition services: an essential component of comprehensive school health programs

It is the position of the American Dietetic Association (ADA), the Society for Nutrition Education (SNE), and the American School Food Service Association (ASFSA) that comprehensive nutrition services must be provided to all of the nation's preschool through grade 12 students. These nutrition services shall be integrated with a coordinated, comprehensive school health program and implemented through a school nutrition policy. The policy should link comprehensive, sequential nutrition education; access to and promotion of child nutrition programs providing nutritious meals and snacks in the school environment; and family, community, and health services' partnerships supporting positive health outcomes for all children. Childhood obesity has reached epidemic proportions and is directly attributed to physical inactivity and diet. Schools can play a key role in reversing this trend through coordinated nutrition services that promote policies linking comprehensive, sequential nutrition education programs, access to and marketing of child nutrition programs, a school environment that models healthful food choices, and community partnerships. This position statement provides information and resources for nutrition professionals to use in developing and supporting comprehensive school health programs.     

Rethinking schools of public health: a strategic alliance model

Canada is in the midst of rejuvenation of public health organizations, mandates and infrastructure. Major planning exercises are underway regarding public health human resources, where academic institutions have a key role to play. To what extent could schools of public health be part of the solution? Many universities across Canada are considering or in the process of implementing MPH programs (some 17 programs planned and/or underway) and possible schools of public health. However, concerns are raised about critical mass, quality and standards. We encourage innovation and debate about ways to enhance collaborative and structural arrangements for education programs. A school of public health model might emerge from this, but so too might other models. Also, novel types of organizational structure need consideration. One example is a "strategic alliance" model that is broad-based, integrative and adaptive--building on the interdisciplinary focus needed for addressing public health concerns in the 21st century. From our perspective, the central question is: what (new) types of organizational structures and, equally important, collaborative networks will enable Canada to strengthen its public health workforce so that it may better address local and global challenges to public health?     

A Statewide Institute to Deliver Professional Development Programs to School Health Personnel in Massachusetts

ABSTRACT: Schoolchildren suffer from health problems ranging from chronic medical and developmental problems to new morbidities related to drugs, violence, and sexual behavior. To help administrators, teachers, and health personnel meet the new challenges in schools, nursing educators from the University of Massachusetts and Simmons College developed the UMass-Simmons School Health Institute. The Institute delivers a series of professional development programs in all regions of the commonwealth to: 1) devise innovative strategies to remove health barriers to learning and to promote the health of children and adolescents, and 2) enhance the design, implementation, integration, and management of comprehensive school health programs, including those mandated and regulated by the Commonwealth of Massachusetts. This article describes a statewide model to prepare school health personnel for delivery of comprehensive school health services.     

Michigan School Health Association Celebrates Golden Anniversary

The Michigan School Health Association celebrated its Golden Anniversary Nov. 10, 1983. As a group dedicated to the promotion of comprehensive school health programs, MSHA has provided members with publications and conferences, and it has encouraged American School Health Association membership. Its members are health educators, college professors, school nurses, affiliated organizations, and voluntary health agency representatives. With 50 years of experience, the Michigan School Health Association is continuing in its leadership role of promoting comprehensive school health programs.     

The Nordic Countries: Perspectives in School Health

Denmark, Finland, Iceland, Norway, and Sweden constitute a geographical and cultural entity referred to as the Nordic countries. These countries all enjoy a high standard of living, and the health of their children can be characterized as good in comparison to that of earlier generations and that of many other nations. In the Nordic countries, school health services constitute a compulsory component of school systems and are free to all students. During the past decade, the World Health Organization's "Health for All by the Year 2000" goals were adopted, including goals for Nordic school health programs. However, school health programs are a neglected area compared to the emphasis placed on other health services. Reasons to improve health education and health services provided within the school setting in the Nordic countries are presented. Several interpersonal, intrapersonal, and organizational barriers to a more active health promotion effort also are identified.     

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.     

Evaluation Of School Health Education: Identifying Purpose, Keeping Perspective

This paper discusses 2 problems associated with evaluation of school health education programs: 1) why evaluate at all; and 2) what criteria, assuming a need to evaluate the programs, are most appropriate for assessing program effectiveness? The need for evaluation arises from public interest in and concern for health promotion and prevention. Given the need to educate the population for purposes of prevention, the specific immediate function of school health education must be clarified so that programs are not judged on outcome criteria that are inappropriate or unrealistic. To this end, school health educators are encouraged to view their teaching tasks in the proper perspective, one of the potentially valuable factors for improving the quality of life of the population served. School programs should especially apply themselves to evaluative research activities addressed to behavioral and health effects to demonstrate the relationships between health education in the school and the benefits the student will accrue over time. In essence, then, school programs should focus on modifying behaviors which will be used to prevent disease or ill health prior to the signs or symptoms of illness. It is emphasized that attempts to establish immediate behavior change as goals of school programs would be naive. Federal and state initiatives are needed to support the necessary cost-benefit studies and the long-term evaluations required for policy decisions concerning school health education programs. Local support is adequate to perform short-term studies of impact on knowledge and skills of specific health education programs.     

Current Status of Statewide School Health Education Programs in Michigan

This study surveyed all Michigan public school principals regarding the current status of comprehensive school health education being provided in Michigan public schools. A 32-item survey was developed, pretested, revised and mailed to all public school principals in Michigan. Followup letters were sent to nonrespondents. A phone survey was conducted to nonrespondent principals after the cut-off date to verify survey responses. All data was analyzed by elementary, junior high school and high school population. The areas of professional preparation, inservice education, application and utilization of the Essential Performance Objectives for Health Education in Michigan , the content and time allotted for health education, and the lack of a well-developed organizational structure for health education have been articulated as deficit areas in the current status of comprehensive school health education. This survey provided much information for future consideration by educators, public and private health organizations, and other individuals and groups interested in school health in Michigan.     

International School Health Network: an informal network for advocacy and knowledge exchange

In Canada, researchers, policy-makers and non-governmental organisations have re-conceptualized the school setting as being an ecological entity, linked to parallel ecologies of the homes and the community it serves. The school, public health and other systems that seek to deliver programs in that setting are open, loosely coupled and bureaucratic. This reconceived view of the school as a setting for health promotion leads to an emphasis on building organizational, system, professional and community capacity. One of the most effective ways of building such capacities when resources are scarce is to invest in a variety of formal and informal networks that can sustain themselves with little or no external resources. A number of recognised researchers from the health and education sectors have emphasized this systems-based approach and the need to build supportive, small-scale networks or learning communities. In recent health promotion research, networking at various levels, across sectors and within communities is viewed as a key strategy within new, more effective health promotion strategies. In education, the notion of networking for educational change has been described as "learning communities" for continuous school improvement. The authors suggest that this strategy of networking be used at the international level to address several global challenges: There is no single, convenient way to obtain basic information about the status and nature of national and state/provincial school health programs around the world. There is no global research agenda in school health promotion, despite the obvious value of sharing such research and knowledge. There is no global mechanism to facilitate the development of common or shared tools for surveillance of child/youth health and monitoring of school health policies and programs, despite the excellent work being done in individual countries and by the European Network of Health Promoting Schools. There is no international mechanism with a focus on school health that brings together the following stakeholders: educational organisations with public health organisations; researchers with government officials and practitioners; those who work in Spanish, English, French and other languages; issue-specific networks with health generalists. An invitation is given to government officials, researchers and national school health associations to join an informal International School Health Network (ISHN) (soon available at: www.internationalschoolhealt.org). Discussions about the formation of the ISHN have been held with a number of participants at several international meetings and have culminated in a fledgling network that will focus on electronic and web-based exchanges of information, developing a global school health research agenda, exchanging effective materials and tools, informing policy-makers about effective practices, policies and programs. This network would build on and not duplicate the work of existing networks and include participation from WHO, OECD, UNESCO, the IUHPE and the World Bank. The next large meeting of the ISHN will occur at the IUHPE 2007 Conference in Vancouver, Canada (www.iuhpe conference.org). Before then the ISHN will organise several on-line projects and teleconferences. For more information, contact dmccall@jcsh-cces.ca.     

Position of the Academy of Nutrition and Dietetics,Society for Nutrition Education and Behavior,and School Nutrition Association: Comprehensive Nutrition Programs and Services in Schools

It is the position of the Academy of Nutrition and Dietetics, School Nutrition Association, and Society for Nutrition Education and Behavior that comprehensive, integrated nutrition programs in preschool through high school are essential to improve the health, nutritional status, and academic performance of our nation's children. Through the continued use of multidisciplinary teams, local school needs will be better identified and addressed within updated wellness policies. Updated nutrition standards are providing students with a wider variety of fruits, vegetables, and whole grains, while limiting sodium, calories, and saturated fat. Millions of students enjoy school meals every day in the US, with the majority of these served to children who are eligible for free and reduced-priced meals. To maximize impact, the Academy, School Nutrition Association, and Society for Nutrition Education and Behavior recommend specific strategies in the following key areas: food and nutrition services available throughout the school campus, nutrition initiatives such as farm to school and school gardens, wellness policies, nutrition education and promotion, food and beverage marketing at school, and consideration of roles and responsibilities.