Building a Healthier Future Through School Health Programs

Eight Priority Actions for Improving the Health of Young People — Part 2

• Priority 5. Establish a Technical-Assistance and Resource Plan that Will Provide Local School Districts with the Help They Need to Effectively Implement School Health Guidelines.
  
  
• Priority 6. Implement Health Communications Strategies to Inform Decision Makers and the Public About the Role of School Health Programs in Promoting Health and Academic Success Among Young People.
  
  
• Priority 7. Develop a Professional Development Plan for School Officials and Others Responsible for Establishing Coordinated School Health Programs and Implementing the School Health Guidelines.
  
  
• Priority 8. Establish a System for Evaluating and Continuously Improving State and Local School Health Programs.
  
  

Priority 5. Establish a Technical-Assistance and Resource Plan that Will Provide Local School Districts with the Help They Need to Effectively Implement School Health Guidelines.
To advance state policies and support the local implementation of priority school health policies and programs that are consistent with the school health guidelines, state and local agencies can develop and implement a plan for providing technical assistance and resources to school districts and schools. State education and health agencies must develop the capacity to help schools improve their school health programs and provide school personnel with the tools they need to help reduce tobacco use, increase physical activity, and support healthy eating patterns among students. State and local health and education agency leaders can

• Establish criteria to help local schools develop, assess, and select effective curricula; institute processes for identifying and reviewing potential programs based on these established criteria; and develop strategies for disseminating information about selected programs to teachers and community members.

• Develop and disseminate guidelines and resources to assist school districts in establishing school health councils.

• Identify and promote the use of resources for developing school health policy and for planning and assessing school health programs (e.g., CDC's School Health Index; NASBE's Fit, Healthy, and Ready to Learn; and USDA's Changing the Scene) and make these resources available to local school districts. For example, in Georgia, the DeKalb County Board of Education and Board of Health have collaborated to promote the use of the School Health Index in DeKalb's elementary schools. In the 2001–2002 school year, 17 schools completed the index, including the action plans, and 8 schools received funding from a variety of Board of Health programs. Funded activities include the following:
  
  
  • Hiring certified physical education teachers for the first time.
  
  
  • Developing walking clubs.
  
  
  • Establishing wellness programs for school staff members.
  
  
  • Purchasing exercise equipment for students to use.
  
  
  • Developing fitness stations on the school campus for use by students, staff members, and the community.
  
  
  • Providing professional development for teachers.
  
  
  • Offering healthier choices in the school vending machines.

• Identify community-resource personnel and programs that complement school health policies and make these available to local school districts to foster community-school partnerships.

• Identify national standards and guidelines for health education, physical education, school nutrition programs, and school health services and convey this information to local school districts to facilitate effective policy and program implementation.

• Establish technical-assistance communication networks (e.g., e-mail networks) or refer school health staff to existing national technical-assistance communication networks. For example, the Maine Department of Education, through its Maine's Learning Results, has developed a technical-assistance plan to strengthen state and local efforts to improve student learning, define professional development needs, update local curricula and instructional practices, and assess student achievement. It also provided additional resources to improve school health programs through its publications, communications networks, and technical assistance.

• Identify a contact or lead person in every school to receive regular school health communications and resources.

• Identify appropriate media campaign materials and resources that can help local health agencies and school districts promote positive health messages and programs for youth.

• Respond to requests for technical assistance and information from local school health staff or strengthen regional technical-assistance systems to support local needs.

• Communicate school health-related findings from the Community Guide to Preventive Services, which features systematic reviews of published studies conducted by the Task Force on Community Preventive Services. In one such review, the Task Force found that physical education classes are effective in improving both physical activity levels and physical fitness among school-aged children. On the basis of these findings, the Task Force issued a strong recommendation to implement programs that increase the amount of time that students spend in school-based physical education classes.

State and local health and education agencies can establish frameworks for allocating funds to support local school health policies and programs that are consistent with the intent of state policies and appropriations. For example, in response to legislation that appropriated health protection funds to the Massachusetts Department of Education, the agency developed specific assurance documents that established school health councils and coordinators in the districts that received these funds. The education agency also provided technical assistance to help local coordinators implement a comprehensive, interdisciplinary Pre-K–12 health education and human services program.

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Priority 6. Implement Health Communications Strategies to Inform Decision Makers and the Public About the Role of School Health Programs in Promoting Health and Academic Success Among Young People.
State and local agencies need to build support at both the state and local levels for school-based programs to reduce tobacco use, increase physical activity, and improve eating behaviors among students. As an important part of this effort, state and local health and education agencies can develop and implement a school health communications plan to promote the value of school health programs among legislative leaders, state and local government policy makers (including health and education leaders), local school leaders, business leaders, parents, students, and other community members. Such a plan should foster communication among state-level partners working to improve school health programs and increase the flow of information and resources between the state and local levels.

For example, the Oregon Department of Education formed an external communications work group to develop and implement an awareness campaign to promote coordinated school health programs among local decision makers and gatekeepers (e.g., school board members, school administrators, county commissioners). The campaign has stressed the links between students' educational outcomes and their physical, social, and emotional health and the critical role that school health programs can play in improving these outcomes. This work group includes representatives from a wide variety of state partners interested in school health, including the Oregon Association for Health, Physical Education, Recreation and Dance; the Oregon School Health Education Coalition; the Oregon Dairy Council; the Oregon Partnership (alcohol use prevention); the Northwest affiliate of the American Cancer Society; the Oregon School Nurses Association; and Children First for Oregon (a Kids Count affiliate). As a result of the work group's efforts, in many districts, school health councils have been formed to plan the implementation of school health programs.

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Priority 7. Develop a Professional-Development Plan for School Officials and Others Responsible for Establishing Coordinated School Health Programs and Implementing the School Health Guidelines.
Professional development is critical to the effective implementation of the school health guidelines and coordinated school health programs.¹³ Any state plan for reducing the risk for chronic disease among young people should include a comprehensive plan for teaching the skills that state and local decision makers, school staff, parents, and community members will need to support and implement a coordinated school health program. This development plan should address the specific training needs of the various target groups and should be informed by literature from the field of professional development and training. States and communities can provide or support professional-development training in a variety of ways:

• Through a cadre of trainers who can provide and model interactive professional development and who are themselves provided with ongoing support, training, and feedback.

• Through multiple delivery systems, such as scheduled workshops, materials centers, interactive Web sites, and district mentoring programs.

• By providing funds for professional-development events and materials.

• By providing support staff to manage the logistics of training.

• Through marketing strategies to create awareness of and encourage participation in professional development and training.

Plans should specify the target audience for each professional-development event and should include learning and performance objectives. Insofar as possible, participants in these events should develop action plans that describe how they will incorporate their newly acquired knowledge and skills into their professional responsibilities. Professional-development events should be evaluated by the quality of those plans and how well they are implemented.

Professional-development events may be needed for school personnel, such as health and physical education teachers, nurses, school counselors, food service directors, and administrators. Others who require professional development may include school board members; parents; health educators in state health departments; health department staff who work with youth-focused, community-based organizations; parks and recreation staff; business leaders; clergy; and social services and juvenile justice staff. Depending upon the work plan and desired outcomes, professional development could include awareness sessions, skill-building training, topical events, or customized offerings for teachers and school health coordinators.

Opportunities for professional development to support school health programs are available through a variety of venues, including national and state-level conferences and other continuing education oppor-tunities offered by professional organizations.

National health organizations also offer specialized opportunities for professional development, such as those offered at the American Cancer Society's School Health Coordinator Leadership Institute. Several states have replicated the institute or are planning to do so. For more information, contact the American Cancer Society, Children and Youth Initiatives, at 404-982-3672.

Other venues for professional development include professional-preparation programs offered by institutions of higher education, professional journals, on-line courses, and list servs. States should develop systems to provide follow-up support to participants after the professional-development events have concluded. Such support could be provided through booster sessions, peer counseling, networking groups, or ongoing sequential training. CDC has developed Training Tracker, a database program that enables agencies and organizations to track their various training and professional-development activities over time. Training Tracker will store data useful for planning and evaluating professional-development events.

State and local health and education agencies should support policies and identify funding that will advance the development of a statewide, comprehensive professional-development plan. In general, state agencies should designate staff to both develop this plan and ensure its implementation at the state and school-district levels. However, if professional-development events are typically delivered at the regional level, it might be more appropriate for regional, county, or local education agency staff to develop their own plans.

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Priority 8. Establish a System for Evaluating and Continuously Improving State and Local School Health Policies and Programs.
Program evaluation is an essential ongoing organizational practice in public health and education. The results of such evaluations not only measure a program's success in meeting its goals but also provide information for planning future program activities. Agencies need to develop clear plans, inclusive partnerships, and feedback systems that foster learning and ongoing improvement. Routine, practical evaluations that provide information for management and improve program effectiveness should be a part of education and public health programs at both the state and local levels.

Program evaluation helps program officials to better understand their programs' needs and assets, to establish priorities, and to use their resources more effectively.

As an agency develops its program goals, objectives, and implementation plans, it should also develop procedures for measuring its success in meeting these goals and objectives. Evaluations can be used to assess the following four aspects of program activities:

1. The development and implementation of health-related education policies.

2. The provision of professional development activities for decision makers and education and public health agency staff.

3. The development and implementation of effective curricula and programs for students.

4. The establishment of sufficient capacity to develop and implement program activities and collaborate with other organizations.

Agencies can perform two kinds of evaluations: process evaluations and outcome evaluations. Process evaluations require accurate and organized records of program activities and are central to the ability of program staff to effectively monitor and report on their activities. By delineating the who, what, when, and where of program activities, process evaluations allow agency staff to assess whether these activities met their goals and objectives. Agency staff can also use process evaluations to chart and report on activities across time in a very systematic and cost-effective manner. Because a basic understanding of the process of program activities is critical to evaluating their outcomes, education and public health agencies should conduct process evaluations annually.Outcome evaluations are used to assess the impact of program activities on their participants, including changes in their knowledge, attitudes, skills, and behaviors both immediately following program activities and over the long term.

Evaluation results are only valuable when they are used to develop and improve program activities. Evaluation results may be communicated to national, state, and local education and public health agencies; to school districts and individual schools;
to community-based organizations; and to community members.

State agencies should develop evaluation resources, tools, and a technical assistance process to help local agencies evaluate their program activities. Agencies may want to consider enlisting the help of post-secondary institutions or of independent evaluators or evaluation firms. However, the respective roles and duties of agency staff and hired evaluators must be clearly outlined, and evaluators and agency staff must agree on the purpose, methods, and procedures of evaluations.

There are four commonly accepted standards for evaluation: utility, feasibility, propriety, and accuracy. Utility refers to the usefulness of evaluation results. Evaluations with good utility specify the amount and type of information collected, make clear the values used in interpreting collected data, and present findings in a clear and timely way. Feasibility refers to the extent that evaluations employ practical, non-disruptive procedures, take into account the differing political interests of those involved, and use resources prudently. Propriety is a measure of how well the rights of those affected by the evaluation are respected. Evaluations with good propriety have protocols and other agreements to ensure that the welfare of human subjects is protected, that the findings are disclosed in a complete and balanced fashion that reflects multiple perspectives, and that conflicts of interest are addressed in an open and fair manner. Accuracy is a measure of how well evaluation results reflect reality. Accurate evaluations describe the program activities and their contexts, articulate the purpose and methods of the evaluation, employ systematic procedures to gather valid and reliable information, apply appropriate methods of analysis and synthesis, and produce impartial reports containing justified conclusions.

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