Coordinated School Health Research Articles

School staff perceptions of factors influencing participation in a Whole-of-School initiative in an Indigenous community

Objectives: The purpose of this study was to investigate teachers’ perspectives on factors influencing their involvement in a Whole-of-School initiative. Methods: A survey was administered to participating teachers/school personnel ( N = 81) and 30 of the teachers/school personnel also participated in mostly individual interviews. The survey was informed by Lohrmann’s Ecological Model of Coordinated School Health Programs focusing on individual, interpersonal, community, organisation and policy factors. Category mean values were calculated for the survey data (along with t tests to explore differences by participant role in the schools), and interview data were analysed via analytic induction using several trustworthiness measures. Findings: Findings revealed that all survey categories ranked 3.5 or higher on a 5-point scale and there were significant differences by participant role. Interview data provided specific examples of each of the school health ecology factors. Conclusion: Results provide support for the model Whole-of-School programme efforts, insights into teacher and school personnel involvement and resistance to a school health change initiative. The project may serve as a model for other schools/districts interested in Whole-of-School health programming. The transformation that took place is especially important in this Indigenous community with significant health concerns.

Evaluating a school-based fruit and vegetable co-op in low-income children: A quasi-experimental study

The purpose of this study was to evaluate the effectiveness of a new school-based food co-op program, Brighter Bites (BB), to increase fruit and vegetable intake, and home nutrition environment among low-income 1st graders and their parents. This was a non-randomized controlled comparative effectiveness trial (2013–2015). Six schools received BB (n=407 parent-child dyads); six comparison schools implemented a coordinated school health program (n=310 parent-child dyads) in Houston, Texas, 2013–2015. Brighter Bites (BB) is a 16-week school-based food co-op comprising weekly distribution of fresh produce (50 servings); nutrition education in schools and for parents; and weekly recipe tastings. Measurements included parent-reported home nutrition environment surveys, and food frequency questionnaires for parent and child. Intervention effects were examined using multivariate analyses. At baseline, the sample was 71% Hispanic, 24% African American; 43% of 1st graders were overweight/obese. Children receiving BB had significant increases in intake of fruit servings (P=0.046), vegetable servings (P=0.049), and decreased intake of added sugars (P=0.014). Among parents, there were significant increases in fruit consumed (P=0.032); vegetable intake increased baseline to midpoint but not post-intervention. Among BB families, there were significant improvements in the home environment including understanding and usage of nutrition facts labels to make food purchases (P<0.05), frequency of cooking (P=0.007), rules and practices regarding eating family meals (P=0.022), serving fruits (P=0.005) and vegetables (P=0.028) at meals, and limiting portion sizes (P=0.016).In conclusion, a school-based food co-op model shows promising results in improving dietary habits and home nutrition environment among low-income families.

Increasing Immunization Compliance by Reducing Provisional Admittance.

Students in Vermont with incomplete or undocumented immunization status are provisionally admitted to schools and historically had a calendar year to resolve their immunization status. The process of resolving these students' immunization status was challenging for school nurses. We conducted a school-based quality improvement effort to increase student compliance with Vermont immunization regulations using a collaborative learning approach with public health school liaisons and school nurses from public schools to reduce provisional admittance in 2011-2012. Strategies included using a tracking system, accessing the immunization registry, promoting immunization importance, tracking immunization plans, and working with medical homes to update records. Participating school nurses observed decreases in the number of provisionally admitted students, although this reduction was not significantly different than matched comparison schools. We also found the number of provisionally admitted students fluctuated throughout the year and resolving the immunization status of New Americans and exchange students required special attention. Our approach supports the coordinated school health model and demonstrates the critical role school nurses play in improving population health outcomes.

Nebraska Team Nutrition Supports Sustaining Healthy Nebraska Schools Through the Coordinated School Health (CSH) Initiative

Nebraska Team Nutrition Supports Sustaining Healthy Nebraska Schools Through the Coordinated School Health (CSH) Initiative

Whole School, Whole Community, Whole Child-Calling School Nurses to Action.

The Whole School, Whole Community, Whole Child model released in 2015 as a collaboration between associations focuses renewed attention on the importance of improved physical, emotional, and social health to student learning. The model replaces and expands upon the Coordinated School Health Model that has been widely implemented in schools since the late 1980s. NASN celebrates this new model and calls school nurses to action in advocating for the implementation of this model in their communities. This article not only introduces this new model to school nurses but shares examples of school nurse advocacy initiatives.

Barriers and Facilitators to Sustaining School Health Teams in Coordinated School Health Programs.

Coordinated school health (CSH) programs address multiple factors related to students' overall health, thereby increasing their physical and mental readiness to learn. A formative evaluation of three school districts in 2010-2011 examined strategies for sustaining the school health teams (SHTs) that lead CSH efforts. Qualitative data from 39 interviews and 13 focus groups revealed facilitators and barriers for sustaining SHTs. Quantitative data from 68 questionnaires completed by SHT members and school principals examined factors associated with having more active SHTs and district and school characteristics SHT members believed to be important to their schools' efforts to implement CSH. Facilitators of sustaining SHTs included administrative support, staff engagement in the SHT, and shared goals and responsibility. Barriers to sustaining SHTs included limited time and competing priorities, budget and funding constraints, and staff turnover. Findings provide valuable insight into challenges and potential solutions for improving the sustainability of SHTs to enable them to better support CSH efforts.

Integrated learning and health: A call for increasing coordination efforts

This commentary reinforces a call to recognize the need for substantive collaboration, communication, and cooperation across education and health sectors. Themes throughout the body of articles contained in the special issue are discussed as strengthening knowledge about the benefits to integration of education and health domains in prevention and intervention. A brief review of coordinated school health efforts in the United States is provided, with discussion related to increasing the roles of student services personnel in leading coordination. Finally, recommendations are made to move the conclusions provided in the issue around the what for potential foci of prevention and intervention to greater focus on the how in integration and sustained implementation in diverse contexts and across broad systems.

Quantifying collaboration using Himmelman ' s strategies for working together

Purpose– Coordinated school health programs (CSHPs), a type of health promoting school (HPS) program adopted by Canada and the USA, were developed to provide a comprehensive approach to school health in the USA. Community partnerships are central to CSHP and HPS efforts, yet the quality of collaboration efforts is rarely assessed. The purpose of this paper is to use Himmelman’s strategies for working together to assess the types of partnerships that are being formed by CSHPs and to explore the methodological usefulness of this framework. The Himmelman methodology describes four degrees of partnering interaction: networking, coordinating, cooperating, and collaborating, with each degree of interaction signifying a different level of partnership between organizations.Design/methodology/approach– Data were collected as part of the 2008-2009 and 2009-2010 CSHP annual Requests for Proposal from all 131 public school systems in Tennessee. Thematic analysis methods were used to assess partnerships in school systems. Descriptive analyses were completed to calculate individual collaboration scores for each of the eight CSHP components (comprehensive health education, physical education/activity, nutrition services, health services, mental health services, student, family, and community involvement, healthy school environment, and health promotion of staff) during the two data collection periods. The level of collaboration was assessed based on Himmelman’s methodology, with higher scores indicating a greater degree of collaboration. Scores were averaged to obtain a mean score and individual component scores were then averaged to obtain statewide collaboration index scores (CISs) for each CSHP component.Findings– The majority of CSHPs partnering activities can be described as coordination, level two in partnering interaction. The physical activity component had the highest CISs and scored in between coordinating and cooperating (2.42), while healthy school environment had the lowest score, scoring between networking and coordinating (1.93), CISs increased from Year 1 to Year 2 for all of the CSHP components. Applying the theoretical framework of Himmelman’s methodology provided a novel way to quantify levels of collaboration among school partners. This approach offered an opportunity to use qualitative and quantitative methods to explore levels of collaboration, determine current levels of collaboration, and assess changes in levels of collaboration over the study period.Research limitations/implications– This study provides a framework for using the Himmelman methodology to quantify partnerships in a HPS program in the USA. However, the case study nature of the enquiry means that changes may have been influenced by a range of contextual factors, and quantitative analyses are solely descriptive and therefore do not provide an opportunity for statistical comparisons.Practical implications– Quantifying collaboration efforts is useful for HPS programs. Community activities that link back to the classroom are important to the success of any HPS program. Himmelman’s methodology may be useful when applied to HPSs to assess the quality of existing partnerships and guide program implementation efforts.Originality/value– This research is the first of its kind and uses a theoretical framework to quantify partnership levels in school health programs. In the future, using this methodology could provide an opportunity to develop more effective partnerships in school health programs, health education, and public health.

A Healthy School Environment as a Precondition for the Welfare of Students and Staff

A healthy school environment is an important element of the Coordinated School Health model, which periodically focuses on the quality of a school’s physical and esthetic surroundings as well as its psychosocial climate, safety, and culture. According to previous studies, the characteristics of a school environment are statistically related to the students’ health and academic achievement. Therefore, the purpose of this paper is to examine various aspects of a school environment, their influences on the well-being of the school community, and the need for improvements. A comprehensive study on school health promotion was conducted with a representative sample of schools in the region of Pleven, Bulgaria. Data were collected by means of a self-administered questionnaire among students, parents, and staff as well as through interviews with school principals. In the region of Pleven, there are a total of 118 schools, which were built between 1912 and 1998. The majority of the buildings have been renovated, and the school surroundings are generally well-maintained. However, approximately 60% of the buildings have no easy access for disabled persons, and according to the school documents, any deviations from the standards of temperature, lighting, and ventilation in the classrooms have not been registered. In addition, approximately 40% of the respondents felt that improvements in human relationships and job satisfaction would create a healthier school community. Based on the findings, the influence of a healthy school environment on the welfare and academic performance of students and staff is confirmed and such an environment should be a precondition for the welfare of other school communities.

Lessons learned from the whole child and coordinated school health approaches.

BACKGROUNDThe new Whole School, Whole Community, Whole Child (WSCC) model, designed to depict links between health and learning, is founded on concepts of coordinated school health (CSH) and a whole child approach to education.METHODSThe existing literature, including scientific articles and key publications from national agencies and organizations, was reviewed and synthesized to describe (1) the historical context for CSH and a whole child approach, and (2) lessons learned from the implementation and evaluation of these approaches.RESULTSThe literature revealed that interventions conducted in the context of CSH can improve health-related and academic outcomes, as well as policies, programs, or partnerships. Several structural elements and processes have proved useful for implementing CSH and a whole child approach in schools, including use of school health coordinators, school-level and district-level councils or teams; systematic assessment and planning; strong leadership and administrative support, particularly from school principals; integration of health-related goals into school improvement plans; and strong community collaborations.CONCLUSIONSLessons learned from years of experience with CSH and the whole child approaches have applicability for developing a better understanding of the WSCC model as well as maximizing and documenting its potential for impacting both health and education outcomes.

The Whole School, Whole Community, Whole Child model: a new approach for improving educational attainment and healthy development for students.

BACKGROUNDThe Whole Child approach and the coordinated school health (CSH) approach both address the physical and emotional needs of students. However, a unified approach acceptable to both the health and education communities is needed to assure that students are healthy and ready to learn.METHODSDuring spring 2013, the ASCD (formerly known as the Association for Supervision and Curriculum Development) and the US Centers for Disease Control and Prevention (CDC) convened experts from the field of education and health to discuss lessons learned from implementation of the CSH and Whole Child approaches and to explore the development of a new model that would incorporate the knowledge gained through implementation to date.RESULTSAs a result of multiple discussions and review, the Whole School, Whole Community, Whole Child (WSCC) approach was developed. The WSCC approach builds upon the traditional CSH model and ASCD's Whole Child approach to learning and promotes greater alignment between health and educational outcomes.CONCLUSIONBy focusing on children and youth as students, addressing critical education and health outcomes, organizing collaborative actions and initiatives that support students, and strongly engaging community resources, the WSCC approach offers important opportunities that will improve educational attainment and healthy development for students.

How the Whole School, Whole Community, Whole Child model works: creating greater alignment, integration, and collaboration between health and education.

BACKGROUNDThe Whole School, Whole Community, Whole Child (WSCC) model calls for greater collaboration across the community, school, and health sectors to meet the needs and support the full potential of each child. This article reports on how 3 states and 2 local school districts have implemented aspects of the WSCC model through collaboration, leadership and policy creation, alignment, and implementation.METHODSWe searched state health and education department websites, local school district websites, state legislative databases, and sources of peer-reviewed and gray literature to identify materials demonstrating adoption and implementation of coordinated school health, the WSCC model, and associated policies and practices in identified states and districts. We conducted informal interviews in each state and district to reinforce the document review.RESULTSStates and local school districts have been able to strategically increase collaboration, integration, and alignment of health and education through the adoption and implementation of policy and practice supporting the WSCC model. Successful utilization of the WSCC model has led to substantial positive changes in school health environments, policies, and practices.CONCLUSIONSCollaboration among health and education sectors to integrate and align services may lead to improved efficiencies and better health and education outcomes for students.

Farm to School Teaching Gardens in an Urban School District: Integrating Nutrition Services, Coordinated School Health and Public Health

Farm to School Teaching Gardens in an Urban School District: Integrating Nutrition Services, Coordinated School Health and Public Health

Educational outcomes associated with childhood obesity in the United States: cross-sectional results from the 2011-2012 National Survey of Children's Health.

BackgroundPast research examining the effects of childhood obesity has largely focused on its projected effects into adulthood. However, there is emerging evidence that childhood obesity may have more immediate effects on school-related outcomes. We examine a range of educational attainment indicators to examine the possible pathway between obesity status and academic performance, while investigating the proximal effects of childhood obesity on health and utilization of health services, and whether these variables attenuate the relationship between obesity status and educational outcomes.MethodsData for the current study come from the 2011-2012 National Survey of Children’s Health, which details the impacts of childhood obesity on a range of outcomes among a nationally representative sample of children and adolescents aged 10-17 years (N=45,255). Educational outcomes (school absences, school problems, repeating a grade and school engagement) were modeled by logistic regression as a function of BMI, overall health status, health care utilization, and a range of sociodemographic variables.ResultsBMI status was significantly associated with all educational outcomes (p<0.001 for all), overall health status (p<0.001), and health care utilization (p=0.016). Prior to adjustment for covariates, obese children were significantly more likely to have school absences and school problems, to repeat a grade, and to have lower school engagement than non-overweight children. After adjustment for sociodemographic and health/healthcare variables, these outcomes remained significant for all but repeating a grade. The odds of having school problems, repeating a grade, and low school engagement that were associated with obesity were attenuated by the addition of sociodemographic variables into the model, while the addition of health and health care variables in the model decreased the odds of school absences.ConclusionsThis study provides evidence that increased weight status in children is associated with poorer educational outcomes. While recognizing that these are cross-sectional data, we suggest that 1) health-related and sociodemographic factors should be a focus point of intervention, and 2) a socio-structural approach including Coordinated School Health intervention is crucial to reducing childhood obesity and improving educational outcomes in this population.

Texas GROW! EAT! GO! Preliminary Findings of Garden, Nutrition and Physical Activity Interventions on Child Behaviors and Obesity

ObjectiveThe goal of the Texas GROW! EAT! GO! project is to assess the efficacy of a Coordinated School Health Program (CSH) enhanced with theory-based, family-focused, experiential garden, nutrition and physical activity programs on the prevalence of child obesity in third grade students.Description1,405 students, 1,200 parents, 128 teachers and 53 volunteers enrolled in Cohorts 1 & 2 of the study at five sites in Texas involving 80 classes of 3rd grade students. Title 1 schools at each site were randomly assigned to receive CHS alone or with Walk Across Texas (WAT), Junior Master Gardener (JMG) or both WAT and JMG over a one year period.EvaluationEvaluation included Child BMI and student surveys (four times over 2 years), parent surveys (3 times over 2 years), teacher and volunteer surveys (2 times over 1 year). Process evaluation included teacher records of implementation, school champion interviews, and weekly reports by on-site leaders.Conclusions and ImplicationsData from student and parent surveys (not matched) indicated increased self-efficacy to consume healthy beverages, reduced consumption of sugar sweetened beverages, increased healthy family meal practices and increased knowledge about nutrition and plant science. Combined treatment effects indicated significant increases in vegetable exposure and preference, decreased screen time, increased moderate to vigorous physical activity and selection of fruit juice over soda. Mixed effects were found related to obesity and overweight change.FundingUSDA Grant #2011-6800-30138, (USDA/NIFA Grant.gov # - 10950125). ObjectiveThe goal of the Texas GROW! EAT! GO! project is to assess the efficacy of a Coordinated School Health Program (CSH) enhanced with theory-based, family-focused, experiential garden, nutrition and physical activity programs on the prevalence of child obesity in third grade students. The goal of the Texas GROW! EAT! GO! project is to assess the efficacy of a Coordinated School Health Program (CSH) enhanced with theory-based, family-focused, experiential garden, nutrition and physical activity programs on the prevalence of child obesity in third grade students. Description1,405 students, 1,200 parents, 128 teachers and 53 volunteers enrolled in Cohorts 1 & 2 of the study at five sites in Texas involving 80 classes of 3rd grade students. Title 1 schools at each site were randomly assigned to receive CHS alone or with Walk Across Texas (WAT), Junior Master Gardener (JMG) or both WAT and JMG over a one year period. 1,405 students, 1,200 parents, 128 teachers and 53 volunteers enrolled in Cohorts 1 & 2 of the study at five sites in Texas involving 80 classes of 3rd grade students. Title 1 schools at each site were randomly assigned to receive CHS alone or with Walk Across Texas (WAT), Junior Master Gardener (JMG) or both WAT and JMG over a one year period. EvaluationEvaluation included Child BMI and student surveys (four times over 2 years), parent surveys (3 times over 2 years), teacher and volunteer surveys (2 times over 1 year). Process evaluation included teacher records of implementation, school champion interviews, and weekly reports by on-site leaders. Evaluation included Child BMI and student surveys (four times over 2 years), parent surveys (3 times over 2 years), teacher and volunteer surveys (2 times over 1 year). Process evaluation included teacher records of implementation, school champion interviews, and weekly reports by on-site leaders. Conclusions and ImplicationsData from student and parent surveys (not matched) indicated increased self-efficacy to consume healthy beverages, reduced consumption of sugar sweetened beverages, increased healthy family meal practices and increased knowledge about nutrition and plant science. Combined treatment effects indicated significant increases in vegetable exposure and preference, decreased screen time, increased moderate to vigorous physical activity and selection of fruit juice over soda. Mixed effects were found related to obesity and overweight change. Data from student and parent surveys (not matched) indicated increased self-efficacy to consume healthy beverages, reduced consumption of sugar sweetened beverages, increased healthy family meal practices and increased knowledge about nutrition and plant science. Combined treatment effects indicated significant increases in vegetable exposure and preference, decreased screen time, increased moderate to vigorous physical activity and selection of fruit juice over soda. Mixed effects were found related to obesity and overweight change.

Feasibility and Acceptability of Brighter Bites: A Food Co-Op in Schools to Increase Access, Continuity and Education of Fruits and Vegetables Among Low-Income Populations.

Intake of fruits and vegetables (F&V) continues to be low in children in the United States. The purpose of this study was to conduct a pilot feasibility evaluation of Brighter Bites, a school-based food co-op to provide access to fresh F&V and nutrition education to low-income children and their families. Brighter Bites is a 16-week school-based food co-op consisting of: (1) Weekly distribution of 50-60 servings of fresh F&V; (2) Weekly bilingual parent handouts and recipe demonstrations; and (3) implementing CATCH, a coordinated school health program in schools. Brighter Bites was pilot tested using a pre-post evaluation design in one charter school in Houston, TX, USA (n = 57 3rd grade parent-child dyads; 94.1 % Hispanic, 91 % low-income). Evaluation, at baseline, midpoint, and post-intervention, included self-reported child and parent surveys on psychosocial factors, dietary habits and mealtime practices. Pearson's Chi square test, Fisher's exact-test or paired t test were used to determine changes pre- to post-intervention (at p < 0.05). Process data using parent surveys, teacher surveys, attendance logs, and produce cost data were used to determine feasibility and acceptability of program. Participants received on average 61 servings of F&V weekly for 16 weeks at the cost of $4.31/family/week. Results showed significant increases in child reported self-efficacy, outcome expectations and attitudes towards consuming F&V (p < 0.05). We found significant increases in child exposure to F&V and child preference of various F&V from baseline to post-intervention (p < 0.05). Parent surveys showed significant improvements in mealtime practices at home: decrease in children eating while watching TV, increase in eating dinner with the family, less fast food, less sugary drinks with meals, more children asking for F&V as snacks. Process data showed 98 % retention rate and high parent acceptability of program components. Brighter Bites is a promising strategy to increase F&V access and education in low-income populations using existing infrastructure of schools and food banks.

Coordinated school health and the contribution of a district wellness coordinator.

A San Francisco Bay Area school health initiative was established in fall 2010 to improve wellness programs in 4 local school districts using the Coordinated School Health (CSH) model. This study examines the role of district-wide wellness coordinators and the ways in which they contribute to intentional coordination of health and wellness programs and activities in their school districts. This study included 8 schools across 4 school districts. Researchers conducted semistructured interviews and focus groups with district and school staff, students, parents, wellness committee members, and wellness coordinators in 2012 to examine a range of perspectives about the coordination of school health and wellness. District wellness coordinators' efforts were linked to an increase in (1) awareness of health and wellness, (2) integration of wellness activities within and across schools and districts, and (3) leveraged resources. Wellness coordinators are critical to successful CSH efforts. Through intentional and strategic collaboration with key stakeholders, wellness coordinators advance CSH goals of integrating health and wellness programs within and across school districts, reaching more students equitably and leveraging resources.

School-based adolescent obesity prevention programming: perceptions of school personnel in Southern Appalachia.

Coordinated School Health (CSH) is a systematic approach to improving the health and well-being of school-age children. It is recommended for its potential to promote healthy weight in adolescents through strategic programming. Resources and programming for adolescent obesity prevention varies among schools, thereby limiting the intended benefits of CSH. The purpose of this study was to understand gaps in schools' approaches to healthy weight promotion and support for overweight/obese students. We evaluated perceptions of adolescent obesity and environmental factors and programs facilitating healthy weight in high schools in Appalachian Tennessee. In 2012, 17 key school personnel from 5 randomly selected high schools were interviewed. Questions addressed their perceptions of adolescent obesity, school-based physical activity and nutrition programming, and support available to overweight/obese students. Thematic analysis was conducted to identify emerging themes. Participants consistently identified adolescent obesity and/or associated risk factors as major health problems within their schools. Barriers to physical activity and healthful eating were identified at multiple levels. Because of the sensitivity surrounding overweight/obesity, no particular programs or curricula targeted overweight/obese adolescents specifically, but they were available to all students. Support is not explicitly available; therefore, overweight/obese students must seek out these resources. Findings suggest that although school personnel are concerned about the impact of adolescent obesity on health outcomes, there is wide variation across schools on the types and quality of programming available to address the issue. Results can be used to encourage school-based strengths and identify gaps in the CSH infrastructure in school systems.

Effect of a School-Based Intervention on Parents' Nutrition and Exercise Knowledge, Attitudes, and Behaviors

BackgroundParents exert a significant effect on children's eating behaviors and physical activity levels, so it is imperative to find successful obesity prevention programs that target whole families in underserved communities.PurposeTo investigate the effects of a Coordinated School Health Program (CSHP) on parents in the program over a 2-year period.MethodsParents of kindergarteners (n = 277) in 7 schools participating in a CSHP that served an underserved, predominantly minority community were surveyed at 3 time points regarding their nutrition and physical activity knowledge, attitudes, and behaviors (KABs). Results after years 1 and 2 were compared with pre-intervention results using t tests. Effects of socioeconomic variables were investigated using multivariate linear regression.ResultsReported unhealthy behaviors were lower at the end of both year 1 (P = .03) and year 2 (P = .04). Numerous factors were associated with changes in KABs in the parents, including parental gender.DiscussionA CSHP may have lasting effects on parental behaviors in an underserved, predominantly minority community.Translation to Health Education PracticeFuture studies should assess the effects of CSHPs in other populations and which factors most significantly affect parental attitude and behavioral changes so that program content may be tailored accordingly.

Exercise Strategies for Children

Exercise Strategies for Children