12: The National Role in Coordinated School Health Programs

National Level Organizations can influence support for CSHP and implementation from both government and nongovernmental organizations. Young people’s health and academic achievement are concerns for hundreds of national organizations and coalitions. Non-government organizations are responsible for implementing specific school health components, such as a school nurses, health teachers, PE teachers, school social workers, counselors, and psychologists. These groups focus on only a few or one aspects of school health. Most of the organizations demonstrate their support by creating position statements, policies or resolutions that place on record the organizations commitment to CSHP or specific aspects of school health. Federal government focus on many areas of a CSHP including, program funding, and development of regulations and guidelines. The federal government helps schools to prevent violence, provide nutritious school lunches, develop health education guidelines, provide physical and mental health services, and implement safety standards. The federal government can do this by helping the schools out with funding and setting guidelines. Two concerns around this are that federal mandates funding that interfere with policy and program funding, and drive to reduce the federal budget deficit. They are worried about increased flexibility, therefore allowing the programs to be more client-focused rather then program-focused. Establishing a sustained and broad-based commitment to successful implementation of a CSHP will require that staff and members of national organizations integrate action on behalf of these programs within their organizational activities and goals.
I feel the same way about this chapter as I did the previous one about the state organizations. There is still a lot that I do not understand about it, but I realize its importance on a CSHP. Everything about a CSHP starts at the top where the guidelines, broad goals, and funding is set by national agencies. From what I have learned so far, it is important for a coordinator to know what’s going on at the state and national level. Though I feel it may be easy for a coordinator to work in their own world and forget about the powers above them, there are many opportunities that can arise for their program if they stay updated with the state and national organizations.

11: The State Role in Coordinated School Health Programs

Even when all the pieces are put together to develop a successful CSHP, it still needs support from outside the school. The community and national organizations play a major role, but the state level really sets the guidelines and influence a program will have. The state legislature, governor, boards of education, education agencies, health official, state agencies, state courts, and nongovernmental players such as businesses, universities, foundations, and the media all are contributing factors to a CSHP. They all play a small roll in developing the importance of a CSHP, and have a major influence on the other. They all combine to form the importance that will be place on implementation, and evaluation on the program. The State can positively affect a CSHP by making objectives for all schools to meet in forming and following a program. It can make it much easier for a school health coordinator, when they have the support and the tools from the state. The State can find out what’s new, and continue to inform and build a solid supportive base for all schools to follow.
There is no doubt that the State is crucial for a successful CSHP. Everything that happens is revolved around the individuals that are formed from all the different areas the state has to offer. The more we can start having an affect on the individuals at the state level, the more we will start to develop healthy minded individuals from the school systems. These individuals will then take over these jobs and continue to improve health throughout the state. It all interconnects, and there are so many great health leaders out there that it will eventually all come around.

10: School-Site Health Promotion for Staff

Students are the centerpiece of school concentrations; which they should be since they are the ones being trained to make it out in the real world. But one thing that is often overlooked is the importance of the staff. They have the tough job of prepping the environment, classes, and lessons to meet all the needs for our future leaders. It is important that schools not only meet the needs of the students, but the staff as well. Working in a school is a very demanding job, and the health of the staff needs to start being a concern. Research continues to show that school-site health promotion programs for school staff not only improve the health of the individual, but their teaching techniques and excitement towards working with the students. A school-site promotion for staff is the promotion of physical, emotional, and mental health, as well as the prevention of disease and disability among school employees. The benefits of a program can go on and on. The employee’s health behaviors and status improve, but they also save money on health care costs and employee absenteeism and improve productivity and morale. For a school-site health promotion to be successful it needs to start by having a strong leader. It also needs training, teamwork, and the ability to work with institutions of higher learning and local community providers. Teachers who become interested in their own health tend to take an interest in the health of student and to serve as health role-models.
After all the chapters, I believe that this concept might be the most important. I feel that this has the ability to affect the widest range of concepts. If you can get the staff to buy into health promotion, then they can improve how they approach the classroom, and integrate health in their class. The teacher will practice and promote health, which could have a much bigger effect then any thing else in a CSHP. When students see their role-models practicing healthy behaviors, and are continually reminded about the importance of health, then that will have a major impact on the students.

9: School Nutrition Services

To help students maximize education achievements, develop healthy lifestyles and lower their risk of chronic diseases, schools need to recognize that nutrition is an essential first step in developing healthy minds and bodies in our students. It has been proven that students who are well nourished perform better in school then those who lack the essential nutrients. Students are skipping breakfast, and three percent of females are becoming bulimic and anorexic. In a school nutrition service, it calls for a stop to all of this. The essential function of a school nutrition program are; access to a variety of nutritious, culturally appropriate foods that promote growth and development, nutrition education that empowers students to select and enjoy healthy food and physical activity, and screening, assessment, counseling, and referral for nutrition problems. National school lunch program (NSLP) and the school breakfast program (SBP) are affordable health meals that appeal to the students. These programs have been set up for all students, especially those ones who are deprived of proper nutrition. The problem is that many of the students don’t take advantage of NSLP and SBP. Students with money are bringing in their own foods, and the ones who can not afford it buy from vending machines and snack bars. There is also nutrition education that can help students practice better eating habits, and educates them on the importance of a proper diet. For nutrition services to be successful it needs the full support of all the staff members, and the proper screenings assessments taken place. There are many individuals and organizations out in the community who are willing to help and support a nutrition program; it just comes down the leadership and the school working together to reach the same goal.
The more I learn about the health content, the more I start to believe that nutrition is the most important component of health. Physical activity is not too far behind, but nutrition is so important to the overall wellness of the body. I really believe that vending and soda machines need to be abolished from the school. I also think that there should be a nutrition week once a year. Kind of like how a lot of schools have winter games every year. They could make nutrition into games and competition that really hammers home the importance of a proper diet. I think that a CSHP should really focus on the community and guardians as well. If we can’t stop vending machines and students buying from snack carts and what not, then we need to educate the parents on how what their allowing their children to eat affects their health. More activities that involve parent involvement can only help. There are so many things that need to be done and could be done to help with the students nutrition, it starts by making an effort to help the students understand how what their doing now will affect them as they grow.

8: School Health Services

In the previous chapter we discussed counseling, psychology, and social services. We now will discuss the services that should be placed in school to help support these professions. Today’s students come to school with health needs that affect their ability to learn and to reach their full potential. Although caregivers have primary responsibility for the health care of their children, schools also have responsibility for promoting the well-being of students. Health services should be placed in schools to help students’ arrive healthy and ready to learn, safe from injuries, given a primary provider for preventive medical and dental services, and receive needed nutrition and mental health, substance abuse, sexual abuse, and other counseling services. A school health service helps students meet these needs. A variety of professionals should be included in a school health service: school nurses, physicians, dentists, dental hygienists, counselors, psychologists, social workers, occupational therapists, physical therapists, and speech pathologists; all of which should either have a license or certificate. The services are often supported by community agencies, state revenues, Medicaid, or other federal and state agencies. As with every aspect of a coordinated school health program, there should be a school health coordinator, as well as a health school team with each member having a specific role. The team should support and work to improve the quality of school health services to enhance the learning of the students.
Like I said in the previous chapter, I agree and like everything the chapter has, but I just can not picture all these programs working in a majority of Maine schools. While I was reading this chapter I thought a lot about consolidation of the schools in Maine. I have not liked it for the main reason that I went to a small school and believe it has a lot to offer. For a coordinated school health program to work, I started to think that consolidation might be the best solution. I realize that I pushed for community agencies to help out in the previous chapter, but I have now thought of a better way. Rather than consolidating all the schools that are planned, stick with the idea of having one superintendent for several districts, as well as having other services for all the districts. Instead of trying to consolidate schools, or try to make a coordinated school health program work in a district that it can not. Create a neutral office for schools that share the same superintendent and have services such as a coordinated school health program that supports all the schools within that superintendent’s reign. This could also work for other services and other programs that are unable to be implemented in the schools. Maybe this idea has already been thought of, as they are constantly changing and leaving me behind. I do realize some schools will need to consolidate, but there are some that can still survive with a set up like this.

7: School Counseling, Psychological, and Social Services

Between 12% and 22% of children suffer from mental, behavioral, or emotional disorder, and only a few of these children receive mental health services. Many students are not fulfilling their mental and physical promise. For students to benefit from their schooling, society must address social, emotional, and physical health problems and other major barriers to learning. Counseling, psychological and social services are essential for students experiencing severe and pervasive problems. These services help the development of the students: responsibility and integrity, self-esteem, social and working relationships, self evaluation and self direction, temperament, personal safety and safe behavior, health maintenance, effective physical functioning, careers and life roles, and creativity. Schools find that counseling, psychological, and social services not only increase these behaviors, but also reduce drop outs, substance abuse, gang activity, teen pregnancy, and many other problems. The overall purpose of these programs is to minimize barriers to student learning and promote students psychosocial development. To do this, there are three broad categories: Direct services and instruction, developing systems, programs, services, and resources, and connecting school and community resources. Each of these requires direct breakdowns that help improve the environment of the school. Very few schools come close to addressing these needs. Addressing the psychosocial barriers to learning and enhancing healthy development for the majority of students is a major issue among schools. Due to the many different fields that can be covered, schools are not able to afford the full time efforts of many of these professionals. Nation wide there is one school psychologist or social worker for every 2500 students and one school counselor for every 1000 students. Since schools are only covering the bare minimal in terms of meeting student psychological needs, one solution is to provide collaborations between the school and community providers. National and state support helps provide schools opportunities to work with organizations throughout the community that can help the student’s psychological needs. In the end, to break down all barriers you must: create a mission statement; organize restructuring; map and analyze resources, help schools find most cost effective to use available resources; develop a staff.
I agree with everything the chapter has to say. Unfortunately, psychological issues are a major problem among youth. Many of these students with the problem do not have the access or resources to get the appropriate help, and neither do the schools. Some of the solutions the chapter gave I thought were good ideas for bigger schools that were located in an urban community. Rural communities do not possess the same services; therefore make it very difficult for small schools with minimal budgets to hire on someone to help with these issues. I believe that the role of the guidance counselor is often overlooked. Most students only refer to them when signing up for classes and applying for colleges. Guidance counselors can be a much more valuable resource, and can recognize what programs or situations students can be placed in to help them fulfill their psychological needs. I realize that this does not solve the problem of filling all the professions that a school health coordinator would like to see, but for schools that have not other option, I believe that a guidance counselor can point to and bring in a professional for certain students needs.

6: Physical Education

A major issue among Americans is the health problems that are arising from the lack of physical activity they are participating in. A lot of individuals do not understand that the lack of physical activity can cause serious health problems down the road. One reason for the lack of understanding is that school do not put as much emphasize on it as they should. This chapter discusses how to successfully implement a physical education program in schools so that children can learn life long activities to help improve and maintain their overall wellness.
Schools are in a great position to teach the students the benefits of lifetime physical activity. They can hire a professional to properly supervise and give instruction; they have all the facilities and equipment to broaden the student’s interests; and they have the power to force students into a physical education class so they can at least have an opportunity to participate in some sport, or learn how it affects their well-being. The problem is that most schools do not do this. In 1995 only 25% of students participated in daily physical education. At the elementary level, only eight states require physical educators to have certificates and only 74% of all secondary physical education teachers were certified in health and physical education. This is a problem; physical education teachers, who are not certified, do not understand the wide variety of activities that should be used during a class, and more importantly can not help students and the school deal with questions or issues regarding physical education. Coaches even play an important role. When the physical education teachers are not involved with the sports programs, some coaches have no one to refer back to in terms of creating a safe, enjoyable, and healthful atmosphere for the student athletes. Schools also place very little importance on physical education, not just in terms of hiring a certified teacher, but by not requiring the students more time in a physical education classroom. The centers for disease and control established some guidelines to help physical education in the classroom:
1.) Establish policies that promote enjoyable, lifelong physical activities.
2.) Provide physical and social environments that encourage and enable young people to engage in safe and enjoyable physical activity.
3.) Implement sequential physical education curricula and instruction in grades K-12.
4.) Implement health education curricula that feature active learning strategies and follow the national health education standards and help students develop the knowledge, attitudes, and skills they need to adopt and maintain a healthy lifestyles.
5.) Provide extracurricular physical activity programs that offer diverse, developmentally appropriate activities.
6.) Encourage parents and guardians to support their children’s participation in physical activities.
7.) Provide training to enable teachers, coaches, recreation and health care staff, and other school and community personnel to promote enjoyable, lifelong physical activity to young people.
8.) Assess the physical activity patterns of young people, refer them to appropriate physical activity programs, and advocate for physical activity instruction and programs for young people.
9.) Provide a range of developmentally appropriate community sports and recreation programs that are attractive to all young people.
10.) Regularly evaluate physical education instruction, programs, and facilities.
By addressing these current needs of the students and developing skills, values, and knowledge to sustain behaviors that promote health, such as physical activity, students are going to be more aware of the importance of participating in a lifelong activity.
I thought this chapter hit everything right on the head. I couldn’t agree more with what they said and the suggestions they gave. I really do believe that many of today’s health issues come from a lack of physical activity, and I feel that it needs to start in the schools. I believe that it comes down to three main reason why schools are failing miserably at this, like in the chapter: there are not enough highly qualified physical education teachers; there is not enough life long and noncompetitive physical activities practiced; and schools do not put as much emphasize on it as they should. Once schools start to recognize these issues, then chronic disease rates will start to go down.

5: A Healthy School Environment

This chapter discusses the important role a healthy school environment plays in a coordinated school health program. The environment helps set the tone for the attitudes, activities, and importance a school is going to place on its overall health. A healthy environment contributes to students learning by: minimizing distractions, physical, psychological, and social hazards, creating a climate in which students and school staff do their best work, expecting all students to succeed, and implementing supportive policies. All of these create the best safe and supportive environment that is needed for all the students to reach their learning potentials. To create a healthy environment, like everything else in school health, you need leadership. A person or group of people who are willing to push and make the learning process fit the students, and staffs needs. To implement the environment, you need more than just one leader, but virtually everyone involved in the school system, including: students, administrators, teachers, custodians, maintenance, counselors, nurses, nutrition services; as well as family involvement and outside public health agencies. All involved work to complete an environment that is suitable and obtainable for everyone. Once there is a group or committee, the next step is to create an action for the school. The first step should be to develop and use data collection system for assessing and monitoring the school environment. Providing leadership and administration support for creating and sustaining a healthy school environment would be next. The plan should than be developed and implemented for sustaining a healthy school environment. Lastly, the implementation of the plan as well as the school environment should be monitored.
I believe that other than leadership, the environment is the most crucial aspect to the success of a coordinated school health program. It sets the tone of how much importance the school is going to place on health. The schools philosophy should be represented by the rules and set up of the school; if it emphasizes all the components of health, than the environment will reflect it, as well as all the members within that environment. Before students are even willing to learn, they must feel safe, intellectually stimulated, and the classroom must meet their basic needs mentally and physically. Creating a healthy environment helps solve this problem. It’s much easier to learn and work in a district that places the overall-wellness of the individuals first, rather than creating an atmosphere that restricts learning and working relationships. If everyone can buy into the environment that has been created, than it’s not only going to improve students and staff members abilities in the school, but it will also expand outside of the school in to the community.

4: Family and Community Involvement in School Health

The focus of this chapter is involving family members and the community in a Coordinated School Health Program. When children feel valued they are more likely to develop skills, avoid risky behaviors, and stay in school. Both the family and community play an important role in helping children feel valued. Each has its own uniqueness, and can help students in some ways that the other may not. It is important to involve parents with in school so that they can trust and feel comfortable about the district. They are also more likely to support school health programs. A way to get families involved is to keep them updated, encourage them to help out in planning, create grade level activities that they can participate/help in, share facilities, support health systems for families, and get to know them. The community plays an important part of the development of students. Involving them is almost as important as family involvement. It is important that the school make time for the community partnerships to get involved, as well as encourage students to be active within the community and its organizations. The school and community should plan together, so that consistent messages will be sent to the students. A school health program can only be successful when all members of the school community participate. This creates a bond and understanding of what is expected and what needs to be done to best benefit the student’s needs.
I thought this chapter gave some good examples of how to get the community and families involved. I typically think it is a success if you can just get parents to attend parent teacher meetings at the high school, but this chapter helped me recognize there is a lot more that can be done to get families involved. I now believe that by making sure the parents know who you are and what your plans are only help the situation that much more, even if they come off as not caring. Trying to get families involved with most of the activities may start off slow, but if you continue to try to get to know them, they will hopefully build a trust and comfort level with them and give you and health programs their support.
The community is always involved with the school, but I believe it is often overlooked, or not involved as much as it could be. It seems that the school involves the community only for traditional or yearly events, or when they are desperate for help. After reading this chapter I think it is more important to involve the community much more and before the school actually needs them. The community is always something you can rely on or fall back on to. I like the idea of students being more involved in it, and actually having classrooms use the community for lessons. This only makes the bond that much stronger. Not to mention the most important part, but the community is where students spend all their time. To send the right messages, it is important that the community and school are at the same level. The community deserves just as much say as anyone else, they are the people, and organizations that help mold our students.

3: Comprehensive School Health Education

The purpose of Comprehensive School Health Education is to motivate students to maintain and improve their health, prevent disease, and avoid or reduce health-related risk behavior. It teaches students to become health literate, which in return will improve the quality of their overall well-being. A major issue with most education departments is the lack of health educators, or qualified health educators. Health education often is not taught in every grade, and more than likely is taught by teachers who have not been professionally trained in health education. Even though it is still a battle to implement a more appropriate health class within a curriculum, health education has come a long way. Thanks to an improved curriculum, the focus has moved from health facts to functional health information that leads to the practice of healthy behaviors. This change took place in 1995 when curriculum added National Health Education Standards, which included performance indicators as sub-headings. The standards were designed to create universal health literacy; including preparation of students to be critical thinkers and problem solvers; responsible citizens; self-directed learners; and effective communication. Each standard has its own performance indicator that defines what students should know and be able to do at grades 4, 8, and 11. To implement a successful curriculum there should be several factors that include: leadership, stable environment, and appropriate health education activities. Included in a successful Comprehensive School Health Education is that of multiple assessment strategies. Assessments should be graded by rubrics that are consistent with that of the national standards.
No knowledge is more crucial than knowledge about health. Without it, no other life goal can be successfully achieved. This quote by Ernest L. Boyer is the opening line for the chapter. I think these two sentences are the best way to describe the importance of health education in the school system. Unfortunately many districts and individuals do not seem to understand this concept. This stats proves that: 80% of health education teachers had been teaching for five of more years, less than 5% majored in health education(Boyer). This is very disturbing to me. Health education is crucial in the development of students. Having that many educators not qualified to teach the subject is not good for the profession or society. Health education is slowly getting better, but I feel that if there was a true health education coordinator in every district, then it would only increase the improvement of the curriculum that is discussed. Some districts do have them, but not nearly enough districts do. I would like to compare districts health programs in the state of Maine that have certified health coordinators, to those districts that do not. I feel it would be an interesting comparison.

2. Implementing School Coordinated Health Programs

This chapter discusses the steps it takes to establish and strengthen CSHP, and build district level support for a CSHP. Most schools have a few elements of a CSHP, but few have all of them. One way of implementing a successful program is by following these characteristics; finding a purpose and potential outcomes, value of identified needs, clarity of purpose, adaptability, replicability, consistency with schools mission, ease of implementation, credibility with school and community, capacity of broadening school and staff knowledge base, and potential ehance or support existing programs. The more these characteristics are used in an innovation, the more likely a school will adopt the program. Along with these characteristics, Rogers has five characteristics that a school can use to create a step by step process for promoting and successfully implementing the program. The process includes; relative advantage, compatibility, complexity, trialability, and observability. Each process has questions that should be answered within the program to insure that it meets all the needs of a CSHP.
CSHP’s can not survive in a school system without support. It’s not only important for members and families of the school to have its back, but also for the district. Having a district level CSHP only makes both programs stronger as they each support the other. Leaders within the school and community can increase the successfulness of a CSHP by working together to meet the needs of the students and community members. Not all CSHP’s are the same, it is important that members of the program understand what issues at the time need to be focused on. This is important in establishing a healthy school team and identifying “key players” to represent the team. Key players should include staff within the school, health care specialists/professionals, parents, members of the community and health educators. The team should understand the importance of assessing student, family and staff needs; mapping existing school and community resources; identifying gaps and duplications; developing action plans; and monitoring implementation.
Other key informants that a team should do are: get the rest of the school staff to buy into the program. Make their needs a top priority so that they are willing to support you. Set up a safety net. Always have a back up in case a strategy causes conflict or falls through. Create a resource map of CSHP. This will help the team understand where they are, where the gaps are, and what is being duplicated. Identify student, family, and staff needs. Understanding their needs is the most important aspect when creating goals and objectives for the program. Identify an implementation and coordination plan. This can take some time, and will call for many resources as well as support to find the needs of the program. Find potential source of funding. Depending on the program, funding is often a major road block. Understand the federal and state funding requirements, as well as look for support locally. The last thing is to look for support from the district. If a district level CSHP is not built, then look to leaders within the district to help out.

1: Linking Health and Learning: An Overview of Coordinated School Health Programs

This chapter is an introduction of a Coordinated School Health Program (CSHP). It discusses how students need’s will be met only when they are healthy, and that their overall well-being should be at the heart of a school program. Most serious injuries in school include; tobacco use, poor eating habits, abuse of alcohol and other drugs, behaviors that result in intentional or unintentional injury, physical inactivity, and sexual behaviors. When these problems emerge, they can disrupt student’s life, which in return affects their learning in school. A CSHP has eight components that will be effective towards students’ health, which will create a much better environment and behaviors for learning. At the moment a CSHP is more of a discussion, then actually movement. With concerns of students needs coming to the forefront, a CSHP seems to be a solution to the improvement of not only the learning capabilities of students, but to all individuals well-being throughout the world.
I found the expected outcome statistics of CSHP the most fascinating aspect of this chapter. I realized their would be a holistic affect in terms of health benefits to everyone throughout their lives, but I had never thought about the money it would save not only the individual, but the nation and all the programs and companies in the health field. Every dollar invested in tobacco, alcohol, and sexual behaviors education saves society a lot more then I would have ever expected.