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Higher Education and
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SHORT ATTENTION span. Little or no commitment to school work. Poor academic performance. Dropping out. These problems, while all too familiar to many educators, have something in common that, at first, may not be quite so obvious: they have all been linked to the health status and health behaviors of school-age children and adolescents. In fact, there is a growing body of literature pointing to a handful of unhealthy behaviors that have known detrimental effects on the academic lives of young people: poor eating habits, tobacco use, abuse of alcohol and other drugs, physical inactivity, interpersonal violence, and sexual behaviors that result in pregnancy or disease.2
Clearly, these six behaviors can do more than impair scholastic performance. They have also been implicated as causes of the so-called new social morbidities. Examples of the latter include cancer and heart disease resulting from tobacco use, injuries from alcohol-related car crashes, and HIV infection resulting from unprotected sex. So, while a hundred years ago infectious diseases posed the greatest threat to health and human life, today the same six behaviors implicated above in poor student performance now account for more than 70% of deaths, diseases, and disabilities among adolescents in the United States.3
The good news, though, is that these unhealthy behaviors are preventable. And since these behaviors are usually established in childhood or adolescence, the elementary and secondary school years offer prime opportunities for preventive intervention.4 What can be done to improve the odds that today's students will be healthy and ready to learn and, as tomorrow's adults, will have the skills and knowledge they need for lifelong health?
As stated above, research has established links between health behaviors and academic outcomes, including graduation rates and standardized test scores.5 Furthermore, numerous studies have established the effectiveness of school health programs in reducing specific risky behaviors. For example, mental health and social service interventions have had positive effects on student functioning and attendance and have reduced teacher frustrations. Evaluations of the impact of certain classroom curricula reveal improvements in student knowledge, attitudes, and practices -- most notably reductions in alcohol, tobacco, and drug use. But experts believe that the potential impact of these efforts could be much greater if programs in specific risk areas were coordinated.6
Coordinated School Health Programs
In the late 1980s experts in the field of school health formulated an approach that is known as the Coordinated School Health Program (CSHP).7 "A Load off the Teachers' Backs: Coordinated School Health Programs," the Kappan Special Report by Harriet Tyson that appears in this issue, details the components that define such programs. In general, comprehensive, coordinated school health programs focus on the key risks to health and learning; they have support from students, family, friends, and adults within the school and community; they incorporate the thoughts and efforts of many disciplines, community groups, and agencies; they use multiple programs or components; they offer staff development programs; and they use inclusive and broadly based program planning.
So what does a CSHP really look like? H. E. Corley Elementary School in Irmo, South Carolina, won a "South Carolina Healthy School Award" in 1998. Some of the healthy school activities at H. E. Corley include a bicycle safety program, healthful food choices in the cafeteria, school health services, health education, a walking and jogging club for students, the Corley Care Buddies (a program that pairs adult mentors and at-risk children), I'm Thumbody (a self-esteem program for first- and third-grade students provided by the local mental health association), the DARE drug-prevention program (provided by local law enforcement agencies), and an on-site faculty/staff wellness program.
The school has established partnerships with local agencies to provide mammograms, flu shots, and health screening for staff members. There are many opportunities for community involvement in the health programs, including Weight Watchers and exercise classes open to the public, a school carnival, and family health screening and vaccinations provided by a local medical center. The staff members at H. E. Corley feel that these activities make the school and community a healthier place for everyone and provide an optimal environment for academic achievement.
All healthy school activities at H. E. Corley are coordinated through the wellness committee, which includes the school nurse, physical education teacher, cafeteria manager, health education teacher, guidance counselor, and other interested staff members. This group assesses student needs and sets goals yearly. While members of the wellness committee are involved in implementing key activities in the program, many of the activities and projects are coordinated by other interested teachers, staff members, parents, or community members. The program has strong administrative support at the school and district levels and strong connections with community organizations such as the office of parks and recreation and the local hospital. Members of the wellness committee stress the importance of broad participation and collaboration in planning and carrying out a CSHP.
It should be emphasized that CSHPs are not add-on programs or unaffordable luxuries. They acknowledge the complexities of "social morbidities" and seek to coordinate the efforts of existing school health personnel and community resources to reduce the impact of these complex problems on academic achievement.
State Programs
At the state level, the emphasis of a CSHP is on the efficient coordination of state resources and the development of effective models that can be replicated at the local level. Typically, the coordination of state resources is handled through a state-level infrastructure or a coalition in support of CSHP.8 For instance, the Centers for Disease Control and Prevention (CDC) have provided funding to state health and education agencies in 15 states to support senior-level positions dedicated to CSHP. These "infrastructure" positions serve to institutionalize collaboration between state agencies that have vested interests in promoting the health of students but that otherwise might not work together on school health issues. Other potential partners in a state's CSHP infrastructure are state social services, mental health agencies, and environmental health agencies.
Another form of state-level coordination of resources is a CSHP coalition, which typically involves representatives from both governmental and nongovernmental organizations. Potential partners in a CSHP coalition include voluntary health agencies such as the American Heart Association; professional associations of nurses, psychologists, and health educators; religious institutions; and parent/teacher organizations.
South Carolina is fortunate to have both a CDC-funded infrastructure project, the South Carolina Healthy Schools Initiative, and a state-level coalition for CSHP, the Healthy Schools/Healthy South Carolina Network. The state infrastructure project is coordinated through the South Carolina Department of Education and the South Carolina Department of Health and Environmental Control and is guided by an interagency work group. It brings together state agencies, nonprofit health organizations, and institutions of higher education. This group's purpose is to ensure that there is state-level infrastructure that includes policies, resources, communication mechanisms, and personnel for implementing CSHPs.
South Carolina's state coalition for CSHP, the Healthy Schools/Healthy South Carolina (HS/HSC) Network, has about 320 members statewide. The institutional home of the HS/HSC Network is the American Cancer Society. The group is guided by an action council that includes regional representatives from both governmental and nongovernmental organizations (state agencies, professional education and health organizations, voluntary health agencies, and advocacy groups) concerned with the health and well-being of South Carolina's children and youths. The mission of the HS/HSC Network is "to promote quality school health programs that involve family and community, develop healthy lifestyles, and build skills to prevent and reduce health problems."
The Healthy Schools Initiative operates within the state government structure to support implementation of CSHPs. The HS/HSC Network's activities include legislative advocacy that is beyond the scope of state agencies, as well as communicating and networking with a large and diverse group not typically affected by state agencies. A joint leadership team coordinates the activities of the two groups. The Healthy Schools Initiative and the HS/HSC Network co-sponsor the annual "South Carolina Healthy Schools Awards," recognizing schools that have implemented quality CSHPs.
Higher Education and CSHPs
It is clear that coordinated planning activities involving the appropriate stakeholders are key to the development both of CSHPs within school districts and of supportive policy and resource environments at the state and national levels. There is one potential partner in CSHPs that we have not yet mentioned: higher education. Institutions of higher education (IHEs) either have limited contact with CSHP efforts or have yet to join the CSHP circle altogether. We have been trying to understand why IHEs are not more involved and to figure out ways to increase both the quantity and quality of their involvement.
There are several major reasons why higher education should become involved in CSHPs. First, there is a need for coordinated preparation of the professionals involved in conducting a CSHP, and higher education already has a role in preservice and inservice training. Students in such programs as school nursing, physical education, health education, and food services should receive training not only in the content of their specialties but also in the CSHP concept and interdisciplinary teamwork.
Second, the health needs of children and youths involve multiple social, economic, and health components and require interdisciplinary approaches. IHEs can offer the resources (e.g., experts from a variety of fields) to assist schools and communities in addressing these complex issues. IHEs could also provide critically needed research on links between health programs and learning outcomes.
Another reason for IHE involvement is the potential benefit of IHE/school partnerships for IHEs. Schools often serve to provide field experiences for students and laboratories for research. Professional development schools, in which IHEs and local schools have collaborative agreements, are mutually beneficial to teachers-in-training, school faculty members, and IHE faculty members. IHE/school partnerships can facilitate the linking of theory to practice in the higher education curriculum.
Colleges and universities have an increasing interest in providing meaningful service. Working with schools and communities to identify and address health and education needs is an important area for service delivery and service learning opportunities.
Colleges and universities should also have an interest in the health and academic performance of children and youths in our public schools because those young people are part of the pool of future applicants to IHEs. Health risk factors and academic deficiencies affect students' college performance, including retention and graduation.
Finally, IHEs are in a position to supply leadership for collaborative efforts. Faculty members are often seen as leaders in the community, and they have the expertise and credibility to provide advocacy on behalf of children and youths.
In 1997 we participated in an effort by the Division of Adolescent and School Health of the Centers for Disease Control to explore how IHEs can best work with school health professionals to promote and disseminate CSHPs. As part of a cross-country network of 10 CDC-funded Prevention Research Centers, we conducted focus groups and interviews on this topic with individuals who were representative of the potential collaborative partners: academics, state-level school health officials, and local school health practitioners. We identified four general areas in which state education agencies and schools have collaborated with IHEs: training, consultation, research, and networking.
Colleges and universities have a long history of providing preservice and inservice training to school health professionals, including teachers, nurses, physicians, counselors, and social workers. In addition to the traditional classroom courses, this training has involved collaborations in which IHEs have placed student teachers and practitioners in school health classrooms and clinics and school health practitioners have come to IHEs as guest lecturers or adjunct faculty members.
As consultants, IHEs have provided technical assistance in programming and curriculum development at the local level. IHEs have also been involved at the state level in the development of guidelines for high school graduation standards and professional credentialing.
In terms of collaborations related to research, IHEs have conducted research projects with local schools and assisted with program evaluation at both the state and local levels. IHEs are typically the main initiators of research activities.
Finally, IHEs and school health professionals have networked with one another. Representatives from state agencies, community organizations, and IHEs have participated in statewide coalitions, school health conferences, and policy advisory committees. State- and local-level partners typically provide the "home" and administrative support for CSHP collaborations that involve IHEs. IHEs also reported networking activities within and among themselves to facilitate multidisciplinary teacher training.
Effective IHE/School Collaboration
Over the past year we have learned a lot about what has and hasn't worked when schools and IHEs collaborate. Our "lessons learned" are presented below in the form of questions that potential collaborators should consider as they approach an IHE/school partnership.
Higher education can play a significant role in efforts to enhance, promote, and disseminate coordinated school health programs. Through our interviews with academics and school health professionals, we have learned about successful collaborations between IHEs and local and state CSHPs, as well as common stumbling blocks. Clearly, there is room for improvement and increased participation in collaborative efforts. The bottom line is that healthy students make better learners. Thus investing in school health at the K-12 level benefits everyone. We strongly encourage schools, state agencies, and institutions of higher education to reach out to one another in order to work together toward this end. And if you're already part of a successful CSHP collaboration, keep up the good work!
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Last updated 23 March 1999
URL: http://www.pdkintl.org/kappan/ksau9901.htm
Copyright 1999 Phi
Delta Kappa International
