Building School Environments that Improve Education and Health

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Building School Environments that Improve
Education and Health

• Sara Smith, State Coordinator of School Health
• Dr. Rebecca Johns-Wommack, Health Education
  Specialist
• Susan Brotherton, Physical Education Specialist
• Office of Coordinated School Health
• Tennessee Department of Education

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Objectives

• History of Coordinated School Health in Tennessee
• Coordinated School Health (CSH) Model
• CSH Tennessee Infrastructure
• Link between Health and Academics
• Tennessee CSH Accomplishments
• Your role in the CSH Model
• A few words from School
• Administrators

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What Is Coordinated School Health?

• How do you define CSH?
• What is the purpose of CSH?

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Discussion Question

• What are the most significant barriers to
  learning impacting students today?

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Typical Education Responses

• Curricula is not relevant to students
• Teaching to the test
• Bias and low expectations of staff
• Poor teacher training
• Student misbehavior
• Unwelcome school environment
• Lack of parent involvement
• Lack of early childhood education

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Typical Public Health Responses

• Lack of school health education
• No clinic
• Poor diet
• No full-time nurse
• No full-time counselor
• Lack of parental involvement
• Physical Inactivity
• Physical, mental, sexual abuse
• Alcohol, tobacco, other drug, use
• Bullying
• Unmanaged health
• conditions

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Whats more important?

• A Childs Education
• OR
• A Childs Health?

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Answer

• You cannot have one,
• without the other!

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Reciprocal Relationship

• Health disparities education disparities
• One child in four is at risk of school failure
  due to social, emotional, and/or physical health
  problems.
• Death rate for those with less than 12 years of
  education is more than twice that for people with
  more education
• 7,000 students drop out of school every school
  day
• 1.2 million every year!

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Factors Associated with the Achievement Gap

• School Factors
• Poor segregated schools/Run Down facilities
• Lower per-pupil spending
• Less credentialed/experienced teachers
• Lack of school safety
• Low parent participation

• Non-School Factors
• Poverty
• Limited education of parents/lack of
  participation
• Poor social environment
• Peers do not value education
• Lack of role model
• Student health problems
• Lack of health care
• Disabilities
• Asthma
• Food insecurity and hunger
• Mental health problems
• Injury due to violence

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CSH History

• The Coordinated School Health Improvement Act of
  1999, TCA 49-1-1002 authorized and funded CSH.
• CSH Standards and Guidelines were passed by the
  Tennessee State Board of Education in 2000.
• Ten pilot sites were established in 2001.
• TCA 49-6-1022 (2006) created CSH funding
• for all school systems in Tennessee.

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Tennessee Coordinated School Health (CSH) Mission

• To improve student health and their capacity to
  learn through the support of families,
  communities and schools.

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CDCs Coordinated School Health Components
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Coordinated School Health

• Works with partners to identify local priorities
  and implement local solutions for health
  improvement.
• Implements a systemic approach to planning that
  aims to eliminate gaps and redundancies.
• Utilizes a rigorous approach that builds on
  accurate data and sound science.
• Focuses on institutionalizing sustainable changes
  in school systems.

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CSH Infrastructure

• CSH Coordinator is responsible for implementing
  the CSH model within the school system.
• CSH Coordinator collects and reports school
  health data.
• Facilitates a system-wide School Health Advisory
  Council.
• Uses the School Health Index school assessment
  tool.
• Develops Healthy School Teams

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CSH Infrastructure

• Develops and expands partnerships with County
  Health Councils, businesses, agencies and other
  community organizations.
• Evaluates and strengthens school health policies
• Provides training for administrators, teachers,
  and other school personnel on the coordination
  and integration of school health efforts into the
  overall school program.
• Maintains a local system and process for
• evaluation.

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Tennessee CSH Emphasis

• Provide a school environment that encourages
• Healthy eating habits
• Increased physical activity to counteract
• sedentary lifestyles
• Understanding of Comprehensive Health
• Education

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• What are the greatest health
• issues facing our children K-12?

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Student Overweight Rates

• Based on CSH pilot site data, 41 of all students
  are either overweight or obese.
• Overweight adolescents have a 70 chance of
  becoming overweight or obese adults.

Statistics from the CDC are alarming. Today,
about 16 of all children and teens in the
United States are obese.
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In Tennessee

• Tennessee has the 3rd highest rate of adult
  obesity (2008) at 27.8 and the 4th highest rate
  of overweight youths (ages 10-17) at 20 in the
  Nation.1
• Heart disease and stroke are the 1st and 3rd
  leading causes of death disability in TN.2
• Tennessees annual tab for obesity is running a
• hefty 1.8 billion dollars a year. 3

1. Trust for Americas Health Report (TFHA) 2. TN
Dept of Health, TN State University, Center for
Health Research, and University of TN Health
Science Center. 2006. The Burden of Heart Disease
and Stroke in Tennessee. Nashville, TN TN
Department of Health. 3. State-Level Estimates of
Annual Medical Expenditures Attributable to
Obesity, Eric A Finkelstein, Ian C. Fiebelkorn,
and Guijing Wang
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Type 2 DIABETES

• One in three children born in the US in 2000
  will become diabetic CDC

NOW 1 of 2
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Percentage of Middle and High Schools That
Required Students to Take 2 or More Physical
Education Courses Selected States, 2006
76.6
Median
States
TENNESSEE
44.4
0
20
40
60
80
100
Percentage of middle and high schools
N 36 participating states Source School
Health Profiles, 2006
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Being Sedentary is an Academic Issue

• Research supports a connection between being
  active and improved brain performance.
• Children who achieve more fitness standards tend
  to score higher on standardized tests.
• Excessive screen time
• undermines children's education.

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Lack of Student Nutrition

• Only 18.3 of all Tennessee High School students
  eat 5 or more fruits/veggies per day.
• Only 12.6 of all Tennessee High School students
  drink 3 or more glasses of milk per day.
• Source 2007 Tennessee Youth Risk Behavior
  Survey

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UNDERNOURISHED
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Being Undernourished is an Academic Issue

• Optimal nutrition is necessary for optimal
  cognitive functioning.
• Zinc, iron, and B-vitamins (along with other
  nutrients) are critically important to brain
  function.
• Sub-optimal nutrition affects academic
  performance and even IQ scores.

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Percentage of Middle and High Schools That
Required Students to Take 2 or More Health
Education Courses Selected States, 2006
43.0
Median
States
TENNESSEE
24.1
0
20
40
60
80
100
Percentage of middle and high schools
N 36 participating states CDC, School Health
Profiles
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This is why we have CSH!

• Increasingly Poor Health Status of TN Students
• Linked to
• Increased absenteeism
• Poor academic performance
• Increased chance of ill health in adulthood
• Increased burden of health care costs
• Decreased quality of life

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Percentage of U.S. High School Students Getting
Mostly As or Mostly Bs and Mostly Ds or
FsWho Engage in Selected Health Risk Behaviors
As reported by students
Source CDC National Youth Risk Behavior Survey,
2003
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High School Graduation Rates

• CSH Pilot Sites TN Schools
• Average
  Average
• 2002 79.4 76.1
• 86.3 79.5
• Difference 6.9 3.4

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Cohort Dropout Rates, High School

• CSH Pilot Sites TN Schools
• Average Average
• 2002 9.4 2.5
• 2006 5.3 9.8
• Difference 4.1 2.7

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CSH Snapshot

• 135 school systems have implemented a CSH
  initiative. 87 of these school systems have
  implemented CSH system-wide.
• 94 of all school systems have provided CSH
  professional development to their staff.
• 98 of all school systems have a School Health
  Advisory Council in place (system-wide
• council).
• Source Annual School Health Data and Compliance
  Report 2008

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CSH Snapshot

• 96 of all school systems utilize CDCs School
  Health Index school assessment tool.
• 93 of all school systems have Healthy School
  Teams that meet regularly (school level team).
• 76 of all school systems have Healthy School
  Teams in all schools in their school system.
• 87 of all school systems have developed
• and implemented staff wellness program(s).
• Source Annual School Health Data and Compliance
  Report 2008

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School Nurses Snapshot

• 32 (515) nurses (LPNs and RNs) served special
  education students and 68 (1,117) nurses (LPNs
  and RNs) served the general school population.
• 95 of all school systems meet the requirement
  for number of nurses per students ratio of
• 13,000. This does not include nurses who are
  contracted or hired to provide
• procedures or treatments only.
• Source Annual School Health Data and Compliance
  Report 2008

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Health Screenings Snapshot

• 104,532 students were referred to a healthcare
  provider as a result of School Health Screening
  programs.
• Most referrals made to a Health Care Provider
  were a result of BMI Screenings (45), vision
  screenings (27), and
• dental screenings (14).
• Source Annual School Health Data and Compliance
  Report 2008

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More Snapshots

• Student Diagnoses
• 116,965 students in school systems have a
  diagnosis of chronic illness or disability. Most
  Tennessee students were diagnosed with
• Asthma (42), ADHD/ADD (24) and
• Severe Allergy (17).
• Individual Health Plan
• 90 of all Tennessee school systems developed
  Individual Health Plans for students with
• chronic or long-term illnesses.
• Source Annual School Health Data and Compliance
  Report 2008

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OCSH Accomplishments

• Received 2 Federal Grants
• HIV 5 Year Grant from CDC
• Schools and Mental Health Grant from
• U.S. Office of Education
• Expanded State Partnerships
• Developed State CSH Program Monitoring System

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OCSH Accomplishments

• Established CSH Statewide
• Provided extensive professional development to
  new CSH Coordinators
• New Standards and Guidelines Developed
• School Health Screening Guidelines
• Health Education Standards Revisions
• Physical Education Standards Revisions

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OCSH Accomplishments

• Provided Professional Development
  Training/Resources to School Staff
• Michigan Model Comprehensive Health Education
• Take 10! Physical Activity in the Classroom
• CSH Regional Institutes
• CSH Annual Training Institute
• CSH Website

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OCSH Accomplishments

• Created Uniform State School Health Screening
  Protocols
• Screen students in K, 2, 4, 6, 8 and one grade of
  high school for vision, hearing, BMI and blood
  pressure. Dental and scoliosis screenings (6th
  grade only)
• are encouraged but not mandated.

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OCSH Accomplishments

• Continued State CSH Evaluation
• Annual CSH Report
• Annual Data and Compliance Report
• Youth Risk Behavior Survey Middle School and
  High School
• TN School Health Profiles (CDC)

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How can you help?

• Physical Activity
• Only 60 of all school systems provide daily
  physical activity for their students.
• Food Vending and A La Carte
• Almost all Tennessee school systems (97) are in
  compliance with the food vending and a la carte
  law.
• HIV Staff Training
• Almost all Tennessee school systems
• (96) are in compliance with the HIV and
• Blood-borne Pathogens staff training law.
• Source Annual School Health Data and Compliance
  Report 2008

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How can you help?

• 2008 Tennessee School Health Profiles Report TN
  Weaknesses
• 23 of all schools require students to take 2 or
  more health education courses
• 53 of all schools taught 12 physical activity
  topics in a required course
• 25 of all schools allow students to
• purchase fruits or vegetables from
• vending machines
• Source 2008 Tennessee School Health Profiles
  Report - CDC

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Director of Schools Quotes

• The Coordinated School Health Program must be
  the foundation on which all other instructional
  programs are built because children must be
• healthy to learn at the level that is necessary
  today to reach success. I believe that every
  step we take in the direction of teaching how to
  live a healthy life increases our academic
  achievement at the same time.
• Nancy S. Zambito
• Director of Schools, Jackson-Madison
• County Schools

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Director of Schools Quotes

• There is no doubt in my mind that the most
  positive addition to Lewis County Schools this
  year has been the CSH project. In one short
  year, we as a system have already become
  dependent on the many services offered by the
  program... The future of the CSH program is
  limitless and I am very excited to see what the
  long-term effect of the program will have on our
  childrens lives.
• Mr. Benjamin Pace
• Director of Schools, Lewis County Schools

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U.S. School Administrators CSH Positive Outcomes

• Reduced absenteeism Fewer classroom behavior
  problems Improved academic performance
  Delayed onset of certain health risk
  behaviors Greater interest in healthy diets
  Increased participation in fitness activities
  Less smoking among students and
• staff Lower rates of teen pregnancy

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Reducing the Barriers to Learning
Everyday in America, Children come to school not
ready to learn.


No AYP
Bullying
ADHD
Diabetic
ASTHMA
Absenteeism

• Community and Parental Involvement is one
  component of CSH

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• Schools could do more than perhaps any other
  single institution in society to help young
  people, and the adults they will become, live
  healthier, longer, more satisfying, and more
  productive lives.
• Carnegie Council on Adolescent Development
• I

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• Please take a moment to
• think If not us, then who?
• If not now, then when?

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Websites

• TN Coordinated School Health TDOE
• CDCs Coordinated School Health
• http//www.cdc.gov/HealthyYouth/CSHP/

http//www.tennessee.gov/education/schoolhealth/
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OCSH Contacts

• Connie Givens
• Director
• connie.givens_at_state.tn.us
• 1-615-253-6029
• Sara Smith
• State Coordinator
• sara.smith_at_state.tn.us
• 1-615-253-4664
• Dr. Rebecca Johns-Wommack
• Health Education Specialist
• rebecca.johns-wommack_at_state.tn.us
• 1-615-253-0065
• Susan Brotherton
• Physical Education Specialist
• susan.brotherton_at_state.tn.us