Sean Slade

What's Next for Coordinated School Health? Moving from Rhetoric to Sustainable Action

This session was held at the recent American School Health Association Annual Conference in Kansas City, Mo., on October 16, 2010. The session was intended to start a discussion about what coordinated school health (CSH) has and has not achieved over the past 20 years, and then further that dialogue into discussing the next moves for CSH.

Below is a summary of that presentation. We have posted it here to elicit comments and engage in a conversation around this topic.

Health and well-being have for too long remained the sole domain of health experts. For too long it has been siloed both geographically and philosophically apart from the school and the educational context. Rarely has health been included or required to be an integral part of the school's educational process—but when it has, the results are surprising. Schools that work purposefully toward enhancing the health—mental, social, and emotional, as well as physical—of both their staff and students, frequently report results that principals and administrators want to hear: higher academic achievement of students [1], increased staff satisfaction and less staff turnover [2], greater efficiency [3], the development of a positive school climate [4], and ultimately the development of a school-community culture that promotes and enhances student growth [5].

So what has held educators back from wholeheartedly embracing health and well-being across their schools and systems? The answer is somewhat twofold—on the one hand there are schools that hold a belief that they are there only to educate the child academically—however the overwhelming evidence that shows that a students' physical, mental, social, and emotional health plays a significant role in determining what students can learn cognitively dispels this notion [6]. On the other hand there are schools that appreciate the effects of student health on student growth and learning—so why haven't these schools done a more comprehensive job in aligning health and education? Ultimately it may be the existence of CSH itself. The fact that there has been a section of the system that has been designed to cater to the health needs of students has in fact allowed education to ignore or push health aside. It has perpetuated the siloing of health and education.

First introduced in 1987, the eight component model of coordinated school health introduced a broader and more defined approach to school health, incorporating aspects that had not previously been organized and coordinated together, such as family and community involvement, counseling, psychological and social services, and a healthy school environment. The key, however, was to have all eight entities aligned and coordinated across the school.

A successful, sustainable coordinated school health program requires a high-quality level of planning, implementation and institutionalization. But achieving that degree of support is difficult when school health is seen as a programmatic issue, rather than as part of a systematic approach to addressing school improvement. Programmatic changes tend to be tried and rolled back or become the project of an individual staff member or department—and when that person leaves, there is usually no one else willing or able to take charge.

This health-centric CSH approach has undoubtedly had some success—it has been adopted by 46 states and has versions adapted into Mexico, Canada, Egypt, and Saudi Arabia. However it has never had the broad encompassing success and influence over the whole-school environment that had been envisioned. It has always been viewed as a health initiative by educators and too frequently by health professionals themselves. In fact this discussion is not new but has been around since at least 1998 and has arisen every 3 or 4 years.

  • "[T]he promise of a coordinated school health program thus far outshines its practice." (Marx, Wooley, & Northrop, 1998, Health Is Academic, p. 10)
  • "In sum, if American schools do not coordinate and modernize their school health programs as a critical part of educational reform, our children will continue to benefit at the margins from a wide disarray of otherwise unrelated, if not underdeveloped, efforts to improve interdependent education, health, and social outcomes." (Kolbe, 2002, The State Education Standard, Autumn, p. 10)
  • "Insistence on alignment of programs under the "health" banner is detrimental to the purpose and mission of both school health and school improvement." (Allensworth, Bartee, & Hoyle, 2009, Journal of School Health, p. 165)
  • "Though rhetorical support is increasing, school health is currently not a central part of the fundamental mission of schools in America nor has it been well integrated into the broader national strategy to reduce the gaps in educational opportunity and outcomes." (Basch, 2010, Healthier Students Are Better Learners: A Missing Link in School Reforms to Close the Achievement Gap, p. 9)

A change in how we view health and education is required—a change in how the two operate, align, and integrate in the school and community setting. However the biggest change may be in how education views health. Improvement in health, well-being, and climate must be understood to be part and parcel of the school improvement process. It needs to be viewed as not only foundational for the growth and development of students but also as foundational for teaching and learning and school effectiveness. Therefore, the conversation must be directed not toward health professionals but toward education professionals. It must outline and define the educational benefits of healthy students, healthy staff, and a healthy, effective school—for education's sake.

Where there was a need 20 years ago to target the health and well-being of students via a separate and distinct structure in order to focus attention and resources towards health, there may well be a greater need today to combine, align, and merge these structures so that systems work in unison. We do not have the time nor resources to continue the current push me-pull me environment, and neither do our children.

So how do we go about aligning health and education? How do we set out to overlap and interlink these entities that have traditionally been divided and siloed?

The first step is belief.

The second is action.

Later this year ASCD will be publishing a monograph outlining these actions required to better integrate health and education. In the meantime, these steps or 9 levers of change are described in Learning, Teaching and Leading in Healthy School Communities.

1. Basch, 2010; Case & Paxson, 2006; Crosnoe, 2006; Hass, 2006; Hass & Fosse, 2008; Heckman, 2008; Koivusilta et al., 2003; Palloni, 2006.

2. Grayson, 2008; Byrne, 1994; Dorman, 2003.

3. Bergeson, 2005; Harris, Cohen & Flaherty, 2008; Lezotte & Jacoby, 1990.

4. Basch, 2010; Benard, 2001.

5. Battlin-Pearson et al., 2000; Bond et al., 2007; Fleming, Haggerty, Catalano, Harachi, Mazza, & Gruman, 2005; Ladd, Birch, & Buhs, 1999; Klem & Connell, 2004; Nelson, 2004; Rosenfeld, Richman, & Bowen, 1998.

6. Basch, 2010; Case & Paxson, 2006; Crosnoe, 2006; Hass, 2006; Hass & Fosse, 2008; Heckman, 2008; Koivusilta et al., 2003; Palloni, 2006.

Comments (6)

Kristine M. Meurer, Ph.D.

October 23, 2010

In order for school health to be embraced by education the first approach may be as simple as changing the terminology we use.  Since 1987 we have attempted to educate schools on health terminology rather than speaking the terminology of schools.  Unfortunately when the word “health” is utilized the school personnel immediately identify it as belonging to the “health folk” (e.g. school nurse, counselor, etc) in the schools and not part of the system.  Even newer initiatives that incorporate health into schools (like full service community schools) do not embed in the name what schools believe to be their mission – academic achievement.  Something as simple as “a systematic approach to academic achievement” may receive more attention by educator and school decision makers.

Some may argue that not including the word “health” in the name will “water down” the approach.  However, it is the Coordinate School Health approach imbedded into the school system that is important not the name.  “A rose is still a rose by any other name”….  and “When in Rome….”

Shirley L.Handler, MSPH, EdD.

October 23, 2010

My experience after almost 30 years at the district level made it clear to me that CSH will not happen without the presence in the school of a person or a team of persons who will ensure that it happens.  In the 1990’s, with grant money, I was able to provide support for stipends in each school for school personnel to use a team approach to see that all of the parts fit together.

siamak khadjenoury

October 28, 2010

It will always remain as a rhetorical excerices so long as we do not understand or have the capacity to appreciate the vlaue and efficacy of local efforts. USDOE has demonstarted lack of creativity and effort in seeking out what is actually and already working on the ground. There are social enterpreneurs who have designed and implemented successful models without the help, guidance or funding from the feds,  building sustainable and efficient delivery systems for the long run. Associations also miss the boat as they too ignore the necessity for the genius of these enterpreneurs. By boxing ourselves into neat framworks and trying to fit in some acceptable mold, they deprive their stakeholders of the inginuity badly needed for what continues to emphasize failure. Get out there, see what is working and help them expand their scope of services.

Lynn Pedraza, Ph.D.

October 28, 2010

I agree with Dr. Meurer. There is no doubt in my mind that education is a public health issue and the Coordinated School Health Model is an approach that allows us to tackle the many societal issues that impact our students.Addressing the components of a CSH model allows our students to access their educational experiences. However, the word “health” may be foreign and uncomfortable for school staff.Our students need the support. We may have to look at how we frame the work and what we call the work so that school staff understand the importance of CSH model and its relation to their work.

Jonnie Hamilton, DNPc, PNP-BC

October 29, 2010

As a NP in a school based health center since 1996 I have seen the improvement in the academic standing of students as well as the improved health status of students especially students with chronic diseases eg asthma diabetes hypertension and obesity

What’s Next for Coordinated School Health? &

November 2, 2010

[...] Child by City Connects   There is a must-read post on ASCD‘s Whole Child Blog today, “What’s Next for Coordinated School Health? Moving from Rhetoric to Sustainable Action.” Based on an Oct. 16 session from the American School Health Association’s annual [...]

Share |

Blog Archive

Blog Tags