Health & Academics

The academic success of America’s youth is strongly linked with their health.
Health-related factors such as hunger, physical and emotional abuse, and chronic illness can lead to poor school performance.¹ Health-risk behaviors such as early sexual initiation, violence, and physical inactivity are consistently linked to poor grades and test scores and lower educational attainment.^2-4
In turn, academic success is an excellent indicator for the overall well-being of youth and a primary predictor and determinant of adult health outcomes.^5-7 Leading national education organizations recognize the close relationship between health and education, as well as the need to foster health and well-being within the educational environment for all students.^8-11
Scientific reviews have documented that school health programs can have positive effects on educational outcomes, as well as health-risk behaviors and health outcomes.^12-13 Similarly, programs that are primarily designed to improve academic performance are increasingly recognized as important public health interventions.^14-15
Schools play a critical role in promoting the health and safety of young people and helping them establish lifelong healthy behaviors. Research also has shown that school health programs can reduce the prevalence of health risk behaviors among young people and have a positive effect on academic performance. CDC analyzes research findings to develop guidelines and strategies for schools to address health risk behaviors among students and creates tools to help schools implement these guidelines.

Spotlight On

Data & Statistics
Fact sheets and presentations on the link between health and academic achievement
The Association Between School-Based Physical Activity, Including Physical Education, and Academic Performance  [pdf 2.5M] (Full report)
Executive Summary  [pdf 309K]
Highlights research studies showing how physical activity is related to academic performance

School Connectedness: Strategies for Increasing Protective Factors Among Youth
Strategies for school personnel and others to use in helping students' feel more connected to their school

References

1. Dunkle MC, Nash MA. Beyond the Health Room. Washington, DC: Council of Chief State School Officers, Resource Center on Educational Equity; 1991.
2. Carlson SA, Fulton JE, Lee SM, Maynard M, Drown DR, Kohl III HW, Dietz WH. Physical education and academic achievement in elementary school: data from the Early Childhood Longitudinal Study. American Journal of Public Health 2008;98(4):721–727. 
3. Spriggs AL, Halpern CT. Timing of sexual debut and initiation of postsecondary education by early adulthood. Perspectives on Sexual and Reproductive Health 2008;40(3):152–161.
4. Srabstein J, Piazza T.  Public health, safety and educational risks associated with bullying behaviors in American adolescents. International Journal of Adolescent Medicine and Health 2008;20(2):223–233.
5. Harper S, Lynch J. Trends in socioeconomic inequalities in adult health behaviors among U.S. states, 1990–2004. Public Health Reports 2007;122(2):177–189.
6. Vernez G, Krop RA, Rydell CP. The public benefits of education. In: Closing the Education Gap: Benefits and Costs  [pdf 7.8M]. Santa Monica, CA: RAND Corporation; 1999:13–32.   
7. National Center for Health Statistics. Health, United States, 2010: With Special Feature on Death and Dying. Hyattsville, MD: U.S. Department of Health and Human Services; 2011.
8. Council of Chief State School Officers. Policy Statement on School Health; 2004.
9. National School Boards Association. Beliefs and Policies of the National School Boards Association  [pdf 278K]. Alexandria, VA: National School Boards Association; 2009.
10. American Association of School Administrators. AASA position statements  [pdf 61K]. Position statement 3: Getting children ready for success in school, July 2006; Position statement 18: Providing a safe and nurturing environment for students, July 2007.  
11. ASCD. Making the Case for Educating the Whole Child  [pdf 1.9M]. Alexandria, VA: ASCD; 2011.
12. Basch CE. Healthier Students Are Better Learners: A Missing Link in School Reforms to Close the Achievement Gap. Equity Matters: Research Review No. 6. New York: Columbia University; 2010.
13. CDC. The Association Between School-Based Physical Activity, Including Physical Education, and Academic Performance. Atlanta, GA: U.S. Department of Health and Human Services; 2010.
14. Freudenberg N, Ruglis J. Reframing school dropout as a public health issue. Preventing Chronic Disease 2007;4(4):A107.
15. Muenning P, Woolf SH. Health and economic benefits of reducing the number of students per classroom in US primary schools. American Journal of Public Health 2007;97:2020–2027.

Coordinated School Health FAQs

Basic Information about Coordinated School Health

How did the concept of coordinated school health (CSH) originate?

The concept of comprehensive school health was introduced in the late 1980s by Kolbe and Allensworth to promote the optimal physical, emotional, social, and educational development of students.¹ The concept expanded from a traditional three-component school health model (school health services, school health education, and school health environment) to eight components, which include

• Health education
• Physical education
• Health services
• Nutrition services
• Counseling, psychological, and social services
• Staff health promotion
• Family and community involvement
• Healthy environment

In 1995, an Institute of Medicine committee reviewed previous health models and definitions and suggested the term “coordinated school health program” to better describe the interdisciplinary and interagency collaboration required. In response to recommendations from a 2007 expert panel, CDC began using “coordinated school health” to better describe the systematic approach needed to coordinate the policies, practices, and components.

Is there a definition for CSH?

Several definitions are found in the literature or used by CDC, states, or local school districts to describe and promote CSH. There is no single best definition of CSH because programs must be tailored to meet each state's, school's, and community’s needs.

• CDC
  CSH is a systematic approach to improving the health and well-being of all students so they can fully participate and be successful in school. The process involves bringing together school administrators, teachers, other staff, students, families, and community members to assess health needs; set priorities; and plan, implement, and evaluate all health-related activities. CSH typically integrates health promotion efforts across eight interrelated components that already exist to some extent in most schools. These components include health education, physical education, health services, nutrition services, counseling, psychological and social services, healthy and safe school environments, staff wellness, and family and community involvement. (CDC. School Health Programs: Improving the Health of Our Nation's Youth—At A Glance 2011, Atlanta: CDC; 2011.)
   
• Health is Academic: A Guide to Coordinated School Health Programs
  “A coordinated school health program (CSHP) is a planned, organized set of health-related programs, policies, and services coordinated at both the district and individual school levels to meet the health and safety needs of K-12 students.” (Marx E, Wooley SF, Northrop D, editors. Health Is Academic: A Guide to Coordinated School Health Programs. New York: Teachers College Press; 1998.)
   
• Institute of Medicine
  “A (comprehensive) school health program is an integrated set of planned, sequential, school-affiliated strategies, activities, and services designed to promote the optimal physical, emotional, social, and educational development of students. The program involves and is supportive of families and is determined by the local community based on community needs, resources, standards, and requirements. It is coordinated by a multidisciplinary team and accountable to the community for program quality and effectiveness.” (Institute of Medicine. Schools and Health: Our Nation’s Investment. Washington, DC: National Academy Press; 1997.)

Are there other models of school health in addition to the eight-component model recommended by CDC?

Yes. Some states, such as Maine, and school districts have adopted models with more components, and other states, such as Wisconsin, have adopted models with fewer components.

How is CSH different from student support services?

CSH and student support services are closely related and have similar goals. Student support services, also known as student services or pupil services, include prevention, intervention, transition, and follow-up services for students and families, especially for students who are experiencing problems that create barriers to learning. CSH often includes the support services provided to students experiencing problems, but also comprises the health-related policies and practices necessary to meet the health and safety needs of all K–12 students.

Implementing Coordinated School Health

Is there a CSH program available for purchase?

No. CDC recommends a coordinated, systematic approach to planning and organizing all school health-related activities, including initiatives, components, policies, and partnerships to continuously improve the health and learning of all students. CSH is not available as a discrete program for purchase.

If our community, district, or school wants to implement a coordinated approach to school health, are there resources to help us get started?

Yes, multiple resources are available here.
The following resources describe CSH programs and relevant policies:

• Program Success Stories illustrate the exemplary work that partners undertake.
• Making It Happen! School Nutrition Success Stories includes stories of schools and school districts that have implemented innovative strategies to improve the nutritional quality of foods and beverages sold outside of federal meal programs.
• Building Healthier Schools describes local collaborations in 13 county health departments and school districts to promote physical activity and nutrition.
• Promising District Practices offers stories of local school district successes.

How can our school district obtain technical assistance and updates if our state is not funded by CDC to implement a coordinated approach to school health to improve physical activity, nutrition, and tobacco use prevention?

Although your state might not have CDC funding for CSH, it might have other resources that can help you.

• Check with your state education and health agencies to see if they offer any grants or technical assistance.
• Join a state or national listserv such as the Comprehensive Health Education Network (CHEN), administered by the American School Health Association, to stay abreast of new developments and learn about national, state, or regional trainings.
• Join a professional organization devoted to CSH so you can network with other school health coordinators. For example, the American School Health Association has a Section specifically for school health coordinators.

Our superintendent designated someone to be the school health coordinator. Where can our new school health coordinator obtain training and information on responsibilities?

Many states offer school health leadership training based on the American Cancer Society’s National School Health Coordinator Leadership Institute. Check with your state education agency. In addition, school health professional associations offer pre- or post-conference training sessions as well as individual conference sessions that address school health leadership. Building Competencies for Managers and Staff of Coordinated School Health Programs  [doc 235K] PDF  [583K] identifies nine school health program professional responsibilities and includes a competency self-assessment tool.

Resources for Coordinated School Health

Our superintendent and school board are focused on improving academic achievement. What resources are available to help us make the case for CSH?

The academic success of America’s youth is strongly linked with their overall health. Scientific reviews have documented that school health programs can have positive impacts on educational outcomes, health-risk behaviors, and health outcomes. Science-based resources for making the case for CSH are available here.

Funding for Coordinated School Health

Is funding available to implement CSH?

Yes, competitive funding is available from several federal agencies and some state and local agencies.
CDC provides competitive funding for state health and education departments so they can work together to help build the capacity of school districts to implement a coordinated approach to school health. All states and territories that meet certain criteria can apply for funding from CDC every 5 years.
CDC also provides competitive funding for national nongovernmental organizations (NGOs) to build the capacity of schools to address specified health-risk behaviors and conditions. All NGOs that meet certain criteria can apply for funding from CDC every 5 years.
Some states provide grants to help schools use CDC’s School Health Index or similar tools to assess the CSH components and develop a plan for improvement or implementation. Check with your state or local education or health agency.
Other federal initiatives related to CSH include the following:

• U.S. Department of Agriculture. Provides funding for school meal programs, including the school lunch and breakfast programs and the fresh fruit and vegetable program.
• Office of Safe and Drug-Free Schools, U.S. Department of Education. Offers grants for physical education programs, elementary and secondary school counseling programs, integration of schools and mental health systems, drug and violence prevention, safe schools/healthy students, and character and civic education.
• U.S. Environmental Protection Agency. Provides resources for sun safety and school chemical cleanup campaign
• Safe Routes to School Program, U.S Department of Transportation states improve the ability of primary and middle school students to walk and bicycle to school safely
• Health Resources and Services Administration Administers programs that provide access to health care services for uninsured, isolated, or medically vulnerable people
• Safe Schools/Healthy Students, Substance Abuse and Mental Health Services Administration Offers initiatives to prevent violence and substance abuse among youth in schools and communities
• Children’s Health Insurance Program, Centers for Medicare and Medicaid Services In some states, school-based or school-linked health centers are allowed to bill Medicaid/Children’s Health Insurance Program for reimbursement of medical services provided to eligible students
   

Which states are currently funded to implement CSH?

Twenty-two states and one tribal government receive CDC funding to promote physical activity, nutrition, and tobacco-use prevention through a CSH approach.

Evaluation and Laws

What evaluation has been done on CSH?

Only a few studies have examined coordination of all eight components of CSH. Some studies provide credible evidence of efficacy of the components included in the CSH framework. Currently, DASH is working with three school districts on a multisite evaluation designed to better understand and operationalize well-coordinated and integrated approaches to CSH.

What laws and policies cover child and adolescent health in schools?

The February 2008 issue of the Journal of School Health published the report "A CDC Review of School Laws and Policies Concerning Child and Adolescent Health," which describes the breadth of health-related federal, state, and local laws and policies under which school operate.
The NASBE State School Health Policy Database is a comprehensive set of laws and policies from 50 states on more than 40 school health topics, including coordination, school health councils, and school health coordinators.

sumber: www.cdc.gov

How Schools Can Implement Coordinated School Health

To achieve the goals of school health and maximize effectiveness and efficiency, schools should carry out the following eight strategies to implement a coordinated approach to improve school health policies and programs.

1. Secure and maintain administrative support and commitment.
   
   
   The superintendent’s support at the district level and the principal’s support at the school level are essential for implementing and maintaining a coordinated and systematic approach to school health. School administrators can support a coordinated approach to school health by

   • Incorporating health in the district’s or school’s vision and mission statements, including health goals in the school’s improvement plan
   • Appointing someone to oversee school health
   • Allocating resources
   • Modeling healthy behaviors
   • Regularly communicating the importance of wellness to students, staff, and parents
    
2. Establish a school health council or team.
   
   
   An effective school health system uses a team approach to guide programming and facilitate collaboration between the school and the community. At the district level, this group is typically called a school health council, and at the school level, it is typically called a school health team.
   
   Ideally, the district school health council includes at least one representative from each of the eight components, and school administrators, parents, students, and community representatives involved in the health and well-being of students, such as a representative from the local health department and the school district’s medical consultant.
   
   School health teams generally include a site administrator, an identified school health leader, teachers and other staff representing the components, parents, students, and community representatives when appropriate.
   
    
3. Identify a school health coordinator.
   
   
   A full-time or part-time school health coordinator is a critical factor for the successful implementation of a coordinated approach to school health. The school health coordinator helps maintain active school health councils and facilitate health programming in the district and school and between the school and community. The coordinator organizes the eight components of school health and facilitates actions to achieve a successful, coordinated school health system, including policies, programs, activities, and resources.
   
    
4. Develop a plan.
   
   
   A school health council or team should use a program planning process to achieve health promotion goals. The process, which should involve all stakeholders, includes

   • Defining priorities based on the students’ unique health needs
   • Determining what resources are available
   • Developing an action plan based on realistic goals and measurable objectives
   • Establishing a timeline for implementation
   • Evaluating whether the goals and objectives are met
      

   Ideally, this plan would be incorporated into a school’s overall improvement plan to link health with learning outcomes. CDC has developed an assessment and planning resource, the School Health Index, to help schools analyze the strengths and weaknesses of their school health policies, programs, and services, and plan for improvement.
   
    
5. Implement multiple strategies through multiple components.
   
   
   Each school health component employs a unique set of strategies. These strategies include classroom instruction, policies and procedures, environmental change, health, counseling and nutrition services, parent and community involvement, and social support. However, no single strategy or single component will achieve all the desired health outcomes for all students. Therefore, it is necessary to implement all of the components so the full range of strategies becomes available to systematically address health behaviors and improve student learning.
   
    
6. Focus on students.
   
   
   The focus of coordinated school health should be on meeting the education and health needs of students as well as providing opportunities for students to be meaningfully involved in the school and the community. School health efforts should give young people the chance to exercise leadership, build skills, form relationships with caring adults, and contribute to their school and community.
   
   Students can promote a healthy and safe school and community through peer education, peer advocacy, cross-age mentoring, service learning, and participation on school health teams advisory committees, councils, and boards that address health, education, and youth issues. Protective factors that are health enhancing in schools include

   • A supportive and nurturing environment that fosters respect, connectedness, and meaningful involvement
   • Adults modeling positive social interactions and having the same expectations of students
   • Group norms that value a healthy lifestyle
    
7. Address priority health-enhancing and health-risk behaviors.
   
   
   Schools can implement policies and programs to help students avoid or reduce health risk behaviors that contribute to the leading causes of death and disability among young people as well as among adults. In the United States, six categories of priority health-risk behaviors are related to the leading causes of death and disability: behaviors that contribute to unintentional injuries and violence; tobacco use; alcohol and other drug use; sexual behaviors that contribute to unintended pregnancy and STDs, including HIV infection; unhealthy eating; and physical inactivity.
   
   Schools can assess health-risk behaviors among young people in these categories as well as general health status, overweight, and asthma, through formal surveys such as the Youth Risk Behavior Survey. Programs that reduce these risk behaviors and promote protective factors have been identified through research and when appropriate be incorporated into school programming (see Registries of Effective Programs). CDC has developed guidelines to help schools promote physical activity and healthy eating and build a systematic and coordinated approach to school health.
   
    
8. Provide professional development for staff.
   
   
   Continuing education is essential for teachers, administrators, and other school employees committed to improving the health, academic success, and well-being of students. All school employees need to stay current in their skills and knowledge. Professional development provides opportunities for school employees to identify areas for improvement, learn about and use proven practices, solve problems, develop skills, and reflect on and practice new strategies. In districts and schools promoting a coordinated school health approach, professional development should focus on the development of leadership, communication, and collaboration skills. CDC recommends six key professional development practices.
    
   Sumber: www.cdc.gov

Goals of Coordinated School Health

Coordinated school health programs could be a critical means to improving both education performance and the well-being of our young people and the adults they will become. School health programs typically have four overlapping, interdependent goals. These goals are most effectively and efficiently achieved when all the goals are addressed simultaneously through a coordinated approach that purposefully integrates the efforts and resources of education, health, and social service agencies.
The following is a summary of the key goals and strategies proposed by Lloyd Kolbe in "Education Reform and the Goals of Modern School Health Programs."¹

1. Increase health knowledge, attitudes, and skills.
   • School health instruction helps young people improve their health knowledge. For example, students learn nutrition facts and how to read product labels so they can make healthy eating choices.
   • School health instruction helps young people develop related life skills, including communication and interpersonal skills, decision making and critical thinking skills, and coping and self-management skills. For example, students learn a variety of ways to refuse alcohol or tobacco and practice those skills.
   • Improved communication and life skills can positively affect students’ health decisions and behaviors and promote effective citizenship.
      
2. Increase positive health behaviors and health outcomes.
   • School health programs can be designed to help youth avoid specific risk behaviors, including those that contribute to the leading causes of injury, illness, social problems, and death in the United States; alcohol and other drug use; tobacco use; injury and violence; unhealthy eating; physical inactivity; and sexual risk behaviors. These behaviors, often established during childhood and early adolescence, are interrelated and can persist into adulthood.
   • Specific school health interventions have proven effective in significantly reducing these risk behaviors, improving health promoting behaviors, and improving health outcomes.
   • School health programs can also create safer schools and positive social environments that contribute to improved health and learning.
      
3. Improve education outcomes.
   • Students who are healthy are more likely to learn than those who are unhealthy. School health programs can appraise, protect, and improve the health of students, thus reducing tardiness and absenteeism and increasing academic achievement.
   • Students who acquire more years of education ultimately become healthier adults and practice fewer of the health risk behaviors most likely to lead to premature illness and death.
      
4. Improve social outcomes.
   • School health programs can provide opportunities to build positive social interactions and foster the development of students’ respect, tolerance, and self-discipline. For example, conflict resolution and peer mediation programs help students learn how to listen and solve problems.
   • School health programs can reduce delinquency, drug use, and teen pregnancy, increasing the likelihood that young people will become productive, well-adjusted members of their communities.
   • School health programs can provide access to community programs and services that can help students contribute positively to their family, school, and community.

References

1. Kolbe L. Education reform and the goals of modern school health programs. The State Education Standard 2002;3(4):4-11.

sumber: www.cdc.gov

Coordinated School Health Data & Statistics

The School Health Policies and Practices Study (SHPPS), the largest, most comprehensive assessment of school health policies and practices in the United States, assesses the characteristics of eight components of school health at the elementary, middle, and high school levels. The following fact sheets about CSH are based on the findings of SHPPS 2006:

• Overview  [pdf 250K]
• School Health Coordination  [pdf 230K]
• Faculty and Staff Health Promotion  [pdf 184K]
• Family and Community Involvement  [pdf 188K]
• Health Education  [pdf 169K]
• Health Services  [pdf 194K]
• Mental Health and Social Services  [pdf 187K]
• Nutrition Services  [pdf 148K]
• Physical Education  [pdf 181K]
• Physical School Environment  [pdf 187K] 

Components of Coordinated School Health

The following are working descriptions of the eight components of coordinated school health.*
Health Education: Health education provides students with opportunities to acquire the knowledge, attitudes, and skills necessary for making health-promoting decisions, achieving health literacy, adopting health-enhancing behaviors, and promoting the health of others. Comprehensive school health education includes courses of study (curricula) for students in pre-K through grade 12 that address a variety of topics such as alcohol and other drug use and abuse, healthy eating/nutrition, mental and emotional health, personal health and wellness, physical activity, safety and injury prevention, sexual health, tobacco use, and violence prevention. Health education curricula should address the National Health Education Standards (NHES) and incorporate the characteristics of an effective health education curriculum. Health education assists students in living healthier lives. Qualified, trained teachers teach health education.
Physical Education: Physical education is a school-based instructional opportunity for students to gain the necessary skills and knowledge for lifelong participation in physical activity. Physical education is characterized by a planned, sequential K-12 curriculum (course of study) that provides cognitive content and learning experiences in a variety of activity areas. Quality physical education programs assist students in achieving the national standards for K-12 physical education. The outcome of a quality physical education program is a physically educated person who has the knowledge, skills, and confidence to enjoy a lifetime of healthful physical activity. Qualified, trained teachers teach physical education.
Health Services: These services are designed to ensure access or referral to primary health care services or both, foster appropriate use of primary health care services, prevent and control communicable disease and other health problems, provide emergency care for illness or injury, promote and provide optimum sanitary conditions for a safe school facility and school environment, and provide educational and counseling opportunities for promoting and maintaining individual, family, and community health. Qualified professionals such as physicians, nurses, dentists, health educators, and other allied health personnel provide these services.
Nutrition Services: Schools should provide access to a variety of nutritious and appealing meals that accommodate the health and nutrition needs of all students. School nutrition programs reflect the U.S. Dietary Guidelines for Americans and other criteria to achieve nutrition integrity. The school nutrition services offer students a learning laboratory for classroom nutrition and health education, and serve as a resource for linkages with nutrition-related community services. Qualified child nutrition professionals provide these services.
Counseling, Psychological, and Social Services: These services are provided to improve students’ mental, emotional, and social health and include individual and group assessments, interventions, and referrals. Organizational assessment and consultation skills of counselors and psychologists contribute not only to the health of students but also to the health of the school environment. Professionals such as certified school counselors, psychologists, and social workers provide these services.
Healthy and Safe School Environment: A healthy and safe school environment includes the physical and aesthetic surroundings and the psychosocial climate and culture of the school. Factors that influence the physical environment include the school building and the area surrounding it, any biological or chemical agents that are detrimental to health, and physical conditions such as temperature, noise, and lighting. The psychosocial environment includes the physical, emotional, and social conditions that affect the well-being of students and staff.
Health Promotion for Staff: Schools can provide opportunities for school staff members to improve their health status through activities such as health assessments, health education, and health-related fitness activities. These opportunities encourage staff members to pursue a healthy lifestyle that contributes to their improved health status, improved morale, and a greater personal commitment to the school's overall coordinated health program. This personal commitment often transfers into greater commitment to the health of students and creates positive role modeling. Health promotion activities have improved productivity, decreased absenteeism, and reduced health insurance costs.
School Wellness Guide: A Guide for Protecting the Assets of Our Nation's Schools is a comprehensive guide that provides information, practical tools and resources for school employee wellness programs.
Family/Community Involvement: An integrated school, parent, and community approach can enhance the health and well-being of students. School health advisory councils, coalitions, and broadly based constituencies for school health can build support for school health program efforts. Schools actively solicit parent involvement and engage community resources and services to respond more effectively to the health-related needs of students.
Parent Engagement: Strategies for Involving Parents in School Health  [pdf 1.1M]
Describes strategies and actions schools can take to increase parent engagement in promoting positive health behaviors among students

SUMBER:WWW.CDC.GOV