Ten million children—one child in four—are at risk of academic failure because of social, emotional, or health handicaps (Dryfoos, 1994). As many staff members will attest, U.S. schools are overwhelmed with health and safety problems that interfere with learning—from violence to disruptive student behavior to physical inactivity, poor eating habits, and near-epidemic asthma. In addition, more than one-third of all students attend classes in school buildings that need serious repair or replacement (U.S. General Accounting Office, 1995).
The school response is often a jumble of services, separately (and often inadequately) funded, separately staffed, and operating in mutual isolation. One approach that can help teachers, administrators, and other school personnel address the complex and interdependent social, emotional, physical, and intellectual needs of students is a coordinated school health program, which integrates eight mutually reinforcing components: comprehensive school health education; physical education; school nutrition services; school health services; school counseling, psychological, and social services; healthy school environment; school-site health promotion for staff; and family and community involvement (Allensworth & Kolbe, 1987). What is special about coordinated school health programs is not the individual components—most schools have many, if not all, of them in place—but the way in which they integrate health-related activities to maximize their effectiveness.
The School Health Finance Project
Identifying, securing, and sustaining funding are among the greatest challenges to establishing and maintaining school programs that help students prosper mentally, physically, and socially in a safe, supportive environment. Although various publications identify relevant funding sources, print materials go out of date quickly and are not accessible to a broad audience. School administrators can find more timely information on the Web sites of foundations or state and federal agencies. Few administrators, however, have the time or the staff to search the Internet regularly for potential resources.
To address these barriers, the Centers for Disease Control and Prevention and the National Conference of State Legislatures, as a part of the School Health Program Finance Project, maintain a continually updated database that offers timely, easily accessible information about federal, foundation, and state-specific funding opportunities for developing or improving a school health program. This database (www.cdc.gov /NCCDPHP/DASH/funding.htm) regularly adds summaries of federal cooperative agreement and grant announcements listed in the Federal Register as well as private-sector funding sources. Database resources are categorized according to the eight components of a coordinated school health program.
Deborah Alvarez, director of San Francisco's Department of Children, Youth, and Their Families, describes the database as "a critical portal to find out what is available and what others are doing." The department, in collaboration with the San Francisco Unified School District and the San Francisco Department of Health, is leading an effort to expand the city's school-based and school-linked health centers at the high school level. Alvarez gained the support of the city's Board of Supervisors by using Web data to demonstrate the availability of multiple sources of funding and the successes of similar efforts in other communities. The department is now following up on contacts in these communities to learn from their experiences.
Foundations and businesses provide substantial financial support to improve the health and education of youth. The Humana Foundation is an example of private-sector funding included in the School Health Program Finance Project database. This philanthropic group supports charitable organizations and institutions that promote education, health and human services, community development, and the arts. In 1998, the Humana Foundation funded both the Partnership for Kentucky Schools, a project that supports innovative education reform in Kentucky's primary and secondary public schools, and the American Lung Association's Teens Against Tobacco Use, a project that discourages teen smoking in nine cities nationwide. Target Stores Corporation supports family-oriented prevention programs, such as parenting education, family counseling, and support groups, in communities that have a Target store.
The National Conference of State Legislatures works collaboratively with the Centers for Disease Control and Prevention to collect information on how states use federal block grants, Safe and Drug-Free Schools and Communities grants, and state revenues to support school health programs. School districts can use the NCSL Web site (www.ncsl.org/programs/health/pp/schlfund.htm) to identify how funds are being distributed and applied in their state.
For example, a state might use Preventive Health and Health Services block grant funds to support a county health department–based school health coordinator who works with the school district to implement a coordinated school health program. The state of Kentucky uses Maternal and Child Health Services block grant funds to support 41 school-based or school-linked health centers that offer preventive health services, health promotion, health education, and case management for junior and senior high school students. By using the Web site, local districts can identify contacts in state departments of health and education who can furnish specific information on how block-grant funding can support child and adolescent health–related activities in schools and communities in their states.
Resource Mapping
School health–related activities often operate independently of one another and are separately staffed and funded. Through resource mapping, a district can identify the many resources that it already has that can support activities to keep students and the school community healthy. Mapping also helps the district identify intersections that might result with staff coordination and blended funding and notice gaps that the district might address when planning for meeting students' current and future needs.
For example, to clarify the availability and allocation of resources, the San Francisco Unified School District used resource mapping to identify existing federal, state, local, and private sources of funding for health services, policies, and education. Planners then linked the eight components of a coordinated school health program to the sources that support them. (Marx, Wooley, & Northrop, 1998, pp. 32–33).
- What resources are currently in place?
- How do they or can they complement one another?
- Does the state allocate such resources as federal block grants, tobacco settlement funds, and general revenues to support activities that affect the well-being of students?
- Is the school district approved as a Medicaid provider so that it can receive Medicaid reimbursements?
- Could the school district and the local health department combine funding from the Maternal and Child Health block grant with funding from the Preventive Health and Health Services block grant to fund school health services?
Categorical federal funding—funding designated to address a particular risk behavior, such as substance abuse or HIV—has frequently been a barrier to the collaboration that is the hallmark of coordinated school health programs. Recently, federal agencies have initiated funding partnerships that encourage local collaboration by requiring communities and schools to work cooperatively and to share resources across categories.
For example, the U.S. Departments of Education, Health and Human Services, and Justice are jointly funding the Safe Schools/Healthy Students Initiative for school districts and communities to develop partnerships and implement strategies for creating safe learning environments. An example of a recently funded site is the Washington County, Maine, Consortium for School Improvement. The Consortium joined with community mental health agencies, the Cooperative Extension Service, and law enforcement agencies to establish a program that includes family outreach and counseling services; early identification, referral, and treatment for troubled children; substance abuse and mental health counseling; and classroom programs to prevent youth violence and substance abuse. See the Safe and Drug-Free Schools Web site (www.ed.gov/offices/OESE/SDFS) for more examples.
Finding and analyzing information about funding availability are essential if schools are to achieve "Healthy Bodies, Minds, and Buildings." A plan that coordinates school staff and community programs can ensure a more effective use of funds. Such a plan avoids underutilization or inappropriate utilization of staff, duplication of services, and turf wars. The School Health Finance Project database helps schools identify resources, and the coordinated school health program model provides the structure for these efforts.
