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Log in to Witsby: ASCD’s Next-Generation Professional Learning and Credentialing Platform
March 1, 2000
Vol. 57
No. 6

Creative Collaborations with Health Providers

From consulting with mental health organizations to working with parents, schools are forging useful alliances to create a healthy environment for learning.

The pressure is on: Increase scores on standardized tests or face dire consequences. More and more, teachers and school administrators are being held accountable for their students' performance on standardized tests. Meanwhile, they find increasing numbers of students with social, physical, psychological, and environmental problems that interfere with their ability to learn and with their teacher's ability to instruct. Further, teachers and administrators have fewer financial and other resources to deal with such problems.
Caught in the middle and told not to use students' problems as an excuse, many teachers and administrators are increasing “academic” rigor and decreasing “frills,” such as physical education, health education, and the arts. Everyone in the school community, from students to teachers and administrators to support staff, feels the strain of increased pressures. Sometimes the results include an improvement in overall test scores, but more often the results are disappointing.
Everyone wants students to graduate able to compete in a global marketplace and prepared to take their places as informed and productive citizens. However, students bring more problems into the classroom today than did students in earlier days. These problems, such as increased child poverty, decreased parental supervision with fewer stay-at-home parents, and increased cases of asthma, are beyond the training and capacity of teachers. Without help from beyond the classroom doors, teachers face an uphill battle in assisting these students to overcome barriers.

Coordinated Health

The coordinated school health program suggests a model for linking the resources in the school with families and community resources to address the physical, emotional, and social health needs of school-aged children (for a detailed description of the model components, see Marx and Northrop, p. 22). The model's creators recognize that every school employee—teachers, administrators, nurses, counselors, cafeteria workers, custodians, front office staff, and even volunteers—has a responsibility to help students succeed in an environment conducive to learning.
In addition to improved health outcomes, the goal of the model is improved academic outcomes (Marx, Wooley, & Northrop, 1998). In a joint statement on school health, the Secretaries of the U.S. Departments of Education and Health and Human Services said: "School health programs support the education process, integrate services for disadvantaged and disabled children, and improve children's health prospects" (1994).
Educators often raise concerns that school health programs take resources away from the main purpose of the school, namely, education. However, schools that have adopted the model's philosophy of looking at the whole child and at what he or she needs to succeed academically and socially find that educators can spend more time on instruction, resulting in improved academic outcomes. Students are in class more often and are better able to learn and perform. Support services, such as quality health instruction and a school nurse or a mental health counselor on staff, result in a reduction in the number of students using psychoactive drugs, participating in binge drinking, becoming pregnant and leaving school, and avoiding school because of fears of violence (U.S. Public Health Service, 1999).

What Schools Have

Many schools in the United States offer a varied, but often uncoordinated, range of support services. Secondary schools and many elementary schools have counselors who advise on academic matters and help students sort out social and mental-health concerns. Most schools have access to a school nurse, but the availability ranges from full-time to once every few weeks for a few hours. School cafeterias serve lunch in almost every school and breakfast in most schools. Some schools have psychologists, social workers, dental hygienists, and other health-care professionals available at the school or through the district or contracted with an outside agency. The contract is sometimes with a school-based or a school-linked health center, often operated by the health department, a local hospital, or a managed-care organization.
Many teachers have worked with their school's counselor, nurse, social worker, health educator, physical educator, or cafeteria staff to undertake specific projects or to help an individual student. This piecemeal approach, however, can result in the duplication of services and a lot of missed class time, with students either falling through the cracks or receiving inappropriate interventions. To address this lack of coordination, many schools are developing school-health teams, coordinating councils, or other administratively supported schoolwide programs. Some are also designating a school employee as a health coordinator with authority and release time to formalize and expand collaborative efforts.
For example, in the Stow-Monroe Falls school system outside Akron, Ohio, Carolyn Kuhn is the designated health promotion coordinator for the 6,200 students and school employees. Under her direction, the district's attendance levels have increased and the number of days lost because of suspensions for alcohol or drug use and violence has decreased over a three-year span. Through a 45-member advisory group, the district works with local businesses, nonprofit agencies, and Kent State University to coordinate and gain access to existing programs and services, enabling the school system to implement a coordinated school health program with virtually no additional funds (Lawton, 1999).

Examples of Partnerships

At the American School Health Association's 1999 annual conference, presenters shared examples of school-based programs in which school staff worked collaboratively with one another or with staff from other agencies for the welfare and academic achievement of students. In addition, School Health: Findings from Evaluated Programs (U.S. Public Health Service, 1999) reviewed more than 50 programs that addressed some aspect of students' physical, emotional, or social health through school-based programs. Such programs have led to improved school attendance, graduation rates, and standardized-test scores, as well as to lifestyles that contribute to good health. The examples that follow represent such collaborative efforts.

Collaborating with School Psychologists

In Florida, school psychologists trained teachers to enhance their problem-solving and classroom-management skills. They also worked with teachers and support staff over a three-year period to create a school climate in which the staff believed that they were responsible for every student. Project ACHIEVE provided training in problem solving; social skills and anger management; effective teaching; curriculum-based assessment; parent training; and organizational planning, development, and evaluation.
Evaluations of the project showed a 75 percent reduction in referrals for special education assessment and a decline from 6 to 2 percent of students placed in special education, compared with 7 percent at a comparison school. During the comparison years, 3 percent of students at the ACHIEVE schools were suspended, compared with 5 percent at the control schools. The study also found an increase in the number of students who scored above the 50th percentile on achievement tests (U.S. Public Health Service, 1999).

Collaborating with Physical Educators

Female athletes from Northern Kentucky University mentored girls who were identified as at-risk in a physical-activity and health-education program. The athlete-mentors gave the middle school students role models of successful women who stayed in school. They also helped the girls feel connected with school and thus increased the likelihood that they would complete their schooling (Ryan & Olasov, 1999).

Collaborating with Social Workers

In Fairfax County, Virginia, the Partnership for Healthier Kids linked needy students with free or low-cost health services. Students who had previously missed school because of untreated medical conditions were back in school quickly and were able to participate fully in instructional activities (Smith & Bealor, 1999).

Collaborating with Community Agencies

In Ohio, a community-based advisory committee supported teachers who were trained to use the adolescent-parent resource guide as part of a family and consumer sciences educational program for pregnant and parenting adolescents, both male and female. The advisory committee linked teachers with community agencies. Many participating schools provided child-care programs and transportation grants to help more students participate.
The program, called Graduation, Reality, and Dual-Role Skills (GRADS), increased the graduation rate for pregnant and parenting teens in the participating schools to 85 percent, compared with 67 to 91 percent in other states; increased the participants' likelihood of delivering a healthy baby; and decreased subsequent pregnancies within the next two years (U.S. Public Health Service, 1999).

Providing Parent Education

In Seattle, Washington, the Social Development Project, later titled Raising Healthy Children, included parent education as well as teacher training and materials for the use of teachers, parents, and students. During several sessions that included skills training, role play and feedback, and homework, parents of 1st and 2nd graders learned how to help their children resist peer pressure, how to apply consistent family management practices, and how to minimize conflict. Parents of 2nd and 3rd graders learned how to improve communication and academic support. Parents of 5th and 6th graders learned ways to reduce their children's risk for drug use. Parents of 43 percent of the children in the full intervention program attended parenting classes. Forty-six percent of those attending were from low-income families (Hawkins, Catalano, Kosterman, Abbott, & Hill, 1999).
Research on this multigrade elementary school program followed students for several years and found that over time, students who participated in the program in elementary school had significantly improved academic achievement as well as lower rates of delinquency, teen pregnancy, tobacco use, and illegal substance use (U.S. Public Health Service, 1999).

Partnering to Provide Health Services

A 23-member public-private health, education, and community partnership helped improve health and attendance among Minneapolis, Minnesota, public school students. In its first year, an immunization campaign increased the number of students with full immunizations from 69 to 98 percent. Because students without immunizations could be withheld from attending school, the campaign improved student attendance at the beginning of the school year. The partnership's current project addresses asthma management with the goal of improving student attendance, which can contribute to learning (Mullett, 1999).
In Harvey, Illinois, the school district worked with the local health department to build a comprehensive approach to school health. The school nurse, a social worker, and a health educator helped the coordinators in each school meet the needs of the district's primarily low-income African American and Latino student body (Woods & Winn, 1999).

Innovative Partnerships

All too often, Teachers' days are shattered by the eruptions of troubled students and by the demands of sick students. Their teaching must break through the emotional flatness of so many students who are depressed, sluggish in body and mind, or preoccupied with inner demons. If we wish to improve school outcomes, we will have to pay attention to the many forces that negatively influence school attendance, attentiveness, behavior, and persistence. (Tyson, 1999, p. K8)Administrators who have implemented coordinated school health programs recognize that teachers are not solely responsible for the academic achievement of their students. By using the coordinated school health model, they seek ways to help students through a variety of resources, both in the school and in the community. The model reinforces the belief that no one profession or institution can single-handedly provide all that children and youth need to develop into healthy, productive adults. Educators in districts with coordinated school health programs in place know when and where to seek help for troubled students and how to create environments in which students can achieve, free from harassment or fear of harm.

Hawkins, J. D., Catalano, R. F., Kosterman, R., Abbott, R., & Hill, K. G. (1999). Preventing adolescent health-risk behaviors by strengthening protection during childhood. Archives of Pediatric Adolescent Medicine 153, 226–234.

Lawton, M. (1999). Healthy kids, healthy learners: Coordinated school health programs embrace the mind-body connection for students. Middle Ground 3(1), 10–16.

Marx, E., Wooley, S. F., & Northrop, D. (Eds.). (1998). Health is academic: A guide to coordinated school health programs. New York: Teachers College Press.

Mullett, S. (1999, October). Healthy learners: Promoting student achievement through improved health and attendance. Paper presented at the meeting of the American School Health Association, Kansas City, MO.

Ryan, C. A., & Olasov, L. (1999, October). A collaborative model to mentor at-risk middle grade students. Paper presented at the meeting of the American School Health Association, Kansas City, MO.

Smith, S. L., & Bealor, S. (1999, October). Partnership for healthier kids. Paper presented at the meeting of the American School Health Association, Kansas City, MO.

Tyson, H. (1999). A load off the teachers' backs: Coordinated school health programs [Special Report]. Phi Delta Kappan, 80(5), K1–K8.

U.S. Department of Education & U.S. Department of Health and Human Services. (1994). Joint statement on school health by the Secretaries of Education and Health and Human Services. Washington, DC: Office of Disease Prevention and Health Promotion.

U.S. Public Health Service. (1999). School health: Findings from evaluated programs (2nd ed.). Washington, DC: U.S. Government Printing Office.

Woods, B. R., & Winn, K. L. (1999, October). The healthy schools partnership: Building a comprehensive school health program in Harvey, Illinois. Paper presented at the meeting of the American School Health Association, Kansas City, MO.

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