1 Healthy Schools Colorado Report Report Prepared by: RMC Health Colorado Department of Education Center for Research Strategies
2 Healthy Schools Colorado Project Evaluation Measures Update Background The goals of the Healthy Schools Colorado (HSC) project are to help support healthy living choices and prevent childhood obesity. The HSC project is targeting schools, using the Coordinated School Health (CSH) Model, to improve school health policies, increase physical activity, increase access to healthy meals and vending, and increase knowledge of school nurses on asthma and diabetes. The CSH Model guides schools through steps related to bringing together a school team, using the School Health Index to assess school health needs, and developing and implementing School Health Improvement Plans (SHIPs) that target school health needs. The HSC project creates the infrastructure within regions, school districts, and schools to support and sustain CSH efforts. In addition, the HSC project supports Physical Education (PE) and School Nurse cadres of trainers to provide training to PE teachers and nurses state- wide. Lastly the HSC project conducts process evaluation of the CSH Model following Colorado s Roadmap to Health Schools and utilizes a web- enabled data tracking system to monitor school level data related to policies and practices in the areas of school health services, physical education, physical activity, and nutrition. The information presented in this evaluation report is from year two ( ) of the HSC project. This report includes completed summaries of the data elements outlined in the Healthy Schools Colorado Project: Evaluation Measures document (See Appendix A). School and Student Reach As reported in the progress report, a coordinator was hired for the three school districts and the two regions funded under the HSC project. District/regional coordinators are responsible for recruiting and training school health teams to implement CSH programs. The large school district, Jefferson County, hired a second coordinator at.5 FTE to help with the implementation and technical assistance to schools. The large region, Pikes Peak, has two coordinators who are both.5 FTE. During year two of HSC, there were 159 schools recruited to implement CSH programs across the five HSC grantees. Adams County Region had 20 schools; Douglas County had 26 schools; Jefferson County had 43 schools; Pikes Peak Region had 33 schools; and Poudre had 37 schools. During the grant year, it was estimated that the schools participating in the HSC project educated nearly 94,257 students.
3 District Infrastructure for CSH To support the district infrastructure for CSH, coordinators were offered multiple professional development opportunities during the year to build their capacity to implement district level changes and school level changes to support and sustain school health and wellness. Coordinators participated in quarterly coordinator meetings that provided professional development and networking opportunities. All coordinators attended the two- day Healthy Schools Leadership Retreat in June 2011, which offered over 20 different breakout- sessions covering the eight components of CSH, wellness policy issues, effective collaborations, SHIP data collection, and more. Coordinators are responsible for several HSC grant assurances and district/regional work plans. Coordinators are required to complete end- of- year reports on their work plan progress and complete a questionnaire to provide information about the process of implementing CSH at the district or regional level. Many successes and much progress were made during the second year of the HSC grant. Appendix B includes a summary report of the district/regional end- of- year reports and a summary of the end- of- year coordinator survey for Some highlights include: Coordinators working in districts (Adams and Douglas) with the Communities Putting Prevention to Work (CPPW) grants have established relationships and ongoing communication with the CPPW coordinator. Two of the districts advisory committees (Poudre and Jeffco) have created smaller working groups that meet regularly to focus on high priority areas. Jefferson County requires schools to develop annual goals that address health and wellness. Adam s 14 advisory committee revised the wellness policy to include that every school should have a wellness team and encourages recess before lunch in elementary schools. Coordinators cited administrative support, resources, and support from organizations such as RMC and CDE as key factors in their success. Lack of time and competing priorities (e.g., academics) were the top barriers reported by coordinators. Coordinators reported many connections, collaborations, and partnerships with community organizations to support CSH.
4 School Infrastructure for CSH Professional development and technical assistance to school health team co- leaders is a large portion of the HSC coordinators job responsibility. Coordinators identified a total of 159 schools that they were working with to implement CSH in Coordinators trained and supported school health teams to conduct the School Health Index (SHI), identify high priority areas in their school, and develop a plan to address and improve school health in physical activity (PA), physical education (PE), nutrition, and other CSH components. CSH 101 and CSH 201 trainings were conducted in the fall of 2010 in each of the districts and regions for new and continuing schools. These trainings were successful and participants indicated that learning objectives were met and that they will use the information and skills they learned in their work. In addition, the majority of schools had representation by one or both school health team co- leaders at the 2011 Healthy Schools Leadership Retreat (see Appendix C for evaluation results for the 2011 Healthy Schools Leadership Retreat.) Participants indicated that the learning objectives were met, that the information and skills presented were useful, and that the learning environment was conducive to their learning. Participant comments were overwhelming positive about the Retreat, specifically about the variety of sessions available, the location, the logistics, and expertise of presenters and keynote speakers. In addition to the Retreat, school health team co- leaders and school staff were offered other professional development opportunities through their district, CDE, and RMC Health. Webinars on conducting the School Health Index and developing School Health Improvement Plans are recorded and available on RMC Health s website. Also, through the Colorado Department of Education, professional development was available to school nurses in chronic disease management and physical education teachers across the state of Colorado. Year two of the grant targeted PE Standards, Fitness Assessment, Brain- based Learning, and Healthy Living = Healthy Learning. Training evaluations showed participants thought trainings were well organized, had useful information and activities, and increased their knowledge. The nurse cadre trained over 390 school nurses and the PE cadre conducted over 35 trainings. See Appendix C for details and training evaluations. A school level survey was conducted at the end of the school year with school team co- leaders to monitor the CSH process (specifically the steps in Colorado s Roadmap to Healthy Schools) and document challenges and successes experienced by school health teams. While results did not differ significantly from year one, the number of schools implementing CSH programs increased and schools are consistently reporting progress with the phases in the Roadmap. Appendix B contains the summary report from this survey. Highlights include: All schools have health teams in place.
5 Schools reported high satisfaction with TA from coordinators. The majority of schools implementing a SHIP reported that they plan to continue components and build on their successes. School team members who attended a CSH 101 or CSH 201 training reported increased knowledge and skills on how to use data to identify needs, write SHIPs, and learned effective strategies to manage school health teams. Schools reported funding, passionate team members and school staff, principal support, and TA from coordinators as factors for success. Schools reported that lack of time, buy- in from administrators, and staff turnover were barriers to implementation. School Health Improvement Plans (SHIPs) As part of the grant requirements, schools developed at least two SHIPs, one focused on physical activity, physical education or nutrition and the second SHIP focused on a high priority area of their choice. A total of 113 teams targeted physical activity or physical education and 64 teams focused on nutrition. A majority of teams (76%) identified two SHIPs, while 12% of teams targeted four or more components of CSH with their SHIPs. Once schools have implemented a SHIP they are required to write at least one success story to describe what was implemented in their school and the outcomes of these efforts. A success story goes beyond the reporting of numbers and documentation of grant requirements and provides a narrative description of a school s program. A success story is able to bring to life how CSH has impacted students, staff, family, and the community. Appendix D contains 11 success stories chosen to represent the exemplary work conducted in schools through the HSC project. These success stories include programs related to: Increasing PA with a fitness course (Rose Hill) Implementing a health curriculum (Rock Ridge, Cresthill) Increasing healthy snacks at parties and school functions (Red Rocks, Monroe, Kyffin) Increasing PA through student activity logs (Mesa) Increasing PA through a lunch intramural program (Creighton) Implementing staff developed nutrition lessons (Columbia) Increasing staff PA through staff pedometer walking challenge (Blevins)
6 Increasing staff wellness through yoga/pilates program (Adams) Coordinator Lessons Learned In year two, coordinators were asked to share their successes and challenges and the strategies they used to implement the CSH Model at the district or region and school level. To collect this information, questions were included on the end- of- year surveys, staff from the Center of Research Strategies conducted interviews with each of the HSC coordinators, and informal brainstorming sessions were conducted at coordinator meetings. Below are highlights from the district and regional coordinators responses. Poudre Valley School District The Poudre Valley School District (PVSD) has strong local partners (e.g., Poudre Valley Health System, the Poudre Valley Health System Foundation and Colorado State University), and maintains wellness as a strong community value. The district has a strong wellness policy and enjoys active parent support for health and wellness policy goals. Securing teacher time for health team activities and staff turnover have been the biggest challenges. Jefferson County School District The Jefferson County School District has made great strides in institutionalizing health and wellness as part of district operations. As part of JeffCo s accreditation plan, schools need health and wellness goals as an addendum to their Unified Improvement Plans. This addendum is called Culture, Climate, Health, Wellness and Environment Plan which should align with the local wellness policy. Budget cuts and staff turnover have complicated efforts to keep the momentum of school team efforts moving forward. Adams School Districts #14 and #50 Building on district support for staff wellness programs, the Adams district coordinator has been purposefully championing the champions. The majority of school teams in both districts 14 and 50 have included staff wellness goals in their school improvement plans. Another priority within the districts has been to communicate with principals any wellness policy changes and how they should be enforced, with the help of the school teams. Other grant programs (e.g., Live Well and Communities Putting Prevention to Work) have helped to reinforce health and wellness programming in the districts. The support on the part of district administrators and principals is perceived as strong.
7 Douglas County School District With the help of additional grant programs (Comprehensive Health Education and Communities Putting Prevention to Work), the Douglas County School District has been strengthening its wellness policies and changing policies regarding recess before lunch and the amount of physical activity minutes built into a school day. Efforts are also being made to reinforce awareness and implementation of the district wellness policies. Programs such as community gardens are serving to unify school communities and to engage parents. Sustaining these efforts is challenged by staff turnover and the need to replace current grant dollars. Pikes Peak Region By bringing together five Southeast Colorado school districts, the Pikes Peak Region has created substantial momentum behind school health efforts. Pikes Peak has designated coordinators or liaisons from each district in the region that meet on a regular basis. This allows for peer mentoring and sharing of local successes. Some communities such as Manitou Springs report taking their wellness efforts from the schools into a community- wide effort. Support from community partners (such as the Teller County Public Health Department), parents and school principals have helped to maintain the region s momentum around health and wellness goals. Healthy Schools Colorado Database Given the goal to develop and support district, region, and school infrastructure to create sustainable systems for school wellness through the CSH Model, data is collected annually to measure the number of students impacted by policy changes in the school and by chronic disease management education through school health services. The HSC project utilizes a web- enabled data tracking system. Data on school level policies and practices in the areas of school health services, physical education/activity and nutrition are collected and entered by HSC coordinators, school teams and school nurses annually. At the end of the second year of the gran ( ), 151 schools had entered data. A third of the schools represented in the database are in Jefferson County School District. The majority of schools in the database are elementary schools (65%.) See Appendix E for a full report on the Healthy Schools Colorado Tracking System. Highlights from the database results include: PE/PA At the school level, coordinators and teams were asked to evaluate whether their school implemented seven guidelines related to best practices in physical education. Findings reveal that a majority of schools reported implementing each guideline (61% to 93%) impacting approximately 52,000 to 78,000 students based on school census data.
8 The highest percentage of schools provided professional development to PE teachers or specialists on PE and the least percentage of schools indicated that they provide PE teachers with a written PE curriculum. NASPE recommends that school age children accumulate at least 60 minutes of physical activity per day or 300 minutes per week. Most HSC schools reporting data in the school year fell short of NASPE s recommendation for physical activity. Per school teams estimates elementary students averaged 140 minutes of physical activity per week. Middle and high school students receiving physical activity breaks, averaged 114 and 87 minutes per week respectively. NASPE recommends 150 minutes of physical education per school week for elementary school children and 225 minutes for middle and high school students. Assuming a 36- week school year, this translates into 90 hours of PE for elementary age students and 135 hours for middle and high school students per school year. Coordinators and school teams estimates suggest that elementary students receive an average of 42 hours of physical education per year, while middle and high school students average 60 and 70 hours respectively per year. School Health Services During the , the school nurse cadre provided both online and in person training on obesity related issues and healthy living strategies and reached nearly 350 participants statewide. While the recommended ratio of nurse to students is 1:750 for well students, the ratio for the entire state of Colorado is a dismal 1:1,931. Among schools participating in the HSC, the estimated ratio is higher with one full time equivalent school nurse for every 2,639 students. In the academic year, school nurses identified 6,179 students being without health insurance and referred 2,260 eligible students to state health insurance. School nurses provided vision, hearing, oral health and height and weight screening to a large number of students (51,165 students for vision to 2,291 students for oral health.) Within the HSC online database, nurses estimated that among the 6,455 students with asthma, 41% of them self- managed their condition and that 28% of asthmatic students kept medicine at school. Have students identified with diabetes (267 students), 59% self- managed their condition and 90% had medicine at school. Nutrition- Access to Healthy Foods Coordinators and school teams were asked to evaluate whether their school implemented six guidelines related to best practices in nutrition services. In most schools many of these guidelines are in place. Ninety- nine percent of schools complied with the USDA regulations and 99% of schools reported that students have access to healthy food
9 choices in appropriate portion sizes. Only 30% of schools require that healthy food options are available to students at school functions and 65% of schools encouraged parents to provide a variety of nutritious foods if students bring lunch or snacks from home. Nutrition- Vending Machines None of the elementary schools offered vending machine access to students. In contrast, 95% of the high schools (19) and 73% of the middle schools (16) had vending machines for student use, including four middle schools that only sold bottled water. The data reveal that all schools with vending machines sold bottled water and the majority (53% - 80%) offered 100% juice beverages and food items containing no more than 35% with total calories from fat or 35% of total weight in sugar. The majority of middle and high schools (63%) do not sell sodas in vending machines. Changes from Year One to Year Two When appropriate comparisons between Cohort 1 (schools who started in year one of the grant) and Cohort 2 (schools that started in year two of the grant) were made to determine progress. Notable improvements in Cohort 1 schools include: PE and PA Policies 14% increase in schools offering opportunities for all students to participate in intramural activities or physical activity clubs 10% increase in schools providing PE teachers with assessment plans 10% increase in schools providing PE teachers with a written PE curriculum The overall number of physical activity breaks increased by 3%, and Nutrition Services Policies 14% increase in schools requiring healthy food choices be available to students at every school function, 8% increase in schools restricting student access to vending machines, school stores, and other venues that contain foods of minimal nutritional value, and
10 Healthy Vending Two schools from Cohort 1 (a K- 8 and a middle school), no longer allow students access to vending machines, Five middle schools and four high schools now offer nuts, seeds, dairy products, fresh fruits or vegetables, dried fruits and vegetables and packaged fruits in own juices, Vending machines in two middle schools no longer sell sodas, and vending machines in two middle schools now sell 100% juice with no added sweeteners, and one high now offers no or low calorie beverages. School Health Services Data A 55% and 20% increase in the number of students (diabetic and asthmatic) receiving information to take home, A 31% increase in the number of referrals of asthmatic students to providers, A 20% and 8% increase in the number of students (diabetic and asthmatic) receiving verbal instruction, and A 12% increase in the number of diabetic students with medicine at school. District Level Changes At the end of year two, all regions and districts had an advisory committee in place. More districts reported adopting health standards to guide their health education and instruction. In addition, at the end of year two, districts focused more on wellness policy work. This included stronger policy language, policy additions such as required health teams in all schools, increased awareness of policies and integrating school wellness policies in larger district accountability systems. All districts reported communicating the policy to a variety of audiences and working with schools and administrators to implement policies in place. Lastly district and regional coordinators established and utilized more partnerships with community organizations to further school wellness efforts in their districts and schools. Conclusion As evidenced during the first two years of Healthy Schools Colorado, the Coordinated School Health Model can impact the health of schools, staff and students and affect policies at the district and school level. The district and regional coordinators
11 have assumed responsibility for and provided leadership for successful implementation of the CSH model. Each district and region successfully increased the number of schools recruited in year two to implement CSH. Coordinators have improved their skills and effectiveness with working with schools and have made much progress working with improving, communicating, and implementing wellness policies. Coordinators have worked extensively with their schools health teams to complete the School Health Index (SHI), to develop School Health Improvement Plans (SHIPs), and provide technical assistance, resources, and links to professional development opportunities. School staff reported many learnings and positive experiences from the technical assistance and trainings they attended. Schools in turn have been successful in developing strong SHIPs and implementing these plans in their school. Schools recruited in year one were implementing their SHIPs in year two and had much success, evident in their success stories and school policy data. Data from the HSC database indicate that schools are implementing best practices and policies in physical education, physical activity, nutrition, and health services. As demonstrated during the first two years of the Healthy Schools Colorado Project, the professional development and technical assistance framework used to implement the CSH Model in Colorado school districts and schools has increased the knowledge and skills of district and school staff as well as affect school wellness policies to reach large number of students, staff, family members, and community members to promote and sustain healthy schools.