Health Educ Behav OnlineFirst, published on May 15, 2009 as doi: /

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1 Health Educ Behav OnlineFirst, published on May 15, 2009 as doi: / Current Developments in Accreditation and Certification for Health Promotion and Health Education: A Perspective on Systems of Quality Assurance in the United States Randall R. Cottrell, DEd, CHES Linda Lysoby, MS, CHES Laura Rasar King, MPH, CHES Collins O. Airhihenbuwa, PhD Kathleen M. Roe, DrPH John P. Allegrante, PhD The health education profession in the United States employs parallel, and overlapping, systems of voluntary credentialing to ensure quality in professional preparation. The U.S. approach to quality assurance comprises credentialing at the individual level, including certification, and at the institutional level, including regional and program-specific accreditation or approval of professional preparation degree programs. These multiple systems and levels of quality assurance have evolved during a half century but have not been uniformly available or universally embraced by the field, employers, or those in the institutional settings in which health educators now receive their professional preparation. This article reviews the current scope of credentialing systems in the United States and explains whom they serve and how they function. Recent developments that are now reshaping the landscape of quality assurance in health education and health promotion are also discussed. Keywords: accreditation; certification; credentialing; health education; professional preparation Health education as a profession has now evolved over the course of a century in the United States. School health educators are responsible for planning and implementing health-related instruction in schools, and public health educators (also called community health educators) work in a variety of settings, including voluntary health organizations, public health departments, and hospitals. The Standard Occupational Classification Index of the U.S. Department of Labor has defined health educators as professionals who Randall R. Cottrell, Health Promotion and Education Program, University of Cincinnati, Ohio. Linda Lysoby, National Commission for Health Education Credentialing, Inc., Whitehall, Pennsylvania. Laura Rasar King, Council on Education for Public Health, Washington, D.C. Collins O. Airhihenbuwa, Department of Biobehavioral Health, Pennsylvania State University, University Park. Kathleen M. Roe, Department of Health Science, San Jose State University, San Jose, California. John P. Allegrante, Department of Health and Behavior Studies, Teachers College, and Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York. Address correspondence to Randall R. Cottrell, Health Promotion and Education Program, College of Education, Criminal Justice, and Human Services, University of Cincinnati, P.O. Box , 526 Teachers/ Dyer Hall, Cincinnati, OH ; phone: (513) ; [email protected]. Health Education & Behavior, Vol. 36(3): (June 2009) DOI: / by SOPHE 451

2 452 Health Education & Behavior (June 2009) Promote, maintain, and improve individual and community health by assisting individuals and communities to adopt healthy behaviors. Collect and analyze data to identify community needs prior to planning, implementing, monitoring, and evaluating programs designed to encourage healthy lifestyles, policies and environments. May also serve as a resource to assist individuals, other professionals, or the community, and may administer fiscal resources for health education programs. (U.S. Department of Labor, 2008) The U.S. Department of Labor estimates that there are more than 61,000 such health educators who are currently engaged in professional practice in the United States. The health education profession currently employs several systems of voluntary credentialing to ensure quality in the professional preparation of health education professionals. These systems include credentialing at the individual and institutional levels, including regional and program-specific accreditation or approval of professional preparation programs. These multiple systems of quality assurance have been developed and have evolved over time for both historical and pragmatic reasons. The purpose of this article is to review and describe two systems of quality assurance: (a) certification or licensure at the individual level and (b) accreditation or approval of professional preparation programs at the institutional level. (Figure 1 displays an overview of these systems.) Furthermore, this article will describe the audiences whom these various systems seek to serve and how they function. Recent developments to reshape the landscape of quality assurance in health education and health promotion are also discussed. INDIVIDUAL-LEVEL CREDENTIALING There are now three distinct forms of individual-level credentialing for health education professionals. These include the Certified Health Education Specialist (CHES), individual certification or licensure for teachers of health in schools, and Certified in Public Health (CPH), which is a general certification for any master of public health graduate of an accredited school of public health professionals. We gratefully acknowledge the following institutions and individuals for their support of the Galway Consensus Conference: Teachers College, Columbia University; Council of Accredited MPH Programs; International Union for Health Promotion and Education; National University of Ireland, Galway; New York University Steinhardt School of Culture, Education & Human Development; Pennsylvania State University; Reykjavik University; Royal Society for the Promotion of Health; Sage Publications, Inc.; Society for Public Health Education; University of Bergen; U.S. Centers for Disease Control and Prevention (Grant No. 5U50DP ); and Dr. Keiko Sakagami, Japanese Society for Health Promotion and Education. The Galway Consensus Conference wishes to acknowledge Prof. Richard Parish, Royal Society for the Promotion of Health (United Kingdom), and Dr. Becky J. Smith, American Association for Health Education (United States), for their contributions during the conference planning phase. The findings and conclusions related to the Galway Consensus Conference are those of the authors and do not necessarily represent the official position of any of the institutions providing meeting support. Editor s Note: This article is one of a collection of 10 manuscripts related to Toward International Collaboration on Competencies and Accreditation in Health Promotion and Health Education: The Galway Consensus Conference, held June 18-16, 2008, at the National University of Ireland, Galway. The conference sponsors, the Society for Public Health Education (SOPHE) and the International Union for Health Promotion and Education (IUHPE), are pleased to provide open access to all of the related manuscripts, half of which are published in SOPHE s Health Education & Behavior and half of which are published IUHPE s Global Health Promotion. To read the entire collection of articles, go to and search for Galway Consensus.

3 Credentialing of Individual Health Educators and Professional Preparation Programs in the United States Individual-Level Certification & Licensure Professional Preparation Program Accreditation or Approval Teacher Licensure Statecontrolled (Educ. Depts.) Certified Health Education Specialist Professioncontrolled (NCHEC) Certified in Public Health Professioncontrolled (NBPHE) SABPAC Undergrad Health Ed. Professional Prep. Programs CEPH MPH Programs and Undergrad. Health Ed prog. associated with MPH Programs NCATE & TEAC Undergrad Teacher Prep. Programs via AAHE Entry Level Advanced Level (In planning stages) National Accreditation Task Forces Figure 1. The current credentialing framework for quality assurance in health education in the United States. NOTE: NCHEC = National Commission for Health Education Credentialing, Inc.; NBPHE = National Board of Public Health Examiners; SABPAC = SOPHE/ AAHE Baccalaureate Program Approval Committee; CEPH = Council on Education for Public Health; MPH = Master of Public Health; NCATE = National Council for Accreditation of Teacher Education; TEAC = Teacher Education Accreditation Council; AAHE = American Association for Health Education. 453

4 454 Health Education & Behavior (June 2009) CHES The CHES credential is administered by the National Commission for Health Education Credentialing, Inc. (NCHEC). NCHEC is an independent certification body whose mission is to improve the practice of health education and to serve the public and the profession of health education by certifying health education specialists, promoting professional development, and strengthening professional preparation and practice (NCHEC, 2008). As of December 2007, there were more than 7,500 health education professionals with active CHES certification. CHES is a voluntary certification, but in a 2007 market survey of current and potential workforce employers, nearly 40% indicated that they look specifically for professionals with a CHES designation when employing or contracting with a health educator. Employers surveyed in this study were identified by practicing health educators using a snowball sampling technique, so results cannot be generalized to all potential health education employers (Hezel Associates, 2007). Currently, a candidate who wishes to sit for the CHES examination must possess a bachelor s, master s, or doctoral degree from a regionally accredited institution of higher education. Within the context of U.S. higher education, regional accreditation is a form of institutional credentialing. Various accrediting groups, for example, the Middle States Commission on Higher Education, a unit of the Middle States Association of Colleges and Schools, examine and accredit a college or a university as an entity within a particular region of the country. In contrast, specialized accreditation in the United States, such as that provided by the Council on Education for Public Health (CEPH) or the National Council for Accreditation of Teacher Education (NCATE), is aimed at accrediting specific degree programs within a college or university. In addition to being a graduate of a regionally accredited institution, a candidate for CHES must submit one of the following: 1. an official transcript (including course titles) that clearly shows a major in health education (health education, community health education, public health education, school health education, etc.) or 2. an official transcript that reflects at least 25 semester hours or 37 quarter hours of coursework with specific preparation addressing the Areas of Responsibility for Health Educators (NCHEC, 2008). After meeting eligibility requirements and passing a written examination, individuals earn and are permitted to use the designation CHES. To pass the CHES exam and become a CHES, individuals must demonstrate skills related to the seven major areas of responsibility of a health educator as defined by NCHEC (see Table 1). To maintain that credential, individuals must pay an annual renewal fee and earn 75 contact hours of continuing education within a 5-year recertification period. CHES certification is accredited by the National Commission for Certifying Agencies (NCCA). This certification industry recognition was created in 1987 by the National Organization for Competency Assurance (NOCA) to help ensure the health, welfare, and safety of the public through the accreditation of a variety of certification programs/organizations that assess professional competence. NCCA has accredited more than 190 programs representing 78 organizations. NCCA accredited programs certify individuals in a wide range of professions and occupations including nurses, automotive professionals, respiratory therapists, counselors, emergency technicians, crane operators and more (NOCA, 2009). Certification programs that receive NCCA

5 Table 1. Health Educator Areas of Responsibility Cottrell et al. / U.S. Systems of Quality Assurance 455 Assess individual and community needs for health education Plan effective health education strategies, interventions, and programs Implement health education strategies, interventions, and programs Conduct evaluation and research related to health education Administer health education strategies, interventions, and programs Serve as a health education resource person Communicate and advocate for health and health education SOURCE: National Commission for Health Education Credentialing, Inc. (2008). Accreditation demonstrate compliance with the NCCA s Standards for the Accreditation of Certification Program (NOCA, 2004). Teacher Certification and Licensure for School Health Educators Health educators who teach in U.S. public schools and most private schools are required to hold a recognized teaching credential from the state in which they teach. Each state maintains its own requirements for obtaining and maintaining this credential. In some states, the credential is a license, whereas in others it is a certification. The University of Kentucky maintains a Web site that has links to the teacher certification requirements for all 50 states (University of Kentucky, 2008). Most school health educators are eligible for CHES certification even though most choose not to pursue this additional credential. Some school health educators believe that there is no added benefit in obtaining CHES status as it is the state certification or licensure credential that permits them to teach in the schools. CPH In the summer of 2008, a new certification became available to public health professionals (including health educators) who have earned a master s or doctoral degree from a school or program in public health that has been accredited by CEPH. This new credential, called CPH, was originally conceived and funded by the Association of Schools of Public Health. The National Board of Public Health Examiners was independently incorporated in September 2005 to develop, administer, and evaluate this voluntary certification and develop an examination process. The examination covers the five core areas of public health knowledge, as defined by CEPH, as well as the seven crosscutting competencies developed by the Association of Schools of Public Health (see Table 2). The exam does not attempt to assess the more specialized areas of health education competency that are covered in the CHES exam, and requirements for recertification have not yet been established (National Board of Public Health Examiners, 2007). Even though this certification will not assess the competencies for health education, it has the potential to become a recognized credential by public health employers as they hire their professional staff, including health educators. Moreover, because this is a new certification, it has yet to be seen how it will interface with the current CHES certification, how employers will view the certification, and how the profession will receive it.

6 456 Health Education & Behavior (June 2009) Table 2. Core Areas in Public Health and Crosscutting Competencies Five Core Areas Biostatistics Environmental health science Epidemiology Health policy and management Social and behavioral sciences Seven Crosscutting Competencies Communication and informatics Diversity and culture Leadership Public health biology Professionalism Program planning Systems thinking SOURCE: National Board of Public Health Examiners (2009). APPROVAL AND ACCREDITATION PROCESSES In addition to individual-level credentialing, the health education profession has developed and devolved parallel systems of professional preparation program-level credentialing, including approval and accreditation processes. These systems support quality assurance in school health education and community/public health education professional preparation. Although these processes have been in place for several decades, they have not been uniformly available or universally embraced by the field or by the institutions currently preparing health educators. SOPHE/AAHE Baccalaureate Program Approval Committee (SABPAC) SABPAC approval is a voluntary credentialing process and designation for undergraduate professional preparation programs in community health education. Approval is a designation awarded by a joint committee of the Society for Public Health Education (SOPHE) and the American Association for Health Education (AAHE). SABPAC approval is recognized by the profession as a standard for entry-level health education preparation programs. The purpose of the review and approval process for baccalaureate programs in health education is to improve the curriculum and educational effectiveness of health education professional preparation programs in U.S. colleges and universities preparing entry-level health educators. SABPAC approval was designed to fill a void in health education accreditation that exists in the United States. Although undergraduate school health education programs can be nationally recognized by AAHE as part of NCATE accreditation and graduate master of public health programs can be accredited by CEPH, there was no accreditation available for undergraduate community/public health programs. The most recent AAHE Directory of Institutions Offering Undergraduate and Graduate Degree Programs in Health Education listed 246 professional preparation programs at the undergraduate and graduate levels (AAHE, 2005). At the graduate level, most health educators are prepared in the context of schools of education; schools of health, physical education, and recreation; or schools of public health. Voluntary SABPAC approval, although not accreditation, has played an important role in establishing professional preparation standards and assessing the quality of the 19 programs that are currently SABPAC approved (SOPHE, 2008). One limitation of SABPAC, as an approval process, is that it is not widely viewed within the context of American higher education as equivalent to an accreditation system and thus has not received full acceptance from some

7 Cottrell et al. / U.S. Systems of Quality Assurance 457 institutions that offer professional preparation in health education. Such institutions might be more receptive to an accreditation system as opposed to an approval process. CEPH CEPH, founded in 1974, is the independent, nongovernmental agency recognized by the U.S. Department of Education to accredit schools of public health and certain public health programs offered in settings other than schools of public health. These schools and programs prepare students for entry into public health careers. The primary professional degree is the master of public health, but other master s and doctoral degrees are offered as well (CEPH, 2008a). CEPH currently accredits 111 schools and programs in public health, and there are 24 applicant schools and programs slated to be accredited between 2008 and Approximately 70 of the 111 CEPH-accredited schools and programs offer master s-level concentrations in health education or health promotion areas. In 2007, the U.S. Department of Education expanded CEPH s scope of recognition to also accredit undergraduate programs in public health; however, currently CEPH accredits only undergraduate programs that are affiliated with an accredited master s-level public health program. The National Task Forces on Accreditation in Health Education have requested that CEPH consider future accreditation of undergraduate community/public health education programs that are in colleges or universities that do not have an accredited master s-level public health program. Although CEPH may be amenable to this request, currently it does not have the infrastructure, capacity, or specific accreditation requirements in place to move forward with this recommended action. NCATE and Teacher Education Accreditation Council (TEAC) NCATE was established in 1954 and is a nonprofit, nongovernmental agency that accredits schools, colleges, and departments of education in U.S. colleges and universities. The mission of NCATE is to help establish high quality teacher, specialist and administrator preparation. Through the process of professional accreditation, NCATE works to make a difference in the quality of teaching, teachers, school specialists and administrators (NCATE, 2008b). As of 2007, there were 632 NCATE accredited colleges and universities with 78 additional colleges or universities seeking NCATE accreditation. Not all of these accredited departments and colleges of education, however, offer health education professional preparation programs. There are currently 53 nationally recognized NCATE programs in health education (S. Wooley, personal communication, April 25, 2008). In addition, some states conduct their own accreditation activities using the NCATE guidelines but do not submit their applications for national recognition (NCATE, 2008a). NCATE utilizes members of professional societies in various subject matter areas to participate in the accreditation process as peer reviewers. In other words, mathematics professionals review mathematics programs, science professionals review science programs, and health education professionals review health education programs. AAHE developed the guidelines to be used in reviewing health education professional preparation programs and oversees the NCATE health education recognition process. To receive AAHE/NCATE national recognition and compliance status, the health education program must submit an approved program portfolio that is then reviewed by AAHEtrained reviewers (AAHE, 2008). AAHE conducts NCATE reviews only at the undergraduate level, which is called the initial level. At the present time, there are no health education advanced-level (i.e., graduate) standards, and NCATE has recommended that advanced-level standards not be developed as few universities pursue

8 458 Health Education & Behavior (June 2009) advanced accreditation in the specific subject areas (B. Smith, personal communication, April 24, 2008). TEAC is an accreditation agency that is an alternative to NCATE. Both NCATE and TEAC accredit teacher education programs. TEAC was founded in 1997 as a nonprofit organization. It is dedicated to improving academic degree programs for professional educators, those who will teach and lead in schools, pre-k through grade 12. TEAC s goal is to support the preparation of competent, caring, and qualified professional educators (TEAC, 2006). Recently, TEAC and NCATE announced that their governing boards have unanimously agreed to work together in developing a single accreditation system that has multiple pathways to accreditation. A joint NCATE/TEAC Design Team has been established to develop a proposal for this unified accreditation system (TEAC, 2008). RECENT DEVELOPMENTS Several recent developments to reshape credentialing in health education began to unfold during the 2000s. Two in particular the National Task Forces on Accreditation in Health Education and the Competencies Update Project (CUP) have been instrumental in the effort to strengthen quality assurance through a linked system of accreditation and certification. National Task Forces on Accreditation in Health Education The National Task Forces on Accreditation in Health Education represent a professionwide effort and were formed to examine and address the accreditation issues facing the health education profession. There have been three distinct task forces. The first National Task Force on Accreditation in Health Education, cochaired by Collins Airhihenbuwa and John Allegrante, was convened from 2001 to After exhaustive study, this task force drew a variety of conclusions and provided a series of key recommendations to the profession (see Table 3; Allegrante et al., 2004). The second National Task Force on Accreditation in Health Education was the National Transition Task Force on Accreditation in Health Education. This task force was cochaired by Kathleen Roe and David Birch and met from 2004 to The mission of the transition task force was to move from recommendations made during the initial study phase on accreditation to the implementation phase. This task force continued to collect data on the status of current health education professional preparation programs and interacted with various stakeholder and other groups with interest in accreditation, culminating in the Third National Congress for Institutions Preparing Health Educators: Linking Program Assessment, Accountability, and Improvement, which was convened in Dallas, Texas, in Late in 2006, the third National Task Force on Accreditation in Health Education, the National Implementation Task Force for Accreditation in Health Education, was formed and was originally cochaired by Kathleen Roe and Randall Cottrell. David Birch replaced Kathleen Roe as cochair in This task force was charged to assist the profession in moving toward an acceptable accreditation system that will meet the needs of most professional preparation programs and serve to advance the profession: Based on the recommendations of the first National Task Force on Accreditation in Health Education and informed by the Third National Profession-Wide Congress in Dallas, 2006, the charge of the National Implementation Task Force for Accreditation in Health Education

9 Cottrell et al. / U.S. Systems of Quality Assurance 459 Table 3. Recommendations From the First National Task Force on Accreditation in Health Education 1. That accreditation be the quality assurance mechanism for health education professional preparation institutions 2. That there be a unified accreditation system, comprising two parallel, coordinated accreditation mechanisms for community and school health education preparation institutions, which are responsive to the needs of the health education profession 2a. That the National Council for Accreditation of Teacher Education be the preferred accrediting entity to provide a single coordinated accreditation mechanism for school health education programs 2b. That the Council on Education for Public Health be the preferred accrediting entity to provide a single coordinated accreditation mechanism for community/public health education programs 3. That a coordinated accreditation system build on the best practices of existing community and school health accreditation mechanisms 4. That graduate professional preparation programs ensure that students perform all health education competencies and that their performance reflect graduate-level proficiency 5. That new designations be created to distinguish the practice level of health educators at the undergraduate and graduate levels, parallel with other professional disciplines such as nursing and social work 6. That the National Commission for Health Education Credentialing be the appropriate entity to oversee the process of individual certification at both the undergraduate and graduate levels. Only students from accredited programs/schools should be eligible for Certified Health Education Specialist (CHES) and Master Certified Health Education Specialist (MCHES) certification 7. That the results of the work of the Task Force be articulated to the American Public Health Association, Association of Schools of Public Health, Association of Teachers of Preventive Medicine, Coalition of National Health Education Organizations, National Commission for Health Education Credentialing, and other relevant groups SOURCE: Allegrante et al. (2004). Copyright 2004 by the Society for Public Health Education. is to help shape the processes and to continue to prepare the field for accreditation as a quality assurance mechanism for the profession. (SOPHE, 2006) The task force is continuing to develop manuscripts, presentations, Web pages, webinars, and promotional materials that can be used to help the profession understand and prepare for the inevitability of program accreditation. Program accreditation is important to help standardize the core elements of professional preparation and to make certain that current key competencies, as identified most recently in CUP, are being taught and imparted to students in professional preparation programs. CUP had as a primary objective to delineate the major responsibilities and key competencies that all health educators are expected to master (Airhihenbuwa et al., 2005; Gilmore, Olsen, Taub, & Connell, 2005). CUP was appropriately named to reflect a continuation of the work that dates back to the Role Delineation Project in the 1980s. The CHES certification as well as the SABPAC approval process and the NCATE/ AAHE accreditation process are based on these competencies. In 2005, CUP, which reverified the roles, responsibilities, competencies, and subcompetencies of a health educator, was completed. A job analysis project is currently under way to again verify the roles, responsibilities, competencies, and subcompetencies performed by the health educator and is expected to be completed in Based on the findings of CUP and

10 460 Health Education & Behavior (June 2009) recommendations made by the National Task Force on Accreditation in Health Education, NCHEC has decided to proceed with a new, advanced level of certification for health education professionals. The three National Task Forces on Accreditation in Health Education have certainly had an impact on quality assurance mechanisms in the profession. Progress has been slow but steady. It requires time to research quality assurance mechanisms, make appropriate recommendations, take the pulse of the profession related to quality assurance, educate the profession, advocate for change with various accrediting and certification bodies, and see those changes brought to fruition. However, the national accreditation task forces have accomplished and continue to pursue and promote these objectives. Not all health educators are in agreement with these quality assurance mechanisms, and complete consensus will never be obtained. Some health educators believe quality assurance mechanisms are merely occupational protection programs designed and enforced to limit access to the workplace. Based on the Dallas Congress outcomes and discussions at numerous professional meetings, the majority of the profession support the development of quality assurance mechanisms and believe that accreditations and certifications advance the profession and ultimately improve health education services to the public. DISCUSSION Multiple individual-level certifications or licenses, or both, are available for health education professionals in the United States, depending on their focus and employment setting. Accreditation, however, is currently available for only professional preparation programs that prepare school health educators at the undergraduate level as well as graduate-level public health educators and certain undergraduate public health education programs affiliated with accredited master s-level programs. But CEPH has yet to permit undergraduate health education programs that are not affiliated with accredited master s-level programs to seek accreditation, and currently, the only graduate-level accreditation available in health education is for public health programs that meet CEPH requirements. Thus, with at least 166 programs for which there is no accrediting body (AAHE, 2005), there is still a large gap in the accreditation of health education programs in the United States. Three profession-wide task forces have been working for almost a decade to advance the cause of accreditation for undergraduate community and public health education programs. Differences of opinion in the profession concerning the accreditation of graduatelevel community health education programs still remain. As of July 2008, there were 40 accredited schools of public health and 71 graduate public health programs; however, not all of these schools and programs offer concentrations in health education (CEPH, 2008b). As of 2005, there were 98 institutions identified in the AAHE Directory of Institutions Offering Undergraduate and Graduate Degree Programs in Health Education that offered non public health focused graduate degree programs in community health education, health education, health sciences, or health promotion (AAHE, 2005). Although these 98 programs could elect to modify their programs to meet CEPH requirements, many have not chosen to do so. This is in large part for several reasons: the belief by some faculty of these programs that there are philosophically important differences between public health education and community health education, the lack of institutional capacity and resources to mount the efforts necessary to undergo and sustain CEPH accreditation, and emerging concerns that accreditation

11 Cottrell et al. / U.S. Systems of Quality Assurance 461 does not yield benefits that are commensurate with the investment of time, energy, and resources. Thus, although progress on creating a system of quality assurance in professional preparation is being made, many barriers exist, and there is still much work to be done to create a unified accreditation system that meets the needs of health education programs in the United States. Regarding individual certification, it has yet to be determined how the CPH certification will be received by graduates and recognized by employers and how it will interface with the current CHES certification. The numbers of individuals with CHES certification is growing, with a 15% increase in the numbers of registrants for the CHES examination in each of the past 3 years (Goldsmith, 2007). Encouraging employers to recognize the importance of this voluntary credential, as well as that of the health education profession, has been a priority activity of key health education membership and credentialing organizations. The recent attainment of NCCA accreditation of the CHES credential attests to compliance with international certification standards and may serve to further strengthen the value of CHES among employers. In keeping with those standards, another analysis of the work of health educators to verify competencies is currently under way. Those results, expected to be completed by the end of 2009, will again catalyze changes in the certification examination, professional preparation, and continuing professional development. This process is iterative and necessary to ensure that certification, preparation, and professional development are based on what is both necessary and desirable in current practice. In the meantime, NCHEC is proceeding with an advanced-level certification and has distributed the proposed parameters in terms of eligibility, mechanism for determining qualifications, and other requirements to the profession. A period of open public comment was concluded in November Final determinations on advanced certification will be made and released in Challenges include complying with certification standards at the same time as developing certification mechanisms that health educators will voluntarily accept. One of the recommendations of the National Task Forces on Accreditation is that only students from accredited programs should be eligible to sit for the CHES examination. Although this is supported by NCHEC leadership in principle as an important quality assurance mechanism, significant progress will have to be made in helping professional preparation programs realize the value of accreditation so that there are a sufficient number of viable schools and programs in existence to continue producing a pipeline of eligible graduates for certification. CONCLUSION Certification or licensure of individual health educators is well established in the United States, and the effort to put into place a unified system of accreditation of health education professional preparation programs is well under way. Health education professionals, their employers, and the general public, however, need to be better informed about the various accreditation mechanisms and certifications now available, the importance of these credentials in establishing professional competence and credibility, and how these systems of quality assurance serve to enhance the profession and ultimately ensure that the services health educators provide to individuals and communities are of the highest quality. Many health education professionals and those involved in professional preparation at the college and university levels believe there is value in

12 462 Health Education & Behavior (June 2009) linking individual-level credentialing to the development of quality assurance mechanisms for professional preparation and training programs on the institutional level. In the United States, health education has developed into a maturing profession in part due to the accreditation and certification processes that are currently in place. Although much progress has been made, there is still much work to be done. The process of incorporating and diffusing new standards and mechanisms of quality assurance, often in the face of resistance to change, will require time. To be successful, that process must both renew and sustain itself during successive generations of leadership that possess the courage to stay the course. References Airhihenbuwa, C. O., Cottrell, R. R., Adeyanju, M., Auld, M. E., Lysoby, L., & Smith, B. J. (2005). The National Health Educator Competencies Update Project: Celebrating a milestone and recommending next steps to the profession. Health Education & Behavior, 32, Allegrante, J. P., Airhihenbuwa, C. O., Auld, M. E., Birch, D. A., Roe, K. M, & Smith, B. J. (2004). Toward a unified system of accreditation for professional preparation in health education: Final report of the National Task Force on Accreditation in Health Education. Health Education & Behavior, 31, ; and American Journal of Health Education, 35, American Association for Health Education. (2005). Directory of institutions offering undergraduate and graduate degree programs in health education. American Journal of Health Education, 36, American Association for Health Education. (2008). Guidelines for AAHE/NCATE folio review of health education basic level programs. Retrieved April 3, 2008, from Council on Education for Public Health. (2008a). About CEPH. Retrieved April 3, 2008, from Council on Education for Public Health. (2008b). Accredited schools and programs in public health. Retrieved April 3, 2008, from Gilmore, G. D., Olsen, L. K., Taub, A., & Connell, D. (2005). Overview of the National Health Educator Competencies Update Project, Health Education & Behavior, 32, Goldsmith, M. (2007). NCHEC reports growth in CHES nationwide. CHES Bulletin, 18(2), 3. Hezel Associates. (2007). Marketing the health education profession: Knowledge, attitudes, and hiring practices of employers. Retrieved September 27, 2008, from aahe/pdf_files/marketprofessionreport.pdf National Board of Public Health Examiners. (2007). Take the exam. Retrieved April 3, 2008, from National Board of Public Health Examiners. (2009). Take the exam! Get certified in public health (CPH)! Retrieved January 13, 2009, from National Commission for Health Education Credentialing, Inc. (2008). Become a CHES. Retrieved April 3, 2008, from National Council for Accreditation of Teacher Education. (2008a). Nationally recognized programs. Retrieved May 21, 2008, from National Council for Accreditation of Teacher Education. (2008b). NCATE: The standard of excellence in teacher preparation. Retrieved April 3, 2008, from documents/ncatemission.pdf National Organization for Competency Assurance. (2004). Standards for the Accreditation of Certification Program. Washington, DC: Author.

13 Cottrell et al. / U.S. Systems of Quality Assurance 463 National Organization for Competency Assurance. (2009). NCCA accreditation. Retrieved January 9, 2009, from Society for Public Health Education. (2006). National implementation task force for accreditation in health education. Retrieved April 3, 2008, from Society for Public Health Education. (2008). SABPAC approved programs. Retrieved January 13, 2009, from final.pdf Teacher Education Accreditation Council. (2006). About TEAC. Retrieved July 15, 2008, from Teacher Education Accreditation Council. (2008). NCATE and TEAC boards give green light for future system of teacher education accreditation. Retrieved July 15, 2008, from University of Kentucky. (2008). Certification requirements for 50 states. Retrieved April 3, 2008, from U.S. Department of Labor, Bureau of Labor Statistics. (2008). Occupational outlook handbook edition. Retrieved June 13, 2008, from