The umbrella represents the holistic framework of Health Promoting Schools under which any wellbeing issue can be addressed.

The umbrella represents the holistic framework of Health Promoting Schools under which any wellbeing issue can be addressed. Acknowledgment to the support agencies who have assisted in the planning and implementation of Fruit in Schools nationally and regionally: the National Heart Foundation of New Zealand, the New Zealand Cancer Society, Sport and Recreation New Zealand (SPARC), the Ministry of Education, School Principals Federation, New Zealand School Trustees Association, Health Research Council, Health Promoting Schools regional co-ordinators, Hutt Valley District Health Board. For more information go to www.moh.govt.nz/fruitinschools Published by the Ministry of Health, PO Box 5013, Wellington in April 2006. HP 4256 Fruit in Schools A how to guide HP 4255 Fruit in Schools looseleaf kit

Contents Introduction 2 Background 6 The Big Picture 8 First Steps 10 Further Reading 13 About this resource This resource has been designed to assist in the implementation of the Fruit in Schools programme using a whole school community approach. It is intended for: Principals, classroom teachers and other school staff, students, Boards of Trustees, parents/caregivers/whänau and school communities, Fruit in Schools co-ordinators and other health promoters/support staff from relevant agencies and organisations. The stapled booklet provides background information to assist all stakeholders gain an understanding of Fruit in Schools. The loose material inserted in the booklet s side panels are working documents designed for use by school communities and health promoters to implement the programme. Health promoters may also insert additional supporting material they feel will assist schools in understanding the concepts behind Fruit in Schools. All material held in this resource, including loose content, but excluding additional resources, will be available for download from the Ministry of Health website: www.moh.govt.nz/ fruitinschools click on the publications tab.

INTRODUCTION What is Fruit in Schools? Fruit in Schools is a unique, innovative initiative targeted at a limited number of primary schools in areas of high deprivation in New Zealand. Up to three clusters of school communities from each region are involved in the first two phases of Fruit in Schools, which began in Term 4 of 2005. Fruit in Schools involves three years of funding for participating schools by the Ministry of Health and has been developed by an interagency group that includes representatives from the Ministry of Health, the Ministry of Education, SPARC, School Principals Federation, New Zealand School Trustees Association, Health Research Council, Health Promoting Schools, School Support Services, the National Heart Foundation of New Zealand, the New Zealand Cancer Society and District Health Boards. Fruit in School aims To enhance student learning through promoting the wellbeing of the school community with particular focus on: healthy eating physical activity being sun smart School community involvement Fruit in Schools expects school communities to involve senior management, staff, Board of Trustee members, parents/caregivers and whänau, students and community members in making changes within the school environment that will improve quality of learning and school community wellbeing in the four identified priority areas and others, as appropriate. Fruit in Schools is a programme that aims to promote the health and wellbeing of children in our schools. Fruit in Schools is linked to the Health Promoting Schools or whole school community approach. Fruit in Schools focuses on four priority areas: healthy eating, physical activity, being sun smart and smokefree. Fruit in Schools will provide fresh fruit to each child in participating schools for three years. being smokefree. Fruit in Schools objectives Children in participating school communities eating more fruit. More school communities promoting health through a whole school approach. Increasing awareness and implementation of policies and practices that encourage healthy eating, physical activity, smokefree and sun protection in school community environments.

Resources and Support Provided Participating schools in the Fruit in Schools clusters will receive: fruit for its students in Year 1 8 (one piece per student per day for three years) free professional development and funding for four teacher-release days a year per school to undertake planning, networking and professional development support and advice for implementing a Health Promoting Schools/whole school community approach from the Fruit in Schools co-ordinator. Access to programmes, resources or staff from the New Zealand Cancer Society, the National Heart Foundation of New Zealand, School Support Services and regional sport trusts will also be a resource for the Fruit in Schools clusters. Fruit and vegetable consumption protects children s health. Research indicates New Zealand children generally have a low level of consumption of fruit and vegetables. Improved hauora (health and wellbeing) enables better learning outcomes for children. The Fruit in Schools programme will contribute to life-long health and wellbeing. Why Fruit in Schools? Fruit and vegetable consumption has been found to have a protective effect against some common cancers, as well as cardiovascular disease. When fruit and vegetables replace less healthy foods in the diet this provides extra health benefits for children, such as maintaining a health body weight. Research on childhood nutrition indicates New Zealand children generally have a low level of consumption of fruit and vegetables. Approximately two out of five children met the recommended number of serves of fruit (at least two per day). About three out of five children met the recommended number of serves of vegetables (three or more per day) (New Zealand Food, New Zealand Children: Findings of the 2002 National Children s Nutrition Survey results summary). Improved hauora health and wellbeing enables better learning outcomes for students and will contribute to their life-long health and wellbeing. By participating in the Fruit in Schools programme, schools will be supported in strengthening their links with the school community and their understanding of effective promotion of wellbeing within it (Health and Physical Education in the NZ Curriculum, 1999, Ministry of Education). The Fruit in Schools model has been adapted and enhanced from pilot programmes in Northland, Auckland and the United Kingdom. Introduction

What does Fruit in Schools involve? How much fruit will schools get? Participating high-need schools that are part of selected clusters will receive one piece of fruit per day for each Year 1 8 student, for three years. How much will it cost? There is no cost to the schools participating in Fruit in Schools. The Ministry of Health funds the provision of fruit to participating schools for three years. Teacher release days for schools in the Fruit in Schools clusters will also be funded to enable staff to meet and undertake professional development in Health Promoting Schools (HPS), healthy eating, physical activity, being sun smart and smokefree. This includes learning about how these areas relate to the New Zealand health and physical education curriculum. What happens with fruit provision after three years? School clusters are expected to work towards becoming self-sustaining by the end of the three-year timeframe, when fruit provision will become the responsibility of the Fruit in Schools school cluster community. For example, this may be through parents/caregivers sending fruit to school, establishing funding for fruit from local businesses, donations of good-quality fruit from local orchards or perhaps establishing a school orchard. After the initial schools have reached the threeyear period and become self-sustaining, funding from the Ministry of Health will then enable another group of schools in high-need areas to participate in the Fruit in Schools programme until they, in turn, develop a self-sustainable supply of fruit. How will Fruit in Schools be evaluated? The New Zealand Council for Educational Research and Health Outcomes International will carry out a three-year evaluation of Fruit in Schools. This will include fruit delivery and quality, levels of consumption, as well as how the schools have implemented the HPS/whole school community approach to promote the four wellbeing priority areas of healthy eating, physical activity, being sun smart and smokefree. Formative evaluation will assist clusters to implement the programme more effectively. Process evaluation will capture how Fruit in Schools is being implemented, and impact evaluation will measure how well the programme is meeting its objectives. Fruit in Schools is being implemented using a Health Promoting Schools/whole school community approach. School clusters are expected to work together and be self-sustaining after three years. Fruit in Schools is being evaluated to measure how well the programme is meeting its objectives.

Why use a cluster approach? International and New Zealand educational research supports the use of clusters as a delivery mechanism because they enable quality learning through effective sharing and use of resources, support planning and implementation of initiatives, and enhance professional development and evaluation. School clusters are already common across educational sectors in New Zealand (eg, literacy, Resource Teachers of Learning and Behaviour). Health Promoting Schools evaluation and experience also support adoption of the cluster model. Do participating schools have to be Health Promoting Schools? Why HPS? Health Promoting Schools is an internationally recognised way for schools to address barriers to learning and the wellbeing of its students, staff, parents/caregivers and whänau. It has been adapted to fit within the bicultural context of Aotearoa/New Zealand. The Health Promoting Schools framework and process allow for it to be school owned and driven, and to engage with the whole school community. Introduction Schools participating in the Fruit in Schools programme are encouraged to adopt the HPS framework and process, but other whole school community approaches may be more appropriate to the needs of the particular school and equally effective in achieving the aims and objectives of Fruit in Schools. The HPS way of working, therefore, is not a prerequisite.

BACKGROUND It s more than fruit The big picture The Ministry of Health implements the Cancer Control Action Plan and the Healthy Eating Healthy Action Implementation Plan. The Cancer Control Action Plan has been developed to look at ways of lowering the incidence of cancer through establishing primary prevention initiatives that focus on tobacco control, nutrition, protection from the sun, physical activity and reducing obesity. These activities can also help reduce rates of preventable diseases such as diabetes and cardiovascular disease. The Fruit in Schools programme has more components than just fruit provision. It contributes to the cancer prevention goals by addressing the primary prevention areas of healthy eating, physical activity, being sun smart and smokefree. History A free fruit to schools programme was piloted in low decile primary schools in Auckland and Northland in 2004 and was successful in increasing fruit consumption. The national programme was planned as an extension of the pilot using a national fruit provider and incorporating the four key priority areas. Implementation District Health Boards are leading the implementation of the Fruit in Schools programme by facilitating school clusters and supporting them through a collaborative approach with a range of key agencies. National oversight is provided through an External Co-ordination Group including representatives from the Ministry of Health, Health Promoting Schools, SPARC, the New Zealand Cancer Society, the National Heart Foundation of New Zealand, New Zealand School Trustees Association, New Zealand Principals Federation, District Health Boards and the Ministry of Education.

A whole school community approach Fruit in Schools works within a whole school community approach. This is a process/practice that brings together school staff including the principal, senior management and the Board of Trustees alongside students, parents or caregivers, whänau, community groups and agencies to work collaboratively on issues. Examples include Te Aho Matua - a Kura Kaupapa Mäori specific educational model, which is child centred and encompasses the total wellbeing of an individual. Language and tikanga Mäori are features of this approach. Iwi specific models also work from a cultural base to meet health and education outcomes. Language and tikanga Mäori are also likely to be features of this approach. Fruit in Schools works within a Health Promoting Schools/whole school community approach. Participating schools must commit to working within a Health Promoting Schools framework or other whole school community approaches. Fruit in Schools has a strong focus on community engagement and action. Your first point of contact is your Fruit in Schools co-ordinator. Health Promoting Schools are another example of the whole school community approach (see section: What are Health Promoting Schools?). Schools must commit to working towards a whole school community approach to health and wellbeing, specifically in the four priority areas: healthy eating, physical activity, being sun smart and smokefree. Fruit in Schools has a strong focus on community and student engagement, and community action. Co-ordinators and staff from other agencies play an important facilitative role. Once the programme has started, schools will be assisted in developing strategic plans for implementing the programme. Classroom learning and the school s physical, social and cultural environment will be linked. Background Many Health Promoting Schools have student health teams, which are involved in planning and implementing wellbeing initiatives. They also work to build strong relationships with a range of key support agencies.

THE BIG PICTURE What are Health Promoting Schools? The Fruit in Schools programme works within the Health Promoting Schools framework. School clusters are encouraged and supported to adopt this, or other whole school community approaches. Health Promoting Schools originated from the World Health Organization, which recognises that the most effective way to improve learning outcomes and health and wellbeing of students in the school setting is through a whole school community approach. This means linking together what is taught in the classroom with the social, cultural and physical environment of the school including the policies and procedures in the school and with community partners and organisations that can support the school. It also means involving the whole school community in activities and structures that promote and protect health and wellbeing. The Health Promoting Schools framework (outlined below) illustrates the interlinking of these three key areas. The Health Promoting Schools process Health Promoting Schools is not a project or a programme. It is a process using a whole school approach to bring together staff, students, parents/caregivers, whänau, community and local organisations to work together on barriers to learning and health and wellbeing. model of health, which forms the basis of Health and Physical Education in the New Zealand Curriculum (Ministry of Education 1999). The four components of Te Whare Tapa Whä are: Taha wairua Taha hinengaro Taha tinana Taha whänau spiritual wellbeing mental and emotional wellbeing physical wellbeing social wellbeing The HPS initiative was developed by the World Health Organization. HPS works through a whole school community approach. HPS is a process not a programme. The HPS approach can only work if the interdependent relationship between health and wellbeing and learning is recognised. Health and wellbeing in a Health Promoting School is holistic and consistent with the Mäori concept of hauora in Te Whare Tapa Whä a Mäori

If we nurture the health, hopes and skills of young people, their potential to improve the world is unbounded. If they are healthy, they can take the best advantage of every opportunity to learn. If they are educated they can live fulfilled lives and contribute to building the future for everyone. Dr Lloyd Kolbe, World Health Organization, 1996 The Health Promoting Schools Framework Curriculum, Teaching & Learning Community Links & Partnerships School Organisation & Environment The Health Promoting Schools framework The Health Promoting Schools framework highlights three interacting components of a school. The framework is a useful guide to help plan what happens in the school in a comprehensive and holistic way. The Health Promoting Schools Process Evaluate & Review The Treaty of Waitangi Partnership Protection Participation Curriculum Prepare & Raise Awareness Identify the structures needed to support the Health Promoting Schools Approach Social & Physical Environments The Big Picture Use the Health Promoting Schools framework to plan & implement action Partnerships & Services Prioritise needs Create a shared vision Identify needs Advocacy Mediation Enablement Ottawa Charter Note: Further information about Health Promoting Schools can be obtained by contacting your local HPS provider.

10 FIRST STEPS How do we get going? Fruit in Schools Co-ordinator Each school will appoint a teacher to co-ordinate Fruit in Schools, who will work to ensure the programme runs smoothly, alongside the following: representatives of all sectors of the school community the fruit suppliers the regional Fruit in Schools advisor other support agencies as appropriate. Fruit delivery The fruit will be delivered to schools twice a week: Monday for eating Monday and Tuesday. Wednesday for eating Wednesday, Thursday and Friday. Fruit is delivered in the morning, in time for morning tea at each school. Delivery instructions are very important to enable the freight person to place the fruit in the storage area to avoid double handling. Fruit storage and preparation Fruit should be stored in a place that is: dry cool out of direct sunlight. The fruit has been washed before packaging. No preparation should be necessary. Fruit quality and variety The fruit being delivered to schools will be: Tag 1 top quality seasonal locally grown (when in season) smaller sized fruit suitable for children (when possible) one type each day different fruit every day with some fruit repeated during the week, including: apples, mandarins, bananas, stone fruit, pears. Distributing the Fruit Systems for distributing fruit in individual schools should include: leadership from the school s Fruit in Schools co-ordinator appointing fruit monitors collecting fruit from the storage area, transferring enough fruit into buckets for each classroom and delivering the fruit to classrooms having a bowl in each classroom (and possibly staffroom) for surplus fruit to be eaten later.

11 Note: Anyone handling fruit should wash their hands. Stringent food safety precautions must be taken if cutting fruit (eg wearing gloves, proper washing of knives, cutting board). In the back pocket of this folder is a Checklist prior to delivery of programme, which can be photocopied. Formative evaluation will assist clusters to implement the programme more effectively. Process evaluation will capture how Fruit in Schools is being implemented and impact evaluation will measure how well the programme is meeting its objectives. Further information on evaluation is on pages 13 15 How do we start planning? How will progress in Fruit in Schools be measured? The Fruit in Schools programme is being carefully evaluated. A key focus of the evaluation is to highlight aspects of good practice around health promotion that can be shared with other schools. Charting changes that occur over time in student knowledge and behaviours, school practices, and community participation in relation to the four priority areas is another key focus. The evaluation will look at change at four levels of the school system: curriculum, teaching and learning school organisation and ethos community links and partnerships (parents) community links and partnerships (health promoting and community groups). In the back pocket of this folder, you will find templates, action plans and other material to assist you in the planning process. Where are we heading? Sustainability: School Clusters International and New Zealand educational research supports the use of clusters as they enable quality learning through effective sharing and use of resources, support planning/ implementation of initiatives, and enhance professional development and evaluation. Health Promoting Schools evaluation and experience also support adoption of the cluster model to enhance effective delivery and sustainability. This is based on schools working together in natural, logical and/or workable clusters, with a cluster leader at a lead school providing co-ordination, mentoring and leadership. First Steps

12 Expectations of the Cluster Leader To support each school community to take responsibility for identifying the barriers to learning and wellbeing issues of students, staff and the whole school community through a whole school approach. To facilitate sharing and collegial support across schools in their cluster, through informal meetings and cluster meetings. To provide information for evaluation of the initiative and keep records of all activities. Using the cluster model will encourage school community ownership. It will empower school communities to take responsibility for influencing the school s learning and achievement environment. Fruit in Schools encourages the engagement and support of the school communities in the cluster. Sustainability: Fruit provision School clusters taking part in the Fruit in Schools programme receive funding for the fruit for three years and will work together to source and distribute the fruit after the first year. This period of funding gives schools time to adopt a whole school approach, prioritising healthy eating, physical activity, sun smart and smokefree. During the three years of funded fruit provision, school clusters will be supported and encouraged to explore opportunities to source their own fruit. This may be through sponsorship, donations, establishing school orchards or other means. Expectations of the Fruit in Schools Co-ordinator To support each school community to take responsibility for identifying the barriers to learning and wellbeing issues of students, staff and the whole school community, and to incorporate this approach as integral to the normal life of the school. To support and maintain regular contact with the cluster leader. To support professional development in the four priority focus areas of healthy eating, physical activity, sun smart and smokefree, and in the Health Promoting Schools framework and process.

13 FURTHER READING Evaluation of Fruit in Schools: Healthy Futures Who is conducting the evaluation? The Ministry of Health has contracted the New Zealand Council for Educational Research (NZCER) and Health Outcomes International to evaluate Fruit in Schools. NZCER has a long history of working in the school sector in New Zealand. What will the evaluation focus on? The evaluation will look at change and how it occurs, as schools, school clusters and school communities address the four priority areas using the Health Promoting Schools/whole school community approach. Changes that occur in student knowledge and behaviours, school practices and community participation will be charted. A key focus of the evaluation is to highlight aspects of good practice around health promotion that can be shared with other schools. Who will be involved in the evaluation and what will be asked of them? The evaluation will involve yearly surveys of school staff and students, interviews with non-school stakeholders, and two sets of good practice case studies of schools in 2006 and 2008. It will look at change at four levels of the school system. These are based on the themes Health Promoting Schools advisors use to structure their work with schools. They are: curriculum, teaching and learning school organisation and ethos community links and partnerships (parents) community links and partnerships (health promoting and community groups). The evaluation is a mixed-method longitudinal study incorporating the collection of information from a range of Fruit in Schools stakeholders. The evaluation will focus on students, teachers and principals. In 2005, the school Fruit in Schools co-ordinators of phase 1 schools were asked to complete a short online survey about the implementation of phase 1. These co-ordinators will be surveyed annually to ascertain their perspective on the different phases of Fruit in Schools and its impact on their school community. Further Reading

14 refine the Fruit in Schools initiative. Over time the evaluation will move to a more in-depth consideration of impacts, good practice and sustainability. Schools will be sent a summary of each phase of the research. Case studies of good practice and resources stemming from the evaluation will be located on the Fruit in Schools website: www.moh.govt/fruitinschools. The perspectives of school staff, students, Board of Trustee members, parent and community groups, health promoters and agency representatives working with schools, will be included in the school case studies. The evaluation will also track change in phase 2 schools. At the end of term 1 2006, a baseline survey of phase 2 participating schools and approximately 40 control schools will be conducted. Participating schools will then be sent surveys at the end of 2006, 2007 and 2008, and control schools at the end of 2006 and 2008. As part of these surveys, one cohort of phase 2 students, who will be at the schools for the duration of the evaluation, will be tracked (ie, those students who are in year 4 in 2006, year 5 in 2007, and year 6 in 2008). Principals, the school Fruit in Schools co-ordinator and a teacher will also be surveyed. The evaluation includes yearly interviews with the phase 1 and 2 regional Fruit in Schools/HPS advisors working with schools, and interviews with non-school stakeholders such as SPARC, the National Heart Foundation of New Zealand, and the Cancer Society. The emphasis of the evaluation in its early stages is on generating information and resources that might guide the Ministry of Health, schools and other stakeholders as they

15 NZCER/HOI Healthy Futures evaluation methods, timeframes, and reporting Fruit in Schools timeframe and key evaluation dates Evaluation methods School-based surveys Case studies Interviews with non-school stakeholders Term 4, 2005: 60 phase 1 schools start Fruit in Schools with national fruit provider Term 4, 2005 Short online survey of 60 phase 1 school Fruit in Schools co-ordinators. Phone interviews with: Phase 1 Fruit in Schools/HPS regional advisors. End term 1, 2006 Baseline survey of year 4 students and selected staff at phase 2 Fruit in Schools schools. Baseline survey of year 4 students and selected staff at 40 control schools. Survey of phase 1 school Fruit in Schools co-ordinators. Phone interviews with: National agency stakeholders. REPORT 1 to Ministry of Health and summary to schools Term 2, 2006: 60 phase 2 schools start Fruit in Schools with national fruit provider Term 4, 2006 Repeat survey of phase 2 Fruit in Schools schools. Repeat survey of control schools. Repeat survey of phase 1 school Fruit in Schools co-ordinators. Visit 6 schools for case studies of good practice. Phone interviews with: Phase 1 and 2 Fruit in Schools/ HPS regional advisors. New national agency stakeholders. REPORT 2 to Ministry of Health and summary to schools. Case studies and resources stemming from the evaluation added to Fruit in Schools website End term 2, 2007: Schools start to organise own fruit Term 4, 2007 Repeat survey of phase 2 Fruit in Schools schools, focusing on year 5 students. Repeat survey of phase 1 school Fruit in Schools co-ordinators. (No control group survey.) Phone interviews with: Phase 1 and 2 Fruit in Schools/ HPS regional advisors. New national agency stakeholders. Further Reading REPORT 3 to Ministry of Health and summary to schools End term 3, 2008: Phase 1 schools finish funding Term 4, 2008 Repeat survey of phase 2 Fruit in Schools schools, focusing on year 6 students. Repeat survey of control schools, focusing on year 6 students. Repeat survey of phase 1 school Fruit in Schools co-ordinators. End term 1, 2009: Phase 2 schools finish funding Visit 6 schools for case studies of good practice. Phone interviews with: Phase 1 and 2 Fruit in Schools/ HPS regional advisors. National agency stakeholders. FINAL REPORT to Ministry of Health and summary to schools. Case studies and resources stemming from the evaluation added to Fruit in Schools website

16 Relevant Government Strategies Cancer control Cancer is a major health issue for New Zealanders. One in three New Zealanders will have some experience of cancer, either personally or through a relative or friend. Cancer control is an organised approach to reducing the burden of cancer in our community through prevention, screening and early detection, treatment, support and rehabilitation, and palliative care. Cancer control has been given a high priority by the government. The aim of reducing the incidence and impact of cancer is one of the 13 population health objectives of the New Zealand Health Strategy, which was launched in December 2000. An environment and society where individuals, families and whänau, and communities are supported to eat well, live physically active lives, and attain and maintain a healthy body weight. What we can do Eat a variety of nutritious foods. Eat less fatty, salty, sugary foods. Healthy Eating Healthy Action Oranga Kai Oranga Pümau Healthy Eating Healthy Action (HEHA) is the Ministry of Health s strategic approach to improving nutrition, increasing physical activity and reducing obesity for all New Zealanders. SPARC (Sport and Recreation New Zealand) is an important partner in HEHA. Improving nutrition, increasing physical activity, and reducing obesity are three of the thirteen health priorities identified in the New Zealand Health Strategy. Eat more vegetables and fruits. Fully breastfeed infants for at least six months. Be active every day for at least 30 minutes in as many ways as possible. Add some vigorous exercise for extra benefit and fitness. Aim to maintain a healthy weight throughout life. Promote and foster the development of environments that support healthy lifestyles.