Evaluation of the National School Health Coordinator Leadership Institute

Article excerpt

In the last few decades, school health has moved from the single-sector approach toward a comprehensive, multi-sector approach. The change mirrors a shift from infectious diseases to chronic diseases as the leading causes of death. (1) The shift also signals the need for preventive interventions that are early, multiple, tailored, and, yes, comprehensive to meet the challenges of chronic diseases.

The eight-component school health model (2) intends by its comprehensiveness to reduce competitiveness and turf building, to fill gaps, and to reinforce health messages. (3) A comprehensive program initiates, encourages, and helps sustain positive health; for example, predisposing messages in the classroom to eat well are enabled by positive choices in the school cafeteria and reinforced by social approval at home. (4) Without coordination, however, the orchestra of comprehensiveness can collapse into cacophony: "Thus the success of [comprehensive school health programs] hinges largely on a coordinating mechanism." (5(p 59))

The need for coordination was recognized early on and refined, sharpened, and expanded. As early as 1977 a call was made to create a role in schools for an individual to focus specifically on coordination of school health programs. (6) Although a coordinated school health program (CSHP) will look different in each school, (7) common core elements are expected in five major infrastructure areas: resources, structures, links, leadership, and development. Resource elements include: a plan that sets goals, defines roles, and sets strategies; (8) personnel; (7,13) release time and compensation; (7) space; (8) and funding and resources. (7,9,10)

Core structures supportive of CSHP include school health advisory councils and coalitions (9,11) and a school health team. (8,12) Links between school structures and the community include connection to agencies, (7) collaboration with government and nongovernmental agencies, (13) as well as family and community involvement. (14) The commitment by and access to leadership is needed to make CSHP work, (8,13) as are supportive policies. (16) Professional development and communications systems are needed to initiate and sustain the collaboration. (23) Although system-level changes are needed, (17) institutionalization may take as long as 10-15 years. (13)

Over time an increased understanding has emerged about the leadership skills needed to coordinate school health. Skills include planning, assessment, engaging crucial stakeholders, advocacy, administration, implementation, resource identification, fiscal management, training, and evaluation. (7,9,18,19) With this combination of skills a school health coordinator can reduce ambiguity and aid implementation.

The school health literature is consistent about the need for coordination, the necessary components of coordination, and the type of individual needed to make it happen. (15) Researchers concluded: "There is currently enough evidence about 'what works' to design strategies and programs that will improve the health and life chances of individual teens." (17(p 216)) In the early 1990s the American Cancer Society (ACS) identified school health education as a core priority and intensified its efforts to launch training that would help build a national infrastructure for school health coordination. According to John Seffrin, president, American Cancer Society, "Comprehensive school health education is integral to our mission of cancer control." (20(p 398))


With more than 60% of cancers linked to behaviors that often start in childhood and with schools as the most organized system to reach the nation's 50 million youth, ACS has had a long-standing interest in school health: "Cancer risk reduction begins with school health." (18(p 5)) Consistent with the growing emphasis on coordinated school health, one component of the ACS approach focused on improving coordination of school health at the district level. …