2007 Model Practice Application (Public)

Steps to a Healthier Houston-Harris County Consortium CATCH Project

Harris County Public Health and Environmental Services

Steps to a Healthier Houston-Harris County Consortium - CATCH (Coordinated Approach to Child Health) Project targeted 400 public elementary schools/260,000 students in Harris County, Texas and addressed the issue of childhood obesity. The program goal is to reduce childhood obesity and meet state mandate regarding coordinated school health programming in elementary schools. Program objectives include:

• Use three school health liaisons to train school teams (three required staff/faculty per school) in the evidence based CATCH program in at least 400 public elementary schools across the 22 school districts.
  
  
• Provide 400 trained schools support through material resources, i.e. physical education supplies, CATCH signage, classroom supplies and CATCH curriculum.
  
  
• Offer trained schools support through human resources, i.e. technical assistance from project school liaisons and assessments from university evaluators.

The rate of obesity among school-age children has become a national concern, with the number of overweight children aged 6 to 11 more than tripling over the past three decades. In February 2007, Texas Department of State Health Services reported the prevalence of 4th graders in the state who are "overweight" or "at risk for being overweight" (according to BMI by age/sex) is 42%. One means of addressing this health issue in schools is to emphasize an "energy balance" approach-calories consumed versus calories expended-to support healthy eating and an active lifestyle (National Center for Education Statistics). CATCH aims to prevent obesity by promoting healthy eating habits and increasing physical activity via changes in the school environment. Since lifelong habits are formed during childhood, targeting children at the elementary school level is critical. Based on the social cognitive theory, CATCH promotes that if changes occur in the school environment, the physical activity and nutrition behavior of children will improve.

Furthermore, there are racial/ethnic disparities in the revalence of overweight and obesity. According to the School Physical Activity and Nutrition Survey (2003) of 4th graders in Harris County (the third largest county in the country), the data revealed that 43.3% of Hispanic and 24.9% of African American children are overweight, compared with 18.9% of White children.

The project's intension is to train schools in CATCH, a state-approved coordinated school health program to meet an unfunded state mandate. The 78th Texas Legislature (SB 474) and the state health department recognize childhood obesity can have physiological, psychological and financial consequences. Since 2005, the Texas Education Code was revised in an attempt to prevent obesity, cardiovascular disease and Type 2 diabetes in elementary school students. The Texas Education Agency (TEA) was charged with overseeing the approval of coordinated school health programs, and the subsequent training and implementation in every school system by summer 2007. Required components include: health education, physical education and physical activity (mandate for daily physical activity for students K-6 was put in place), nutrition services; and parental involvement.

At the school level, the Steps CATCH project supports CATCH implementation by providing material resources so schools gain additional curricula, PE supplies and signage to help enhance the transformation of the school environment into a healthy place to be where coordinated school health is practiced. Steps CATCH school liaisons serve as technical advisors after the trainings. The school liaison model is essential to the implementation phase. The three staff liaisions are each responsible for more than 100 schools. They work with the trained school personnel to coordinate their existing resources and efforts, and to empower them with the resources they need to become independent, creative, active teams.

The project addresses the issue of childhood obesity through coordinated school health programming. Immediate health consequences of childhood obesity include Type 2 diabetes, abnormal menstrual cycle, asthma and obstructive sleep apnea syndrome. Long-term effects include high blood pressure and cancer. The Steps Consortium, a public private partnership, used consensus to determine the childhood obesity's relevance to the county. The Steps Consortium established the Ad Hoc School Working Group to develop strategies to address childhood obesity and build capacity for the schools. Key stakeholders in school health from school districts serving on the HCPHES School Health Leadership Group joined the Working Group. The strategies were based on research including local chronic disease data; evidence based obesity prevention programs; anecdotal observation of community members, public health professionals and school personnel; and national and local calls to action. Recommendations were submitted to the Steps Consoritum and CATCH was accepted. At this juncture, Houston Endowment, Inc expressed keen interest in the Steps Consortium and its possible application of CATCH. Steps Consortium invited all school districts in Harris County to a forum to discuss and obtain feedback and commitment to the identified strategies and plans for action. The plans responded to the school districts' needs to implement new unfunded legislative mandates. The state legislation addressed the childhood obesity issue directly requiring schools serving students in grades K-5 to institute 30 minutes per day of physical education and to implement a state-approved coordinated school health program. (CATCH was approved).

Steps CATCH trains school personnel, providing them with the skills to create a healthy school environment, supports schools in acquiring curriculum and physical activity materials necessary to implement a coordinated school health program, and via the work of the school liaisons, increase schools' capacity.

Steps CATCH project differs from other approaches of addressing childhood obesity. Harris County Public Health and Environmental Services, the local health department, has played an active role in building the consortium. Its strong school health program has provided ongoing support and expertise. A school health liaison model was incorporated to assist in the dissemination effort in such a large and multi-ethnic population as Harris County. The University of Texas School of Public Health conducts formal evaluation. The school liaisons have been able to pass along their extensive field notes to contribute to the ongoing practice-based research. The Steps Consortium is a model for CATCH initiatives in other locales to establish public/private collaborations to support CATCH training and implementation.

In 2004, Dr. Herminia Palacio, as local health director and as chair of the executive committee of the Steps to a Healthier Houston Harris County Consortium, worked to secure private funding for the Steps CATCH project. As chair of the executive committee, she convened local and private organizations to respond to the increasing severity of obesity in Harris County by identifying a best-practice intervention and securing the funding from the private sector. The intervention planning of the CATCH project was the work of a Consortium Ad Hoc School Health Working Group. This group was composed of consortium members, including those from health associations, school districts, the city and county health departments, the YMCA, and academia. Upon being awarded the 2.4 million dollar grant, Dr. Palacio has been active and instrumental in the health department's role as fiscal agent. Her project support extends above and beyond required tasks as she provides guidance to project staff and executive insight in partnering with 22 school districts and more than 30 consortium agencies. She supports designated HCPHES staff to serve on the Steps Consortium and its various committees, and provides support to the Steps CATCH project as needed. Oversight for the implementation of the project is managed by the CATCH project director (who resides at Harris County Public Health and Environmental Services) and the Steps Consortium Executive Committee. The executive committee represents local institutions highly invested in the issue of childhood obesity.

Houston Endowment, Inc. provided funding in the amount of $2,083,500. In-kind support from Harris County Public Health and Environmental Services included office space ($33,500), staff ($50,000) and other ($35,000).

Use three school health liaisons to train school teams (three required staff/faculty per school) in the evidence based CATCH program in at least 400 public elementary schools across the 22 school districts.

• February 2006-date: Master CATCH trainers from CATCH office in Austin use train the trainer model with school liaisons to season them with knowledge and skills to conduct CATCH trainings independently.
  
  
• October 2005-May 2007: Assess eligibility for one-day all-component CATCH trainings.
  
  
• March 2006-August 2007: Conduct trainings in school districts with at least 10 complete teams of required team members (three members per school).
  
  
• March 2006-August 2007: Administer pre and post-test training assessments at trainings.

Provide 400 trained schools support through material resources, i.e. physical education supplies, CATCH signage, classroom supplies and CATCH curriculum.

• October 2005-September 2007: Assess eligibility for material resources from contracted vendor from school participation agreement form and training participation.
  
  
• March 2006-September 2007: Notify vendor of number of school kits and shipping address.
  
  
• March 2006-September 2007: Notify school district of shipment.
  
  
• March 2006-September 2007: Receive notification of arrival of shipment by school district.

Offer trained schools support through human resources, i.e. technical assistance from project school liaisons and assessments from university evaluators.

• March 2006-October 2007: Phone school CATCH contact(s) to offer support, schedule site visits, etc.
  
  
• March 2006-May 2007: Gather, organize and develop resources.
  
  
• March 2006-March 2007: Give supplemental presentations at schools to faculty and other staff.
  
  
• March 2006-October 2007: Act as consultant to CATCH trained teams in schools to enable CATCH team members to implement Coordinated School Health and share CATCH information with co-workers and other school community members.
  
  
• June 2006-October 2007: Use data collection forms to record observations.
  
  
• Spring/Fall 2006: baseline SOFIT data collected; spring/fall 2007 post-test SOFIT data collected.
  
  
• Spring 2007: SPAN and BMI data collected.
  
  
• Spring-Fall 2007: Implementation assessment administered.

Commitment to continue the Steps CATCH project is at both district and school levels. Some districts have included the CATCH program and CATCH activities in the USDA-mandated wellness policies. In some districts, the person assigned to work as project contact person for the Steps CATCH project has now been formally assigned to oversee CATCH in the schools for the project period and beyond. This has been reflected in job responsibilities and job title changes. Some districts previously not engaged in HCPHES School Health Leadership Group have begun attending meetings. The Leadership Group informs and supports the districts in coordinated school health programming, inclusive of but not exclusive to CATCH. Districts participating in the Leadership Group will certainly be able to stay committed and sustain the practice of CATCH over time.

On a school level, the role of the project's school health liaisons is key. The liaisons visit the trained schools, assist the staff with getting the supplies and curriculum correctly distributed so the appropriate personnel can use the materials and provide the CATCH school team with resources for implementation. Most important, the liaison facilitates and assists in any way the team to identify the school's culture and existing resources and match them with the objectives of CATCH: to increase the students' physical activity and to improve their nutritional intake. Childhood obesity remains a core issue for the Steps Consortium and Harris County Public Health and Environmental Services. The Steps Consortium Executive Committee is currently considering funding possibilities to extend the technical assistance functions of the Steps CATCH project and explore the benefits of using a community-based approach to complement the CATCH project.

The program goal is to reduce childhood obesity and meet state mandate regarding Coordinated School Health Programs.

Objective 1: Use three school health liaisons to train school teams (three required staff/faculty per school) in CATCH in at least 400 public elementary schools across the 22 school districts.

Performance Measures: 400+ schools trained in CATCH by August 2007; 22 schools districts having participated in CATCH training by August 2007.

Outcome: To date, 260 schools have received project's training in the state-approved coordinated school health program (CATCH) to meet state mandate.

Objective 2: Provide trained schools support through material resources, i.e. physical education supplies, classroom supplies, CATCH signage, CATCH curriculum.

Performance Measures: Verify completed school/CATCH project agreement form for program participation; Distribute shipments from CATCH publisher and production supplier to schools.

Outcome: To date, more than 300 school project participation agreements have been received in the Steps CATCH office and shipments have sent to nearly 250 schools.

Objective 3: Offer trained schools support through human resources, i.e. technical assistance from project school liaisons and assessments from university evaluators.

Performance Measures: Site visits; District conferences/meetings; Implementation of CATCH.

Outcome: Between 100-200 site visits to schools have been conducted; Project staff have attended/presented at more than 20 district events across the county.

Lessons learned include:

• Some participants miss signing in on official sign-in sheets so record is inaccurate. Attendance is required by a classroom teacher, a PE teacher and a food service manager from each school. However, individuals may not always label themselves by the explicit identifiers which leads to problematic recordkeeping of who attended. Specific announcements are made stressing the importance to signing in on the official sign in sheet. One district has requested that an attached notice be attached to sign in sheet stating the sign-in requirement.
• Eligibiltiy requirements and training team requirements were clarified in 2006-2007 agreement; agreements are not usual protocol for CATCH practice. Training attendance lists must be verified before school shipments are ordered. Some participants miss signing in on official sign-in sheets so record is inaccurate. Attendance is required by a classroom teacher, a PE teacher and a food service manager from each school. However, individuals may not always label themselves by the explicit identifiers which leads to problematic recordkeeping of who attended. Package kit of resources could be tailored to each school need. While CATCH and PE activity boxes are standard for CATCH implementation, the Steps CATCH project provide an enhanced supply of materials, supplies and PE equipmert as an incentive for participation and enhance sustainability of the project.