2007 Model Practice Application (Public)

School Health Leadership Group

Harris County Public Health & Environmental Services

The School Health Leadership Group project targeted key district-level stakeholders from all 22 Independent School Districts (ISDs) in Harris County, Texas. These stakeholders have the potential to impact school health related issues in their ISDs through their ability to influence decision makers’ knowledge of best practices, policies, and laws related to coordinated school health. Harris County is the 3rd largest county in the Nation, with approximately 500,000 students attending its public schools. This project impacts six priority health risk behaviors of children (unhealthy diet behaviors, physical inactivity, alcohol and other drug use, sexual behaviors, behaviors that contribute to intentional and unintentional injuries, and tobacco use) using the CDC’s Coordinated School Health Program 8 Component Model.

There are 2 main goals of the SHLG project: 1. Develop and maintain relationships between Harris County Public Health & Environmental Services (HCPHES) and ISD district-level stakeholders who have the potential to impact school health. 2. Increase ISD stakeholders’ knowledge of and favorable attitudes and beliefs towards coordinated school health issues, best practices, policies, and laws, and increase their capacity to create change in the school environment by modifying determinants which impact health risk behaviors of school-aged children. The program has the following objectives:

• School Health Program will coordinate 3-4 SHLG meeting per year and will actively develop communications with identified stakeholders within each ISD who potentially impact coordinated school health and encourage attendance at meetings.
  
  
• School Health Program will distribute resources to increase knowledge of and attitudes and beliefs about coordinated school health issues, best practices, policies, and laws.
  
  
• School Health Program will coordinate or provide trainings/ workshops and presentations to increase skills related to coordinated school health programs, best practices, policies, and laws.
  
  
• Each SHLG meeting will include time to discuss coordinated school health issues, best practices, policies, and laws and will encourage sharing and over-coming barriers brainstorming and networking amongst group members.
  
  
• School Health Program and ISD stakeholders will communicate regularly through onsite visits, phone calls, and emails.
  
  
• School Health Program will participate on ISDs’ School Health Advisory Council (SHAC) meetings as available.
  
  
• School Health Program will offer ongoing, onsite technical assistance as needed.

Many short and medium term outcomes are related to the SHLG including:

• Relationships developed with stakeholders within ISDs have facilitated reach of other health department projects.
• Dissemination of public health information reaches school-level stakeholders as a result of the district-level stakeholder’s influence.
  
  
• Implementation of coordinated school health and other public health best practices has increased.
  
  
• Action (strategic) plans have been developed by districts to address various public health issues (pandemic influenza, childhood obesity, etc.) often as a result of conducting local needs assessments.

There are 22 Independent School Districts (ISDs) in Harris County serving approximately 500,000 school-aged children. Local Youth Risk Behavior Surveillance (YRBS) data collected in 1999 revealed that some children in Harris County school districts were affected by certain health risk behaviors that could be affected by quality, evidence-based public health interventions which impact the determinants of each risk behavior. Working through schools was identified as the best way to reach this captive audience and create a large impact on multiple health risk and health promoting behaviors. The HCPHES School Health Leadership Group (SHLG) project impacts priority health risk behaviors of children (unhealthy diet, physical inactivity, alcohol and other drug use, sexual behaviors, intentional and unintentional injuries, and tobacco use) as well as other public health issues as identified (pandemic influenza, handwashing, rabies, post-hurricane recovery, etc) through coordinated school health efforts and capacity building. The SHLG is responsive to the needs of both HCPHES and the ISDs by creating a better understanding of how schools work and how to work with schools. Through the SHLG, stakeholders have a network to share their experiences, successes and barriers related to educating the whole child while helping to implement programs to support each of the 8 coordinated school health program components (health education, physical activity/ education, clinical health services, child nutrition services, mental health services, family involvement, safe school environment, and staff health promotion). The members of the SHLG serve as valuable and objective experts on various coordinated school health issues and facilitate further collaboration between HCPHES and ISDs to implement changes that impact the entire school district.

The School Health Leadership Group (SHLG) project is a network of inter-disciplinary stakeholders who meet and communicate regularly. This unique approach to working with schools is different than the traditional direct-services, health education classes and/or health fairs in which health departments often participate. The SHLG provides direct input and early buy-in to projects of Harris County Public Health & Environmental Services (HCPHES) and other stakeholders such as the “Steps to a Healthier Houston Harris County Consortium” - one of which recently resulted in funding from Houston Endowment, Inc. of over two million dollars to implement coordinated school health programs in over 400 elementary schools in Harris County. Using the familiar practice of stakeholder meetings and adding accepted health education theory and practices, such as Diffusion of Innovations, the SHLG has provided guidance to ISDs with the development of coordinated school health programs, best practices, and capacity building. The SHLG project is similar to NACCHO’s model for “Building Healthy Schools” in that it respects the district’s educational agenda and gains stakeholder support. However the SHLG is different in that it engages multiple districts (urban to rural) simultaneously and enables sharing of resources to improve knowledge, attitudes, beliefs, and capacity to affect change in their respective school districts. The SHLG provides opportunities for local solutions to be developed using best practices and proven effective programs.

Harris County Public Health & Environmental Services (HCPHES) School Health Program provides leadership and management of the School Health Leadership Group (SHLG). The bulk of the SHLG membership consists of the following district-level directors: Nursing Services, Child Nutrition, Health/ Physical Education, and Safe and Drug Free Schools along with ISD School Health Advisory Council (SHAC) facilitators, and District Wellness Coordinators. Those who participate on the SHLG are expected to disseminate resources and information provided to them through their channel of networks and to provide input to HCPHES and other partners with the development of school-related programs, research, etc. Various program coordinators from HCPHES are invited to attend the SHLG meetings as relevant content applies to their programs. The School Health Program actively solicits ideas and needs for future SHLG meetings and researches available resources to provide at each meeting. Planning of the meetings are done in partnership with other HCPHES programs, community partners and ISD stakeholders to ensure that content provided meets the needs of all involved. At most SHLG meetings, a guest speaker provides expert guidance to increase the knowledge, change attitudes and beliefs and increase the skills of the SHLG members as it relates to a specific topic. Guest speakers representing the following agencies have presented information about local resources, curriculum and school-based interventions to address specific risk-factors at previous meetings: Texas Department of State Health Services, Texas Education Agency, American Heart Association, Steps to a Healthier Houston Harris County Consortium, St. Luke’s Episcopal Health Charities, Superintendent of McComb ISD in McComb, MS, Pat Cooper (via DVD), and various HCPHES programs.

HCPHES funds one full-time employee to manage the School Health Program which coordinates the School Health Leadership Group (20% FTE). The SHLG project in itself does not require any specific funding. This project has no costs other than normal office supplies, meeting space and minimal mileage expenses to attend meetings. In-kind costs include food donations to provide snacks for meetings.

The School Health Leadership Group (SHLG) project resulted following a brainstorming session between colleagues in the Health Education & Promotion Division of Harris County Public Health & Environmental Services (HCPHES). In an effort to address identified public health issues of HCPHES and the coordinated school health related issues affecting the 22 Independent School Districts (ISDs) in Harris County, the School Health Program sought a way to bring ISDs and the health department together as partners. A solution to this unique need was found by bringing various district-level stakeholders who have the potential to impact school health related issues in their ISDs through their ability to influence decision makers’ knowledge of and attitudes about best practices, policies, and laws related to coordinated school health to the table – literally – to discuss issues important to both the health department and to the school districts.

The School Health Program further developed the idea and built upon an established trust with a few ISD stakeholders using health education theory, existing research, laws, and best practices related to coordinated school health program issues. The information gathered following the first two meetings of the SHLG provided for development of an implementation plan including specific goals and objectives. This plan was developed with input from HCPHES and the participating ISDs at that time (October 2004). Three to four SHLG meetings occur during the school year, and approximately 4 emails are provided to the entire SHLG members each month along with numerous individual phone calls, emails, and personal visits with participating members. This project has no end and was established to be on-going as long as HCPHES and the ISDs are benefiting.

The initial steps taken to achieve the first goal were the most important to the success of the SHLG. Using the CDC’s 8-Component Coordinated School Health (CSH) Program Model as a guide, the School Health Program invited each ISD to send representative stakeholders to the first SHLG meeting. Each ISD determined who their stakeholders were depending on what issues of CSH were most important to them, and stakeholders attending the meetings were invited to bring another stakeholder whom they thought would be influential in their district and helpful in facilitating changes needed. The School Health Program then developed relationships with those stakeholders through regular communication, scheduled visits, participation on ISD School Health Advisory Council (SHAC) meetings, and technical assistance as needed.

The second goal of the SHLG is accomplished through regular SHLG meetings, communications, and other trainings/ workshops as needs develop. Each SHLG meeting provides resources related to and discussion of topics important to both HCPHES public health issues and to the ISDs. Depending on the subject matter, various health education theories are used to guide the structure of the meetings, development of the SHLG agendas and resources provided. Adequate time is allowed for networking and usually a healthy lunch is provided. By allowing time to network, stakeholders visit with other ISDs to explore how they are making school health related changes happen in their district.

The Harris County Public Health & Environmental Services (HCPHES) School Health Program is a county-funded position. This helps to ensure that School Health Leadership Group (SHLG) management and leadership is sustained as long as the SHLG continues to benefit both HCPHES and the ISDs involved. Other stakeholders in HCPHES could provide project management should it ever become necessary; however unless the School Health Program position is vacated, such leadership would not be needed. Theoretically, any member of the SHLG is a stakeholder and could facilitate meetings; however the design of the project was intentional so that no district bears additional burden. The HCPHES School Health Program’s year long work plan includes the SHLG as a scheduled project and devotes at least 20% time to the project and related technical assistance that stems as a result of changes made within the ISDs as a result of SHLG activities. Human resources are committed to the SHLG project, as well as office supplies, in-kind donations, and upper-level administrative support. The SHLG has met at least quarterly since it’s inception in October 2004 and currently has meetings scheduled through the 2007-2008 school year. This win-win partnership can be replicated and sustained by any health department desiring to have a better relationship with the school districts in its jurisdiction.

The goal of this practice is to develop and maintain relationships between Harris County Public Health & Environmental Services (HCPHES) and ISD district-level stakeholders who have the potential to impact school health related issues within each of the 22 Independent School Districts (ISDs) in Harris County, TX.

Objective 1: School Health Program will coordinate 3-4 SHLG meeting per year and will actively develop communications with identified stakeholders within each ISD who potentially impact coordinated school health and encourage attendance at meetings.

Performance Measures: At least 2-3 stakeholders identified for each of the 22 ISDs in Harris County; Active roster developed; 9 meetings held since inception of project = 2.5 school years.

Outcomes: Over the 9 meetings that have occurred, at least 1 stakeholder from 18 of 22 Harris County ISDs has attended the meeting; On average, each meeting has 13 ISDs attending each sending 1-2 persons; On two occasions the School Health Program was contacted by ISDs to join the group; Relationships developed with stakeholders within ISDs have facilitated reach of other health department projects; and Dissemination of public health information reaches school-level stakeholders as a result of the district-level stakeholder’s influence.

Objective 2: School Health Program will distribute resources to increase knowledge of and attitudes and beliefs about coordinated school health issues, best practices, policies, and laws.

Performance Measures: # of changes in the ISDs related to coordinated school health issues, best practices, policies, and laws as a result of information provided.

Outcomes: Difficult to measure this objective due to possible confounders. 75% of all districts which participate in the SHLG have reported at least one significant change that they were able to affect in their district as a result of participation in the SHLG.

Objective 3: School Health Program will coordinate or provide trainings/ workshops and presentations to increase skills related to coordinated school health programs, best practices, policies, and laws.

Performance Measures: # of trainings/ workshops; Development of action plans or other document indicating materials were used (policy/ environment change, completion of School Health Index, etc.).

Outcomes: Implementation of coordinated school health and other public health best practices has increased. Action plans have been developed by districts to address public health issues such as pandemic influenza and childhood obesity.

Lessons learned include:

• Reminder phone calls were directly related to increased attendance at meetings, and SHLG roster needed to be reviewed prior to and following each meeting and updated accordingly.
  
  
• Meeting dates set keeping in mind ISDs testing/ holiday calendar and snacks or lunch provided at no cost.
  
  
• Helpful to have at least one new resource/ discussion topic for each of the 8 components of school health. This keeps all representatives engaged.
  
  
• Be well versed in any issues that affect laws and how schools are required to comply as it relates to coordinated school health issues.
  
  
• Must be patient and persistent when working with schools to create change. Sometimes must re-educate that coordinated school health is a PROCESS and not a PROGRAM.