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2008 Model Practice Application (Public)
Application Name: 2008 Model Practice Application (Public) : Tulsa Health Department : It's All About Kids School Health Program
Applicant Name: Dr. Bruce D. Dart, PhD
It's All About Kids School Health Program
Tulsa City-County Health Department
Tulsa Health Department's (THD's) "It's All About Kids" program seeks to reduce childhood obesity, enhance decision-making and negotiation skills among students, and improve overall school performance. The goals of the program are to: Help students recognize and implement a healthy eating pattern in their lifestyles, while training parents and school personnel to support students in maintaining a healthy eating pattern. Help students engage in regular physical activity. Improve school performance. Improve school attendance. Enhance decision-making and negotiation skills among youth.
The objectives of the program include: 100% of first- through fifth-grade students will participate in the program and learn the importance of eating healthy and exercising regularly; Parental involvement will increase by 25%; School performance and attendance will improve by 25%; School suspension rate will be reduced by 25%; Schools will experience a reduction in overweight and obese students by the end of the school year; Students will experience a reduction in mobility rates.
Responsiveness and Innovation
The program addresses the issue of childhood obesity.
THD used data collected from the state health department and in the county to determine the need for this program and also data collected from the Youth Risk Behavior Surveillance. According to the United Health Foundation, obesity in kids has doubled in the last 20 years. Oklahoma ranked 44th in the nation for overall health in 2006, and the percentage of the population that is overweight has gone up from 11.6% in 1990 to 26.8% in 2006. According to the Oklahoma State Health Report for 2006, 65% of premature deaths are related to lifestyle choices, tobacco use, lack of physical activity, and poor diet. In Oklahoma alone, the cost of obesity-attributable medical expenses is $854 million per year.
From all of the data collected and available, it became evident that THD should address this public health issue.
The program uses a coordinated approach to address the issue of childhood obesity comprehensively. The program is modeled after the CDC's Coordinated School Health Program (CSHP) model and includes eight components: Nutrition, Physical Activity, Health/Case Management services, Social Services, Health Education, Oral Health Education, Parental Involvement, and School Personnel Involvement.
Agency Community Roles
THD's role in this program is to administer the It's All About Kids program.
THD has many partners that participated in planning and implementing this program. Their role included the following: Participation in planning meetings; Being part of an ongoing School Health Council; Helping to staff parenting events and in some cases conducting the activities at the parenting events such as gardening nights for parents, cooking demonstrations; virtual tours of the Food Pyramid; virtual tours of the Physical Activity Pyramid; Partnering with THD on grant opportunities to further expand and sustain the program.
In an effort to foster collaboration and cooperation among the community stakeholders, THD presented information to schools at the beginning of each school year. THD also has an ongoing School Health Council that assists in identification of new partnership opportunities or funding opportunities. This collaborative effort helps maintain this program as a community-based program and also serves to broaden the resource base for accomplishing goals and objectives.
Again, partnerships are of utmost importance in creating a successful program of this magnitude.
Costs and Expenditures
The implementation and startup costs included staffing and operating supplies. Staffing included one nurse case manager, one social worker, two health education specialists, two oral health educators, and one physical education instructor. The in-kind costs came from various partners. Staff from various organizations provided resources for parenting events and in many instances helped staff the events or provide services for parents. The partners also participated in a School Health Council.
Examples of in-kind donations included OSU Extension Center providing cooking demonstrations at parenting events. Another partnership was the OU College of Nursing assisting with nutrition education. Tulsa Public Schools also assisted with parenting events by helping support a Walk Through the Pyramid for parenting events. The program also partnered with the Saint Francis Hospital Healthzone to do some one-on-one physical activity with students who had really high body mass indices (BMIs). Other partnerships included the YMCA, OU Bedlam School-based clinics (it provided the clinical care; the local health department provided prevention services), Oklahoma Fit Kids Coalition, and Community Health Foundation, which provided funding for incentives for the parents and students at parenting events.
Specific tasks of the program are ongoing during each school year (listed below) and THD also participates in summer programming. The specialized Physical Education program will be offered to students who meet the criteria, are willing to participate, and have appropriate parental consent. The focus of this program will be on helping students become more active and eat healthier so they can reduce their risk of childhood obesity. THD will also be working with families to help them learn ways they can incorporate physical activity at home. A registered dietitian will work with families to conduct a nutrition assessment and write nutrition plans for the families in an effort to assist them in eating healthier. THD's IAK staff will facilitate the nutrition curriculum in the classroom. The Coordinated Approach to Children’s Health (CATCH) Curriculum is research-based and designed to engage students in activities that teach them to make healthy food choices and overcome barriers to healthy lifestyles. Physical activity is also discussed in many of the lessons so students learn to maintain a balanced lifestyle. Students will also learn to identify the categories of GO foods, SLOW foods, and WHOA foods.
Nurse Case Manager: A Nurse Case Manager will also be assigned to schools. Job responsibilities of the Nurse Case Manager will include but not be limited to the following: Home visits specific to truancy issues and home visits for other appropriate health issues; Arranging transportation for medical health issues; Assisting in the collection of BMI measurements; Assisting in Medicaid applications for students and their families; Facilitating instruction for the nutrition curriculum; Facilitating referral process among IAK staff after receiving the referral from appropriate, identified school staff; Acting as a resource for information as it pertains to public health; Assisting families in accessing medical care; Acting in an advisory capacity by participating in the Healthy & Fit Advisory Committees. A child development specialist, social worker, or psychologist will be available to provide workshops and trainings to parents, teachers, school personnel, and the community; the training will involve parenting skills, increasing a child’s self-esteem, and childhood development knowledge. This person will also be involved with the following: Transportation for social service needs; Workshops and training to increase parent and teacher knowledge concerning childhood development; Acting as a walking resource guide in an effort to link people to resources in the community; Providing follow-up with students or families as appropriate.
THD will also offer a Dental Health Program for fourth-grade students. The goal of the dental program is to encourage the practice of good dental hygiene. Health education specialists will be assigned to all schools to provide an age-appropriate, detailed curriculum that is evidence-based and covers a wide range of topics, such as Decision Making, Anger Management, Self-Esteem, Bullying, Teambuilding, and Communication.
Building community partnerships are paramount to the success of the program.
Community stakeholders are committed to sustaining this program. While funding is not provided directly to the program, the stakeholders provide in-kind resources on an ongoing basis. THD also mutually supports their efforts in such a way as to sustain their involvement.
The local board of health is committed to ensuring ongoing funding of this program to address this public health issue, and THD also has a commitment from the state department of health.
However, in an effort to sustain the program over time and to expand, THD continues to seek funding through partnerships and additional grant opportunities. One such partnership is through an PEP grant received by the YMCA. This funds an additional Health Education Specialist position and also furthers efforts to conduct health education in the schools served.
Outcome Process Evaluation
Initial outcomes of the program showed the following: During the 2005-06 school year, BMI data were collected on 538 students and were classified as Normal, At-Risk, or Overweight. Generally, students demonstrated no change (83%) in BMI status from fall to spring. Students who experienced a change in BMI status were more likely to improve than decline. Many children considered in At-Risk and Overweight fall BMI categories experienced improvements when measured in the spring.
Additional data will be collected over time to determine the effect of the program on BMI changes, parental involvement, nutrition education, and improvement in overall school performance.
Most students experienced a change in knowledge, attitude, and behavioral changes with respect to nutrition education.
In the 2006-07 school year, THD obtained 2,291 BMI scores from students. Generally, results for those schools for which both fall and spring data were collected indicated that most participants maintained their BMI status between fall and spring semesters.
There was statistically significant improvements in Knowledge, Attitudes, and Behaviors with respect to nutrition education in the pre-test versus the post-test.
Additional data will be collected over time to determine the effect of the program on BMI changes, nutrition education, parental involvement, and improvement in overall school performance.
THD has been used for technical assistance all across the State of Oklahoma and has set the benchmark for a Coordinated School Health Program.
Information not provided in 2008
Key Elements Replication
Information not provided in 2008