THE HEALTHY SCHOOL REPORT CARD

A TO O L TO S U P P O RT H E ALTHY SCHOOL COMMUNITIES: TH E H E A LT H Y S C H O O L REPORT CARD Theresa Lewallen | Association of Supervision and Curriculum Development & Sandra Vamos | Simon Fraser University

The Health and Learning Link Evidence supporting the link between health and learning has been prompting schools to adopt whole-school health programs. It is clear that health education and health promotion in schools can improve children’s health, learning, and overall well-being (Public Health Agency of Canada, 2005; World Health Organization, 2006a). This awareness has encouraged education and health professional to unite and facilitate programs, services, and policies in a multifaceted approach to support optimal health and learning.

The Role of the School: Creating Healthy School Communities Schools make a substantial contribution to a student’s health and well-being...The way the school is organized and conducted has an impact...A considerable body of evidence has emerged in the last twenty years to inform governments, schools, non government organisations (NGO’s), teachers, parents and students about effective school health programmes. School programmes that are integrated, holistic and strategic appear to produce better health and education outcomes than those which are mainly information based and implemented only in the classroom. (St. Leger, 2005, p. 145) It has long been recognized that schools are an ideal setting to teach our children and youth about health knowledge, skills, and behaviours (St. Leger, 2004; Canadian Association for School Health, 2005; Lister-Sharp, Chapman, & Swoden, 1999). This evolving outlook of creating a comprehensive and coordinated approach engaging the entire school and community system to benefit the well-being of students and school staff was first described in a groundbreaking article by Allensworth and Kolbe (1987) in a special issue of the Journal of School Health. Complementing this notion in the early 1990s, was the introduction of the ‘healthpromoting schools’ concept by the World Health Organization (WHO), the European Commission (EC), and Council of Europe (CE). The premise of health-promoting schools was founded on the principles and strategies of the Ottawa Charter for Health Promotion (WHO, 1986; WHO Regional Office for Europe, 1996). Central to the health-promoting school concept was the unifying concept that schools can serve as effective settings to improve the well-being of schools and their communities by integrating education and health promotion activities (StewartBurgher, Barnekow-Rasmussen, & Rivett, 1999). In 1991, these three leading international organizations cooperatively established the European Network of Health Promoting Schools (ENHPS) to continue to achieve healthy lifestyles by developing supportive

environments conducive to education and health by promoting collaboration within school and between school and local community (WHO, 1993). In 1995, WHO then continued to launch the Global School Health Initiative (GSHI) which seeks to strengthen both education and health promotion activities at the global, national, regional, and local levels (WHO, 2006b). WHO’s initiative aims to increase the health of students, staff, families, and communities through schools. Through the GSHI, WHO’s goal is to increase the number of ‘health-promoting schools’ across our globe by sharing the same vision of “… a school constantly strengthening its capacity as a healthy setting for living, learning, and working” (WHO, 2006b).

Our Strategies: Assessment & Planning Tools To improve health through the school setting that supports the ongoing process of education improvement and health promotion utilizing school and community partnerships, a systematic approach to build a climate of public interest and coordination for action is necessary. The use of school-level planning and assessment tools is one successful strategy for schools and members of their community to come together and discuss what they are currently doing to promote well-being and recommend actions through multi-level partnerships enabling schools and their communities to become healthier places. Based on its extensive knowledge of schools, the Association of Supervision and Curriculum Development (ASCD) created a mechanism that would encourage schools to include health programming in the school improvement process. This mechanism increases the likelihood that schools and the surrounding communities will more conscientiously focus on improving and sustaining supports for the well-being of students and staff and that school health efforts would be acknowledged to be as important to positive outcomes for children and youth as literacy and numeracy. Physically and emotionally healthy, engaged students make better learners. Educators know that when a student’s social, emotional, physical, intellectual, spiritual, environmental, occupational needs are met they attend school regularly and focus better on classroom instruction. Likewise, teachers whose well-being is supported by the school are less stressed by their work and can provide consistent, high quality instruction throughout the entire day. However, even though research increasingly reinforces the links between high quality education and good health programming, the evidence about systems and structures has not always been integrated into school improvement processes.

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| HEALTHY SCHOOL REPORT CARD |

To enable Canadian schools to become healthier school communities, a newly developed school-level assessment process from the Association from Supervision and Curriculum Development (ASCD) entitled the Healthy School Report Card – Canada Edition (HSRCC) is being released January 2007 to provide schools and their communities with the vehicle to facilitate the implementation of essential structures to support a coordinated approach to a school-wide health program. This tool was created as the next ASCD national edition to be used with the original action tool, Creating a Healthy School Using the Healthy School Report Card (2005): An ASCD Action Tool. The Healthy School Report Card national editions of the action tool are school-level assessment processes based on research, best practices, and practical information that enable schools to integrate changes into their school-wide improvement plans.

The Development of ASCD’s Original Healthy School Report Card (HSRC) In 2003, The Robert Wood Johnson Foundation, provided a grant to Association of Supervision and Curriculum Development (ASCD) to undertake a research and development effort to identify the characteristics and indicators of a high quality, high performing school that specifically related to school health programming and to create a tool through which schools could assess and report their school health efforts. ASCD is a non-profit education association with nearly 180,000 members worldwide that represent all professions in education. Recognized for its quality professional development, translation of research to practice, and resources that support the success of each student and educator, ASCD is an important ally in reaching school leaders about the links between health and learning. The association has 63-year history of educational leadership efforts and is in the forefront of focusing on education as a means for developing healthy, responsible, engaged citizens. David K.Lohrmann,consultant to the project and associate professor at Indiana University, Bloomington, identified 11 characteristics of schools that are high quality, high performing schools through an extensive review of the literature across a variety of disciplines and expert panel review. The goal was to create a process through which schools could establish a culture, which extended to the family and community and enables, motivates, supports, and reinforces student adoption and practice of healthy behaviours (Lohrmann, 2003). The starting point for examination of the structural factors that support such a culture was an approach promulgated by the U.S. Centers for Disease Control and Prevention’s Division of Adolescent and School Health. This approach – Coordinated School Health Programs (CSHP) – has been adopted as the primary method for creating health-promoting schools in the United States. Lohrmann’s research supported the use of this approach with a few changes – the school environment component was split in two to separate climate and culture from facilities and transportation – two factors were added – coordination along with policy and planning. 24

Assessment of these characteristics is the focal point of a school improvement process that engages school and community stakeholders in prioritizing their efforts to improve the environment in their school so that it can support teaching and learning by creating a healthy culture. Published as Creating a Healthy School Using the Healthy School Report Card: An ASCD Action Tool (Lohrmann, 2005), the tool brings together evidence-based best practices in teaching, learning, and leadership; policy and infrastructure support; and student, parent and community engagement. A key factor in the successful use of the tool is that the process is more important than the outcome. School administrators who have used the process as outlined in the tool have found that it encourages engagement with staff and community stakeholder in new ways. The assessment process allows schools to identify and celebrate their successes as well as acknowledge areas that need improvement. The tool is designed to be an iterative process that helps schools move forward on the continuum of becoming a high quality, high performing school.

The Emergence of ASCD’s Healthy School Report Card – Canada Edition (HSRCC) ASCD recognizes that the education and health contexts vary from nation to nation and that those contexts play a significant role in how schools and their surrounding communities address student and staff well-being. Before the publication of the Action Tool with the US assessment, the association undertook efforts to support and acknowledge the work being done in Canada to create healthy schools. The Healthy School Report Card – Canadian Edition was created by reviewing and modifying the original Healthy School Report Card (United States) to take the Canadian context into account. During the development process, a draft version was prepared with a focus on the most recent national, provincial, and territorial guidelines. Sandra Vamos, consultant to the project and currently an Assistant Professor of Health Education at Simon Fraser University who previously served as a faculty member in the US focusing on guiding improvements in CSHP programs reviewed the national, provincial, and territorial literature across the provinces. Experts and stakeholders provided input from across Canada. Although, there is variability among current programs across the country, it is clear that effective school health promotion can improve the health and well-being of those involved and such multifaceted approaches are encouraged to allow society to speak in a unified and universal voice. While respecting the broad diversity of school health programming across Canada, the HSRCC incorporates health and education standards, regulations, and guidelines common to programs across the country and internationally and is reflective of promising practice embracing the health-promoting schools approach. The tool is built upon a systematic approach to garnering support consistent with WHO’s Global School Health Initiative to improve living, learning, and working. Appropriate Canadian resources and references are used and provide useful contextual and practical resources to guide such practical school action.


What is HSRCC? The Healthy School Report Card Canada (HSRCC) is a self-assessment process based on research, best practices from across Canada, and practical information related to healthy whole-school environments. It is a mechanism through which schools coordinate school, parent, and community stakeholders to assess, identify, and prioritize the changes that a school can make to improve the physical, mental, academic, and social health of its community, through systemic changes within a school-wide improved plan.

Creating A Healthy School Using the HSRCC The Healthy School Report Card – Canadian Edition is a section of Creating a Healthy School Using the Healthy School Report Card: An ASCD Action Tool. The ASCD Action Tool contains five sections: 1) Introduction; 2) Organizing; 3) Scoring; 4) Reporting; and 5) Using the Results that outlines the multi-step process (see Figure 1). Each of the steps in the process and the tasks required for accomplishing each step is described in detail in its own section of the action tool. Within ‘Section 3 – Scoring’ includes the Healthy School Report Card and instructions for assessing your school, inputting responses into the online spreadsheet and generating the data analysis and preliminary recommendations. The Healthy School Report – Canadian Edition is the version developed for schools, districts, territories, and provinces to use within Canada. The indicators provided for each characteristic are intended to assist schools reflect and respond to their local contexts. The evidence-based indicators include accepted standards and guidelines for creating an environment that supports learning and teaching through a coordinated approach to school health programming. The indicators are designed to help schools identify the high quality programming already in place and to strive to become a high quality, high performing school. The HSRCC includes references for each characteristic that include guidance to help you incorporate recommendations into the school’s improvement plan. An online resource section that will be updated periodically is also available to assist with implementation.

What Is In HSRCC? The Healthy School Report Card – Canadian Edition is developed around health-promoting school characteristics, with corresponding indicators to describe aspects of a health-promoting school. Each characteristic supports and is supported by the other characteristics to help create a healthy school community (see Figure 2). The set of evidence-based indicators for each characteristic has been identified because they support the implementation and sustainability of comprehensive and coordinated school health programming and its institutionalization within the school.

Creating a Healthy School Using the Healthy School Report Card – Canadian Edition assesses the following 11 characteristics of a healthy school: 1. School Health Program – District Coordination, Policy, and Support – the school culture supports health through compliance with comprehensive policies that address all aspects of a coordinated approach to school health 2. Coordination of School Health Program – the school facilitates coordination of all health programs to eliminate gaps and overlaps, expand access to health resources, and ensure high quality

3. Healthy Emotional and Social Environment – the school climate and culture is conducive to making students, families, and staff members feel safe, secure, accepted, and valued 4. Family and Community Involvement – the school climate and culture encourages, supports, and facilitates involvement of parents or guardians and the broader community in health programming

5. Healthy Physical Environment – the school culture ensures that buildings, grounds, and vehicles are secure and meet all established safety and environmental standards

6. Health Education – the school climate and culture strongly supports and reinforces the knowledge, skills, behaviours, and attitudes essential to the development of student health literacy through a high-quality curriculum 7. Physical Education and Physical Activity – the school climate and culture strongly supports and reinforces the lifelong fitness knowledge, skills, behaviours, attitudes, and values students learn through a high-quality curriculum 8. Nutrition Services – the school climate and culture supports, promotes, and reinforces healthy eating patterns and food safety for students and staff

9. School Health Services – the school climate and culture ensures student access to primary prevention, intervention, and treatment of disease and medical conditions 10. Counselling, Psychological, and Social Work Services – the school climate and culture ensures student access to primary prevention, intervention, and treatment of mental health and substance misuse problems 11. School Health Promotion for Staff – the school climate and culture ensures high-level job performance and healthy role models for students by supporting and facilitating the holistic well-being of all employees.

The results of the assessment process using Healthy School Report Card – Canadian Edition provide an evidence-based view of the quality of a school’s health programming. The report offers a picture of the positive aspects of a school’s health program – those things already in place that are of high quality and can be maintained at their current level. The report also gives a prioritized set 25


Figure 1: Each of the 11 characteristics support and are supported by the other characteristics. of recommendations about the portions of a school health program that either need work to become high quality or do not exist at all. The process allows stakeholders to strategically leverage resources for improvement by identifying areas where the community is likely to achieve the greatest return on its investment of time, personnel, and fiscal resources. The Healthy School Report Card – Canadian Edition is intentionally designed to respond to each school’s local context. The reporting system was developed to preclude attempts to generate hierarchical rankings or comparisons.

A Functional Perspective: Using the HSRCC 1.

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Creating a Healthy School Using the Healthy School Report Card – Canadian Edition is focused on school-wide improvement to unite stakeholders such as students, teachers, parents, administrators, school nurses, counsellors, allied-health professionals and organizations to identify and highlight what a school is doing well and what it could be doing to improve student outcomes. This organizing framework to engage stakeholders and stimulate dialogue is a vehicle to prioritize and incorporate those identified changes into an overall school-wide improvement plan. The process

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involves reflective practice and a sustained commitment to the development of progressive school-community change as a strategy using educator-driven approaches to school health promotion in contextual settings. The tool helps to identify professional development activities that are needed to meet the changes and goals identified by the stakeholders during the strategic planning process. Creating a Healthy School Using the Healthy School Report Card – Canadian Edition is a data-driven decisionmaking tool enabling, motivating supporting stakeholders in school-based health promotion. Each characteristic within the tool supports and is supported by the other characteristics. The HSRCC clearly identifies promising practices and essential structures to support a coordinated approach to school health. Thus, the HSRCC provides a catalyst for comprehensive, coordinated, and systematic action based on solid data and research leading to school health promotion (see Figure 2). The Healthy School Report Card – Canadian Edition Emphasizes positive improvement: The HSRCC does not generate a summary score for either the individual characteristics or the entire instrument. Instead, the online scor-


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ing system employed revolves around planning purposes only and there is no grade given to a school. Each indicator under every characteristic is assigned three questions: i) Does it exist, and if so, is the quality what it should be? ii) How much benefit would accrue from undertaking efforts to improve it? and iii) How much effort would improving it require? The combined answers to these three questions produce a coloured-coded scoring result to determine whether that indicator needs to be addressed at all and the level of priority it should be given at a particular school. The Healthy School Report Card – Canadian Edition Advocates a National Goal: The HSRCC is a school-level approach in which schools, families, and community partnerships synchronize endeavours to address the health status and academic achievement of those involved. This process involved in the renewed attention to a comprehensive and coordinated concept brings together an overarching goal of improving both the health and learning of our children and youth and thus, achieving healthier communities across our nation.

Canada’s School Health Programs: Promising Reforms & The Future Ahead To help avoid the ever-so-common approach of compartmentalizing interventions and professionals within and outside of the school, it is important to rely on systematic and negotiated planning (Deschesne, Martine, & Jomphe-Hill, 2003). The Healthy School Report Card Canada is designed to assist schools and their communities to work together in the school improvement process. This will require not only a participatory health promotion orientation but creating healthy school communities must first be considered to be an important and essential aspect of members of the school community. This is not a prescriptive approach but a pathway allowing the incorporation of the cultural, organizational, and political considerations within a school community’s school improvement process. Even though the health promoting schools approach and components of a CSHP framework appear to support teachers and schools, they require guidance, professional development and resources before the permanent notion of health

Figure 2: Systemic approaches infused when utilizing the Healthy School Report Card Canada

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promoting schools is used as a planned strategy throughout individual schools (St. Leger, 1999; Vamos, 2006). A planned strategy adopted by individual schools offers momentum and promise toward positive outcomes for creating healthier school communities; as does a planned strategy adopted by districts, regions, provinces, territories, nations, or the globe. Canada can contribute to WHO’s international goal of increasing the number of health promoting schools through the integration of social reform movements. Linking all of the crucial components of how schools do business, which shape individual lives can effect not only the preparation for life but the quality of life. Shifting educational and health norms and striving to integrate academic and health promotion activities into everyday patterns of school can achieve progress towards a new Canadian school health program paradigm.

References For a full list of references, please contact the authors at: [email protected]

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About the Authors Theresa C. Lewallen is senior director of ASCD’s Healthy School Communities initiative. The program is designed to create and sustain a worldwide imperative for the integration of health and learning by promoting best practices in leadership and instruction, school-community partnerships and policies that support healthy schools. Sandra Vamos, Ed.D. is an Assistant Professor of Health Education in the Faculty of Education at Simon Fraser University in British Columbia, Canada. Dr. Vamos has been involved in the education systems in Canada, Australia and the U.S. from K-12 to higher education.

THE HEALTHY SCHOOL REPORT CARD

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