How Schools Work

How How to
Schools
Work & Work with
Schools
A Primer for
Professionals
Who Serve
Children
and Youth
2003
By James F. Bogden, MPH
National Association of State Boards of Education

Development of this
publication was supported
by Cooperative Agreement
U87/CCU31O215 from the
Centers for Disease
Control and Prevention
Acknowledgements (CDC), National Center

for Chronic Disease
Prevention and Health
The original edition, written by Janice Promotion (NCCDPHP),
Earle, William Kane, and Candace Sullivan, Division of Adolescent
and School Health (DASH).
was published in 199O.
Its contents are solely
the responsibility of the
The National Association of State Boards
authors and do not
of Education gratefully acknowledges the necessarily represent the
following people who reviewed drafts of official views of CDC.
the updated document:
Howard Adelman, Nora Howley, MA,

PhD, University of CHES, Project
California, Los Director,
Angeles (UCLA) HIV/School Health
School Mental Project, Council
Health Project/ of Chief State
Center for Mental School Officers
Health in Schools
Frances A. Meyer,
Ginny Ehrlich, PhD, CHES,
MPH, Team Comprehensive
Copyright 2OO3
Facilitator, School Health
National Association of
Coordinated School Specialist, State Boards of Education
Health Programs Virginia State All rights reserved.
Initiative, Oregon Department of ISBN XXXXXXXXXXXX
State Department Education
of Education Additional copies of this
report are available for
Howard Taras, MD,
$14 each plus 1O% for
Brenda Z. Greene, American Academy shipping and handling
Director, School of Pediatrics ($4.5O minimum) from NASBE
Health Programs, Committee on at 277 South Washington
National School School Health and Street, Suite 1OO,
Boards Association physician consult- Alexandria, VA 22314. All
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ant to the San
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A Primer for Professionals Who Serve Children and Youth
Table of Contents
1
Introduction 4
School and community professionals working
together for children, youth, and families 5
The coordinated school health program model—

A framework for collaboration 8
The Core Mission of Education 8
2
How Schools Work 13
The school—Helping students grow and learn 15
The local school district—Responsive to community needs 23
The state—Authority tempered by respect for local control 27 3

The national level—Limited but influential 31
3
How to Work with Schools 34
Understanding the context—Politics and priorities 36
Preparation—Key to credibility 38
Garnering broad support—Power in numbers 40
Getting decisions made—Engaging the process 42
4 Conclusion
Endnotes
44
45

How Schools Work and How to Work with Schools
1
Introduction
This primer is a guide

for those who want the
education, health, and
social services sectors to
work more closely
4
together at the local and
state levels to improve
the health and well
being of young people.
It aims to bridge professional cultures
and languages and help practitioners find
their way through the complex education
system. The guide describes how the
education system works, how to identify
leverage points for action, how to build
positive working relationships with

educators, and how to overcome A shared responsibility
“The health and the education of our children are inextricably linked. Children
challenges of working together
who are sick, hungry, abused, or using drugs, feeling that nobody cares, and who
on common goals. may be distracted by family problems are unlikely to learn well. Schools are also
places where foundations for future health behaviors are laid. The promotion of
School and community good health for children and youth in the school setting is a shared responsibility
professionals of families, schools, and communities.”
working together —Joint Statement of the New Mexico Secretary of Health and
for children, the New Mexico State Superintendent of Public Instruction2
youth, and families
People increasingly recognize not learn as well as healthy chil- tial personal and social skills, and
that health and education are dren. Yet, millions of young peo- have positive behavior consistent-
intertwined; education goals ple and their families lack access ly reinforced. If children and
cannot be achieved without or cannot afford needed health, youth are well prepared for adult
attention to health, and health mental health, and social services. life, adopt healthy lifestyles, and
goals cannot be achieved with- Health and social services pro- avoid behaviors that threaten
out attention to education. fessionals also know that good their health, they, their families,
5
Educators recognize through education leads to better health and the nation will benefit.
personal experience that students and well-being (see box, “More Schools work to enhance all
who have trouble seeing or hear- education = better health”). The students’ academic success, career
ing, lack energy, are troubled or classroom may be the only place skills, and aspirations; however,
distracted, have chronic illnesses, many young people receive few schools operate modern
or use drugs or alcohol often do health information, build essen- school health programs that are
well coordinated, high quality,

Health and education joined
and cost efficient. Educators may
“Health and education are joined in fundamental ways with
each other and with the destinies of the nation’s children.
not be prepared to teach health
Good health facilitates children’s growth, development, and
optimal learning while education contributes to children’s education or establish effective
knowledge about being healthy.”
—Joint Statement of the Vermont Secretary of Human school health programs. With
Services and the Vermont Commissioner of Education1

More education = better health
Increasing the high school graduation rate is an official health objective for the appropriate help, schools can enhance
nation for the year 2010 (Number 7.1). Following is an excerpt from Healthy student health literacy and health status
and improve family, community, and
People 2010: Understanding and Improving Health from the U.S. Department of
other supports for lifelong success.
Health and Human Services:3 Health, social services, and educa-
“In general, population groups that suffer the worst health tion professionals who work together
status also are those that have the highest poverty rates and can better achieve their respective
the least education. Disparities in income and education lev-
goals. By addressing students’ well
being and preparation for adult life in
els are associated with differences in the occurrence of illness
a coordinated way, schools and com-
and death, including heart disease, diabetes, obesity, elevated munities can avoid gaps, collaborate on
blood lead level, and low birth weight… overlapping functions, eliminate dupli-
“The average level of education in the U.S. population has cation of efforts, and enhance every-
one’s effectiveness. For example, evi-
increased steadily over the past several decades—an important
dence clearly indicates that school-
achievement given that more years of education usually trans- based efforts to prevent tobacco use are
late into more years of life. For women, the amount of edu- most effective when coordinated with
cation achieved is a key determinant of the welfare and sur- community-wide tobacco prevention
vival of their children. Higher levels of education also may and cessation programs.5
Yet, for numerous reasons the worlds
increase the likelihood of obtaining or understanding health-
of health, social services, and education
related information needed to develop health-promoting typically remain far apart. Specialized
behaviors and beliefs in prevention… professions sometimes use the same ter-
“Among people aged 25 to 64 years in the United States, minology to mean different things (e.g.,
the overall death rate for those with less than 12 years of
surveillance in health means to track dis-
ease, while in education it refers to
education is more than twice that for people with 13 or
6 more years of education. The infant mortality rate is
school building security). People from
diverse professional backgrounds rou-
almost double for infants of mothers with less than 12 tinely make unexamined, conflicting
years of education compared with those with an educa- assumptions (e.g., that helping every
young person gain optimal lifelong
tional level of 13 or more years.”
health is a top priority of every education
leader). Effective cross-agency collabora-
Chart 1 tion can be hindered by fragmented gov-
Percentage of U.S. population age 25+ who ernance within and across the education,
reported being in “excellent” or “very good” health, and social services sectors;
bureaucratic obstacles (e.g., incompatible
health, by educational attainment, 1997
budgeting, procurement, and contracting
procedures); the absence of multipro-
Bachelor’s degree
or higher
8O% gram data systems; and other challenges.
Intense pressures for improved academic
Some college,including 68% achievement and public misconceptions
vocational/technical
High school diploma or

about the purposes and goals of school
equivalent 58% health programs (e.g., the distorted view
that school health is mainly sex educa-
Less than high school 39%
tion) can also hinder efforts. Non-educa-
tion professionals who want to work
with schools often end up puzzled and
Source: National Center for Education Statistics4 frustrated. Typical questions include:
Why work with schools?
• Elementary and secondary schools serve • Connections exist between students’ immedi-
children and youth during 13 developmen- ate health status and academic performance.8
tally critical years. Schools have more influ- • Leading causes of mortality and morbidity
ence on the lives of young people than any among all age groups are related to cate-
other social institution except the family, and gories of behavior that are often established
provide a setting in which friendship during youth, extend into adulthood, and
networks develop, socialization occurs, are frequently interrelated. These include
and behavioral norms are developed and behaviors that contribute to unintentional
reinforced. 6 injuries and violence, tobacco use, alcohol
• Schools can be a valuable setting for preven- and other drug use, sexual behaviors that
tion and early intervention services—fully contribute to unintended pregnancy and
99 percent of young people ages 7–13 are STDs including HIV infection, unhealthy
enrolled in school,7 and students are in dietary choices, and physical inactivity.9
direct sustained contact with professionals • Public health problems associated with obesity
who, with appropriate preparation and sup- among young people are a major economic
port, can recognize emerging problems. burden and jeopardize individual health.10
• More than 60 million students and staff • Research shows that well-designed, well-
7
members, about 22 percent of the U.S. pop- implemented school health programs can
ulation, can be reached through schools. indeed promote healthy behaviors.11
Add family members and no other social • School-aged children and youth are often
institution reaches as many people. underserved. For example, Mental Health: A
• Schools can be an efficient conduit for Report of the Surgeon General stated in 1999
assisting families in poverty or those with that 20 percent of children and adolescents
undocumented immigrant status. experience signs and symptoms of a mental
• Schools are located in every community and health or addictive disorder during the
are focal points of community life. course of a year, and that 70 percent of
• Schools have always had a public health young people who need treatment do not
role—health education, physical education, receive mental health services.12
basic health services, attention to safety and
sanitation, and food service programs have
long been part of the school experience.
• How does the education page; additional models are dis- schools are implementing the
system work? cussed on page 38). CSHP model in some form,
What distinguishes the CSHP non-education professionals
• Who is in charge of what? model is coordination and consistency might consider how their expert-
of approach across all activities so ise can work with the model.
• How are services paid for? each component supports and
reinforces the other. For example,
The Core Mission
• How does a community school staff members who partic-
of Education
professional work with a ipate in an employee wellness
school or district? program are more likely to be It may seem evident that
enthusiastic about the value of high-quality school health pro-
• Why doesn’t everyone good health, an attitude that can grams help students learn better,
welcome me with open arms motivate many students. School yet some education policy-mak-
and cooperate fully? food service meals and other ers, educators, and leaders do
foods and beverages available at not recognize the necessity of
• Why are school health topics school ought to complement—or school health programs.
so frequently controversial? at least not undermine—what A community professional trying
students learn about nutrition. to strengthen the school health
This primer aims to answer The school environment should program is more likely to meet
these questions and, by doing so, encourage the enjoyment and with passive non-cooperation than
help school and community pro- practice of daily physical activity. a clearly stated rejection. Non-
fessionals work together for Because a growing number of education professionals offering
mutual benefit and for the bene-
fit of children, youth, and their
families.
8 Benefiting from reduced
The coordinated health care costs
school health “It is true that healthy children make better students. It is also true
program model—A that healthy students are less expensive to the health [care] system
framework for
collaboration and that they also make healthier adults. School budgets are typical-
ly saddled with the largest portion of costs to provide school health
The Division of Adolescent [services] programs that improve student health. Yet, it is the public
and School Health (DASH)
within the Centers for Disease health system and the private health systems that enjoy the benefits
Control and Prevention (CDC), of successful school health endeavors, even if some of those bene-
along with many experts in the
field of school health, promote a fits may not be enjoyed for years to come. Public health and private
modern coordinated school health systems can and should step up to the plate more often and
health program (CSHP) model
accept some of this responsibility—both fiscally and otherwise.”
of education, strategies, and serv-
ices. The model provides a —Dr. Howard Taras, American Academy of
framework for community pro- Pediatrics Committee on School Health13
fessionals to collaborate with
schools in ways that support each
others’ work (see box on next
The eight-component coordinated school health program model
The Making Health Academic website of the Education Development • School health services: Preventive services, education, emer-
Center (EDC) at www2.edc.org/MakingHealthAcademic offers the gency care, referral, and management of acute and chron-
following definition of the CSHP model: ic health conditions. The services are designed to pro-
Health is not just the absence of disease—it is mote the health of students, identify and prevent health
complete physical, mental, and social well problems and injuries, and ensure appropriate care.
being. A school health program that effectively • School nutrition services: Integration of nutritious, afford-
addresses students’ health, and thus improves able, and appealing meals; nutrition education; and an
their ability to learn, consists of many different environment that promotes healthy eating habits for all
components. Each component makes a unique children, designed to maximize each child’s education
contribution while also complementing the and health potential for a lifetime.
others, ultimately creating a whole that is more • Counseling, psychological, and social services: Activities that
than just the sum of its parts. address the cognitive, emotional, behavioral, and social
needs of individuals, groups, and families. The services
are designed to prevent and address problems, facilitate
Healthy School
Environment positive learning and healthy behavior, and enhance
Family/Community Health healthy development.

Involvement Education
• Physical education: Planned, sequential instruction that
promotes lifelong physical activity, designed to develop
Health
Health Promotion
Services
basic movement skills, sports skills, and physical fit-
for Staff
ness, as well as to enhance mental, social, and emo-
tional abilities.
Physical Nutrition • Health promotion for school personnel: Assessment, educa- 9
Education Services
tion, and fitness activities for school faculty and staff,
Counseling,
Psychological & designed to maintain and improve the health and well-
Social Services
being of school staff who serve as role models for students.
The CSHP model has eight components: • Family and community involvement in school health:
• Healthy school environment: The physical, emotional, Partnerships among schools, families, community groups,
and social climate of the school, designed to provide and individuals, designed to maximize resources and
both a safe physical plant and a healthy and a sup- expertise in addressing the healthy development of chil-
portive environment that fosters learning and pro- dren, youth, and their families.
motes healthy behavior. Leadership, partnership, and coordination are the glue
• Comprehensive school health education: Classroom instruc- that holds the pieces together to form a coherent whole.
tion that addresses the physical, mental, emotional, and Because individuals, institutions, needs, and resources
social dimensions of health; promotes knowledge, posi- differ from across communities, no two CSHPs are
tive attitudes, and skills; and is tailored to each expected to be identical. In each new setting, a unique
age/developmental level. The education program is group of people and agencies will determine the needs
designed to motivate and help students maintain and facing young people in their schools and build on exist-
improve their health and reduce risk behaviors. ing resources to support positive youth development.

to help school might encounter a lack of
enthusiasm for several reasons:
• Some might think that school health
programs duplicate community
services.
• Some education administrators
might perceive health- and social
health-related programs as expensive
or as long-term commitments, even
if financial help is initially available.
• School leaders tend to be wary of
controversy. Because most schools
depend on voters’ willingness to pro-
vide adequate financial resources,
school boards and administrators
want to avoid alienating influential
constituencies and media-savvy
interest groups. (Despite the occa-
sional conflict that draws media
attention, however, public support
for school health programs is strong
whenever it is credibly measured.
Direct opposition is relatively rare.14)
• School staff members might have
learned from experience to be suspi-
cious of short-lived school improve-
10 ment programs that administrators
eagerly push one year and abandon
the next. As Ronald Brandt, former
Executive Editor of Educational
Leadership, has noted, “The road to
educational reform is strewn with
the wrecks of many bandwagons.”15
• Perhaps the most common reason
for education leaders’ reluctance to
embrace school health is the belief
The school mission that school health program goals are
The overwhelming concern of all educators is to
desirable, but not a school’s job.
Many are concerned about diverting
ensure that every student demonstrates good
time and resources from academic
performance to challenging academic standards. learning. Community members who
Community professionals who understand this core consider health and social goals
mission are more likely to forge productive working extraneous to the education mission
relationships with schools. might oppose burdening schools
with health-related programs.
Before approaching any school leader,
it is critical to recognize that the over-
whelming concern of all educators is to
ensure that every student can • Creating reporting and sionals can help education lead-
perform to challenging academic accountability systems ers understand that health- and
standards. For two decades designed to pinpoint failures family-related issues hold too
prominent political leaders have and spur higher performance many students back from high
been harshly criticizing the pub- from students, teachers, and academic achievement and that a
lic education system for wide- schools. substantial number of students
spread failure, even though pub- • Guiding the recruitment, need help if all are to meet chal-
lic schools’ educational deficien- preparation, placement, and lenging education standards.
cies are often exaggerated.16 Some ongoing support of a higher- From this perspective, commu-
fear that influential groups are quality workforce. nity professionals should support
determined to discredit and ulti- In the current climate, educa- extensive assessment, reporting,
mately dismantle the public edu- tion leaders will not permit and accountability reforms
cation system. health and social goals to divert because these measures will help
With the recent passage of the or distract schools from the core document and pinpoint barriers
No Child Left Behind Act, the mission of education and the to student learning.
federal government requires states ambitious agenda of standards- School health programs have
and school to increase academic based reform. Instead, every ini- been perceived as supplemen-
achievement for all students; elimi- tiative addressing non-academic tary to a school’s core func-
nate achievement gaps among goals needs to be cast in terms of tions—a nice option when
racial, ethnic, and income groups; supporting the education mis- money is available but first on
and rapidly improve—or close— sion. For example, the Richard the chopping block when budg-
every persistently failing school. David Kann Melanoma ets are tight. The alternative
Beleaguered education leaders have Foundation of West Palm Beach, view is that components of a
accepted the need for schools to FL worked with the School modern school health program
demonstrate greater accountability District of Palm Beach County are vital academic and support
for results. Every state is at some to implement the SunSmart activities that strengthen stu-
stage of implementing standards- America curriculum. They did dent performance and help 11
based education reform, which pri- this by delineating for teachers reduce barriers to student
marily involves: exactly which Sunshine State learning. Even if the education
• Adopting academic-content Standards in science, language accountability system does not
and student-performance arts, and health could be satisfied hold schools directly responsi-
standards that clearly state by using skin-cancer prevention ble for such outcomes, support-
what students should know lessons.17 ers of school health programs
and be able to do. The education system’s argue that it is essential to pro-
• Developing challenging emphasis on academic perform- vide students with programs
assessments aligned with the ance presents an opportunity and that support their physical,
standards. a challenge. Community profes- mental, and social growth.
Rising to the challenge

“School systems are not responsible for meeting every need of their stu-
dents. But when the need directly affects learning, the school must meet
the challenge.”
—Carnegie Council Task Force on the Education of Young Adolescents18

Helpful resource
• “Making the Connection: Health and Student Achievement” is a PowerPoint presentation that
summarizes current research and data on the links between students’ health status and academ-
ic performance and includes a full bibliography. It was developed by the Society of State
Directors of Health, Physical Education and Recreation (SSDHPER, at www.thesociety.org),
and the Association of State and Territorial Health Officials (ASTHO, at www.astho.org), and
can be ordered from their websites.
Note: Selected resource organizations are highlighted throughout this guide, though many other organizations also
offer high-quality materials and technical assistance. Some of the mentioned organizations maintain hyperlink lists
that lead to additional resources.
Talking points:
Why schools need to address health and social goals
• Schools cannot achieve their primary mission of education if stu- absence, tardiness, and psychosocial problems, and
dents and staff are not healthy and fit physically, mentally, and greater improvements in standardized test scores and
socially. To prepare students to be productive adults,
19
math grades than did children who qualified for the
health is “basic to the basics.” program but did not participate.23
12
• To be truly serious about educating all students, it is impera- • Schools by themselves cannot, and should not be expected
tive to take a critical look at the reasons why some do not to, address serious health and social problems. Educators
learn well, then address those problems. For example, skip- have no choice, however, but to deal with the con-
ping breakfast can adversely affect children’s per- sequences of students’ illnesses, chronic condi-
formance on problem-solving tasks.20 Studies have tions, crises, and tribulations. As Michael Usdan of
long shown that chronically undernourished children the Institute for Educational Leadership has said,
earn lower scores on standardized achievement tests, “Schools are where the kids are and they bring
especially tests of language ability. They are often irri- their problems with them.”24
table, have difficulty concentrating, have low energy, • Problem behaviors that interfere with learning include poor
and are more likely to fall behind in class. 21
conduct and attitudes, alcohol and drug use, early sexual
• Health problems cause poor attendance, and children cannot activity, delinquency, and violence.25
learn if they are not present in school, alert, and attentive. For • Infusing health topics into the general education-reform agenda
example, chronically undernourished children are more does not dilute that agenda, as some suggest, but helps ensure its
likely than other children to be sick and miss school.22 In success. For example, today’s state-of-the-art health edu-
contrast, studies of low-income elementary school stu- cation reinforces important academic skills.26
dents have found that those who participated in the fed-
eral School Breakfast Program had reduced rates of
2
How
Schools
Work
The U.S. elementary and
secondary education
system (i.e., kindergarten
through grade 12) is a 13
massive enterprise,
spending some $389 billion
in 2000 and employing more
27
than 7.6 million people.
Nearly all school-aged children and youth are
enrolled in more than 91,000 public and
27,400 private elementary and secondary
schools. This section is a brief guide to
the many institutions and people who make
major decisions in the complex K–12

America’s great hope and great duty

“Public schools are some of the most important institutions of democracy. They take children of every background,
from every part of the world, and prepare them for the obligations and opportunities of a free society. Public schools
are America’s great hope, and making them work for every child is America’s great duty.”
—U.S. President George W. Bush28
education sector. All are potential specific facilities, programs, and school districts, and schools are
points of access for community issues can be a challenge because technically agents of the state.
professionals who wish to work the public education system is a The federal government offers
with schools. shared duty of local, state, and national leadership and enforces
Private schools, which enroll federal governments, and has civil rights laws, but provides
about 12 percent of children in multiple participants, agencies, only limited program funding. As
grades K–8 and 8 percent of high and organizations (and numerous summarized by former Secretary
school students, and home acronyms) at each level. of Education Richard Riley,
schools, which account for about Constitutionally, state govern- “Public education is a state
1.7 percent of total enrollment, gen- ments are primarily responsible responsibility, a local function,
erally operate with minimal govern- for public education and local and a federal priority.”29
ment influence or control. The
degree of public oversight depends
14 on the state.
Some 78 percent of private Chart 2
schools are affiliated with religious
organizations; the rest are nonsec- The public education governance
tarian. Volunteer boards of trustees
who might be prominent commu-
structure, simplified
nity members or school alumni
usually set policies for individual
private schools or groups of schools. State GOVERNOR LEGISLATURE STATE BOARD OF EDUCATION
Community professionals who Level CHIEF STATE SCHOOL OFFICER Note: Each state’s governance
wish to work with private school structure is unique: lines of
authority among policymakers vary
populations can usually deal directly STATE EDUCATION AGENCY STAFF
with school building principals, or

sometimes with regional offices
(e.g., Catholic dioceses). School SCHOOL BOARD Local government
In contrast, governance of District SUPERINTENDENT

public schools, which enroll 86 Level CENTRAL OFFICE STAFF
percent of students in grades K–8
and 90 percent in grades 9–12, is
much more complex (Chart 2).
Determining precisely who has
School PRINCIPAL School improvement council
decision-making authority over

Level SCHOOL STAFF
In practice, this means that How public schools are funded
schools must operate according to Traditionally, most funds for K–12 public schools are raised through local taxes on
several layers of rules, regulations, private property. Few people realize that state funds account for less than half the
and laws, as well as meet expecta-
total, and that federal funds account for only about 7 percent of the money spent
tions of parents, families, and
community members. The result nationwide.30
is a confusing structural and polit- Although a local property tax is a fairly stable source of funding, disparities in local
ical web that can be intimidating wealth often directly affect the funds available to schools. Even if voters choose to tax
for educators—and even more so themselves at relatively high rates, low community property values can mean inade-
for community professionals—to
quate resources for schools. Legal challenges to the traditional finance system on
negotiate. Yet, with a little
grounds of assuring funding equity and adequacy for public schools have led some
patience and guidance non-educa-
tors can find effective leverage states to smooth out such differences by redistributing locally raised taxes.
points. Each level of the education States are also accepting a growing share of the financial burden to improve
system is described below in turn: equity and adequacy. On average, states accounted for 49 percent of revenues for
school, school district, state, and elementary and secondary schools in the 1998–99 school year, ranging from 9 per-
national.
cent in New Hampshire to 88 percent in Hawaii.31 Though more equitably dis-
tributed, state funds typically rely on the yield from sales taxes, income taxes, and
The school—Helping corporate taxes, sources that vary with the health of the economy and thus are
students grow and
more vulnerable to unpredictable budget shortfalls.
learn
Although schools in many large cities might appear relatively well funded, gross
No single national model exists
per-pupil expenditure figures tend to understate the higher costs of operating in
for a school’s organization by stu-
urban environments and the greater needs of many inner-city students for non-
dent grade or age. Perhaps the most
common model consists of ele- instructional support services. When these costs are accounted for, many inner-
mentary schools that serve stu- city schools are actually underfunded, as evidenced by the challenge of recruit- 15
dents from kindergarten through ing and retaining highly qualified and motivated staff, and by the poor physical
grade 5 (generally ages 4–11), mid- condition of many urban school buildings. A recent analysis of education
dle schools that serve students in
finance data by the Education Trust documented that, in most states, school dis-
grades 6–8 (ages 11–14), and high
schools that serve students in tricts that educate the greatest number of poor and minority students have less
grades 9–12 (ages 14–18). In anoth- state and local money to spend—an average of $966 less per student—than do dis-
er common model, elementary tricts with the fewest poor and minority students.32
schools serve grades K–6, junior There is a spirited debate among educators and policymakers about the rela-
high schools serve grades 7–9, and tionship of school funding to student academic performance.33 The Education
high schools serve grades 10–12.
Trust argues that adequate funding does make a difference:34
Most districts have alternative
schools for students who for vari- “Many argue that fiscal inequities of this sort won’t matter, because
ous reasons do not thrive in the the effects of poverty and family background overwhelm anything
regular school environment. Many, that schools can do. But our experience and a growing body of
but not all, are for students with research teach us that all children can achieve at high levels when the
behavioral or serious academic
right combination of tools and strategies are employed. These
problems.
include: high expectations and clear standards that are applied to all
Many districts support magnet
schools that offer specialized students, rigorous curricula, well prepared teachers supported with
courses of study in such areas as high quality professional development, additional instructional time
technology, the performing arts, or for students who aren’t meeting standards, and more focused
resources. And yes, these things cost money.”

even health sciences. Magnet pline; enforces federal, state, and might also be included. Any of
schools are often established as a district rules, policies, and laws; these people might enthusiastically
strategy to better integrate a school evaluates teachers; and represents support improved school health
district’s various populations. the school to parents and the policies and programs.
Charter schools (also called community. Some schools have A school may employ a full- or
community schools) are a hybrid one or more assistant principals. part-time school health program
of public and private schools. They Principals are key gatekeepers. coordinator to facilitate harmo-
operate with public money but They can wholeheartedly promote nization and consistency among
have considerable autonomy. They school health programs, passively staff working on school health pro-
usually have their own governing allow them, or actively undermine gram components, or to help carry
bodies and have great latitude in them. A principal with vision out school health-related policies.
adopting their own policies, cur- who exercises effective leadership Some schools establish school
riculum, and programs. They must can inspire and guide the school health councils to assist the prin-
still conform, however, to certain staff to achieve broad objectives cipal with oversight, management,
specified state requirements, health for students’ healthy growth and planning, and evaluation of school
and safety standards, and federal well being. Conversely, a weak health programs and policies. Such
civil rights laws. In some places principal or one opposed to an a council often includes parents and
charter schools report to the local expanded mission for schools can community representatives. It
school district or a state-level be a serious obstacle. Regardless, might simply be an advisory body,
agency, in others to an authorized it is important that the principal or it could have some designated
sponsoring organization such as a stays fully informed of everything authority to enhance program
university. that happens in the school. coordination among staff members
Schools, even those in the same Typically, this is done by the working in school health program
school district, vary greatly in qual- school staff members a commu- components. The school health
ity and character. The most effec- nity professional is collaborating council can also serve as the advi-
tive schools have strong adminis- with. Time-tested advice: consult sory body required by federal pro-
16 trative leadership, a climate con- early and consult often. grams such as Safe and Drug-Free
ducive to learning, school-wide In some school districts, indi- Schools and Communities. In a
emphasis on instruction, high vidual schools may have consider- recent national study, about half of
teacher expectations for student able autonomy and be managed schools reported having a group
achievement, active parent/family with significant input from key that helps develop or coordinate
involvement, and a commitment decision makers on school- one or more school health pro-
to addressing barriers to student improvement or site-based gram topics.35 Anecdotal evidence
learning. management teams. The abounds, however, that few schools
At each school the most required composition of such gov- enjoy the benefits of a strong and
important decision maker is the ernance teams varies, but they gen- active school health council.
principal. This person supervis- erally include parents, teachers, and Offering to help establish a school
es the school’s instructional pro- perhaps other staff members. or district-level health council
gram; maintains order and disci- Influential community members might be a good first step for a
community professional.
Teachers and other instruction-
Helpful resources on principals al personnel can play important
• Find out more about the work and concerns of principals at the web- roles in improving student health
sites of the National Association of Elementary School Principals even if they are not designated
health teachers. They can incorpo-
(www.naesp.org) and the National Association of Secondary School
rate health topics into nearly any
Principals (www.nassp.org).
subject’s lesson plan, foster healthy
Helpful resources on school health councils

• The American Cancer Society offers Improving School • The Iowa Department of Public Health offers an online
Health: A Guide to School Health Councils. Obtain it through version of Promoting Healthy Youth, Schools, and Communities:
your local chapter, call (800) ACS-2345, or download it A Guide to Community-School Health Advisory Councils at
from the Texas Division of ACS at http://208.142.197.5 www.idph.state.ia.us/fch/fam_serv/advisory.htm.
/hkn/pdfs. Browse the Texas Division’s useful “Healthy
Schools—Healthy Kids” website, www.schoolhealth.info.
classroom and school environ- versed in general theories of child education responsibilities at the
ments, help identify and refer stu- development). School or district middle- and high-school levels are
dents who are troubled or ill, and leaders might counsel—or even often assigned to teachers with
personally model healthy lifestyles require—teachers to avoid certain minimal or no professional prepa-
by engaging in wellness activities. controversial topics.36 And few ration or support in health educa-
The degree to which a teacher schools or districts operate work- tion (Chart 3, page 18). Many
fulfills these roles depends on the site wellness programs that encour- teachers who have not received
individual and the institutional age staff to maintain good health- specialized preparation are
context. Teachers are held respon- promotion habits. Nevertheless, uncomfortable dealing with such
sible for classroom instruction examples abound of dedicated sensitive topics as human sexuality
according to state and district cur- teachers who provide exemplary and mental health. Community
ricular guidelines, which some- health education lessons with few professionals can also lend their
times do not emphasize health resources or support. expertise by helping design or
instruction. Few teachers have At the middle- and secondary- implementation an ongoing pro- 17
received professional preparation school levels, teachers specialize in fessional development program
or continuing education in instruc- one or more subject matter disci- for currently employed health
tional methods particular to health plines. Most states offer specialist education teachers.
education (although all certified teaching certificates in health edu- Resource teachers are respon-
teachers, particularly at the ele- cation, physical education, or a sible for working with students who
mentary school level, are well combination. Nevertheless, health require extra attention, such as
Helpful resources for school staff

• The Health Information Network, a nonprofit health school nurses, and school physicians that offers help and
affiliate of the National Education Association (NEA), advice on quality school health programs. Go to
maintains a regularly updated website of school health www.ashaweb.org.
information and resources for teachers and other school • The National Middle School Association (NMSA) pro-
personnel at www.neahin.org. vides professional development, journals, books, research,
• The American School Health Association (ASHA) is a and other information geared to the educational and
multidisciplinary organization of administrators, coun- developmental needs of young adolescents; online at
selors, dentists, health educators, physical educators, www.nmsa.org.

typically assigned many critical
Chart 3 responsibilities, including:
In most schools, health education specialists • Providing first aid and
are not the only ones assigned to teach emergency services.
• Monitoring chronic health
required health education courses
conditions and health care
outcomes.
• Dispensing medication and
Middle Schools Senior High Schools
administering nursing proce-
dures, particularly for stu-
12% dents with disabilities or spe-
7% 26% cial health-care needs.
• Conducting health screenings
and assessing student health
7% status.
81% 67% • Maintaining confidential
health records of students
and school staff members.
• Identifying educational diffi-
culties that might have
Health Education Specialist Only
underlying health causes and
Physical Education Specialist Only arranging for referrals.
Teachers of Various Backgrounds • Case-managing students with
complex health needs,
Source: CDC School Health Policies and Programs Study (SHPPS) 200037
including interacting with
physicians and families.
18 • Helping design special diets
and physical education pro-
those in special education or bilin- subject matter. The number of stu- grams for students with spe-
gual education. These teachers may dents they interact with daily is cial health concerns.
work with students in self-con- subject to local regulation. • Providing health education to
tained classrooms (serving special- About three-quarters of all individual students.
needs children exclusively), in schools have access to profession- • Conducting direct classroom
resource settings (requiring special- ally trained school nurses, who instruction in the absence of
needs student to leave the classroom can funded by the education sys- a health teacher.
to join the resource teacher for a tem, public health agencies, local • Serving as a resource for teach-
short period of time), or in regular hospitals, or other entities. Some ers, curriculum developers,
classrooms with a mix of students. are assigned to one school; many and other school personnel.
Paraprofessionals and class- divide their time among multiple • Helping schools and districts
room aides are responsible for schools. As of 2000 only 53 per- develop and implement poli-
assisting the teacher in routine class cent of schools had the recom- cies and procedures to pre-
activities, sometimes working with mended nurse-to-student ratio of vent the spread of communi-
small groups of students on partic- 1:750 or better.38 cable diseases and blood-
ular projects or even performing School nurses provide or borne pathogens such as
very specialized medical proce- supervise the management of a HIV and hepatitis.
dures in special-education settings. range of health services and • Providing health information
Aides might be assigned to work in responsibilities routinely provid- and health-promotion activities
specific classrooms or with specific ed on school campuses. They are for staff and family members.
• Taking a leadership role in col- increasing number of elementary Disabilities Education Act
laborating with community schools find them useful for deliv- (IDEA).41 In recent years, schools
agencies to identify and pro- ering essential primary care servic- have progressively expanded such
vide programs that meet the es, including diagnostic and treat- student support services, pupil
physical and mental health ment services, to children and their services, or auxiliary services
needs of children and families. families. States may provide some (guidance, health, mental health,
Whether school nurses are direct funding, but most school and social services) to address
employed by the school system or health clinics rely on a mix of grant unmet needs among children and
a local public health agency, they funds from foundations, local hos- adolescents, and to facilitate
help bridge the health and educa- pitals, and health departments. healthy growth, development, and
tion systems, translating policies, Many also bill Medicaid and pri- educational achievement (Chart 4,
legal responsibilities, priorities, per- vate health insurance firms for page 21). As a recent surgeon gen-
spectives, terminology, and special- services provided. eral’s report observes, “Schools are
ized jargon. Although only about 7 percent the primary providers of mental
A third of schools use part- or of schools have a school-based health services for children” and,
full-time health aides to help health center, 16 percent have a “offering services in the schools
provide student health services. part-time or full-time school improves treatment access.”42
Often, minimally trained and sup- physician who provides health Guidance counselors are tra-
ported school administrative staff services to students. In addition, 33 ditionally responsible for providing
members are given some responsi- percent report that they have made students with academic support,
bility for keeping health records arrangements with a local health including class scheduling, assess-
and administering first aid: 94 per- department, local mental health or ments, college counseling, and
cent of school districts allow school social services agency, private career guidance. Increasingly, they
faculty and staff to administer pre- physician or dentist, local hospital, also provide personal and crisis
scription drugs to students.39 managed-care organization, or uni- counseling, refer students to need-
School health center staff, versity or medical school to pro- ed services, and provide follow-
who are generally nurse practition- vide student services.40 up. Most states require that coun- 19
ers or physicians’ assistants, work School-based mental health selors are licensed or certified and
in clinics located on school services have long focused on stu- that they have a master’s degree in
grounds (school based) or nearby dents in special education because counseling. But because each
(school linked). Such clinics were diagnostic and treatment services counselor is typically assigned hun-
originally established mainly in are mandated to some extent by dreds of students, there is little
middle and high schools, but an the federal Individuals with time for in-depth student contact.
Helpful resources on school health services

• The National Association of School Nurses at • The American Medical Association’s Program on Child
www.nasn.org. and Adolescent Health at www.ama-assn.org/ama/pub/
• The Center for Health and Health Care in Schools at category/1947.html.
www.healthinschools.org/home.asp. • The Society for Adolescent Medicine at
• The National Assembly on School-Based Health Care at www.adolescenthealth.org.
www.nasbhc.org.
• The American Academy of Pediatrics at
www.schoolhealth.org.

Nearly a quarter of schools have includes interviewing the child and the U.S. Dietary Guidelines for
no full-time—or even part-time— family to determine the appropriate Americans. About one in six
guidance counselor.43 action; facilitating communication schools contract with outside man-
About two-thirds of schools between parents and school staff; agement companies to operate the
employ part-time or full-time intervening in problem situations; school food service program.46
school psychologists who are facilitating school–community Virtually all high schools (98
trained in mental health, child relations, and providing a variety of percent in 2000), most middle
development, school organization/ services to students in special edu- schools (74 percent), and nearly
adminstration, learning, behavior, cation programs. half of elementary schools (43 per-
and motivation, and certified or School pupil services are often cent) have a vending machine or a
licensed by the state in which serv- underfunded, understaffed, frag- school store, canteen, or snack bar
ices are provided. School psycholo- mented, poorly coordinated, and where students can purchase car-
gists perform duties related to men- marginalized.44 Simply co-locating bonated beverages and snacks
tal and social health prevention, community agency services at foods such as chips, candy and
intervention, and education. A key schools without integrating them cookies that have little nutritional
responsibility is assessment of aca- into existing school services, how- value.47 Typically, these venues are
demic skills, learning aptitudes, per- ever, can cause turf conflicts and not managed by school food serv-
sonality and emotional develop- exacerbate these shortcomings. Drs. ice staff. Revenues often accrue to
ment, social skills, and eligibility for Howard Adelman and Linda Taylor athletic programs, other student
special education. They are often of the University of California, Los activity programs, or the general
tasked with establishing collabora- Angeles, Center for School Mental school fund. Many educators argue
tive relationships with community- Health Services suggest that school that, in the absence of adequate
based personnel and families to pro- leaders, community agencies, and public funding for education,
vide integrated services for psy- families pool their resources and schools have no choice but to rely
chosocial wellness. together plan a comprehensive, on lucrative profits generated by
Nearly half (44 percent) of multifaceted continuum of inter- the sale of such items. Most
20 schools employ a part-time or ventions designed to address barri- school boards, however, have at
full-time school social worker. ers to learning and promote healthy least one member who agrees
Working with teams of other development.45 that schools have a responsibility
school personnel, social workers School food service staff to maintain a healthy nutritional
help children and youth with phys- members include the food service environment. Community health
ical or learning disabilities or emo- manager and workers. They plan professionals can offer their assis-
tional problems, or those who face meals, purchase supplies, and tance and help build community
child abuse, neglect, domestic vio- prepare and serve meals, guided by awareness and support for school
lence, poverty, or other problems. U.S. Department of Agriculture policies that address the nation’s
Often the social worker’s job regulations and in accordance with epidemic of obesity.
Helpful resources on mental and social health

• The American School Counselor Association (ASCA) at • The UCLA School Mental Health Project at
www.schoolcounselor.org. http://smhp.psych.ucla.edu.
• The National Association of School Psychologists (NASP) • The Center for School Mental Health Assistance at
at www.nasponline.org. http://csmha.umaryland.edu.
• The National Association of Social Workers (NASW) at
www.socialworkers.org.
Chart 4
Mental health and social services provided in U.S. schools Percent of

schools
Crisis intervention for personal problems 94
Identification of or referral for physical, sexual, or emotional abuse 93
Identification of or counseling for mental or emotional disorders 85
Stress management 79
Tobacco use cessation 64
Alcohol or other drug use treatment 58
Assistance with enrolling in the state/federal Children’s Health Insurance Program (CHIP) 50
Child care referrals for teen mothers 49
Eating disorders treatment 47
Assistance with enrolling in WIC or accessing food stamps or food banks 42
Services for gay, lesbian, or bisexual students 41
HIV testing and counseling 23
Prevention/education services Percent of

(provided in one-on-one or small group discussions by mental health or social services staff) schools
Violence prevention 87
Suicide prevention 77
Alcohol or other drug use prevention 76
Tobacco use prevention 67 21
Pregnancy prevention 60
Eating disorders prevention 54
STD prevention 53
HIV prevention 52
Accident or injury prevention 51
Nutrition and dietary behavior counseling 44
Physical activity and fitness counseling 32
Methods of service delivery Percent of

schools
Individual counseling 90
Case management for students with behavioral or social problems 83
Group counseling 76
Peer counseling or mediation 67
Comprehensive assessment or intake evaluation 64
Family counseling 61
Self-help or support groups 60
Source: CDC School Health Policies and Programs Study (SHPPS) 200011

Helpful resources on school nutrition environments

• CDC’s Division of Adolescent and School Health offers Promote Healthy Eating at School” that addresses how
Guidelines for School Health Programs to Promote Lifelong Healthy vending machine contracts can be revised to improve the
Eating at www.cdc.gov/nccdphp/dash/guidelines/ nutritional value of foods sold without affecting profit lev-
nutguide.htm. els. Download the sample policies at
• The U.S. Department of Agriculture offers Changing the www.nasbe.org/HealthySchools/fithealthy.mgi.
Scene: Improving the School Nutrition Environment, a free action • The National Schools Boards Association (NSBA) has
kit that can be used at state and local levels to educate deci- compiled excerpts from key documents and sample district
sion makers about the critical role of the school environ- policies in a Healthy Eating 101 packet. Visit
ment. Order the kit online at www.fns.usda.gov/tn/ www.nsba.org/schoolhealth.
healthy/index.htm. • California Project LEAN (Leaders Encouraging Activity and
• Part I of NASBE’s Fit, Healthy, and Ready to Learn: A School Nutrition) is a national leader in promoting healthy eating
Health Policy Guide contains a chapter on “Policies to in schools. Go to www.californiaprojectlean.org.
School personnel such as secre- members may actually participate in cent of parents of adolescents said
taries, custodians, bus drivers, school decision making through health education is either more
playground monitors, and cross- election or appointment to school important or as important as other
ing guards are often worth con- governing bodies. Organizations subjects taught in school.48 A more
sulting about student health status. that represent parents and family recent national poll in 2000 docu-
These individuals have frequent, members include Parent-Teacher mented that 81 percent of parents of
informal contact with students and Associations (PTAs), which are school-age children wanted their
22 often know what is happening in part of an established national net- children to participate in daily phys-
their lives. work, and Parent-Teacher ical education.49 Even sex education
Most educators recognize the Organizations (PTOs), which consistently receives solid support
importance of parents, other family operate independently. from parents and families in credi-
members, and community mem- Families tend to be enthusiastic ble surveys.50 Families are natural
bers in fostering student achieve- about and supportive of school allies for those who advocate quality
ment. Many schools actively seek health programs. When surveyed, support services in schools.
their opinions on school policies parents consistently rate health as an Finally, student organizations
and programs as members of advi- important topic for schools to such as student government, clubs,
sory boards and school improve- address. For example, a 1993 Gallup or honor societies can also be valu-
ment committees. Where site-based poll sponsored by the American able allies in efforts to address issues
school management exists, family Cancer Society found that 82 per- of health and well being.
Helpful resources on parent involvement

• The National Parent-Teacher Association maintains a par- • The National Parent Information Network (NPIN),
ent involvement section at its website addressing health, administered by the National Library of Education in the
safety, and drug and alcohol prevention. Browse it at U.S. Department of Education, provides access to
www.pta.org/parentinvolvement/index.asp. research-based information about the process of parenting
• Resources on parent involvement are available from the and about family involvement in education. Go to
U.S. Department of Education at www.ed.gov. http://npin.org.
The local school entirely of elected members, most of All are public-spirited volun-
district—Responsive whom are elected on a non-partisan teers—two-thirds serve without
to community needs basis and spend less than $1,000— compensation and spend an aver-
usually their own money—on their age 25 hours per month on board
The school district (also called campaigns. Campaigns tend to be business. Substantial numbers,
the local education agency, or more expensive in larger districts, especially in large districts, spend
LEA) is the public school system’s with funds raised from unions and 20 or more hours per week on
primary unit of administration in a businesses. Some large cities have this challenging community serv-
designated geographic area. There moved toward systems of appoint- ice. Though a great many are
are nearly 15,000 U.S. school dis- ment by other office holders. working parents, three-quarters of
tricts. In Florida, Louisiana, and West Although two-thirds of school board members also serve on
Virginia, school district boundaries board members are college gradu- another community board or
neatly coincide with county lines. ates, fewer than one in seven are committee, and a third report
More typically, district boundaries do professional educators (Chart 5). serving on three or more.
not correspond with those of other
agencies and government jurisdic-
tions. For instance, the Los Angeles Local school board demographics
Unified School District encompasses
• Male board members comprise 56 percent of the total in large districts
an area that includes the city of Los
(more than 25,000 students) and 63 percent in small districts (fewer
Angeles and all or parts of 28 other
cities. Illinois has nearly 900 school than 5,000 students). The average among all districts is 61 percent.
districts, and sparsely populated • School boards are somewhat less racially diverse than the nation as a
South Dakota has 177. whole (86 percent white, 8 percent African American, 4 percent
The number of schools and stu- Hispanic)—but are more diverse than most state and national elective
dents served in a school district also
bodies.
varies. New York City has more than
• Three-quarters of board members are between 40 and 59 years old.
1.1 million students, while a great 23
many districts consist of just one Another 20 percent are older than 60.
school building. Less than 2 percent Chart 5
of the nation’s school districts have
25,000 or more students, but 32 per- Occupations of local school board members
cent of all students attend school in
Other 6%
these mostly urban districts and their Nonprofit
organization or Business or
concerns get the most media atten- government 11% professional 44%
tion. At the other end of the size
range, more than one-third of school
districts had fewer than 600 students; Education 13%
these mostly rural districts accounted

for only 3 percent of public school
enrollment.51
In most districts, primary gover- Homemaker or
nance authority lies with the retired 26%
school board (sometimes called a

Source: National School Boards Association53
school committee). On most
boards, between five and eight
members serve four-year terms.52 • Visit the website of the National School Boards Association (NSBA) at
The average length of board service
www.nsba.org for more information about the work of school boards.
is nearly seven years. Some 93 per-
cent of school boards are composed

The school board’s role in
establishing and maintaining a Chart 6
school health program is critically Self-i
identified political orientation of local
important because the board sets a
school board members
district’s guiding vision, makes No label 4%
budget choices, chooses curricu-
lum, and determines many poli- Liberal 16%
Moderate 44%
cies that guide daily decisions of
the local education agency and its
schools. Local school board
authority is not complete, how-
ever. According to every state
constitution, public education is
primarily a state responsibility. Local Conservative 36%
districts are subject to state laws and
policies that may direct, limit, or
Source: National School Boards Association54
otherwise influence local policy-
making and implementation.
Similarly, school boards that accept how their children are educated. best for children, but members
federal funds are required to adhere Ideally, they are an expression of often disagree about what that
to federal policies and regulations. grass roots democracy, representa- means. In addition to their person-
School boards were founded on tive of and accountable to the al views, which tend to be political-
the belief that local citizens should whole community. Every school ly moderate (Chart 6), school
control policies that determine board member wants to do what is board members can be strongly
Helpful resources on legal issues

24
• Contact the state education agency or state health or conditions—be provided a “free, appropriate
department to learn about state-specific laws that gov- public education” that meets his or her educational
ern the provision of education. needs to the same extent as other students.
• Find federal legislation, regulations, and policy guid- • The Americans with Disabilities Act of 1990
ance online at the website of the U.S. Department of (ADA), which extends Section 504’s provisions to
Education at www.ed.gov. private non-religious schools and protects adults
• The Council of School Attorneys (COSA), an affiliate in every workplace
of the National School Boards Association (NSBA), • The Civil Rights Act of 1991, which also prohibits
offers many publications and links to other sources of discrimination and harassment based on a disability.
information on specific laws and legal issues. Go to • The Family Educational Rights and Privacy Act of
www.nsba.org/cosa/index.htm. 1974 (FERPA, also known as the Buckley
• NASBE’s Someone at School has AIDS: A School Health Amendment), which places certain privacy restric-
Policy Guide Concerning HIV Infection (2001) offers expla- tions on student records maintained by schools
nations and lists of resources on several important fed- that receive federal funds.
eral laws that affect school health programs, including: • The Protection of Pupil Rights Act of 1994,
• Section 504 of the Rehabilitation Act of 1973, which requires written parental consent before
which mandates that every public school student using federal education funds for some kinds of
with a disability—including chronic health diseases student surveys.
Helpful resources on local interagency collaboration

• The American Academy of Pediatrics offers the valuable • The National Center for Education in Maternal and Child
manual Moving from Principle to Practice: A Resource Guide at Health (NCEMCH) and Georgetown University operate
www.aap.org/advocacy/washing/rguide.htm. the Bright Futures project, which has produced sets of
• The Council of Chief State School Officers (CCSSO) has expert guidelines on health care for children and adoles-
practical resources for interagency collaboration at cents based on the principle that optimal health involves
www.ccsso.org/collpub.html. trusting relationships among the health professional, the
• The UCLA School Mental Health Project/Center for child, the family, and the community, all as full partners.
Mental Health in Schools offers many free resources to Visit www.brightfutures.org.
help build school-community partnerships at • The National Association for the Education of Young
http://smhp.psych.ucla.edu. Children (NAEYC) position statement, “Principles to
• The Public Education Fund (PEN) is a national associa- Link By: Integrated Service Systems that are Community-
tion of local education funds (LEFs), which are nonprofit Based and School-Linked,” contains useful practical guid-
community-based organizations independent of the school ance at www.naeyc.org/resources/position_statements/
districts in which they operate that collaborate with school pslink98.htm.
principals, teachers, administrators, boards and districts, • The Institute for Youth, Education, and Families, a special
businesses, community organizations and local citizens to entity of the National League of Cities (NLC), helps
develop and implement whole-school improvement municipal leaders take action on behalf of children, youth,
strategies, create model programs, leverage resources, and families in their communities. Visit
award grants, and enhance the standing of public schools www.nlc.org/iyef.
in the community. Go to www.publiceducation.org.
25
influenced by the values and inter- independence, often with their examples of school districts and
ests of those they consider their own taxing power. Approximately other agencies engaging in collabo-
primary constituents. Organized 15 percent of local school boards rative policymaking to provide
special interest groups or vocal are required to work with the more efficient and effective servic-
minorities (e.g., teacher unions, mayor, city council, or county es for children and families.
ideological groups) can have a dis- supervisors where those bodies A practical obstacle to collabora-
proportionate influence on board have budgetary authority. Relations tion is that school boards continual-
policies and programs. While a among local school boards and city ly address an overwhelming num-
democratic system allows interest or county government can some- ber of issues within tight fiscal and
groups to form and compete for times be strained. scheduling constraints. Their tasks
influence, diverse constituencies can The relative independence of include budget planning, contract
make it difficult for board members local school districts from other negotiations, personnel decisions,
to reach consensus on a common government agencies and commu- school closures, redistricting, facili-
vision and strategy, particularly with nity power structures can pose ties construction, and more.
regard to controversial, value-laden challenges for collaborative policy- During the 1990s, boards report-
issues. Some school boards may making. For example, jurisdictional ed spending an increasing
therefore prefer to avoid dealing boundaries that do not align can amount of time on student
with these matters. result in critical gaps or wasteful achievement issues. School
Local school boards operate in duplication of services. boards may be reluctant to add
most jurisdictions with full fiscal Nevertheless, there are many new issues to a full agenda unless

they perceive the issues as urgent the school district.55 Some 84 per-
or critically important. cent are male and 90 percent are
Some school boards delegate In theory... white. The average superinten-
oversight authority on specified The school board makes policy; dent serves for about five years;
health-related issues to a school the superintendent implements it. turnover is more rapid in large
health coordinating council urban districts, where the average
(similar to that described earlier at tenure is about 2.5 years. A high
the school level) that includes turnover rate can cause problems
parents and community represen- Superintendents are responsible with program continuity because
tatives. Such a council might for providing educational new superintendents tend to
operate as a standing committee leadership, translating policy into want to make their own marks.
of the board or as a distinct body. practical operating procedures, The term central office
It might simply be an advisory managing district personnel, and often refers to the superinten-
body, or have authority to serving as the district’s public dent’s administrative and sup-
enhance program coordination spokesperson. In any sort of crisis, port personnel who help develop
among staff members working in the superintendent is the official and implement district policies
school health program compo- in charge. and programs. The size of the
nents. If such a council exists, is Several gray areas exist staff depends on the district’s
active, and has real influence, it is between a school board’s policy- size and resources; many employ
a natural forum for community making authority and a superin- school health program coor-
professionals to become involved tendent’s administrative responsi- dinators, school nursing
with the school district. The bilities. The superintendent or a coordinators, or school food
states of Virginia, South Carolina, senior aide usually develops the service coordinators who pro-
and Texas require all their districts school board’s agenda in consul- vide guidance and technical
to maintain school health coun- tation with the board chair and assistance to school staff mem-
cils. Non-education profession- typically drafts policy for the bers. A district might also
26 als might wish to offer their help board to consider. On the other employ curriculum specialists
to establish and operate a well- hand, boards sometimes become or instructional specialists in
functioning school health council immersed in the daily adminis- health education, physical educa-
with a broad mandate. (See page tration of their districts. tion, drug prevention, or related
17 for helpful resources). Overlapping authority and com- fields. Such central office experts
The school district superin- petition for leadership can result are natural points of contact for
tendent is the chief executive in tension between the superin- community professionals who
officer of the local district. In tendent and the school board. want to work with schools. A
most districts, the superintendent About a third of superintend- call to the central office should
is hired by the school board. ents are promoted from within lead to the right person.
Helpful resources for school administrators

• The American Association of School Administrators sional education associations in the world. Their
(AASA), which primarily represents district superin- 160,000 members include superintendents, supervi-
tendents, offers online information and resources on sors, central office staff, principals, teachers, profes-
Safe and Healthy Schools at www.aasa.org. sors of education, school board members, students,
• The Association for Supervision and Curriculum and parents. Visit their Health in Education website
Development (ASCD) is one of the largest profes- at www.ascd.org/ health_in_education/index.html.
Many health-related staff posi- Every jurisdiction has unique fea- Rapid turnover due to term lim-
tions and school health programs tures, relationships, dynamics, its in these political offices can
are paid for with state or federal and tensions arising from differ- also challenge policy continuity.
categorical program funding. ent demographic profiles, cir- Often, the most influential
Larger districts might have spe- cumstances, and historical tradi- shapers of policy initiatives are
cialists in tobacco-use prevention, tions. The following description staff members in governors’
special education (for students of major players and institutions offices, legislators’ offices, and
with handicapping conditions), is necessarily generic. legislative committee offices.
school safety, or HIV prevention. The governor proposes a Advocates of school health poli-
Categorical funds can only be state budget and new programs, cies, education, services, and
spent on specific populations or while the legislature has the programs should not be dis-
program areas. Staff and pro- final word on all state laws, tressed if, on a visit to the state
grams supported through such budgets, state staff positions, and capitol, they get appointments
restricted funds are generally pro- distribution of state funds. In only with staff members. These
tected from local budget cuts but recent years, activist governors might be precisely the people
tend to be eliminated if the feder- and legislators of both major who can best advance school
al or state funding stream ends. parties have discovered that health-related goals.
attending to systemic education- In most states, policy responsi-
al reform can bring popularity bility for elementary and second-
The state—
and support. By commanding ary education is shared by the
Authority tempered media attention, these high-pro- legislature with the state board
by respect for file leaders can be valuable, con- of education (SBE). The precise
local control structive shapers of public opin- scope of authority of these boards
State governance of public ion and can mobilize broad sup- varies widely, but state boards
education is complex; the precise port for needed changes. typically adopt education goals
participants and arrangements On the other hand, these offi- and standards, set graduation
vary from one state to another. cials understandably want to requirements, establish teacher 27
The United States does not have demonstrate dramatic results certification requirements, adopt
a uniform education system. during their brief terms of textbooks, and develop assess-
Rather, distinct state, territorial, office. Some are therefore prone ment programs to ensure that
and tribal school systems differ in to simplistic, politically expedi- school districts and schools per-
substantive ways but work in parent reforms that appear mean- form at acceptable levels.
allel. The governance structure is ingful but might distract the The governor appoints state
spelled out either in the state public from more substantive board members in about two-
constitution or the education (and costly) long-term issues in thirds of the states. Members are
code adopted by the legislature. education and children’s welfare. directly elected in most of the
Helpful resources for state policymakers

• Learn about issues addressed by the National • The National Association of State Boards of Education
Governors Association (NGA) at www.nga.org. (NASBE) offers policy assistance and advice to state
• The National Conference of State Legislatures education leaders. Go to www.nasbe.org.
(NCSL) offers policy guidance on child and adoles- • The Council of Chief State School Officers (CCSSO)
cent health issues at provides assistance to senior officials in state depart-
www.ncsl.org/programs/health/health.htm. ments of education. Visit www.ccsso.org.

completely tobacco-free (12 states

have such a policy).56
The concept of local control State boards might stay silent on
Compared with most public health, social services, and youth services agen- many school health-related issues,
deferring decisions to local districts
cies, the U.S. public education system is highly diffuse and radically decen-
or schools. For example, only 29
tralized. The concept of local control is strong in every state. states have policies on inspection
State governments are constitutionally responsible for assuring that every or maintenance of playground
young person is educated. In practice, however, much authority is usually grant- facilities and equipment, and only
ed to local communities. Principals of individual school buildings are key gate- nine require schools to assign
someone to oversee or coordinate
keepers for day-to-day programs, and local school boards take responsibility for
mental health and social services.
everything that happens in the schools. Though they are technically agents of State funding might not be avail-
the state, local board members frequently object to oversight or interference by able for many worthwhile servic-
state and federal governments. This state/local tension is institutional and exists es. As the value and importance
nearly everywhere.
of school health programs have
received greater recognition in
Local control has obvious benefits, including democratic responsiveness
recent years, however, a growing
and programmatic flexibility. But one disadvantage is that altering standard number of states are adopting
operating procedures or adding new services often depends on building rela- policies in this area.
tionships and influencing decision makers one school at a time. States cannot Most state boards are assigned a
state board executive officer
simply impose policy mandates and expect immediate results. Changing the
(the specific job title varies) to
education system can be a long, incremental process. coordinate the board’s work and
handle administrative tasks. This
28 person tends to be well-informed
about who does what and how to
rest. A few states have hybrid require that all students be taught get things done in the state educa-
elected/appointed boards, while health education (as of 2000, tion agency. Many executive offi-
Minnesota and Wisconsin have no some 40 states require health cers are closely involved with the
state boards of education. Like education at some level), that all policy-development process.
local board members, few state students participate in daily phys- Depending on the state, the
board members are professional ical education (only Illinois chief state school officer (com-
educators and they represent every requires daily P.E. in every grade), monly called ‘the chief ’) goes by
point on the political spectrum. or that all school grounds are several titles: state superintendent,
Yet all are public-spirited volun-
teers and many are receptive to
broad ideas about what is best for
children and families.
A state board takes action
State boards set many policies In August 2002, the Michigan State Board of Education unanimously
related to school health pro- adopted a set of policy recommendations from its Task Force on Integrating
grams. For example, by establish- Communities and Schools to “create a connected community so that all
ing competitive grant opportuni- students achieve by making collaborative use of the efforts and resources of
ties, state boards can encourage
all community partners/stakeholders.” View the task force report at
schools to establish school-based
health centers or staff wellness www.michigan.gov/documents/ Integrat_35279_7.doc.
programs. State boards can
commissioner, secretary, or director
of education. In any case, this pow- Strategic partnerships are essential
erful official is a prominent educa- “Education reforms alone will not overcome deprivations of nutrition, child
tion leader who functions as the care, housing, health, family support, and other conditions which impede suc-
chief executive officer over the state cessful student progress. We are committed to strategic partnerships among
education agency and is responsible
community, business, faith institutions, and educators as essential to over-
for translating state laws and poli-
come poverty and deprivation and assure success in education.”
cies into programs and regulations.
The chief is also the primary public —2001 Statement of Priorities from the
spokesperson for the state public Council of Chief State School Officers57
education system.
Typically, the chief is hired by
the state board of education, but and key state leaders, and by propos- such as the state department of edu-
in 14 states the chief is an inde- ing draft policies for consideration cation or state department of public
pendently elected politician by decision makers. The governor instruction. Career public servants
(Chart 7). In other states the gov- and legislature often consult the who staff the SEA write and moni-
ernor appoints the chief. chief about possible legislative poli- tor regulations that govern many
The chief plays an important pol- cies and programs. federal and state programs, develop
icymaking role by bringing timely States have different names for standards and curriculum guide-
issues to the attention of the public the state education agency (SEA), lines, measure results, distribute
Chart 7
Method of selection of the chief state school officer
29
Appointed by the state board of education (26 states)
Appointed by the governor (10 states)
Elected on a partisan ballot (8 states)
Elected on a non-p
partisan ballot (6 states)
A description of each state’s education governance structure is available online at

www.nasbe.org/Educational_Issues/Governance/Governance_chart.pdf.

state and federal funds to local
school districts, and implement
state policies. SEA school health staff
SEAs are often viewed by local • The Council of Chief State School Officers (CCSSO) maintains direct
education officials as intrusive
regulators and adversarial compli- links to school health program offices within state education agencies at
ance monitors. Yet in recent years www.ccsso.org/seahealth.html.
most SEAs have worked to
change their roles and be helpful
providers of technical assistance State Children’s Health cal (topic-specific) funds to
and professional development Insurance Program (SCHIP), or encourage and help districts and
while administering a flexible participate together on state coali- schools. Some SEAs have
system of support and accounta- tions to improve children’s resources to build local capacity
bility for results. Complicating health. Collaboration can be hor- for school health programs by
this shift, however, is radical izontal across state agencies (e.g., providing model policies, guid-
downsizing in many states. A sig- interagency initiatives), or vertical ance documents, and staff who
nificant proportion of SEA posi- across multiple levels (e.g., provide professional development
tions are now supported with aligned policies and procedures). and technical assistance. SEAs can
federal, not state, dollars. Many Sometimes the greatest need for be particularly influential in rural
SEAs have repeatedly reorganized collaborative relationships is with- districts that cannot afford their
as a result of changing leadership in an education, health, or social own specialists.
and political climates. services agency. Although most public education
An increasing number of SEAs Most SEAs employ education services are provided in traditional
participate in interagency initia- specialists in health education, schools overseen by school dis-
tives that address the compre- HIV and AIDS education, physi- tricts, many states provide direct
hensive needs of children and cal education, child nutrition, instructional services through cer-
30 families. For example, many substance abuse and violence pre- tain programs. These might
SEAs and state health depart- vention, and health services. include, for example, education for
ments work together on outreach They generally are paid by and young people in the juvenile jus-
activities for Medicaid and the supported from federal categori- tice or prison systems, schools for
Helpful resources on state interagency collaboration

• The Policy Exchange project of the Institute for communities increase the number of eligible children who
Educational Leadership (IEL) offers resources for state benefit from health insurance coverage programs. For
level interagency collaboration at online research, policy recommendations, and project
www.iel.org/programs/policy.html. descriptions visit www.coveringkids.org.
• CDC’s Division of Adolescent and School Health funds • The Council of Chief State School Officers (CCSSO)
several states to build state-level infrastructure to support offers Building Bridges to Healthy Kids and Better Students:
coordinated school health programs. Learn about the ini- School-based Outreach and Enrollment for the State Children’s
tiative at www.cdc.gov/nccdphp/dash/about/ Health Insurance Program and Medicaid online at
healthyyouth.htm#3. www.ccsso.org/healthpublications.html.
• The Robert Wood Johnson Foundation established • Additional resources about interagency collaboration are
Covering Kids: A National Health Access Initiative for Low- on page 25.
Income, Uninsured Children to help states and local
students who are deaf or blind, or eligible for free or reduced-priced • Exercising policy leadership
state-sponsored virtual schools that school meals (states keep a small by sponsoring education
provide supplemental instruction percentage of funds for adminis- research and pilot programs.
via the Internet. trative costs). Despite the auto- The federal role expanded
For efficient delivery of tech- matic distribution of funds, for- significantly with the 2001
nical assistance and other servic- mula-grant recipients must sub- reauthorization of ESEA,
es, some larger states maintain mit applications and conform to referred to as the No Child
regional education service program regulations. Left Behind Act (NCLB),
agencies, which go by different In contrast, competitive which represents a ground-
names (e.g., intermediate school grants are awarded after a breaking federal initiative to
district). Programs that provide process of ranking the quality of improve the education of all
support for local school health applications received. The children. Though the propor-
programs, such as professional process is administered by the tion of federal dollars has not
development services, sometimes state for some programs, directly appreciably increased, Congress
operate at this level. by the federal government for established a national accounta-
others. An advantage of a com- bility system that affects all
petitive grant system is that it schools, districts, and states and
The national
awards scarce funds to programs involves serious consequences
level—Limited but that are most likely to make an for persistently failing schools.
influential impact and that will serve as A key provision is that states
The federal government has positive examples to others. A must operate extensive student
only constrained, narrow influence disadvantage is that underper- academic assessment (testing)
over education policy because the forming schools or districts programs. The pressure on
U.S. Constitution assigns it no might lack the staff to submit schools to ensure that every
responsibility for public educa- high-quality applications that student achieves according to
tion. Instead, education is prima- include credible evaluation high academic standards has
rily a state responsibility. The plans. Helping a school prepare a never been greater. 31
federal government provides only sound competitive grant propos- Nevertheless, another recent
about 7 percent of all K–12 edu- al is a valuable way that commu- trend has been to grant greater
cation dollars nationwide, most nity professionals can help a flexibility to states, districts,
of which is channeled through school and its students. and schools in choosing how
the U.S. Department of Health education, physical edu- best to use federal funds.
Education (ED) under the cation, food services, and other Health and social services are
terms of the Elementary and aspects of school health programs allowable activities in many
Secondary Education Act have never been central responsi- major education grant programs
(ESEA) originally passed by bilities of ED. Over the years, included in NCLB, including
Congress in 1965. The Congress has focused the depart- the following:
Individuals with Disabilities ment’s role on three major tasks: • ED’s largest formula grant
Education Act (IDEA), origi- • Enforcing civil rights laws program is called
nally passed in 1975, is another that prohibit discrimination Improving Academic
major piece of legislation that and ensure equity. Achievement for the
channels resources to schools. • Providing partial funding to Disadvantaged (commonly
Federal assistance is usually states and local school called Title I or its previous
distributed to states, districts, and districts for educational designation, Chapter 1),
schools in two ways. Formula programs for economically which channels funds to
grant programs make funds disadvantaged children and districts and schools with
available to school districts and children with special needs, large concentrations of stu-
schools based on specified factors such as those with limited dents of families living in
such as the number of students proficiency in English. poverty. Although the pro-

gram’s main emphasis is on before-school, after-school, school health, chronic dis-
improving students’ reading and summer recess activities ease prevention, or
and math proficiency, that advance student aca- HIV/AIDS prevention funds
schools designated for tar- demic achievement. The list to most state education
geted assistance are permit- of allowable activities agencies and some large
ted to use Title I funds for includes recreation. cities. Some funding pro-
comprehensive health, Program flexibility goes two grams are formula-based,
nutrition, and other social ways: states, districts, and schools others are competitive.
services “as a last resort” if may choose to spend federal funds DASH also provides valuable
such services are “not rea- solely on direct academic instruc- guidance and collects useful
sonably available from other tion. Those who wish to strength- data on youth risk behaviors
public or private sources.” en school health programs must and school health policies
• The most direct ED involve- make their concerns heard by and programs. Go to
ment in school health educa- those who make these decisions. www.cdc.gov/HealthyYouth
tion and programs is via the The U.S. Department of for a full description of their
Safe and Drug-Free Health and Human Services activities and services.
Schools and Communities (DHHS) has no direct policy • The Maternal and Child
formula grant program (Title authority over state or local edu- Health Bureau (MCHB)
V of NCLB). Program dollars cation agencies. Some grant operates numerous programs
must focus on violence or funding for school health efforts, that serve children and
substance use prevention, but however, comes from agencies youth. State-by-state exam-
such efforts can be part of a within the large department: ples of MCHB-funded pro-
coordinated school health • Most notably, the Division grams in adolescent health
program. of Adolescent and School are available online at
• 21st Century Community Health (DASH) within the www.mchb.hrsa.gov/
Learning Centers is a com- Centers for Disease programs/adolescents/
32 petitive grant program Control and Prevention programexamples.htm.
administered by SEAs for (CDC) encourages and helps • The Bureau of Primary
school districts, community- states support the wide- Health Care (BPHC) pro-
based organizations, and spread implementation of vides some competitive grant
other public or private enti- coordinated school health funding for school-based
ties. Funds can be used for programs. DASH provides and school-linked health
Helpful resources on federal education funding

• A more complete description of opportunities for • The ED home page contains a section devoted to
school health in the No Child Left Behind Act of 2001, “Finding Grants and Contracts” at http://ed.gov/index.jsp.
prepared by Nora Howley of the Council of Chief State • CDC’s Division of Adolescent and School Health maintains
School Officers (CCSSO), is in the May 2002 online the Healthy Youth Funding Database (HY-FUND), a
edition of School Health Program News from the searchable source of information on federal, foundation, and
Education Development Center (EDC) at state-specific funding sources for school health programs.
www2.edc.org/MakingHealthAcademic/PDF/ Explore it at www.cdc.gov/nccdphp/dash/funding.htm.
shpn502.pdf, pages 7-9. • Many association newsletters alert members to federal
grant opportunities.
centers, including the similar programs. Regulations Some associations are organ-
Healthy Schools, Healthy require these programs to offer ized according to profession
Communities program that meals that conform to the U.S. (e.g., the National Association of
supports comprehensive Dietary Guidelines for School Nurses), others focus on
school-based services for Americans. Learn about the vari- a broad range of education poli-
high-risk children. The ous school food programs at cy issues (e.g., NASBE), some
bureau’s Center for School www.fns.usda.gov/cnd. The represent particular constituen-
Based Health offers online Healthy School Meals cies (e.g., the National Alliance
resources for school-based Resource System provides for Hispanic Health), and some
health centers at www.bphc. information to persons working are organized to promote specif-
hrsa.gov/Center. with school food programs at ic policy goals (e.g., the
• The Centers for Medicare http://schoolmeals.nal.usda.gov. Campaign for Tobacco-Free
and Medicaid Services The Office of Juvenile Kids). A complete list of associa-
(CMS) operates the Justice and Delinquency tions that partner with the CDC
Medicaid program, which Prevention (OJJDP) of the Division of Adolescent and
can reimburse qualified U.S. Department of Justice School Health is available online
school-based health centers supports state and community at www.cdc.gov/nccdphp/
for certain health services efforts to develop and imple- dash/partners/index.htm.
provided to eligible children, ment effective and coordinated Some private foundations
and the State Children’s prevention and intervention pro- provide leadership on school health
Health Insurance grams, and improve the juvenile and youth-development policy
Program (SCHIP), which justice system so it promotes issues through grant-making activi-
subsidizes the purchase by public safety, holds offenders ties and sponsorship of original
low-income families of basic accountable, and provides treat- research. Among the most notable
health insurance and enlists ment and rehabilitative services. at the national level are:
schools to help identify eligi- Numerous resources about • The Carnegie Corporation
ble families. Learn more at healthy youth development are of New York 33
www.cms.hhs.gov. available online at http://ojjdp. (www.carnegie.org).
• Head Start, a preschool ncjrs.org. • The Robert Wood Johnson
program for economically In addition to federal govern- Foundation (www.rjwf.org).
disadvantaged families, ment programs at the national • The David and Lucile
stresses health, nutrition, level, many private, nonprofit Packard Foundation
and family support, as well national associations address (www.packfound.org).
as school readiness. The dues-paying members’ needs in • The Annie E. Casey
Head Start Bureau maintains various ways. Associations are Foundation (www.aecf.org).
a website for service generally charged with: • The William T. Grant
providers, parents, volun- • Representing member needs Foundation (www.wtgrant-
teers, community organiza- and interests at the national foundation.org).
tions, and others at level.
www2.acf.dhhs.gov/ • Providing advice, assistance,
programs/hsb. and professional develop-
The U.S. Department of ment to members.
Agriculture (USDA) provides • Developing state-of-the-art
funding support and supplies for standards for best practice.
school food services through the • Disseminating news,
National School Breakfast research findings, and other
Program, the National School current information to
Lunch Program, and several members and the public.

How to Work
3
with Schools
How a non-education
professional works within
34
the education system
depends on the magni-
tude of the goal:
• Applying specialized skills. A community
professional might want to use special-
ized skills to assist with, for example, an
after-school program or school-based
health center, help an individual student
in need of special support, or establish a
referral linkage to an adolescent-friendly
HIV/STD testing and counseling pro-

gram. Such small-scale, straight-
forward objectives might be eas-
ily achieved with a simple phone

Many ways to become
call to the right person. An involved with schools
Young people are more likely to adopt health-enhancing behaviors
administrative staff member at if they receive consistent messages from many sources. Individual
volunteer professionals, state and local government agencies, private
the district or school office
businesses, youth-serving organizations, and other community
should be able to provide the organizations can add value to school health programs by:
• Participating on school health coordinating councils at the
appropriate contact person. school, district, or state levels.
• Sitting on other education advisory boards and task forces.
• Partnering on a survey, research, or
• Helping existing programs by offering specialized services in the
materials-development project. school setting.
• Coordinating school and community health promotion efforts,
University programs and non- services, referral procedures, or emergency response plans.
• Providing expert advice and assistance to school health program
profit organizations might seek
planners.
to enter into agreements with • Conducting professional development activities for school per-
sonnel. 35
schools or districts on specific • Helping educators navigate complex health and social services
systems.58
projects. School administrators
• Encouraging educators to join community advisory boards, such
as HIV prevention community planning groups.
will want to know that any
• Educating policymakers about the rationale and goals of school
undertaking demanding time or health programs.
• Offering to serve as a guest speaker or resource for student learn-
energy from students or staff has ing within a full education program (but avoid one-time special
events, which research shows have little or no lasting effect).
tangible benefits for the school,
• Offering opportunities for student service in the community.
its students, or their families. • Helping raise funds to support specific school health program
activities.
• Improving specific policies, programs,
or services. Some health, mental
health, and social services pro-
fessionals might want to engage

schools as partners in achieving their agen-
cies’ objectives. They could work collabo-
ratively with school or district administra-
tors to fill gaps in existing services or estab- Restructuring school systems to
lish or strengthen particular policies or pro- promote health and development
grams. Initiatives to change policies or
In addition to the coordinated school health program (CSHP)
establish new programs will likely take time
framework (page 9), several complementary models of school
and effort, and might involve building trust
and support among a variety of people. organization integrate comprehensive health and social goals:
• Becoming involved with a systemic restructuring • The Full-Service Community School (a.k.a. Caring
initiative. Community professionals might Communities, Beacon Schools, Healthy Start, Schools of
want to participate in a long-term effort to the 21st Century) model envisions schools that are open
systematically restructure a school or dis-
to students, families, and community members before,
trict so that physical, mental, and social
health goals join academic learning as during, and after school throughout the year. Working in
essential aspects of its core mission (see full partnership with non-education agencies, medical,
box, “Restructuring school systems to pro- dental, mental, and social health services are readily avail-
mote health and development”). able. Family support centers can help with parent
Fundamentally revamping an education involvement, child rearing, employment, and housing;
institution would almost certainly require
community residents might participate in adult education
an extended commitment of time and
energy and involve participation in a broad, and job training programs. Information, policy guidance,
ongoing coalition. and examples of programs in 17 states are available online
Following are suggestions for approaching, at www.communityschools.org.
engaging, and influencing education decision • The UCLA School Mental Health Project/Center for
makers to achieve the above goals. Crucial
Mental Health in Schools promotes the concept that
36 points are to understand the decision-making
school decision makers add an enabling component to
context, be well prepared, garner widespread
support, and strategically engage the decision- instructional and management components. This com-
making process. Each topic is addressed on the ponent consists of an integrated set of comprehensive
pages following. services that address barriers to learning. For more infor-
mation visit http://smhp.psych.ucla.edu.
Understanding the • The School Development Program, developed by Dr.
context—Politics and James Comer of the Yale University School of Medicine,
priorities is a school- and system-wide intervention that aims to
From the start of any initiative to strengthen bridge child psychiatry and education. The program is
the emphasis on school health and social goals, designed to address six developmental pathways of chil-
an effort should be made to understand the
dren’s growth—physical, cognitive, psychological, lin-
current political dynamics of the community,
guistic, social, and ethical—and includes a process for
the school board, and the schools. Topics that
might seem straightforward can raise unexpect- mobilizing adults to support student learning and overall
ed passions, such as instituting guidelines on development. For online information go to
school vending machines, assuring that recess is http://info.med.yale.edu/comer/index.html.
not squeezed out of the elementary school day,
assuring the right of students with HIV to
attend school, or banning tobacco from all
school premises.
This essential research can help
in deciding how best to frame,
First questions introduce, and steer a proposal.
• What do I want from schools as part of a partnership effort? Attending board meetings can
provide insight into board mem-
• What can I offer schools as part of a partnership effort?
bers’ interests and the current
• How does my proposal fit the educational mission of schools? issues; many school boards pub-
lish their agendas on the district
To lay the groundwork for a to approach individual board webpage. Another suggestion is
support-building effort, and to members and the board as a to identify an influential champi-
anticipate and deal with contro- whole. Ascertain who should on for the proposed initiative. At
versy, become familiar with key introduce issues to crucial play- least one member of every state
education leaders and the rela- ers, and who should make policy or local board of education has a
tionships among them. The best recommendations. Find out who broad vision of the education
way to learn how to work effec- is particularly respected and how system’s role in fostering the
tively with decision makers is to much influence is held by parent healthy growth and development
ask a knowledgeable insider such organizations, professional associ- of children and youth. This per-
as an administrative staff mem- ations, school councils, commu- son can help shepherd a propos-
ber. A friend might be able to nity interest groups, and other al for a new or revised program
provide a connection to someone bodies. Find out how various or policy through the policy-
who can offer candid information school board factions, if any, making process. Alternatively, a
and advice. influence policy. Anticipate who widely respected, influential
If school board action is neces- is likely to be supportive and who community member can also be
sary, seek advice on the best ways might oppose a policy proposal. an effective champion.
Helpful action planning resources 37

• The online Community Tool Box is a website created guides to involving the faith community and dealing
and maintained by the University of Kansas Work with conflict, at www.teenpregnancy.org.
Group on Health Promotion and Community • The National Heart, Lung, and Blood Institute
Development in Lawrence, KS, and AHEC/ (NHLBI) and the National Recreation and Park
Community Partners in Amherst, MA. How-to Association (NRPA) have developed a Hearts N’ Parks
sections use simple language to explain tasks necessary community mobilization guide, available online at
for community health and development, including www.nhlbi.nih.gov/health/prof/heart/obesity/hrt_n_pk/
leadership, strategic planning, community assessment, hnp_resg.htm. Additional community mobilization
advocacy, grant writing, and evaluation. Go to guides, including guides for working with religious
http://ctb.ukans.edu/tools/EN/section_1045.htm. congregations and Latino communities, are available
• Get Organized: A Guide to Preventing Teen Pregnancy from through the online NHLBI Educational Materials
DHHS and the National Campaign to Prevent Teen Catalog at http://emall.nhlbihin.net.
Pregnancy is a three-volume practical manual for those • For an international perspective, the World Health
interested in taking action in their schools and commu- Organization (WHO) offers Local Action: Creating
nities. Download it free at http://aspe.hhs.gov/hsp/ Health-Promoting Schools, which provides practical guid-
get-organized99/index.htm. ance, tools, and tips from schools around the world.
• The National Campaign to Prevent Teen Pregnancy Download it from the Internet at www5.who.int/
offers many other resources for professionals, including school-youth-health/ download.cfm?id=0000000088.

Preparation—Key to tion gathered from school staff, resources listed in this guide.
credibility community members, family • Assess existing policies and programs.
members, or students can also Working with the school health
Careful and thorough prepara- help build a case for action. council or a school staff person,
tion enhances personal credibility Preparing children to live determine if existing policies or
and raises the likelihood of success, healthy lifestyles is often among programs already address the
particularly when attempting a the top priorities of parents and issue. Are they adequate to the
major initiative. Following are key business leaders—if anyone task? Can an existing effort be
matters to address: takes the time to ask them. revised and improved? It is
• Document the extent of the prob- Enlist a health education or often easier for education lead-
lem and align it with existing edu- civics teacher to use a class proj- ers to rework a policy or pro-
cation goals. Gather relevant ect to plan and conduct an gram than to adopt a new one.
data and information from the opinion survey of family mem- It could be that the issue is
public health department, the bers, the business community, already being quietly addressed.
juvenile justice system, or or the general public. This In other cases, there could be a
child advocacy organizations. could also be a task for graduate significant gap between official
The school or district might students. policies and programs and
have pertinent data; for exam- • Research best practices on the pro- school practice. Discreetly con-
ple, attendance and tardiness posed policy or program. Assemble sult with teachers, school and
records could be relevant to a information on current scientif- district-level administrators, and
physical, mental, or social ic and medical findings; useful school health program staff
health problem. Statistics that resource materials; relevant fed- such as the school nurse to
are local and population-spe- eral, state, or local laws; sample learn the extent to which
cific have the most impact. policies; and examples of suc- schools are implementing state
Youth culture is fairly uniform cesses elsewhere. The state or district policies and pro-
across America, however, so department of education or grams. Ask how effective they
38 statewide or even national department of health might be think these policies and pro-
data can be used if good local a source for model policies and grams are in improving stu-
records are unavailable. guidance documents. Access dents’ lives, and what more
• Survey and anecdotal informa- professional associations and could be done.
Helpful needs assessment resources

• CDC’s School Health Index: A Self-Assessment and Planning also available for most states and local data are available for
Guide provides a practical, detailed checklist of the ele- some large city school districts. For more information go
ments of exemplary policies and programs on physical to www.cdc.gov/nccdphp/dash/yrbs/index.htm.
activity, healthy eating, and tobacco-use prevention. • KIDS COUNT, a project of the Annie E. Casey
Designed for use by school health councils or teams of Foundation, is a national and state-by-state effort to track
teachers, community members, students, and family the status of children in the U.S. and provide benchmarks
members, this tool helps schools identify strengths and of child well being to policymakers and citizens. In addi-
weaknesses in their policies and programs and develop tion to national and state data, county-level data is available
action plans for improving student health. Download it for many jurisdictions. Visit www.aecf.org/kidscount.
free at www.cdc.gov/nccdphp/dash/SHI/index.htm. • State Health Facts Online, an Internet resource from the
• CDC’s Youth Risk Behavior Survey System (YRBSS) pro- Kaiser Family Foundation, provides current data on nearly
vides scientifically credible national data on the prevalence 50 topics. Go to www.statehealthfacts.kff.org.
of six categories of priority health risk behaviors. Data are
Helpful policy and program guidance resources
• The school district central office, state education and or decrease substance abuse and other high-risk
health agencies, and state affiliates of health and edu- behaviors. Go to http://modelprograms.samhsa.gov
cation associations might have model policies, useful for online descriptions.
data and information, or direct technical assistance. • Child Trends, in partnership with the John S. and James
• CDC produced a series of school health program L. Knight Foundation, has identified programs and
guidelines developed from exhaustive reviews of pub- approaches that experimental research studies have found
lished research and input from experts. Each guideline to be successful in improving youth outcomes and behav-
document includes detailed recommendations that iors. Visit www.childtrends.org/whatworks_intro. asp.
will help states, districts, and schools implement • The American School Health Association (ASHA)
effective health programs and policies. For online offers School Health: Findings from Evaluated Programs,
information go to www.cdc.gov/HealthyYouth. which summarizes evidence of program effectiveness
• The book Health Is Academic: Creating Coordinated and implications for practice for 51 school health pro-
School Health Programs, from the Education grams. Order it at (330) 678-1601 or online at
Development Center (EDC), contains detailed infor- www.ashaweb.org.
mation on the roles of professionals at all levels in • The Office of the Surgeon General has produced sev-
developing and implementing school health pro- eral major reports on critical physical, mental, and
grams. Contact Teachers College Press at (800) 575- social health needs of American youth that are avail-
6566 or visit EDC’s online support website, able online at www.surgeongeneral.gov.
www2.edc.org/MakingHealthAcademic. • CDC’s online Guide to Community Preventive Services
• NASBE’s Fit, Healthy, and Ready to Learn: A School provides recommendations on health topics important
Health Policy Guide contains a complete orientation to to communities, public health agencies, and health
“The Art of Policymaking” and offers sample policies care systems. It summarizes what is known about the 39
that schools, districts, and states can adopt or adapt. effectiveness and cost-effectiveness of population-
Call (800) 220-5183 or go to www.nasbe.org. based interventions designed to promote health and
• The National School Boards Association (NSBA) prevent disease, injury, disability and premature death,
provides consultation and technical assistance to and exposure to environmental hazards. Browse
school districts on school health policies and pro- through it at www.thecommunityguide.org.
grams. NSBA offers a series of policy issue briefs on • Healthfinder, operated by DHHS, is a guide to online
foundation policies and other school health issues, publications, clearinghouses, databases, websites, sup-
and maintains a database that includes sample district port and self-help groups, and government agencies
policies and important research information. Call and non-profit organizations that produce reliable
(703) 838-6722 or visit www.nsba.org/schoolhealth. information for the public at www.healthfinder.gov.
• The federal Safe and Drug-Free Schools and • Federal Resources for Educational Excellence (FREE)
Communities program requires grantees to use “one is a one-stop website for hundreds of federally sup-
or more strategies of the proven strategies for reduc- ported teaching and learning resources from more
ing underage alcohol abuse…whose evidence of effec- than thirty Federal agencies. Visit www.ed.gov/free.
tiveness includes scientifically based research.” The • A large number of school health program resources
Center for Substance Abuse Prevention (CSAP) lists are available online at the School Health Resource
approved model programs that have been tested in Center of the University of Colorado Health Sciences
U.S. communities and schools and proven to prevent Center at www.uchsc.edu/schoolhealth.
• Research the legal issues. In our liti- • Design the policy or program. In grams must be consistent with
gious society, decisions of prin- collaboration with the appropri- community standards and sensi-
cipals and school boards are ate education staff members, tive to the considerable racial,
often influenced by concerns draft a specific proposal based ethnic, and cultural diversity in
about legal liability and rising on the information assembled today’s schools. In some cases, a
insurance costs.59 For example, above. Gather ideas from a vari- school board might have to bal-
schools are legally obligated to ety of school personnel. Call on ance professional best-practice
provide adequate supervision at colleagues, local community recommendations with com-
high school proms and prevent experts, professional associa- munity opinion to find a work-
foreseeable injuries. This means tions, and other state and able compromise.
the school must recruit enough national agencies and organiza-
chaperones, abide by curfew tions. The state department of
Garnering broad
laws, enforce drug and alcohol education, regional school dis-
support—Power
prohibitions, and even ensure trict, or state school boards asso-
that the entertainers indemnify ciation might be able to provide
in numbers
the school for negligent actions policymaking advice and sample Arguably, the most important
or intentional misconduct.60 policies. Be open to ideas for step in promoting any school health
Liability concerns can interfere filling gaps, meeting needs, solv- policy or program is to enlist wide-
with community use of school ing problems, and making spread backing for its goals and
recreation facilities,61 limit sports essential improvements. strategies. Education policymaking
and cheerleading activities,62 or • Policies and programs tend to be in the United States is grounded in
influence sex education class most effective when they are democracy, and policies reflect local
content.63 Cautious principals based on scientifically grounded opinions and priorities. To a great
approached by a community theories and carefully researched extent, a policy’s quality and useful-
professional to institute a new evidence of effectiveness. They ness depends on who proposes and
program will want to be fully also need to reflect the unique supports it.
40 informed about applicable laws, characteristics and circumstances A community professional’s
potential liabilities, and how to of a state, district, and commu- influence with schools depends in
steer clear of potential lawsuits. nity. Proposed policies and pro- part on intangible factors, including
Helpful resources for building public awareness and support

• The Council of Chief State School Officers (CCSSO) • Building Support for School Health Programs: An Action Guide,
and the Association of State and Territorial Health developed by NASBE with help from professional social
Officials (ASTHO) jointly produced Why Support a marketing firms, provides step-by-step guidance on how
Coordinated Approach to School Health?: A Starter Kit, which to encourage state and local businesses to support school
contains easy-to-use, research-based tools and materials to health efforts. To order call (800) 220-5183 or visit
educate and motivate school administrators and the public. www.nasbe.org/NASBE_Bookstore/Safe_Healthy.html.
To order call (202) 408-8072 or go to • HealthComm KEY is a database of health-communication
www.ccsso.org/starterkit.html. research and practice maintained by CDC’s Office of
• The American Cancer Society is very active at promoting Communication. Browse through it at
school health programs in many state and local jurisdic- www.cdc.gov/od/oc/hcomm.
tions. Among their publications is Improving School Health: • CDC’s HIV Prevention Marketing Initiative was a suc-
A Guide to Developing Targeted Awareness Campaigns. Contact cessful community-level strategy for promoting abstinence
your state or local chapter, call (800) ACS-2345, or visit and safer sex to adolescents in five cities. Learn about it
http://creatinghealthyschools.org. online at www.cdc.gov/hiv/projects/pmi/index.htm.
personal prestige, standing (e.g., as efforts; plus other voluntary corporate priorities for commu-
an expert, parent, or civic leader), organizations, including sorori- nity action. Their discussions in
and constituency. In some cases, an ty and fraternal groups (e.g., and out of the workplace can
individual may want to enlist the Elks and Lions Clubs, Veterans help promote the need for
support of one or more medical of Foreign Wars, Greek letter school health programs.
societies or professional associations, groups), and faith-based and The support of those affected by
public agencies, community groups, seniors’ organizations. the policy or program should also
or faith-based organizations to bol- • Youth-serving community agen- be enlisted. No education initiative
ster a cause. A school health coali- cies such as the YMCA, will be effectively carried out with-
tion in the state, city, or community YWCA, 4-H, and Boys & out significant acceptance from
could provide valuable backing. A Girls Clubs; recreation those who are expected to imple-
process that includes many view- departments; and social serv- ment it. School staff members, par-
points takes time, but the energy ices agencies that could help ents, students, and others need to
expended to develop broad support improve coordination and participate in its development, revi-
is usually a worthwhile investment. consistency among initiatives. sion, or review.
Key constituencies to involve • Business leaders, who are often Education decision makers are
might include: influential in the education- more likely to attend to a proposed
• Health and social services providers reform debate. Many recognize new policy or program that has a
such as physicians, nurses, that school health programs groundswell of public support.
social workers, pharmacists, that foster development of Those who want to strengthen
dentists, optometrists, and their healthy behaviors during child- school health programs might have
professional organizations; hood and adolescence can help to conduct well-organized commu-
health clinic administrators and prevent substance abuse, smok- nications efforts to increase public
staff; mental health practition- ing, poor nutrition, disease, and awareness about the value of school
ers; and staff from juvenile jus- violence in employees’ fami- health programs. Proven marketing
tice and child welfare agencies. lies—and the future workforce. processes, principles, and tech-
• Influential community groups Many companies support caus- niques can be harnessed for such 41
such as local chapters of the es that create goodwill in the comprehensive communications
American Cancer Society, the community and enhance their and media plans. For example, the
American Heart Association, corporate image. Healthier Schools Coordinating
the American Lung Association, • Private-sector employees, many of Committee in New Mexico used a
the American Red Cross, and whom have school-age chil- campaign theme: “Healthier schools
individuals who conduct com- dren. They often play a large are the heart of our community—
munity health promotion role in determining internal put your heart into it.”
Helpful resources for locating program funding

• CDC’s Division of Adolescent and School Health main- ing assistance, conducts workshops in different cities, and
tains the Healthy Youth Funding Database (HY-FUND), offers access to an online nationwide directory of founda-
a searchable source of information on federal, foundation, tions. Its Foundation Finder at http://fdncenter.org/funders
and state-specific funding sources for school health pro- is a search tool for basic financial and contact information
grams. Explore it at www.cdc.gov/nccdphp/dash/ on more than 67,000 private and community foundations
funding.htm. in the U.S.
• Many family- and business-related foundations at the state • Fundsnet is dedicated to providing nonprofit organizations
and local levels provide direct funding for specific school with online information about financial resources available
health activities. The Foundation Center in Washington, on the Internet at www.fundsnetservices.com.
D.C., provides useful guidance on how to search for fund-

Chart 8 simple, clear, accurate, and contents in elementary and middle

free of jargon (discipline-spe- schools, where parental support for
Local school boards that
cific terminology). Effective action is likely to be higher than it is
provide formal opportunities for champions that often have an in high schools. It might be prudent
community input on policy formation impact with policymakers to establish an after-school personal
include physicians, parents, counseling program in a single
8O% prominent business people, school and add schools gradually
61% and well-prepared students. rather than trying to establish such
6O% Written materials should be programs everywhere at once.
45% concise and to the point. Some complex topics, such as
4O% Education decision mak- implementing HIV, STD, and teen
35%
ers, who continually deal pregnancy-prevention programs,
with an overwhelming num- might need extra time for extensive
2O%
ber of concerns, may be study, deliberation, or building
reluctant to consider school community support. Determining
O% health topics unless the what is politically feasible requires
Small
Large Medium problem is urgent and can be good judgment and a solid under-
districts districts districts
(25,OOO+) (5,OOO- (<5,OOO) addressed at an acceptable standing of the school and the
24,999)
cost. From the outset, be community.
Source: National School Boards Association
64
forthcoming about anticipat- It is wise to anticipate, respond
ed costs, legal considerations, to, and involve potential critics.
and potential implementation Decision makers need to be made
Getting decisions
problems. It helps to offer several aware of would-be opponents and
made—Engaging the policy options for consideration. controversies that could arise during
process Depending on current policies the policymaking process. They
The next tasks are to deter- and attitudes, incremental steps might want speaking points provid-
42 mine the most effective way to might be more appropriate than a ed in advance. Inviting thoughtful
formally bring the proposed pro- major push for an ideal policy or challengers into the development
gram or policy to the attention of program. For example, it could ulti- process can have positive results.
decision makers, and devise mately be more effective to initially Opponents’ constructive criticism
appropriate strategies for getting add a daily physical education could strengthen a proposed policy;
their approval. Crucial decision requirement in a few grades, or they might even be persuaded to
makers might be a school, dis- tackle the issue of vending machine support the effort.
trict, or state administrator; a site-
based management council; or a
committee of the local or state
User-friendly information
school board. Rely on key Information is often most useful to decision makers when:
informants to learn about the for- • Brief oral presentations (5–10 minutes) cover only the most important
mal and informal decision mak- points and are accompanied by written summaries.
ing processes. For example, a • Documents are succinct without sacrificing accuracy or context.
school board might provide for- • Research summaries on major policy questions address disparate findings
mal opportunities for community from credible organizations in balanced ways.
input, such as conducting an • Information is clearly written in language that policymakers, parents, and
open public hearing (Chart 8). other laypersons can understand (i.e., a minimum of academic, public
Suggest that the entire school health, and social services jargon).
board hold study sessions prior to • Unadorned charts and graphs illustrate key findings.
any vote on the issue. Arrange for • The information is timely.
brief presentations by trustworthy
• Specific conclusions and policy options are presented.
experts who use language that is
Some final • Compromise does not mean defeat. persistent. As noted by an
considerations Professionals who feel strongly anonymous sage,
about their proposed program “Organizational change occurs
• Respect the hierarchy. Most admin- might be upset when policymak- through gentle pressure, relent-
istrators dislike surprises and ers implement it piecemeal, lessly applied.”
want to know about policy and institute only a modest pilot pro-
program initiatives being gram, or otherwise fail to fully • Sustain the effort. Skeptical school
planned, especially if the matter adopt best-practice recommen- personnel are familiar with pro-
might come to the school board. dations. Compromise is an grams that are instituted one
An eager professional who inherent feature of the demo- year and eliminated the next.
works without the cooperation cratic political process. Rather After the initial push for imple-
of the principal or superinten- than considering it a defeat, view mentation of a new policy or
dent can create a new set of compromise as a partial victory program, attention may flag as
problems. that lays a foundation for future compelling new issues arise. To
efforts. sustain the effort, periodically
• Stay focused on the ultimate goal. As note how well the policy is
the fine points of a proposed pol- • Do not expect quick or easy success. managed and enforced. Bring
icy or program are being worked School health supporters who lapses to the attention of appro-
out, it can be difficult to find an have successfully implemented priate school officials. Note
acceptable balance among com- new policies or programs rou- unanticipated problems—and
peting objectives. It can help to tinely report that their accom- benefits—of the policy. Help
refocus the discussion on overall plishments took more effort ensure that evaluation and feed-
goals and the best interests of than they anticipated—and back processes built into the
children and youth. much more time. Be patient, yet policy work smoothly.
43
Tips for engaging policymakers

• Note serious problems and needs but emphasize proposed • Enlist highly respected community members to express their
solutions and policy options. support.
• Articulate measurable short-term benefits such as effects on • Enlist the endorsement of the business community.
student and staff attendance. • Help students research issues, prepare presentations, and be
• Use current data from credible sources as justification. included on public-hearing agendas.
• Stress how the proposal is consistent with existing poli- • Make presentations at meetings and conferences attended by
cies and programs and helps advance state and district policymakers.
education goals. • Suggest a pilot study or other alternatives if a broad-based
• Use current terminology used by policymakers, such as policy or program does not gain support.
“education reform,” “ready to learn,” “student achievement,” • Help sympathetic policymakers by briefing them on answers
and “leave no child behind.” to difficult questions and arguments that might arise in pub-
• Highlight the coordinated school health program model as an lic meetings.
emerging trend supported by an increasing number of boards.

Conclusion
5
Taking the time and
effort to work with
schools can be extremely
rewarding, both profes-
sionally and personally.
44 As this document highlights, there are
many opportunities for health, social
services, and other professionals who
work with youth to lend expertise to
those in the education community.
Armed with the tips in this guide on
navigating the complex education sys-
tem, community professionals can move
forward in their efforts to work with
schools. Only by working together can
health and education professionals effec-
tively support the healthy growth and
development of all children and youth.

1. Vermont Department of Education. “Joint
Statement on School Health.” 1995.
2. New Mexico Department of Education.
“Report Card of School Health Programs.” 1991.
Endnotes 3. U.S. Department of Health and Human Services.

Healthy People 2010: Volume I (2nd ed.). Washington,
DC: U.S. Government Printing Office, Nov 2000.
Available: http://www.health.gov/healthypeople/
Publications.
4. National Center for Education Statistics, Office
of Educational Research and Improvement, U.S.
Department of Education. The Condition of Education
2002. NCES 2002–025, Washington, DC: U.S.
Government Printing Office (online), May 31,
2002. Available: http://nces.ed.gov/pubs2002/
2002025.pdf.
5. Prevention Enhancement Protocols System,
Center for Substance Abuse Prevention, U.S.
Department of Health and Human Services.
Reducing Tobacco Use Among Youth: Community-
Based Approaches, Pub. No. (SMA) 97-3147.
Washington, DC: U.S. Government
Printing Office, 1997. Available: http://
www.health.org/govpubs/PHD745. 45
Independent Evaluation Consortium.
Final Report of the Independent Evaluation of the
California Tobacco Control Prevention and Education
Program: Wave I Data, 1996-1997. Rockville, MD:
The Gallup Organization, 1998. Available:
http://www.dhs.cahwnet.gov/
tobacco/documents/TCSFinal798
Gallup.pdf.
Flynn, B.S., J.K. Worden, R.H. Secker-Walker, G.J.
Badger, B.M. Geller, and M.C. Costanza.
“Prevention of Cigarette Smoking Through Mass
Media Intervention and School Programs.”
American Journal of Public Health 82 (1992): 827–834.
6. U.S. Department of Health and Human
Services. Healthy People 2010.
7. U.S. Census Bureau, Administrative and
Customer Services Division, Statistical Compendia
Branch. 2001 Statistical Abstract of the United States. Last
Revised: May 1, 2002. Washington, DC: U.S.

Government Printing Office. Available: http://www.surgeongeneral.gov/library/ Foundation, conversation with the
http://www. mentalhealth/home.html. author, August 21, 2002, Atlanta, GA.
census.gov/prod/2002pubs/01statab/stat- 13. Taras, Howard. E-mail to the Information available: http://www.
ab01.html. author, June 4, 2002. melanomafoundation.com.
8. Wolford-Symons, Cynthia. 14. For example, see: 18. Quoted in Policy Leadership Cadre
“Bridging Student Health Risks and Marzano, Robert J., John S. Kendall, for Mental Health in Schools. “Mental
Academic Achievement through and Louis F. Cicchinelli. What Health in Schools: Guidelines,
Comprehensive School Health Americans Believe Students Should Know: Models, Resources, and Policy
Programs.” Journal of School Health 67 A Survey of U.S. Adults. Aurora, CO: Considerations.” Los Angeles, CA:
(Aug 1997): 224. Mid-continent Regional Educational Center for Mental Health in Schools
9. Centers for Disease Control and Laboratory (Sep 1998). Available: (May 2001). Available:
Prevention. “Youth Risk Behavior http://www.mcrel.org/ products/stan- http://smhp.psych. ucla.edu.
Surveillance—United States, 2001.” dards/survey.pdf. 19. Tyson, Harriett. “KAPPAN Special
MMWR; June 21, 2002; 51(SS04); 1- Kaiser Family Foundation and ABC Report—A Load Off the Teachers’
64. Available: Television. National Survey of Americans Backs: Coordinated School Health
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yrbs/info_results.htm. Menlo Park, CA: Kaiser Family K-1. Available: http://www.pdkintl.org/
10. Obesity-related annual hospital Foundation (Sep 1, 1998). Available: kappan/ktys9901.htm.
costs increased 3-fold over the 20-year http://www.kff.org/content/archive/ 20. Meyers, A.F., A.E. Sampson, M.
period from 1979 to 2000. During that 1430/abc.pdf. Weitzman, B.L. Rogers, and H. Kayne.
time, annual hospital costs for obesity- Kaiser Family Foundation. National “School Breakfast Program and School
related conditions among youth aged 6 Survey of Public Secondary School Performance.” The American Journal of
to 17 increased from $35 million to Principals: The Politics of Sex Education. Diseases of Children 143 (Oct 1989):
46 $127 million. Wang, Guijing and Menlo Park, CA: Kaiser Family 1234-39.
William H. Dietz. “Economic Burden Foundation. December 10, 1999. 21. Pollitt, E., R.L. Liebel, and D.
of Obesity in Youths Aged 6 to 17 Available: http://www.kff.org/content/ Greenfield. “Brief Fasting, Stress, and
Years: 1979–1999.” Pediatrics 109 (May 1999/1560/Toplines.pdf. Cognition in Children.” The American
2002):E81-1 (online). Available: 15. Ronald S. Brandt, quoted by Allan Journal of Clinical Nutrition 34 (Aug
http://www.pediatrics.org. Dornseif in Pocket Guide to School-Based 1981): 1526-33. For a complete listing
11. Kann, Laura, Nancy D. Brener, Management. Alexandria, VA: of research findings that demonstrate
and Diane D. Allensworth. “Health Association for Supervision and links between healthy eating and aca-
Education: Results from the School Curriculum Development (1996). demic achievement, visit the Reports
Health Policies and Programs Study 16. Center for Education Reform and and Studies section of the U.S.
2000.” Journal of School Health 71 (Sep American Youth Policy Forum. Do You Department of Agriculture’s Healthy
2001): 266-278. Know the Good News About American School Meals Resource System:
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the U.S. Public Health Service, U.S. Education Reform (2000). Available: Resource/resportsandstudies/
Department of Health and Human http:// www.cep-dc.org/pubs/ reportsandstudies.html.
Services. Mental Health: A Report of the goodnewsamericaned2000/ 22. Pollitt, et al. “Brief Fasting, Stress,
Surgeon General. Washington, DC: U.S. goodnewsamericaned2000.htm. and Cognition in Children.”
Government Printing Office, 1999. 17. Shamban, Jill, executive director, 23. Murphy, J. Michael, Maria E.
Available: Richard David Kann Melanoma Pagano, Joan Nachmani, Peter
Sperling, Shirley Kane, and Ronald E. house.gov/ news/releas- from the School Health Policies and
Kleinman. “The Relationship of es/2002/04/20020430-5.html. Programs Study 2000.” Journal of School
School Breakfast to Psychosocial and 29. “National Testing: Prepare for a Health 71 (Sep 2001): 266-278.
Academic Functioning: Cross-section- Battle.” Education World, September 15, 38. Brener, Nancy D., Gale R.
al and Longitudinal Observations in 1997. Available: http://www.education- Burstein, Martha L. DuShaw, Mary E.
an Inner-city School Sample.” Archives world.com/a_admin/admin020.shtml. Vernon, Lani Wheeler, and Judy
of Pediatric and Adolescent Medicine 152 30. National Center for Education Robinson. “Health Services: Results
(1998): 899–907. Available: http:// Statistics, The Condition of Education from the School Health Polices and
archpedi.ama-assn.org/issues/v152n9/ 2002. Programs Study 2000.” Journal of School
abs/pnu7508.html#aainfo. 31. National Center for Education Health 71 (Sep 2001): 294-304. For a
24. Usdan, Michael. Presentation to Statistics, The Condition of Education summary, see Fact Sheet: Health Services:
the NASBE Study Group on 2002. http://www.cdc.gov/nccdphp/dash/shpps
Education Governance, January 15, 32. The Education Trust. The Funding /factsheets/fs01_health_services.htm.
1995. Gap: Low-Income and Minority Students 39. Ibid.
25. NASBE Study Group on Receive Fewer Dollars. Washington, DC, 40. Ibid.
Confronting Social Issues: The Role Aug 2002. Available: http://www. 41. Brener, Nancy D., Jim Martindale,
of Schools. The Future Is Now: edtrust.org/main/documents/ and Mark D. Weist. “Mental Health
Addressing Social Issues in Schools of the investment.pdf. and Social Services: Results from the
21st Century. Alexandria, VA: National 33. For an overview of the debate, see School Health Polices and Programs
Association of State Boards of the education finance hot topic at the Study 2000.” Journal of School Health 71
Education (1999). website of Education Week: (Sep 2001): 305-312. For a summary,
26. American Association for Health http://www.edweek.org/ context/top- see Fact Sheet: Mental Health and Social
Education. “National Health ics/issuespage.cfm?id=22. Services: http://www.cdc.gov/
Education Standards: An Introduction 34. The Education Trust, The Funding nccdphp/dash/shpps/factsheets/fs01_ 47
to Student Standards” (online). Gap: Low-Income and Minority Students mental_ health_social_ services.htm.
Available: http://www.aahperd.org/ Receive Fewer Dollars. 42. U.S. Department of Health and
aahe/template.cfm?template=natl_ 35. Small, Meg .L, Sherry E. Jones, Human Services, Mental Health: A
health_education_standards.html. Lisa C. Barrios, Linda S. Crossett, Report of the Surgeon General.
27. All education statistics pages 13-15 Linda L. Dahlberg, Melissa S. 43. Brener, “Mental Health and Social
are from the U.S. Census Bureau, Albuquerque, David A. Sleet, Brenda Services.”
2001 Statistical Abstract of the United Z. Greene, and Ellen R. Schmidt. 44. Adelman, Howard S. and Linda
States. Employment figures cited are “School Policy and Environment: Taylor, “Impediments to Enhancing
for 1978; the number of private and Results from the School Health Availability of Mental Health Services
public schools and school districts is Policies and Programs Study 2000.” in Schools: Fragmentation,
for the 1998-99 school year; school Journal of School Health 71 (Sep 2001): Overspecialization, Counterproductive
expenditure figures are for 2000. 325-333. Competition, and Marginalization.”
28. Office of the White House Press 36. Kaiser Family Foundation. National University of North Carolina at
Secretary. “President Promotes Survey of Public Secondary School Greensboro, NC, School of Education:
Compassionate Conservatism.” Press Principals: The Politics of Sex Education. ERIC Clearinghouse on Counseling
release on speech by President George 37. Kann, Laura, Nancy D. Brener, and Student Services (Feb 21, 2002).
W. Bush in San Jose, CA, April 30, Judith C. Young, and Christine G. Available: http://ericcass.uncg.edu/
2002. Available: http://www.white- Spain. “Health Education: Results nasp.html.

45. Ibid. 54. Ibid. School Principals. “Football, Cheering
46. Wechsler, Howell, Nancy D. 55. Ibid. and Marching Bands—Recent
Brener, Sarah Kuester, and Clare 56. All statistics on this page are from Conflicts with Old Traditions.” Legal
Miller. “Food Service and Foods and School Health Policies and Programs Lowdown (Oct 24, 2001). Available:
Beverages Available at School: Results Study (SHPPS) 2000: A Summary http://www.principals.org/
from the School Health Polices and Report, Journal of School Health 71 (Sep services/lowdown102401.html.
Programs Study 2000.” Journal of 2001). See state-level summaries and 63. Kaiser Family Foundation Daily
School Health. 71 (Sep 2001): 313-324. fact sheets: http://www.cdc.gov/ Reproductive Health Report. “South
For a summary, see Fact Sheet: Foods nccdphp/dash/shpps/index.htm. Carolina Schools Not Complying
and Beverages Sold Outside of the School 57. Council of Chief State School With State Sex Education Laws, Audit
Meal Programs: http://www.cdc.gov/ Officers. “2001 Priority: Ensuring the Finds.” (Nov 20, 2001). Available:
nccdphp/dash/shpps/factsheets/fs01_ Education Rights of All Children” http://www.kaisernetwork.org/
foods_sold_outside_school.htm. (online). Available: http://www. daily_reports/rep_index.cfm?hint=2&
47. Ibid. ccsso.org/priority2001.html. DR_ID=8122.
48. Gallup Organization. National 58. For a useful guide that describes 64. Hess, Frederick. School Boards at the
Telephone Survey of 1,003 Parents of public health, how the public health Dawn of the 21st Century.
Adolescents Enrolled in U.S. Public system works, challenges faced today,
Schools, 1993. Atlanta, GA: American and current issues, see Hooker, Tracey
Cancer Society. and Lisa Speissegger. Public Health: A
49. Survey by Opinion Research Legislator’s Guide. Denver, CO:
Corp. based on interviews with a National Conference of State
nationally representative sample of Legislatures (2002). Item No. 016690,
1,017 adults, Feb 2000. ISBN 1580242103.
48 50. See endnote #14. 59. National School Boards
51. National Center for Education Association. “School Boards Paying
Statistics, Overview of Public Elementary More for Liability Coverage.” School
and Secondary Schools and Districts: Board News (May 22, 2001). Available:
School Year 2000-01, Washington, DC: http://www.nsba.org/sbn/01-may/
U.S. Government Printing Office 052201-5.htm.
(May 2002). Available: 60. National Association of Secondary
http://nces.ed.gov/pubsearch/pubsin- School Principals. “Potential Prom-
fo.asp?pubid=2002356. blems: A Checklist for Minimizing
52. Statistics on school districts and Liability.” Legal Lowdown (May 6,
school boards in this section are from 2002). Available: http://www.
Hess, Frederick M. School Boards at the principals.org/services/
Dawn of the 21st Century: Conditions and lowdown051602.html.
Challenges of District Governance. 61. Bogden, James F. Fit, Healthy, and
Alexandria, VA: National School Ready to Learn: A School Health Policy
Boards Association (May 2002). Guide. Alexandria, VA: National
Available: http://www.nsba.org/ Association of State Boards of
bookreports/SBDawn21stCent.pdf. Education (May 2000): D-37–46.
53. Ibid. 62. National Association of Secondary

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How How to

By James F. Bogden, MPH

National Association of State Boards of Education

Acknowledgements (CDC), National Center

the updated document:

Howard Adelman, Nora Howley, MA,

The coordinated school health program model—

The Core Mission of Education 8

The local school district—Responsive to community needs 23

The state—Authority tempered by respect for local control 27 3

Garnering broad support—Power in numbers 40

Getting decisions made—Engaging the process 42

National Association of State Boards of Education

This primer is a guide

and languages and help practitioners find

their way through the complex education

system. The guide describes how the

education system works, how to identify

leverage points for action, how to build

positive working relationships with

well coordinated, high quality,

National Association of State Boards of Education

High school diploma or

Family/Community Health healthy development.

National Association of State Boards of Education

Rising to the challenge

National Association of State Boards of Education

enrolled in more than 91,000 public and

27,400 private elementary and secondary

schools. This section is a brief guide to

the many institutions and people who make

major decisions in the complex K–12

National Association of State Boards of Education

America’s great hope and great duty

—U.S. President George W. Bush28

with school building principals, or

In contrast, governance of District SUPERINTENDENT

decision-making authority over

National Association of State Boards of Education

Helpful resources on school health councils

Helpful resources for school staff

National Association of State Boards of Education

Helpful resources on school health services

National Association of State Boards of Education

Helpful resources on mental and social health

Mental health and social services provided in U.S. schools Percent of

Prevention/education services Percent of

Methods of service delivery Percent of

National Association of State Boards of Education

Helpful resources on school nutrition environments

Helpful resources on parent involvement

these mostly rural districts accounted

school board (sometimes called a

National Association of State Boards of Education

Helpful resources on legal issues

Helpful resources on local interagency collaboration

National Association of State Boards of Education

Helpful resources for school administrators

Helpful resources for state policymakers

National Association of State Boards of Education