Manual For School Health Programs


Chapter 1: Whole School, Whole Community, Whole Child

“Health and education affect individuals, society, and the economy and, as such, must work together whenever possible. Schools are a perfect setting for this collaboration.”

(ASCD & CDC, 2014, p.4)

A school health program must effectively address student health and improve their learning ability. Over the years, schools have used many frameworks to coordinate all the important school health partners to make this happen.

Most recently, the Centers for Disease Control and Prevention (CDC), American Supervision and Curriculum Development (ASCD), and others have merged their organizational models to create the Whole School, Whole Community, Whole Child (WSCC) framework. The model, first released in 2014, provides “a valuable framework designed to help school districts and schools address the needs of the students by strategically and systematically focusing on the whole child,” according to the National Association of Chronic Disease Directors (NACDD, 2017, p. 3).

Whole School, Whole Community, Whole Child Conceptual Model
Figure 1. Whole School, Whole Community, Whole Child Conceptual Model (CDC, 2014)

The Whole School, Whole Community, Whole Child model has 10 components, each important to the framework's success.

Table 1. Components of the WSCC model

Components of the WSCC Model
Health EducationFormal, structured health education consists of any combination of planned learning experiences that provide students with the opportunity to acquire information and the skills they need to make quality health decisions.
Physical EducationSchools can create an environment that offers many opportunities for students to be physically active throughout the school day. A comprehensive school physical activity program (CSPAP) is the national framework for physical education and youth physical activity.
NutritionThe school nutrition environment provides students with opportunities to learn about and practice healthy eating through available foods and beverages, nutrition education, and messages about food in the cafeteria and throughout the school campus.
Health ServicesSchool health services intervene with actual and potential health problems, including providing first aid, emergency care and assessment and planning for managing chronic conditions (such as asthma or diabetes). In addition, wellness promotion, preventive services and staff, student and parent education complement care coordination services.
Counseling, Psychology, and Social ServicesThese prevention and intervention services support the mental, behavioral, and social-emotional health of students and promote success in the learning process.
Social and Emotional ClimateSocial and emotional climate refers to the psychosocial aspects of students’ educational experiences that influence their social and emotional development.
Physical EnvironmentA healthy and safe physical school environment promotes learning by ensuring the health and safety of students and staff.
Employee WellnessSchools are not only places of learning but also worksites. Fostering school employees’ physical and mental health protects school staff and helps support students’ health and academic success.
Family EngagementFamilies and school staff work together to support and improve students' learning, development, and health.
Community InvolvementCommunity groups, organizations, and local businesses partner with schools, share resources, and volunteer to support student learning, development, and health-related activities.

(CDC, 2021)

The WSCC model aims to create school environments where students can learn, teachers can teach, and the family and community can contribute to the child's success. The model encircles the child by coordinating policies, processes, and practices to ensure the program has permanence and structure. Improving learning and improving health are also balancing the child and are the ultimate goals of the model.

“Academic achievement and health are closely linked, and healthy students are more ready and able to learn”

(NACDD, 2017, p. 9).

The inner circle of the framework has five tenants from the original American Supervision and Curriculum Development (ASCD) model that represent important ideals for implementing WSCC—safe, healthy, challenged, supported, and engaged.

  • Safe means that each student learns in an environment that is physically and emotionally safe for students and adults.
  • Healthy means that each student enters school healthy and learns about and practices a healthy lifestyle.
  • Each student is challenged academically and is prepared for success in college or further study and employment and participation in a global environment.
  • Each student has access to personalized learning and is supported by qualified, caring adults.
  • Each student is actively engaged in learning and is connected to the school and broader community (ASCD, n.d.).

The outer ring of the framework emphasizes community partnerships. Collaboration and partnership with community organizations can provide resources that schools might not otherwise have access to. Local public health departments, social service agencies, and businesses, for example, may be able to provide services with the students’ well-being in mind.

The model is a framework that schools can modify and adapt to meet the needs of the district, school, and community to increase sustainability (NACDD, 2017, p.16). School districts may start working on their WSCC program with teams or committees already in place, such as wellness, safety, or school climate committees. Involving the school nurse, as well as other school staff and administrators will improve the success of any programming. For a step-by-step guide and other resources for using the WSCC model, visit CDC, ASCD, and NACDD websites provided in the reference section.

“A unified approach acceptable to the health and education communities is needed to assure that students are healthy and ready to learn.”

(Lewallen, Hunt, Potts-Datema, Zara, Giles, 2015, p. 1)

Missouri School Improvement Program

The Missouri School Improvement Program (MSIP) is designed to promote excellence in the state's public schools. The State of Missouri has a dual responsibility for the quality of education provided to its citizens. First, it must ensure that all schools meet certain basic standards. Second, it must ensure that the schools continue to strive for excellence in an increasingly competitive world.

The Missouri School Improvement Plan (MSIP) involves many components of educational data collection, for which districts are responsible. The Plan’s purpose is to always look for ways to reduce barriers to learning and improve learning outcomes. It looks at a district’s test scores, attendance rates, school climate, and other areas that impact learning. This continuous process helps districts identify areas where they need to improve.

School Nurse’s Role in the WSCC and MSIP Programs

The school nurse’s role in developing a robust school health program in their district or school is to be the leader in the health environment. School nurses are the health experts in a district and, therefore, should practice to the full extent of their job description and practice ability. Not only should the school nurse be “seen” in the health office, but they should also be part of the larger school community—helping to form a school health committee that includes school staff, parents, students, and community members, as all members have a part in WSCC programming. The school nurse can also use the nursing process: assessing, diagnosing, outcome identification, planning, implementation, coordination of care, health teaching and health promotion, and evaluation, in developing WSCC programming, which is critical to the success of any program.

School nurses have an important role in identifying and mitigating factors contributing to absenteeism. National studies have shown that students with chronic health conditions miss more school or are too impacted by their disease condition to participate fully in the educational process. Working with students and their families to identify these issues and to develop individualized health plans (IHPs) has shown success in improving attendance at school. Students with properly managed asthma, diabetes, and seizure disorders can usually stay in school where the school nurse safely manages them.

Knowing that school nurses have the expertise to improve the health of the students they work with and that students who are healthy learn better, it is critical for school nurses to be at the forefront of planning a WSCC program. The school nurse also has the potential to improve a district’s MSIP rating by impacting student attendance, student health, school climate, and, ultimately, student learning.

Establishing or Strengthening a School Health Program

School health programs vary according to community needs and aspirations, but effective programs share these common elements:

  • They are carefully planned.
  • They focus on modifiable risk factors associated with health and the quality of life.
  • They employ multiple methods and approaches developed through collaboration with pertinent stakeholders.
  • They address identified needs and differences within target populations.
  • Those receiving the program are important contributors in the planning and delivery process.
  • Those responsible for the delivery of the program are competently trained.
  • They are evaluated regularly and revised or refined as needed.

The following components can lead to an effective, comprehensive school health program:

  1. Leadership
    Leadership at both the district-level school level and district level is critical for ongoing and consistent support of a comprehensive school health program. Ideally, the school principal, the superintendent of schools, and one or more members of the board of education – the people committed to success for all children and who understand the importance of addressing the whole child – will be involved to some degree. At the district level, a person designated as the program manager or coordinator is needed for a successful program. This individual must be able to adequately present school health needs and successes to the school board and community members while utilizing all resources and facilities in the community to foster the health of students. A program manager may be a school nurse, health educator, or a contracted local health department staff. The program manager’s responsibilities include organizing the school health advisory council, review and revision of health-related policies, and enforcement of state laws regarding school health.
  2. School Health Advisory Council
    A School Health Advisory Council (SHAC) is an ongoing advisory group composed of individuals selected from segments of the community that may include students, parents, community representatives, and school staff. The role of the SHAC is to collectively provide guidance and support to the school health program. The role of each advisory council member is one of active participation. SHACs are often advisory to an entire school district, but individual school buildings may establish a SHAC if desired.

    The general functions of an advisory council may include but are not limited to:
    • Fulfilling the statutory requirements for supporting at-risk youth, safe school environments, and drug-free schools.
    • Gathering information about local needs and resources.
    • Prioritizing needs and resources for development of a school health plan.
    • Developing a school health plan in conjunction with school officials.
    • Providing a forum for students, parent(s)/guardian(s), community members, and school staff to express health-related concerns.
    • Facilitating linkages between school and community resources.
    • Advocating for the school health program and its participants.
    • Facilitating communication with groups interested in school health.
    • Helping to find funding sources.
    • Assisting in program evaluation.
  3. Board Policies that are Supportive
    In most districts, school board policies already support various components of a school health program. With assistance from school staff, the School Health Advisory Council can identify relevant policies within the district and ensure that clear procedures exist for implementing the policies at each school site. They can also suggest new policies if gaps exist and eliminate policies that are not being enforced and/or are out-of-date. One way of ensuring that current policies are available to school staff, board members, students, and families is to develop and distribute guidelines that consolidate school and district policies and procedures related to all aspects of the school health program.
  4. Existing School-Based and Community-Based Resources
    Most schools have numerous elements of a school health program in place. The school health program model serves as a framework for thinking broadly and identifying duplications and gaps. Activities, services, and policies to support existing school health programs can enhance current programs.
  • Needs Assessment
    The school health coordinator with assistance from the SHAC can use needs assessments to identify gaps in the school’s health program and make decisions about how to strengthen or modify existing health-related efforts. They can prioritize the programmatic needs based on factors such as relative importance for academic achievement; resources required, such as professional development, funding, and time requirements; number of students, family members, or staff that will benefit; and readiness of the school community.

    The CDC’s School Health Index (SHI) is a tool to assess both elementary and secondary schools. The SHI assists schools with assessing policies and activities related to tobacco use, physical activity, nutrition services, sexual health, asthma, and safety.

    Another assessment tool to consider is the American Academy of Pediatrics’ Enhancing School Health Services through Training, Education, Assistance, Mentorship, and Support Program (TEAMS). TEAMS is a free program that provides training, resources, and technical assistance to school districts and states that are interested in strengthening policies, practices, and infrastructure related to school health services. School districts participating in TEAMS assemble 3-4 member teams, including a district health services/education representative, public health professional (department of health), mental health professional, and pediatrician partner. TEAMS emphasizes the use of school health services policy and protocol to drive long-term sustainable change.
    • TEAMS grew out of the recognition that:
      • Strengthening school health services improves the health of students and leads to better educational outcomes.
      • Schools provide a key point of access for health care for many children.
      • Children benefit from a coordinated system where school health services, public health departments, and health care providers all work together to optimize care.
    • School health programs may also obtain useful data from:
      • Statewide Disease and Chronic Conditions Report.
      • Physical fitness, vision, and hearing screenings.
      • Local or county health department, which often have local or regional data on pregnancy rates, incidence of sexually transmitted diseases, etc.
      • The Youth Risk Behavior Survey (YRBS), administered by the Missouri Department of Elementary and Secondary Education (DESE) during odd-numbered years. YRBS, a survey of randomly selected students in grades 9 through 12, provides useful self-reported data about health behaviors that contribute significantly to the leading causes of death, disability, and social problems among U.S. youth and adults. These include:
        • Tobacco use
        • Unhealthy dietary behaviors
        • Inadequate physical activity
        • Alcohol and other drug use
        • Sexual behaviors that can result in HIV infection, other sexually transmitted diseases, and unintended pregnancies
        • Behaviors that may result in intentional injuries (violence and suicide) and unintentional injuries (motor vehicle crashes)
  1. Plan Development
    Cooperative planning ensures the development of a single plan or shared vision, which reduces duplication and increases program effectiveness.
    The first step in planning is to define the school health goals and objectives, which should align with the school district’s goals and objectives.
    • Program goals are broad, general statements of what you hope to achieve during or by the end of the plan’s timeframe.
    • Objectives are measurable, attainable, time-referenced statements with results related to the goals. Objectives should contain four major statements:
      • What—is the change or event to occur?
      • Who—the group in which the change or event occurs (target population, i.e., students, faculty, etc.).
      • How much—the change to occur (sometimes expressed in percentages or using the word “all”).
      • By when—the time or date the change or event will occur.
    • Once the SHAC identifies objectives, they will:
      • Select activities or strategies that will accomplish the goals and objectives.
      • Develop a mechanism for evaluating how well the activities and strategies worked for accomplishing the goals and objectives.
  2. Ongoing Evaluation
    Evaluation is the process of gathering useful information to help make decisions. The goal of evaluation is to increase the likelihood that the SHAC will make informed decisions. Evaluation begins by identifying meaningful questions that need answers. When identifying how to evaluate activities, think about gathering both quantitative information (how much) and qualitative information (how good).

Types of Evaluation

Process Evaluation

Process evaluations focus on whether programs and activities are operating as intended and if they are serving the target population. SHACs should develop a plan to conduct process evaluations ongoing throughout the year. They can then continually review the data collected and consider program improvements. A process evaluation often collects data such as:

  • Details of program operation,
  • Demographic characteristics of program participants,
  • Collaborative partnerships, and
  • Staffing and training conducted.
Impact Evaluation

SHACs should also evaluate activities to measure the impact of the program. Impact evaluation collects data that measures the program’s effectiveness in producing gains in knowledge and changes in the health behaviors that the program targeted. Impact evaluation is based on the specific objectives developed. The SHAC should prepare annual reports on the program’s impact on specific objectives for the school board. Examples of impact evaluation include:

  • Pre- and post-tests to measure students’ health knowledge and skills,
  • Measuring students’ intent to practice healthy behaviors and
  • Measuring health-related behaviors.
Outcome Evaluation

Improved health status is the intended goal of quality school health programs. Outcome evaluation measures changes in health status over time—usually years. For example, if a program successfully delayed the onset of or reduced alcohol use among teenagers, you would expect:

  • A reduction of injuries and deaths resulting from motor vehicle crashes,
  • A reduction of unintended pregnancies and sexually transmitted diseases and
  • A reduction of injuries and death from violent acts.
Suggested Steps for Developing an Evaluation Plan
  • Use the measurable objectives the SHAC identified for their plan's short- and long-term goals, to develop a list of what to evaluate.
    • Example: Evaluate the effectiveness of the screening program.
  • Focus the evaluation on a modest, manageable number of important program-relevant activities.
    • Example: The number of students referred for a specific health deficit that receive care because of the screening.
  • Determine the standards of acceptability.
    • Example: 85 percent referral follow-up rate.
  • Develop a timeline or schedule for the evaluation to occur.
    • Example: All referrals will be returned by the end of the school year.

School health programs are one of the most efficient strategies a nation might use to prevent major health and social problems. Health and success in school are inextricably intertwined. A successful school health program can have a powerful influence on student health, health-related behaviors, and, therefore, learning.

Chapter 1 References

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