Healthy Schools Colorado
2012-2013
Data Report
Background
Healthy Schools Colorado, a program funded by The Colorado Health Foundation since 2009, has been designed to create healthy school environments that encourage students to adopt healthy living choices. Healthy Schools Colorado uses the Centers for Disease Control and Prevention’s model of Coordinated School Health as the strategy to improve the health and well-being of children and youth in Colorado schools. Coordinated School Health provides a framework to organize school health efforts around eight health-related components: Healthy School Environment, Health Education, Physical Education, Nutrition Services; Health Services; Counseling, Psychological, and Social Services; Health Promotion for Staff; and Family/
Community Involvement.
Healthy Schools Colorado funds district and regional coordinators who recruit and train school-level teams. Teams use the School Health Index to assess their school’s health and safety policies and programs with respect to the components of Coordinated School Health and then develop School Health Improvement Plans that define goals for improving policies and programs in physical education, physical activity, or nutrition. Additional School Health Improvement Plans may target other components of Coordinated School Health.
Schools that use Coordinated School Health are ideally poised to encourage healthy eating, physical activity, and other healthy behaviors. The broader benefits of Coordinated School Health align with the mission of schools to enable students to learn and to provide them with the knowledge, skills, and judgment to make healthy choices in life.
In addition to creating an infrastructure within schools that supports and sustains Coordinated School Health, Healthy Schools Colorado also funds a cadre of Physical Education and Regional Nurse Trainers who provide professional development to physical education instructors and school nurses. These opportunities are designed to increase the capacity of school personnel to utilize best practices in physical education instruction and chronic disease management. While the ultimate program goal is for Colorado children to be healthy and ready to learn, the long-term outcomes of Healthy Schools Colorado promote changes in school policies and their implementation to support youth in adopting healthy living choices. These long-term outcomes include:
• Increase the number of children who receive healthy meals at school and have access to healthy food and drinks in vending machines;
• Increase the number of children and adults who eat adequate amounts of fruits and vegetables daily;
• Increase the number of children and adults who engage in moderate or vigorous physical activity; and
Demographics
Since school year 2009-10, Healthy Schools Colorado has funded five grantees encompassing a total of 10 school districts. Three grantees represent large school districts, and two grantees are regions with two and five schools districts. The five grantees are:
• Adams County Region: Adams D14 and Adams D50 • Douglas County School District
• Jefferson County School District • Poudre School District
• Pikes Peak Region: Academy D20, Colorado Springs D11, Falcon D49, Harrison D2, Manitou Springs D14
The large metropolitan school districts each recruited 38 to 42 schools and outdoor education laboratories, and the regions each recruited 28 to 35 schools. A total of 180 schools and three outdoor education laboratories were recruited to participate in Healthy Schools Colorado. Collectively, these educational entities serve 118,754 students.1
Table 1 depicts the number of schools recruited by each grantee. Among the grantees, Douglas County School District recruited the largest number of schools and outdoor education laboratories (42), and students from these schools represent nearly one quarter of the student population served under Healthy Schools Colorado.
Table 1. District Characteristics: School & Student Figures (SY2012-13)2
Grantees/School Districts SchoolsNo. of Percent of Schools StudentsNo. of Percent of Students
Healthy Schools Colorado Districts
Douglas County School District 42 23.0% 34,194 28.8%
Jefferson County School District 38 20.8% 27,980 23.6%
Poudre School District 40 21.8% 21,287 17.9%
Healthy Schools Colorado Regions
Adams County Region: 28 15.3% 16,277 13.7%
Adams D14 10 5.5% 6,572 5.5%
Adams D50 18 9.8% 9,705 8.2%
Pikes Peak Region: 35 19.1% 19,016 16.0%
Academy D20 5 2.7% 2,807 2.4% Colorado Springs D11 12 6.6% 5,625 4.7% Falcon D49 5 2.7% 4,074 3.4% Harrison D2 9 4.9% 5,012 4.2% Manitou Springs D14 4 2.2% 1,498 1.3% Total 183 100.0% 118,754 100.0%
As illustrated in Figure 1 and Table 2 the majority of participating schools are elementary schools. These schools educate over 58,000 students, nearly half of the student population served by Healthy Schools Colorado. In addition, three outdoor education laboratories offer programming to nearly 8,600 students in fifth through seventh grades in the Jefferson County School District and Douglas County School District. Other categories of participating schools include high schools (26,889 students), middle schools (22,571), and K-8 and K-12 schools (1,989 students).
Figure 1. Number of Schools by Type for SY2012-13
Table 2. Student Figures by School Type
(SY2012-13) No. of Students Percent of Students
K-8 1,588 1.3% K-12 401 0.5% Elementary 58,714 49.4% Middle 22,571 19.0% High 26,889 22.6% Outdoor Laboratories2 8,591 7.2% Total 118,754 100.0%
Data Collection
To assess progress towards its intended goals, Healthy Schools Colorado has established a measurable results data collection process to document the progress of its grantees as well as to establish what works and determine which areas may require more targeted resources. In the following sections, we report on the progress made by Healthy Schools Colorado towards these intended milestones, which are tied to The Colorado Health Foundation’s measurable results. A variety of data collection methods and sources were utilized to track the activities and success of regions, districts, and schools.
1. Data tracking system. A web-enabled data tracking system has been used to collect and utilize school-level data related to policies and practices in the areas of school health services, physical education/activity, and nutrition. Data have been collected and entered by district/regional coordinators, school teams, and school nurses annually. Note: Student population estimates were made by linking schools to the Colorado
Department of Education’s October Count Census data. However, in the case of physical activity minutes and physical education hours, school teams were asked to estimate the number of students participating in those events, thus, in those cases, the Colorado Department of Education’s census data were not used.
2. Professional development data. Professional development surveys were developed and distributed to all participants attending physical education/physical activity/school nurse trainings. A follow-up survey was developed for the Standards-based Instruction of the Colorado Standards for Physical Education training. A survey was developed and distributed to school nurses to gather feedback on the Regional Nurse Specialist model.
3. School success story data. As part of the Healthy Schools Colorado database, schools submit a success story based on their School Health Improvement Plan(s). In the 2012-13 school year, 160 stories were submitted and downloaded in an EXCEL format.
4. Process data. A survey for school team co-leaders and a survey for district and regional coordinators were developed and distributed at the end of the 2012-13 school year. These surveys gather information on district and school efforts, implementation, support for school health, challenges, and successes. Coordinators completed a final 2012-13 progress report to report on their work plan objectives and activities.
This report reflects the final results from the one-year grant for October 15, 2012 through July 31, 2013. Healthy Schools Colorado was previously funded from school years 2009-10 through 2011-12. In addition to summarizing the activities and results for the performance measures, this report details process learnings and recommendations for the future.
Successful Implementation of Healthy Schools Colorado
Coordinator Model
Healthy Schools Colorado evaluation reports have consistently shown that the coordinator model is successful. One coordinator states, “districts really do need a wellness coordinator or policies and climate can easily be dismissed with high staff turn-over.” All grantees have put at least a 1.0 FTE coordinator position in place. The coordinator has worked with district and school personnel, students, parents, and community members/organizations on identified school health priorities.
Coordinators have benefited from technical assistance, professional development, and quarterly coordinator meetings.
• One hundred percent (100%) of coordinators said the goals of the coordinator meetings were clear;
• One hundred percent (100%) of coordinators said the coordinator meetings were an effective use of time; and
• One hundred percent (100%) of coordinators said they gained skills to implement and address specific school health topics and processes.
School teams overwhelmingly indicate that the district or regional coordinator is an integral position that has provided great support for the school-level health and wellness work. Ninety-eight percent (98%) of school health team co-leaders indicated that the coordinator:
• Met the needs of the school health team;
• Increased the school health team’s awareness around school health issues and Coordinated School Health; and
• Provided the school team with the information and resources needed to implement their School Health Improvement Plan(s).
“Our district coordinator is amazing, professional and energetic. She is incredibly connected in the community and to all the schools and is a tremendous help
Health Advisory Council
Each grantee was required to maintain a Health Advisory Council. The Health Advisory Councils have been instrumental in the progress of the districts and regions, meeting from one to six times over the year. Noteworthy successes in the 2012-13 school year include:
• Adams County Region
o Adams D50 has supported healthy fundraisers.
o Adams D50 focused on community building and evaluating recess before lunch. o Adams D50 made healthy snacks recommendations to supplement the Wellness
Policy regulations.
o Note: Adams D14 did not re-convene their District Health Committee. • Douglas County School District
o A Wellness Oversight Committee is in place. It was initially a challenge for the coordinator to gain support from the district for this committee’s existence. • Jefferson County School District
o Created a Student Health Advisory Council that met nine times over the year and focused on alcohol, tobacco, and other drugs.
o Developed a charter for the Health Advisory Council.
o Developed a School Health “Checklist” as an assessment tool for principals to complete.
o The Health Advisory Council elevated district wellness policies, school health and wellness practices, and shared school successes.
• Pikes Peak Region
o More school teams are incorporating health and wellness goals in their Unified School Improvement Plans.
o Developed a school/community partner success plan to engage and participate in community health and wellness efforts.
• Poudre School District
o Replaced the old council structure with a new Wellness Advisory Council for
Schools. This council worked on a new wellness definition, vision, and by-laws. This is a formal district committee with the same structure and voice as other district committees.
o An Employee Wellness Advisory Council was created to work on staff wellness issues.
Successful Wellness Policy Development, Improvement, and
Implementation
Healthy Schools Colorado has placed an emphasis on policy work. Districts and schools have continued to recognize the importance of policy to support and guide their health and wellness efforts. Local wellness policies have been reviewed and updated to include Coordinated School Health language, school health teams, physical activity requirements aligned with HB1069, and guidance for healthy snacks and celebrations. Specific policy successes this last year include:
• Adams Region
o Adams D50 Wellness Policy Regulations were adopted in March 2013. The district created healthy snack guidelines for schools, and school teams are working to promote classroom physical activity breaks to align with the wellness policy and HB1069.
• Douglas County School District
o Supplementary documents have been gathered or developed to support the district wellness policy. These documents contain specific language related to classroom physical activity guidelines; physical education and health education guidelines; and healthy food, snacks, and celebrations guidelines. The school-level work is directly aligned with these policies.
• Jefferson County School District
o A Healthy Schools toolkit was provided to each school team with guidance for writing health and wellness goals along with resources, the district wellness policy, and other supporting policies (e.g., health education, tobacco). In Jefferson County, schools are asked to submit Culture and Climate goals. In 2012-13, 135 schools submitted goals and 216 goals addressed health and wellness, primarily focusing on physical education/physical activity and nutrition. Examples included implementing daily brain breaks, healthy rewards and celebrations, and structured recess activities.
• Pikes Peak Region
o All five districts in the region updated their district wellness policy. Districts have added Coordinated School Health, recommendations for school health teams, and a district coordinator position, along with stronger health and wellness language. A healthy snack policy at one school became part of the district’s wellness policy. This is a great example of how a school’s strong commitment influenced district policy! • Poudre School District
o All school teams received wellness binders with a sustainability checklist, Coordinated School Health resources, the district’s wellness policy and new strategic direction goals, and wellness resources. A newly structured advisory council was created and will focus future work on revising the wellness policy, developing new implementation strategies for school wellness and create a long-term district wellness work plan.
Districts and regions have strengthened and aligned school-level work with district health and wellness policies. School team co-leaders indicated the topics covered in their district wellness policy and/or their school policy or guidelines, as shown in Figure 2.
Figure 2. Topics Covered by School/District Wellness Policy
Furthermore, school team co-leaders generally agreed with the following statements related to their school’s implementation of the wellness policy:
• Staff in this school are aware of the school/district wellness policy (70% agreed). • This school communicates the wellness policy to staff, students, and families (69%
agreed.)
• The wellness policy is reviewed and updated as needed (74% agreed.)
80%
60%
40%
20%
Partnerships
Partnerships and collaborations at the local and school levels with health departments, recreation centers, community organizations, businesses, and health care providers have prospered across the grantees. Notable partnerships include the following:
• LiveWell Colorado – supports school wellness teams, provides resources, and seminars
• Community Enterprise – provides resources for creating healthy schools
• The Children’s Hospital’s HealthTeacher.com – online resource of health education tools including lessons, interactive presentations, and additional resources to integrate health
• Kaiser Permanente – educational theater program • Denver Urban Gardens – community and school gardens
• Slow Food Denver – supports school gardens, youth farmer’s markets, and garden to cafeteria programs
• Healthy Kids Club – healthy celebrations
• Colorado State University – Cooking with Kids grants
• Anthem Blue Cross and Blue Shield – funds for staff wellness
• Fuel Up to Play 60 – funds and resources promoting physical activity and nutrition • Local businesses – funds, food, and materials to support health and wellness events
and activities
• Cooking Matters – healthy cooking classes for families
• Bicycle Colorado – support with writing and implementing Safe Routes to Schools grants and programs
Sustainability
Intregal to Healthy Schools Colorado are structures, processes, and practices that build sustainability, such as the district health advisory council, policy implementation and
enforcement, professional development to increase skills and knowledge, partnerships, and the coordinator position to lead the charge. In year four of Healthy Schools Colorado, grantees were expected to expand their sustainability efforts even further to support health and wellness in years to come. Districts that have strong administrative support and buy-in clearly have made larger strides to sustain their health and wellness programs, but all districts have made steps in the right direction.
Adams Region
The Adams Region experienced a change in momentum from the early years of the grant. In the first year, the coordinator was housed in Adams D14 and did not work with Adams D50 wellness teams until year two. Since then, Adams D14 has decided to discontinue their health and
wellness efforts because of high staff and leadership turnover in the district, and Adams D50 has seen increased support from schools and the community. Administrators from Adams D50 intend to pursue funds to sustain the coordinator position and school wellness teams.
Douglas County School District
Many schools have created other funding sources for their health and wellness work through parent group support, small grants, 5K and fun run income, etc. The district is working on plans for sustaining and expanding their program and positions at the district level through other funding sources. District support started slowly, but in year four, after a change in administrative structure, the program has ultimately been recognized as a 21st Century Skills program supported by the district.
Jefferson County School District
Jefferson County has committed to fund one half of the Healthy Schools Coordinator position using Medicaid reimbursement funding, as available. Jefferson County received a three-year Colorado Department of Education Comprehensive Health Education grant to continue the healthy schools team’s dedication to health education via at least a half-time position. While the district doesn’t plan on financially supporting the work beyond what is mentioned above, it has expressed support of the Healthy Schools team and the work being done.
Pikes Peak Region
Four of the five districts in the Pikes Peak Region applied for the latest Healthy Schools Colorado grant opportunity. This is due to the collaboration and coordination between the districts, which has produced positive and successful programs. There is strong support across these districts as well as interest from schools. Creating new wellness opportunities is a priority. Districts are pursuing additional funding for activities. One district received a physical education grant for curriculum and standards alignment.
Employee Wellness Advisory Council was created to work on staff wellness issues. This should renew support for staff wellness efforts, which will be emphasized with the opening of the new employee wellness clinic in fall 2013. One example of collaboration is with community partners such as TEAM Fort Collins for new substance abuse prevention curriculum. For elementary implementation the nutrition education guidance document will start the process in elementary schools.
School-level Support
Support and buy-in at the school level is just as important for sustainability. School team co-leaders reported moderate levels of support for health and wellness in their schools.
• Seventy-seven percent (77%) of school team co-leaders perceived an overall level of support for school health and wellness from school administration.
• Sixty-one percent (61%) of school team co-leaders perceived an overall level of support for health and wellness from school staff.
• Forty-seven percent (47%) of school team co-leaders perceived an overall level of support for health and wellness from families.
Successful Professional Development
Healthy Schools Colorado builds the capacity of coordinators, school co-leaders, physical education teachers, school nurses, and other school and district staff to implement, evaluate, and sustain effective policies and practices through professional development opportunities and resource development. The main professional development activities of Healthy Schools Colorado have included:
1. Joint meetings/professional development to coordinators of Healthy Schools Colorado, the Student Wellness Grant Program, the Colorado Legacy Foundation Health and Wellness Program, and LiveWell Colorado.
2. Bi-annual Healthy Schools Leadership Retreat.
3. Tailored technical assistance to coordinators including site visits and facilitation of co-leader professional development events conducted by district and regional coordinators. 4. Health Education and Physical Education cadre trainings to boost implementation and
assessment of instruction aligned with Colorado’s Comprehensive Health and Physical Education Standards.
5. School Nurse Cadre trainings on childhood obesity, healthy eating, and active living. Notable successes related to professional development offered through Healthy Schools Colorado are described in more detail below.
PE Cadre
The cadre of physical education trainers provides professional development on best practice guidelines for quality physical education to physical educators across the state. This cadre has developed and implemented training on Colorado’s new physical education content standards, best practices in assessment strategies for physical education, and assessing student fitness levels. In addition to reaching physical education instructors, the cadre of trainers also offered training to school personnel on how to increase movement in the classroom and incorporate brain- based learning techniques. In all, these trainings have reached 875 teachers and other school personnel. (This number reflects the number of unique participants; some individuals attended multiple trainings.)
Evaluation results of the PE cadre trainings indicate the trainings have had positive impact on participants. Overall, the majority of participants indicated that the objectives of the trainings were met; facilitators were knowledgeable and effective; and participants intended to apply the knowledge and skills learned back at work.
Standards-based Instruction of the Colorado Standards for Physical Education
• The majority of participants (96% to 97%) “agree” or “strongly agree” they understand the Colorado Physical Education Standards; how they were created; can identify the Evidence Outcomes aligned with the workshop activities; and identify three
standards-Assessment Strategies
• Ninety-three percent (93%) of participants understand the difference between formative and summative assessments.
• Ninety-eight percent (98%) of participants plan to integrate best practices to support assessment in their classroom.
• Participants commented that the resources such as the assessment-planning guide, assessment examples, assessment-writing activities, and the concept maps were most useful.
Brain-based Learning
• Ninety-four percent (94%) of participants had a deeper understanding of how the brain functions.
• Ninety-six percent (96%) of participants learned strategies that are needed for cognitive enhancement in both the female and male brain.
• Ninety-eight percent (98%) of participants learned physical activity techniques that can be implemented in the classroom.
• Participants found the activities and classroom applications very useful and easy to take back to their classrooms and implement immediately. Many individuals mentioned learning about different learning styles and gender differences.
Curriculum Project Meetings
• Evaluation results from the curriculum project meetings indicate that participants are able to identify curricula elements, identify steps to create a curricula, and develop physical education curricula.
• Participants commented that the support and assistance from instructors were invaluable.
Follow-up Survey on Standards-based Instruction of the Colorado Standards for Physical Education Training
• Follow-up survey data to the Standards-based Instruction of the Colorado Standards for Physical Education training show participants applied what they learned. Sixty-eight percent (68%) to seventy-three percent (74%) of respondents developed assessments, made improvements to their teaching and program, and feel students have benefited as a result of the training. Respondents reported support from their district and schools to implement what they learned (88%) and eight-seven percent (87%) shared learnings with colleagues.
Regional Nurse Cadre
To promote and advance the use of evidence-based practices, the Regional Nurse cadre developed a series of trainings related to chronic disease conditions such as asthma, obesity, and behavioral/ mental health. Additionally, regional workshops for school nurses were conducted to provide information on head injury, special education considerations, emergency planning, and insulin management. In all, these trainings have reached 582 unique Colorado school nurses.
Evaluation results of the Regional Nurse cadre trainings indicate the trainings have had positive impact on nurses. Overall, the majority of participants indicated that the objectives of the trainings were met, the facilitators were knowledgeable and effective, and participants intended to apply the knowledge and skills learned back at work. The results reported below demonstrate the important reach of these efforts.
Asthma Management and Asthma Education
• One hundred percent (100%) of participants learned to navigate the Children’s Hospital website for resources and how to collaborate with Adams State University to implement the Open Airways for School Programs.
• One hundred percent (100%) of participants increased their knowledge of tools and strategies to promote self-care.
Mental Health
• One hundred percent (100%) of participants learned of existing behavioral/mental resources and how to access resources.
• Ninety-two percent (92%) of participants were able to identify common psychiatric medications used to treat children.
• Ninety-two percent (92%) of participants were able to identify methods to collaborate with other community members on health and wellness of children.
Regional Nurse Trainings
• Ninety-seven percent (97%) of participants know the components of evidence-based head injury in schools.
• Ninety-five percent (95%) understand the school nurse’s role in Special Education and the new disability criteria.
• Ninety-three percent (93%) can describe the components of emergency planning. • Ninety-four percent (94%) can apply information learned on insulin administration and
diabetes management for students with diabetes.
Regional Nurse Specialist Model - Feedback Survey
A survey to learn more about the Colorado Regional Nurse Specialist for School Health model was developed and administered to Colorado school nurses. The Regional Nurse Specialist position is a grant-funded, part-time position charged with the mission to build the capacity and provide support for school nurses on best practices and emerging school health services issues. Results show that the Regional Nurse Specialist model was not only effective in reaching school nurses across Colorado, but school nurses gained knowledge and access to resources through the trainings and technical assistance provided by the Regional Nurse Specialist.
• Seventy-seven percent (77%) of respondents indicated they knew who their Regional Nurse Specialist was and that they had attended, on average, two trainings during the past year (with a range from one training to eight trainings).
• Forty-eight percent (48%) of respondents said they used the information they learned to “some extent” and thirty-four percent (34%) said a “considerable extent.”
• Eighty-nine percent (89%) of respondents said the Regional Nurse Specialist met their needs to implement best practices in school health services.
• Ninety-three percent (93%) of respondents indicated the Regional Nurse Specialist was knowledgeable about current health issues and state and federal regulations.
• Ninety-percent (90%) of respondents said the Regional Nurse Specialist provided linkages to resources, local health departments, and community organizations.
Healthy Schools Leadership Retreat
The bi-annual Healthy Schools Leadership Retreat was held in June 2013. It was the largest retreat to date with 422 participants in attendance. School professionals from around the state gathered to learn new strategies to promote learning environments that are healthy and nurturing, and to celebrate healthy schools’ successes. The two-day retreat included forty breakout sessions and two keynote speakers. The sessions covered the link between health and academics, physical activity, nutrition, assessment, parent involvement, effective school teams, social-emotional health, administrator support, using data, policy, and more.
Participants indicated they learned skills and knowledge they will apply when they are back at work (Table 3). One hundred percent (100%) of respondents rated the overall Healthy Schools Leadership Retreat “good” or “excellent”.
Table 3. Healthy Schools Leadership Retreat Results
Very Unlikely Unlikely Likely Very Likely Not Applicable
a. I will apply the knowledge and skills I learned at this Retreat back at work.
2.08% 3 0% 0 11.11% 16 83.33% 120 3.47% 5 b. I will try a new
strategy or practice in my program. 2.10% 3 0% 0 13.99% 20 79.02% 113 4.90% 7 c. I will share new
strategies or ideas acquired from the Retreat with peers
2.08% 3 0% 0 11.11% 16 84.03% 121 2.78% 4
Individuals specified the Retreat environment was supportive of their learning; was well organized; was relevant to their work; provided useful materials and resources; and was the right length of time.
Thank you for the inspiring and relaxing retreat in Vail! I can’t imagine the time and effort you put forth to make this event successful! Together I think we will instill fitness and health in our young children!—Retreat Attendee
I have already talked to my school administrator about Minds in Motion and Here Come the Health Nuts. Both are very innovative and valuable programs that I would love to see integrated into our school. —Retreat Attendee
I can’t wait to get back to school and use the Academics in Action that I learned. —Retreat Attendee
I have never been treated more special than we were treated at the health conference. It was a great experience and I feel very blessed that I was apart of it. I wish all teachers could experience this! —Retreat Attendee
Thank you for the inspiring and relaxing retreat in Vail! I can’t imagine the time and effort you put forth to make this event successful! Together I think we will instill fitness and health in our young children!—Retreat Attendee
I have already talked to my school administrator about Minds in Motion and Here Come the Health Nuts. Both are very innovative and valuable programs that I would love to see integrated into our school. —Retreat Attendee
I can’t wait to get back to school and use the Academics in Action that I learned. This was one of the best retreats I have ever attended in my 20 years as an educator. I felt very privileged to be a part of it — Retreat Attendee
Healthy Meals at School and Access to Healthy Food and Drinks in Vending
Machines/Adequate Amounts of Fruits and Vegetables Daily
As detailed below, the participating Healthy Schools Colorado schools have had a broad impact on their students in terms of promoting access to healthy meals within the cafeteria, through vending machines and school stores and as a result of policies related to healthy snacks and lunches brought from home. Results show the reach of these policies and practices during the 2012-13 school year.
Measurable Result - Number of Students Impacted During 2012-13 (Tables 4-6)
• 102,236 students have access to healthful food choices in appropriate portion sizes. • 80,373 students benefit from schools encouraging their parents to provide a variety of
nutritious foods if students bring lunch or snacks from home.
• 92,597 students are in schools that put restrictions in place for student access to vending machines, school stores, and other venues that contain foods of minimal nutritional value.
Complementing efforts to enhance access to healthy food choices, schools instituted practices that increased the consumption of fruits and vegetables during the school day. These
improvements benefitted nearly all (or 99.4%) of students within the participating schools.
Measurable Result - Number of Students Impacted During 2012-13 (Table 4)
• 101,793 students have access to fresh fruits and vegetables during the school day.
Table 4. Schools Implementing Healthy Nutrition Guidelines (SY2012-13)
Student census in all 163 reporting schools = 103,652 SchoolsNo. of Percent of Schools w/ “Yes” No. of Students Impacted Ensure that all foods & beverages comply with USDA regulations
and state policies. 163 99.4% 102,740
Encourage parents to provide a variety of nutritious foods if
students bring lunch or snacks from home. 163 81.6% 80,373
Require that healthy food choices are made available to
students at every school function that includes foods. 163 37.4% 41,024 Every student has access to healthful food choices in
appropriate portion sizes. 163 98.8% 101,793
Students have access to fresh fruits and vegetables during the
school day. 163 99.4% 102,236
Put restrictions in place for student access to vending machines, school stores, & other venues that contain foods of minimal
nutritional value 163
Table 5. Student Access to Vending by Type of School (SY2012-13)
Type of School No. of Schools w/ Student Access to Percent of Schools Vending
No. of Students with Vending Access K-8 3 0% 0 K-12 2 0% 0 Elementary 110 0% 0 Middle3 29 67.9% 14,728 High 19 100.0% 22,750 Outdoor labs 3 0% 0 TOTAL 163 23.3% 37,478
Table 6. Schools with Vending Machines Accessible to Students (SY2012-13)
37,478 students have access to vending machines Vending machines contain:
Percent of Schools Answering “Yes”
MS
N=19 N=19HS No. of Students Impacted -Nuts, seeds, dairy products, fresh fruits or vegetables, dried fruits and
vegetables, and packaged fruits in own juices 68.4% 63.2% 22,215
-Any other food item containing no more than 35% total calories from fat
and no more than 35% of total weight in sugar. 52.6% 63.2% 21,823
-Fat free or low fat milk* 63.2% 52.6% 19,260
-Fat free or low fat flavored milk up to 150 calories* 63.2% 52.6% 19,260
-100% juice, with no added sweeteners* 57.9% 73.7% 23,205
-Bottled Water 00.0% 94.7% 36,501
-No sodas (neither regular nor diet sodas) 89.5% 84.2% 33,263
-No or low calorie beverages with up to 10 calories / 8 oz (e.g., unsweetened or diet teas, low calorie sport drinks, fitness waters,
flavored waters, seltzers). N/A 100.0% 22,750
-Other drinks, up to 12 oz servings with no more than 66 calories / 8 oz N/A 89.5% 20,043 -At least 50% of non-milk beverages must be water and no/low calorie
Success Story Results
In addition to healthy food policies, eight percent (8%) of the school teams implemented specific building-level policies in the following areas:
• Policies regarding classroom/birthday celebrations;
• Policies promoting healthy snacks for students and teachers;
• Policies promoting healthy foods at lunch and via the vending machines; and • Nutrition policies promoting healthy snacks and brain breaks.
More broadly, school teams report explicitly aligning their work with District-level wellness policies while instituting school policies that promote healthy food choices in the classroom and within the larger school community.
While working on policy changes related to healthy foods, the school teams reported targeted improvements to increase access to school breakfast programs, to improve healthy food options during lunch and to promote healthy snack choices. Seven school teams set up salad bars while others instituted fruit and vegetable challenges.
Success Stories with Nutrition as a Topic (2012-13 school year)
School Health Improvement Plan Goals Number of Schools
Increased Access to Breakfast 21 (12%)
Instituted Healthy Lunch Programs 47 (29%)
Physical Education
The National Association for Sport and Physical Education recommends 150 minutes of physical education per school week for elementary school children and 225 minutes for middle and high school students. Assuming a 36-week school year, this translates into 90 hours of physical education for elementary age students and 135 hours for middle and high school students per school year. As shown in Table 7, most schools participating in Healthy Schools Colorado fall short of this recommendation. The mean number of hours of physical education per school year ranges from 50 to 54 hours for primary school students and 67 to 109 hours for secondary school students.
Table 7. Estimated Hours of Physical Education / School Year (SY2012-13)
Grade SchoolsNo. of (Standard Deviation)Mean No. of Hours No. of HoursMin – Max Estimated No. of Students Impacted
K 984 50 (40) 12 - 265 6,493 1 105 53 (39) 20 - 265 7,385 2 105 53 (39) 20 - 265 7,084 3 104 54 (40) 20 - 265 7,290 4 104 53 (39) 20 - 265 7,294 5 104 53 (39) 20 - 265 7,002 6 60 67 (52) 20 - 265 6,356 7 28 76 (41) 27 - 180 5,862 8 28 74 (40) 27 - 180 5,469 9 16 101 (73) 24 - 300 4,711 10 17 107 (71) 24 - 300 3,940 11 16 109 (73) 24 - 300 3,162 12 16 109 (72) 24 - 300 2,959
At the same time, participating Healthy Schools Colorado schools reported that most of their physical education teachers received professional development to assist them with their programs. The trainings were offered through the Colorado Department of Education Physical Education cadre and promoted best practices and skill-building to enhance physical education programs (see Successful Professional Development section for more information). The results reported below show the extensive reach of the physical education training in terms of numbers of students impacted.
Measurable Result - Number of Students Impacted During 2012-13 (Table 8)
• 86,729 students have the opportunity to benefit from physical education teacher or specialists who received professional development on physical education during the current school year.
• 84,528 students have the opportunity to benefit from physical education instructors who have been certified, licensed, or endorsed by the state in physical education. • The physical education teachers of 83,917 students have been provided with goals,
objectives, and expected outcomes.
Table 8. Schools Implementing Physical Education Guidelines (SY2012-13)
Student census in the 182 reporting schools = 110,816 Schools No. of Percent of Schools w/ “Yes” Students No. of Impacted
Are all staff who teach PE are certified, licensed or endorsed by the
state in PE? 158 91.8% 84,528
Did any PE teachers or specialists receive professional development
on PE during this school year? 158 92.4% 86,729
Are those who teach PE provided with goals, objectives & expected
outcomes? 158 89.9% 83,917
Are those who teach PE provided with a chart describing the annual
scope & sequence of instruction? 158 74.1% 68,305
Are those who teach PE provided with plans for how to assess
student performance? 157 74.5% 69,809
Are those who teach PE provided with a written PE curriculum? 157 74.5% 69,809 Does the school offer opportunities for all students to participate in
intramural activities or PA clubs? 158 74.1% 70,519
Success Story Results
Through their school health improvement plans, school teams worked to promote evidence-based physical education and physical activity programming through curricula such as SPARK, the Great Body Shop, and JAMmin’ Minute. They encouraged classroom teachers to institute brain breaks and provided resource materials to encourage students to become more active. Other classroom changes include fitness equipment purchases, teacher training, and classroom team incentives as rewards for achieving physical activity goals.
Success Stories with Physical Education/Activity as a Topic (2012-13 school year)
School Health Improvement Plan Goals Number of Schools
Moderate or Vigorous Physical Activity
To complement the physical education standards previously described, the National Association for Sport and Physical Education recommends that school age children also accumulate at least 60 minutes of physical activity per day or 300 minutes per week. Physical activity may include recess or a structured physical activity that increases the heart rate of students. As shown in Table 9, most schools participating in Healthy Schools Colorado fall short of this recommendation. Among the schools offering physical activity breaks, the mean number of minutes of physical activity per school week ranges from 150 to 174 minutes for primary school students and from 117 to 131 minutes for secondary school students. Unfortunately, seven percent of the 162 schools reporting data on physical activity do not offer physical activity breaks; these schools include one online school serving grades 7 to 12, one middle school, and ten of the 19 high schools.
However, Healthy Schools Colorado schools do offer their students substantial opportunities for physical activity through intramural activities and physical activity clubs. In addition to the physical activity breaks offered in schools, some districts offer opportunities for older primary school students to participate in outdoor education laboratories. Two outdoor education laboratories in the Jefferson County School District participated in Healthy Schools Colorado and served over 6,000 sixth grade students during the 2012-13 school year.2 These students engaged in 900 minutes of physical activity during their week-long excursion, which is the equivalent to three hours of daily physical activity for five days. At the Douglas County Outdoor Education Center, students spend three days and two nights camping. Curriculum dictates that the students are outside 85% of the time, engaged in activities like hiking and folk dancing.
Measurable Result - Number of Students Impacted During 2012-13
• 70,519 students have opportunities at school to participate in intramural activities or physical activity clubs. (Table 8)
• 68,347 students are estimated to have recess or physical activity breaks that increase their heart rates. (Table 9)
• 6,226 sixth grade students in Jefferson County School District participated in 900 minutes of physical activity over one week while attending an outdoor education laboratory.
2 The total number of students attending the Outdoor Education Laboratories during the 2012-13 school year was
Table 9. Estimated Minutes of Physical Activity Breaks / Week 5 (SY2012-13)
Grade SchoolsNo. of No. of Minutes Mean
(Standard Deviation)
Min – Max
No. of Minutes Estimated No. of Students Impacted
K 106 170 (75) 20 - 350 7,189 1 107 174 (73) 20 - 400 7,491 2 107 171 (70) 20 - 400 7,197 3 106 161 (71) 20 - 400 7,377 4 106 153 (67) 20 - 400 7,409 5 106 150 (67) 20 - 400 7,122 6 61 131 (74) 15 - 375 6,758 7 29 118 (93) 15 - 375 6,625 8 29 119 (93) 15 - 375 6,415 9 6 118 (113) 30 - 300 1,700 10 6 117 (114) 30 - 300 1,292 11 6 117 (114) 30 - 300 945 12 6 117 (114) 30 - 300 827
Success Story Results
In their efforts to promote physical activity, school teams addressed changes within the
classroom, during recess and outside of school hours through structured recess programs, sports clinics, and intramural games. Fitness challenges included recess mileage clubs and running programs for students, teachers, and parents. Other school teams sponsored fitness “days” to engage the entire school community in physical activity events.
School teams also focused on staff wellness, promoting physical activity among teachers and staff through workshops, wellness programs, workout centers, and incentive programs. Several school teams coupled their staff wellness programs with stress reduction initiatives.
Success Stories with Physical Activity as a Topic (2012-13 school year)
School Health Improvement Plan Goals Number of Schools
Promoted Walking 30 (19%)
Promoted Physical Activity Breaks 27 (17%)
Encouraged Movement 33 (21%)
Promoted Fitness 46 29%)
Evidence-based Care for Chronic Disease
Nurses within Healthy Schools Colorado schools tracked the numbers of students with chronic diseases and the proportion able to self-manage their conditions. To promote and advance the use of evidence-based practices, the Regional Nurse Cadre developed a series of trainings related to chronic disease conditions such as asthma, obesity, and behavioral health. The results reported below demonstrate the important reach of these efforts.
Measurable Result - Number of Students Impacted During 2012-13
• 8,503 students have asthma, 392 students have diabetes (types 1 and 2), and 1,678 students have behavioral / mental conditions. (Table 10)
• 1,673 students with asthma and 185 students with diabetes have medicine at school. Among these students, 1,084 students with asthma and 102 students with diabetes are able to self-manage their disease. (Table 12)
• Additionally, school nurses have screened over 66,000 students for vision, over 44,000 students for hearing, and nearly 5,000 students for oral health. Among these students, 8.4%, 3.7%, and 7.6% of them were referred to specialists for vision, hearing, and oral health respectively. (Table 11)
• School nurses identified 1,617 students who were without health insurance coverage; 26.7% of these students were referred to child health plan specialists. (Table 11)
Table 10. Number of Students with Select Health Conditions (SY2012-13) Students with… No. of Schools Reporting StudentsNo. Of Percent of Student
Body
Mean # of Students /
School
Asthma 166 8,503 8.7% 51
Allergies (life -threatening) 166 3,518 3.6% 21
ADHD 162 3,085 3.2% 19
Behavioral / mental 1,678 1.8% 10
Traumatic brain injury
(or history of) 164 1,581 1.6% 10
Gastrointestinal 164 703 0.7% 4
Orthopedic 165 657 0.7% 4
Seizure disorder
(within past 2 years & on meds) 165 653 0.7% 4
Cardiovascular 165 574 0.6% 3
Diabetes type 1 157 340 0.4% 2
Cancer 143 95 0.1% .7
Table 11. Number of Students Screened & Referred (SY2012-13)
# Schools
Reporting # Screened # Referred Percent Referred
Vision 166 66,436 5,571 8.4%
Hearing 127 44,580 1,634 3.7%
Oral health 126 4,951 377 7.6%
Height & weight 126 5,567 24 .4%
# Identified # Referred Percent Referred
Students w/out health insurance 94 1,617 431 26.7%
Table 12. Number of Students Screened & Referred (SY2012-13)
# Schools
Reporting # Screened # Referred Percent Referred
Vision 166 66,436 5,571 8.4%
Hearing 127 44,580 1,634 3.7%
Oral health 126 4,951 377 7.6%
Height & weight 126 5,567 24 .4%
# Identified # Referred Percent Referred
Students w/out health insurance 94 1,617 431 26.7%
School Nurse Caseload
Colorado has a high school nurse-to-students ratio and is ranked 40th in the nation by the National Association of School Nurses in terms of this ratio. While the National Association of School Nurses recommends a ratio of 1:750 for well students, the ratio for the entire state of Colorado is a dismal 1:1,788. Among schools participating in Healthy Schools Colorado, the estimated ratio is even higher, with one full-time equivalent school nurse for every 2,521 students. The number of schools assigned to nurses ranged from one to eight schools with an average of four schools per nurse.
Additional School Health Services Data
• Nurses have conducted 4,769 special education assessments during the 2012-13 school year, which is an average of 30 per school
• There have been 284,840 visits to health rooms during the school year; this is an average of 2,297 visits per school.
Challenges
The challenges reported over the years and in this most current year of Healthy Schools Colorado have remained consistent. Similar circumstances exist in all the districts:
administrators and teachers feel overwhelmed with the constant changes and expectations and are hesitant to take on new endeavors; those that do sometimes feel inundated and time-stretched with educating, seeking buy-in and support, and working to keep staff involved.
Support
• Districts lose administrative and school champions each year. This becomes a
challenge to the momentum, especially in schools that lose principals. These schools need additional support as they transition leadership, which was the case for 50% of schools in one district.
• It takes time to create a network of the right people to impact change; identifying champions in each school building and every level of the administration is a challenge.
Funding
• Programs become hard to sustain when funding is an annually changing variable. • Grant-funded positions are sometimes viewed differently than internal funded
positions. The coordinator position needs to be valued at the district level and supported for long-term success.
Priority Status
• There is a continuing perception that health is not a priority in schools.
• It takes diligent work to elevate the importance of health in school systems and the notion that healthy students are more successful students.
Time
• Schools struggle to meet recommended levels of physical activity during the school day.
• Schools struggle to offer the recommended hours of physical education. • Colorado school nurses have too high caseload compared to national average.
Next Steps
Healthy Schools Colorado targets individuals, organizations, the community, and public policy. Through professional development, technical assistance, support for the district coordinator model, Coordinated School Health, and the development and dissemination of resources, Healthy Schools Colorado aims to change knowledge, beliefs, and behaviors in addition to changing the policies and environment for these to occur.
As evidenced during the many years of the grant, Healthy Schools Colorado impacts the health of schools, staff, and students and affect policies at the district and school levels. At the school level, teams have worked extensively to complete the School Health Index, develop School Health Improvement Plans, and to provide technical assistance, resources, and links to professional development opportunities. Data from the Healthy Schools Colorado database indicate that schools are implementing best practices and policies in physical education, physical activity, nutrition, and health services. At the district level, infrastructures are in place that focus on health and wellness for all students, including health advisory councils, policies, partnerships, programs, and activities.
The professional development and technical assistance framework used to implement Healthy Schools Colorado increased the knowledge and skills of district and school staff and school nurses, and also affected school wellness policies to reach a large number of students, family members, and community members to promote and sustain health programs in schools. Looking forward, key action steps for Healthy Schools Colorado include:
Process
• Continue to utilize Coordinated School Health to address school health needs. • Fund districts and regions through grants using the coordinator model.
• Develop capacity of the Physical Education, Health Education, and Regional Nurse Cadres.
• Develop resources for district and school personnel.
• Provide professional development and technical assistance to promote healthy schools and students.
• Improve capacity and commitment of staff to implement programs and teaching practices that will impact behavior change of students.
Sustainability
• Build program sustainability of current and new grantees through effective community partnerships, leverage funding from other sources, and improve and maintain
infrastructure to support healthy school policies in funded districts.
• Encourage districts and schools to include school health goals in their school unified improvement plans and policies.
Culture and Norms
• Communicate the link between health and academics.
• Improve infrastructure to support healthy school policies in funded districts. • Increase implementation and enforcement of healthy school policies.
• Foster improved/sustained collaboration among statewide school health partners. • Establish and maintain effective school/community partnerships.
(Footnotes)
1 These figures include all schools recruited by Healthy Schools Colorado and three outdoor education laboratories.
2 This figure is not a unique count of students (i.e., it is comprised of students who attend both Healthy Schools Colorado schools and outdoor education laboratories).
3 Three middle schools only sell bottled water.
4 Seven of the 115 schools did not offer physical education for Kindergarten students. 5 Data reflect schools offering physical activity breaks.
