Our journey to good health: a Mississippi educator details what hi district does to connect healthy bodies to strong minds.

Imagine a public school district in which every school has the resources and the commitment to promote the physical, emotional and mental health of students and staff, in which violence is nearly nonexistent, and in which dropout rates and discipline referrals are low.

This is a picture of McComb Separate School District, a predominantly conservative, minority, low-income district in Mississippi that five years ago was fraught with low student achievement, high dropout rates and student discipline problems. Today, McComb, which serves about 3,000 students, boasts improved average attendance, increased graduation rates and a dramatic decrease in discipline referrals, in-school detentions and out-of-school suspensions.

Perhaps the most striking change during the past five years has been the dramatic improvement in second grade reading readiness. During the 1996-97 school year, according to Success for All reading testing, just 11 percent of our students were reading on grade level at the beginning of second grade. By 2000-2001, that figure had jumped to 82 percent. Although McComb enrolls predominantly low-income minority students, the district's 7th grade students recorded the highest scores in Mississippi on the state writing assessment in that grade. Today, all schools in the district would be designated successful or exemplary according to the new Mississippi accountability standards.

Much of this positive change can be linked to the implementation of the Coordinated School Health, Wellness and Safety Model, the foundation of which was developed and adopted by the Centers for Disease Control. While other initiatives have played a part in increasing achievement and improving the overall climate, the increased focus on the health and physical well-being of the McComb students and staff has played the central role in these achievements.

Attuned to Health

As school administrators we're faced with the daunting challenge of improving student performance. In our incessant focus on test scores, however, the social and mental well-being of the individual child is often overlooked. Health is tied to achievement, and part of our job is to do our best to fill the vacuum represented by Maslow's hierarchy of needs so every child has the opportunity to achieve.

In McComb, we support the position of the Action for Healthy Kids initiative, a collaboration with the nation s leading children's health and education organizations. We believe an effective, long-lasting, sustainable school reform initiative can only succeed if it is based on a healthy school system. If our children, their families, administrators and teachers are healthy, then they will come to school and, just as important, they will be ready and able to teach and to learn. The National Association of School Nurses (www.nasn.org) has compiled a listing of those studies that also validate this premise.

At a time when much attention was focused on raising academic test scores, the McComb community, parents and school board heartily supported sweeping health-related changes. Why?

When I joined the McComb district in 1997, I'd already led similar changes at a district in Louisiana and had just finished four years as director of the Center for Disease Control's National School Health Education Coalition. I believe that what I learned about the link between health and academic performance could work in McComb. The critical component was letting the community lead the way. That's what we did in McComb. Based on our success, I suggest several steps for bringing health to the forefront of every district's agenda.

* Get community buy-in. We collected data from all resources to look not only at the condition of the school system, but the community as well. The head of the local hospital was quick to say that the community's children were a very expensive group because most of their primary health care came from the emergency room. Unemployment rates, teen-age birth rates and lack of recreation and public transportation all contributed to poor health. The public appreciated knowing all the pieces of the puzzle, and it was important that they did.

We sent out personal invitations, ran ads in the local newspaper and invited all interested community members to join us at a meeting where we could discuss ways to improve the school district. More than 350 people attended that initial meeting, including the mayor, judges and other government leaders, fire and police officers, the director of Head Start, medical personnel, business and community leaders and many parents.

We challenged attendees to look at the school district's success in relation to the community's success. What problems were we facing in the community that might be affecting the schools? How could we work together to tackle these problems in order to benefit both the community and schools? We talked about truancy, crime, one-parent households and drugs and alcohol.

* Build on community leadership. Based on the discussions at the first meeting, we developed a 350-person study team that included representatives from all parts of the community: black and white, rich and poor, staff from the school, state heart and cancer associations, city and county representatives of local government, law enforcement, clergy and the state health and education departments. They were charged with designing a model comprehensive school health program to address the needs of the community.

The members of the community study team broke into five smaller units to focus on specific issues such as technology, academics, facilities and community relations. One ream focused on the general health of the community as well as the health of our school-age children and their families.

We voted as a group on each aspect of the comprehensive plan we developed (see page 22 for school health components), and after nine months we brought our entire school restructuring plan to the school board. The heart of the plan concentrated on the health of our students and families, using Maslow's hierarchy of needs as our infrastructure and the nine-component model of school health as the avenue for attaining our results. The board approved the entire plan because it was developed and supported by the community.

Hard Questions

* Be a proactive leader. While I did not dictate a plan for comprehensive health when I came to McComb, I did share my philosophy, my expertise and, most important, my belief in the McComb community.

For the first nine months of my super-intendency in McComb, I spent literally every day visiting teachers, students, food service staff, school nurses, community health workers, city leaders, parents and many other community leaders. I pushed district staff members to learn more about grant programs and other opportunities to fund and support the community's vision.

I encouraged district staff to think outside the box, to ask tough questions and to explore the flexibility of rules and regulations. For example, could money from Title I be used to fund school nurses in every McComb school? Should we use our federal Safe and Drug-Free Schools funds to buy red ribbons or should we hire people who could be role models and mentors to help our children stay away from drugs?

We all learned a lot. Some was in the form of increased "book knowledge," but much was related to taking risks, trying new things and asking tough questions.

* Implement the program step by step. Once we had gained the support of the community and the school board, we began to build the Coordinated School Health program step by step, focusing on one or two of the nine components each year.

This gradual implementation allowed us to obtain funding for each item, to get principal and teacher buy-in and to educate parents and other community members about the overall program. Initial funding has come from such federal sources as Coals 2000 (Educate America Act), Title I (Education for the Disadvantaged), Title II (School Improvement), Title IV (Safe and Drug-Free Schools), Title VI (mostly folded into the No Child Left Behind Act) and Special Education (for preschool and K-12).

Local, state and private sources have been tapped, such as state pilot health projects, Medicaid, hospital and private partnerships, interagency agreements with public health and social service agencies, university medical and dental partnerships and Partnership for a Healthy Mississippi.

Staff Impact

* Support health and wellness for everyone in the school environment. In addition to ensuring our students have access to medical care through Medicaid programs and through in-school case management, we've also worked hard to ensure that teachers and staff members are managing their health as well.

One teacher who has diabetes, for example, was missing school days. She was having seizures and even passing out in class because she wasn't taking care of herself. Now a child is assigned each day to remind her and even accompany her to the nurse's office to get her blood sugar checked. Since we've made this change, the teacher has missed far fewer days of school, and her students are seeing good health care in action.

* Recognize and support the potential of every student. In a community where many students have historically had no access to health care, where 82 percent of students are on free or reduced lunch and where many families have never experienced educational success, the job of building and nurturing student self-esteem is critical.

While many of our students are experientially, economically and emotionally impoverished, they are in no way intellectually limited. Teachers, staff and administrators are constantly reminded that "no one is really educated unless everyone is educated" and they all work together to support every student.

* Keep your eyes on the prize. In our focus on student health, nutrition, fitness and safety, we never lose sight of our schools' core purpose: to create an environment in which every teacher can teach and every student has the opportunity to learn. In fact, as I mentioned, we added "academic opportunity" as a ninth component to the original eight-component national model for Coordinated School Health precisely to remind ourselves that student academic success is our goal.

It takes time to make changes, but if you can get kids to school, if you can get them to behave appropriately and if you can make sure they're not sick, they'll have a much better chance at succeeding academically.

We are continually working to be better at all the components. We expanded physical education and health classes and pay a lot of attention to the obesity epidemic. We are starting this year to look at a new nutrition and fitness initiative that will focus on teaching students to eat in a healthier manner. We just revamped our counseling and therapy program to provide a full-time master's level mental health therapist at each school.

Saving Our Students

If we are serious about saving a generation of kids, ensuring that not one of them is left behind, we must see that health and achievement go hand in hand. Only when children are healthy and safe will we be able to focus on improving their academic performance and improving the stress-filled lives of our teachers and principals.

Simply providing access to education will not solve anybody's problems if the nation's schools are overwhelmed. We must work together to take action for children's nutrition, fitness and overall health, to create healthy, safe, supportive schools where teachers can teach and children can learn.

RELATED ARTICLE: A District's Nine Facets of Health and Wellness

The McComb Coordinated School Health program is an expansion of the eight-component school health model adopted by the Centers for Disease Control.

The McComb, Miss., Independent School District added the ninth component-academic means, which we think clinches the program's success. The nine-component model is used at both the site level and districtwide.

The nine components are as follows:

* Health instruction. A planned, sequential, prekindergarten through 12th-grade curriculum that addresses the physical, emotional, mental and social dimensions of health. The curriculum focuses on health literacy to enhance each student's independent thinking skills and decision making.

* Health services. Services provided for students in a clinic setting to appraise, protect and promote health. Each school has a health clinic with a full-time registered nurse and a health and wellness student assistance team to focus on prevention. A centralized district health office is administered by a health service supervisor.

* Healthful school environment. Physical and aesthetic surroundings and psychosocial climate and culture in schools that maximize the health of students and staff. McComb strives for a safe and attractive learning environment that is conducive to learning. Security officers are on site at each school to promote a safe and secure climate. Self-esteem and interpersonal relationships and communication are promoted.

* School food services. Provision of services to students and staff that promote health and nutrition through access to a variety of nutrition and appealing snacks and meals. School nutrition programs reflect the U.S. dietary guidelines for Americans and respond to the health and nutrition needs of all students.

* Health promotion for staff. Programming for school staff that provides health assessments, health education (including health education intervention training and programs) and health-related fitness activities. Programs encourage and motivate school staff to live healthier lives and model the district commitment to healthy lifestyles.

* Counseling and psychological services. Services provided include broad-based individual and group assessments, interventions and referrals that attend to the mental, emotional and social health of students. Each school has a mental health counselor/interventionist on staff. Behavioral interventionists provide prevention training and implement interventions to address behavior issues at each school site.

* Physical education. A planned, sequential, preschool-12 curriculum that provides cognitive content and learning experiences such as basic movement skills; physical fitness; rhythms and dance; games; team, dual and individual sports; tumbling and gymnastics; and aquatics.

* Parent/Community involvement. An integrated school, parent and community approach that establishes a dynamic partnership to enhance the health and well-being of students. Parents have the opportunity for training in literacy, parenting and violence prevention.

* Academic opportunity. Using every available means to the school district so every student has the chance to succeed academically. Early identification and intervention ensure all children begin their formal education experiences prepared for success. Teachers have sufficient time to provide appropriate instruction and students have sufficient time in which to learn. Model programs that have shown proven results include Success for All, Character Counts!, Quest, Imagine U and Second Step.

To learn more about the McComb Healthy Schools Project and to view and download a copy of my online publication The Safety Net, visit 208.142.197.5/Hkn/word_docs/DR_COOPERS_BOOK.doc.

Maximizing Student Health Resources

By Howard Taras

In my 17 years of working with school districts in San Diego County on student health matters, I've concluded that public schools sometimes waste good intentions, time and resources on practices that don't in the end serve the greater good of the student population.

We all understand how a young child's or adolescent's poor health frustrates even the best-laid pedagogical plans to educate them. But it's less defensible that school health interventions themselves also often frustrate school administrators.

Difficulty with launching health programs smoothly and concerns about cutting into precious time and money for instruction of core subjects are familiar feelings to school leaders. Granted, school districts do not see improvement of student health as a primary goal. Most school personnel are trained on methodologies and theories that help achieve educational objectives directly.

Justifiably few receive training on how to indirectly improve achievement through work on health issues (such as dealing with student sleep patterns, immunization rates or compliance with doctor's prescribed therapies). As such, health program administration in a medical facility may always be a more comfortable fir than it is in a school district.

Basic Guidelines

Nevertheless, implementing health policy and administering health programs in schools stand a better chance of being relatively undemanding and effective if a few basic guidelines are followed. As a pediatrician who has worked with several school districts, I can attest to several common, avoidable pitfalls that complicate school leaders' tasks. Here are some suggestions:

* Tap underutilized community resources.

Hospitals, managed care plans, medical schools and physician groups are just as interested as you are in preventing student health problems. One school district asked such partners to provide each school site with free asthma management equipment. One HMO paid a school district each time a school-age member of their health plan received health education at school--something the school was doing anyhow.

Refer students with behavior problems early on to their doctors. Be sure doctors receive schools' written descriptions of the aberrant behavior. You benefit with a better performing student and lower suspension and expulsion rates. And because children with behavioral problems overuse health resources, the health system and the students benefit too.

* Don't isolate health issues into separate silos.

Funding for health programs is often disease-specific or issue-specific. For example, funding may be designated solely for school-based prevention of drug abuse or for management of attention deficit disorder. But issue-specific funding is often short-lived and then is replaced by funding for the latest hot topics, such as school violence or childhood obesity.

School staff should not be wasting time building issue-specific infrastructure only to let it whittle away while they turn to build another equally temporary program. To avoid this, apply policies and practices you develop for one funded health program to all similar health issues. For example, if you are setting up a physician referral system for students with asthma who are frequently absent, then apply that system for students frequently absent for any reason.

Another example: Because youth violence, drug abuse, teen-age pregnancy and other risk-taking behaviors share similar antecedents, school leaders could redirect funds from a program serving one health problem to strategies that address factors relating to all of them, such as a history of abuse or disengagement from school.

* Get the health expertise you need.

Include a school nurse in the district's inner administrative circle to help direct limited health education and program funds to the most cost-effective programs.

You don't want to be taken for a ride by unchallenged health information. On individual education plans and Section 504 plans, districts unwittingly overspend on health-related services prescribed by students' doctors (such as special transportation or 1:1 nursing ratio). A school nurse (or a school doctor on a voluntary, contracted or hourly arrangement) should interact directly with students' physicians to establish the best way for schools to meet a special health care need.

Resist the temptation to replace school nurses with health aides. The latter play an essential role in the functioning of a school health program, but only school nurses are trained to converse easily with doctors of ill-faring students and educate students and parents on health problems.

It's no more expensive to purchase and promote health education curricula that actually change student behaviors than unproven programs. Use health educators, resources from the Centers for Disease Control and local university experts to scrutinize the literature and identify curricula that change student behaviors.

Ask Hard Questions

* Screen your school health requests carefully.

Aside from mandated vision and hearing screens, schools often are recruited to host other health screenings, such as cholesterol levels, drug testing of athletes and undiagnosed asthma and obesity.

Ask these hard questions before committing to host a screening program: Has the screen been proven to identify students likely to have future problems and to clear those who will nor? Have schools been proven to be more cost-effective places to perform these screens versus a doctor's office? Are resources in place to assist all students who "fail" the screen, regardless of health insurance status or parent income? Is the financial interest of a proprietary firm behind the screen's promotion? Will the screen's results help you educate students? Are school staff using precious time to elicit parent permission, explain the screen, make the referrals and assure follow up?

Enlist a local public health official to help answer some questions. You may find that cholesterol screening is not recommended for all children. Efficacy of vision therapy is highly controversial. And drug testing excludes alcohol (the most widely abused drug and contributor to sports injury). No research yet demonstrates that school- or grade-wide screening for asthma or obesity improves these children's eventual outcome.

When you receive requests to advertise a community-based health program in your newsletters or when asked to help celebrate "National Disease 'X' Month," ask a health professional on your staff to determine whether this cause fits into your school health priorities. If it does, study how it can be linked specifically to activities that already exist. Finally, turn the tables around and inform those who have made this request on how modifying their services would better fit your schools' needs. This is what the Centers for Disease Control promotes as "coordinated" school health programs.

* Be proactive by developing your own health objectives.

Determine what health problems are most important to your school district. Is it excessive absenteeism for illness? Behavioral problems disrupting the classroom? Overspending on special health procedures? Outdated health policies and procedures? A districtwide health council that includes community representatives, teaching staff and health staff can effectively identify priorities.

Howard Taras, a pediatrician, is a professor of community pediatrics at University of California at San Diego, 2251 San Diego Ave., San Diego, CA 92093. E-mail: [e-mail]

Healthy Schools Summit

The Healthy Schools Summit, a national meeting of education and health leaders last fall, has led to the launching of a new nationwide initiative to combat the deterioration of child health. More than 30 organizations, including AASA, are involved.

Action for Healthy Kids Teams now have formed in nearly every state, and school leaders at the local level are encouraged to join. To learn about state teams, visit www.actionforhealthykids.org/press/index.htm.

The Action for Healthy Kids teams are responsible for supporting good nutrition and physical activity as part of a total learning environment in public schools.

Pat Cooper is superintendent of the McComb Separate School District, P.O. Box 868, McComb, MS 39649. E-mail: [e-mail]. He formerly directed the Centers for Disease Control's National School Health Education Coalition.