a history of school health program evaluation in the united states

7
A History of School Health Program Evaluation in the United States R. Morgan Pigg, HSD R. Morgan Pigg, Jr., H.S.D.; Assistant Professor of Health Education; Department of Health and Safety; University of Georgia; Athens, GA 30602. During the 19th century, no organized school health education program existed in American schools, but the foundations upon which the areas of health services, healthful living, and health in- struction were to be laid were clearly present. Since no organized school health program existed, formal procedures to evaluate such programs received min- imum attention prior to 1900. The advent of the 20th century brought changes which were to provide the impetus for the development of a distinct school health program and for procedures intended to assess the efficiency of such programs. Anderson’ (p8) suggests health education and physical education were considered synonymous un- til 1910 when the American Physical Education Association recognized a distinction between the two fields by utilizing “School Hygiene and Physi- cal Education” as the theme for the 17th annual meeting. As the school health program developed, efforts to formally assess the effectiveness of var- ious aspects of the program through evaluation be- came increasingly prevalent. School Health Services In 1923, the American Child Health Association initiated a survey to determine what organized activities were being conducted by public and pri- vate agencies to improve the health of the school child. The results of the survey were published in 1925 as A Health Survey of 86 Cities2 The survey was significant in that the researchers realized a knowledge of child health practices as such was of limited value. As a result, a second study involving 70 cities was initiated in 1925 to provide data for use by administrators in the evaluation of local school health activities. The results of the second study were published as five School Health Research Monographs from 1929 to 1932: (pviii) One of the earliest intensive evaluations of a local school health services program was the Astoria Demonstration Study which was conducted from July, 1936 to June, 1940 under the direction of Dr. Dorothy B. Nyswander. Based on the findings of the previous American Child Health Association studies, the study was conducted to determine the effectiveness of the school health service program of the Astoria Health District of New York City. In essence, the study accomplished its main goal, pro- viding better health services for the school child.3 By the late 1940s, efforts to evaluate the effective- ness of school health programs had been refined, and various organizations and agencies were actively involved in establishing evaluative criteria for school health service programs. In 1947 the Michigan School Health Association in cooperation with the American School Health Association prepared a checklist to be used by school administrators and health officials in the evaluation of school health service programs. The checklist gave attention to the administrative aspects of school health services and included a section on school sanitation which health educators would eventually place under the area of the Healthful School Environment.’ The decade of the 1950s continued to reflect an increased sophistication in evaluation of school health services. A number of studies were conduct- ed to evaluate the role of school health services and health service personnel. In 1952, Weatherbe’ pro- duced a Check List for School Health Services, and in 1953, the American Public Health Association Committee on Professional Education released “A Proposed Report on the Educational Qualifications of School Physicians.”6 Shortly thereafter, Bland’ and Netche? focused attention on the evaluation of the school nurse in studies involving school nurses in Indiana. Poe and Irwin9 continued the emphasis on the school nurse by publishing an article in 1959 which delineated the functions of a school nurse. Of particular importance at this time was the work of the Committee on School Nurse Policies and Prac- tices of the American School Health Association. THE JOURNAL OF SCHOOL HEALTH 583

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A History of School Health Program Evaluation in the United States

R. Morgan Pigg, HSD

R. Morgan Pigg, Jr., H.S.D.; Assistant Professor of Health Education; Department of Health and Safety; University of Georgia; Athens, G A 30602.

During the 19th century, no organized school health education program existed in American schools, but the foundations upon which the areas of health services, healthful living, and health in- struction were to be laid were clearly present. Since no organized school health program existed, formal procedures to evaluate such programs received min- imum attention prior to 1900. The advent of the 20th century brought changes which were to provide the impetus for the development of a distinct school health program and for procedures intended to assess the efficiency of such programs.

Anderson’ (p8) suggests health education and physical education were considered synonymous un- til 1910 when the American Physical Education Association recognized a distinction between the two fields by utilizing “School Hygiene and Physi- cal Education” as the theme for the 17th annual meeting. As the school health program developed, efforts to formally assess the effectiveness of var- ious aspects of the program through evaluation be- came increasingly prevalent.

School Health Services In 1923, the American Child Health Association

initiated a survey to determine what organized activities were being conducted by public and pri- vate agencies to improve the health of the school child. The results of the survey were published in 1925 as A Health Survey of 86 Cities2 The survey was significant in that the researchers realized a knowledge of child health practices as such was of limited value. As a result, a second study involving 70 cities was initiated in 1925 to provide data for use by administrators in the evaluation of local school health activities. The results of the second study were published as five School Health Research Monographs from 1929 to 1932: (pviii)

One of the earliest intensive evaluations of a local school health services program was the Astoria Demonstration Study which was conducted from July, 1936 to June, 1940 under the direction of Dr. Dorothy B. Nyswander. Based on the findings of the previous American Child Health Association studies, the study was conducted to determine the effectiveness of the school health service program of the Astoria Health District of New York City. In essence, the study accomplished its main goal, pro- viding better health services for the school child.3

By the late 1940s, efforts to evaluate the effective- ness of school health programs had been refined, and various organizations and agencies were actively involved in establishing evaluative criteria for school health service programs. In 1947 the Michigan School Health Association in cooperation with the American School Health Association prepared a checklist to be used by school administrators and health officials in the evaluation of school health service programs. The checklist gave attention to the administrative aspects of school health services and included a section on school sanitation which health educators would eventually place under the area of the Healthful School Environment.’

The decade of the 1950s continued to reflect an increased sophistication in evaluation of school health services. A number of studies were conduct- ed to evaluate the role of school health services and health service personnel. In 1952, Weatherbe’ pro- duced a Check List for School Health Services, and in 1953, the American Public Health Association Committee on Professional Education released “A Proposed Report on the Educational Qualifications of School Physicians.”6 Shortly thereafter, Bland’ and Netche? focused attention on the evaluation of the school nurse in studies involving school nurses in Indiana. Poe and Irwin9 continued the emphasis on the school nurse by publishing an article in 1959 which delineated the functions of a school nurse.

Of particular importance at this time was the work of the Committee on School Nurse Policies and Prac- tices of the American School Health Association.

THE JOURNAL OF SCHOOL HEALTH 583

Begun in 1952 under the direction of Miss Eunice Lamona and continued under the direction of Miss Lyda Smiley, the Committee published in 1956 a paper entitled “Recommended Policies and Practices for School Nursing”lo which has served as the basis for a number of revisions.

In keeping with the mood and momentum of the preceding decade, the 1960s reflected a growing movement toward an expanded and defined school health service program. Studies by Watters” and Trausneck’l reflected the direction of the 1960s in that the studies produced extensive, definitive stand- ards in the form of evaluation instruments to be used in assessing school health services.

Studies conducted in the early 1960s by Bonvec- hi^,'^ the American Nurses’ Association,” and the National League for Nursing” expanded efforts be- gun in the 1950s to more clearly define and evaluate the role of the school nurse and the school physician in the school health service program. In addition, specialized evaluative criteria such as Kilander’s “Checklist for the Emergency Care Program in Schools”’6 (pp510-513) were continually being de- veloped to accommodate the expanded scope of school health services.

The decade of the 1970s appears to be develop- ing as a period of consolidation and synthesis in the evaluation of school health services. Research activ- ities, such as the study conducted by Baker,17 seem to be concentrating on the implementation of evalu- ative procedure developed during the 1960s. A re- view of existing information suggests evaluative research in school health services has tended to vacillate between generation and synthesis of data. For this reason, it seems reasonable to anticipate new evaluative research in school health services will be forthcoming during the 1970s. I t is encourag- ing to note certain accrediting organizations now routinely include evaluation of school health services within the accreditation process. The Commission on Secondary Schools of the North Central Associa tion’* has evaluative criteria for health services in the secondary school, while the National Study of School Evaluation has produced evaluative criteria for health services at the elementary,’9 junior high/ middle school,?0 and secondary school2’ levels. Such actions are merely another indication of the accept- ance of the importance of school health services.

The Healthful School Environment There is no lack of quantitative, evaluative data

relating to the school environment. In fact, the vol- ume of material from the late 1800s and early 1900s

relating to the school environment makes it impracti- cal to attempt a detailed report on the period. When one reviews the material from the preceding ?nod collectively, it becomes apparent evaluators of the period were primarily concerned with a quantita- tive assessment of the physical characteristics of the school environment. Numerous score cards, check lists, and reports were produced which dealt with such matters as heating, ventilation, seating, fire safety, water supply, plumbing facilities, light- ing, building structure, and the school site.

Any report of efforts to evaluate the school en- vironment would be incomplete without some men- tion of the work of N.L. Engelhardt and G.D. Stray- er of Columbia University Teachers College. During the early 19009, both individually and as a team, Engelhardt and Strayer were amazingly prolific in the quantity of evaluative standards they produced concerning various aspects of the school plant. Standards were established for rural school build- ings,22 city school b~ildings?~n~‘ elementary school building^?^ and high school buildings?6 In addition, evaluative materials were prepared concerning the planning of school building programs27 and admin- istrative policies and programs concerning the school plant.2* Utilizing the preceding materials, Engel- hardt and Strayer evaluated scores of school plants in cities throughout the country.

During the 1930s and early 1940s, evaluation of the school environment continued to be quantita- tive in nature. Researchers such as Holy and Ar- nold29’30 continued to produce materials to be used in the quantitative evaluation of school facilities. By the late 1940s the school health program was emerging as a separate field, and health educators began to review the relationship between the school environment and the concept of a total school health program. In 1949, the Subcommittee on School En- vironment of the California State Joint Committee on School Health produced an extensive “Checklist for Healthful and Safe School E n ~ i r o n m e n t ” ~ ’ which reflected the emerging concept of the school environment as a specialized area with unique po- tential for contributing to the total health of the school child.

The movement toward a philosophical revision of the role of the school environment in the total school health program continued to gain momentum during the 19509, and professional preparation in- stitutions became involved in determining standards to be used in evaluating the school environment. During this period, the role of safety and safety edu- cation in relation to the total school health program received particular attention. In 1953, the National

584 DECEMBER 1976 VOLUME XLVl NO. 10

Commission on Safety Education of the National Education Association prepared a comprehensive 325 item checklist to be used in evaluating the status of school safety and safety e d ~ c a t i o n . ~ ~ Shortly thereafter, Anderson ’ (pp445-447) produced a “Sur- vey of Healthful School Living” which included a categorized listing of over 100 questions dealing specifically with the school environment.

By the early 1960s, the philosophical foundation underlying the role of the school environment in re- lation to the total health education of the child had assumed a certain degree of substance. In addition to dealing with environmental and structural fac- tors, evaluators began to direct attention toward the specialized aspects of the school environment. The evaluation of safety and safety education pro- grams, present in the preceding decade, was encour- aged by the development of additional evaluation instruments.’6 (pp222-223)

In addition to programs in safety and safety edu- cation, evaluators were involved in determining standards for the school food service program. In 1963, Simon3‘ produced a comprehensive 21 page evaluation instrument to be used in determining the efficiency of school food service programs. In School Health Administration published in 1964, Dr. Oliver B ~ r d ~ ~ i n c l u d e d a chapter on school lunch- room sanitation. Within the chapter was included “An Administrative Check List for Evaluation of School Lunchroom Sanitation” composed of 50 ques- tions to be answered by the evaluator.

By the early 1970s, evaluation of the school en- vironment had undergone considerable revisions from the procedures employed during the early 1900s. Though consideration continued to be given to evaluating the environmental and structural aspects of the school plant, the concept of the health- ful and safe school environment had been expanded to include evaluation of such factors as health pro- grams and personnel programs for school faculty members, the effect of the schedule of the school day on the mental health of the child, and the emo- tional climate of the classroom: In 1971, A d c o ~ k ~ ~ produced a comprehensive, valid, and reliable eval- uation instrument which reflected the expanded con- cept of the school environment by giving attention to the areas previously cited.

Though contemporary efforts to evaluate the school environment have achieved a certain degree of sophistication, evaluators and health educators in general seem to remain somewhat undecided as to the ultimate role of the school environment in relation to the total school health program. Though the school environment is suggested as an excellent

source for reinforcement of the principles present- ed in health instruction classes, a universal model for such a procedure has not been forthcoming. Since the educational aspects of the school en- vironment have not been fully utilized, evaluators have not incorporated the assessment of the ef- fectiveness of such efforts into the evaluation of the school environment. With the proliferation of research activities in school health education, the prospect for future evaluative research in the pre- ceding area seems encouraging.

Health Instruction Since 1843 when Horace Mann advocated phys-

iology and hygiene be included in the c u r r i c ~ l u m ~ ~ health educators have attempted to assess the re- sults of health instruction through the use of health knowledge tests. However, due to the relatively re- cent development of the concept of health instruc- tion as a multifaceted aspect of the total school health program, efforts to evaluate health instruc- tion as an area have been modified in comparison to earlier efforts.

Though the idea of a school health program was merely in the developmental stage in the early 19OOs, health educators of the period believed school chil- dren could benefit from a planned program of health instruction. As a result, a number of demonstration studies were conducted to evaluate the impact of quality health instruction on school children. Demon- stration studies were conducted in Baltimore, Mary- land in 1914; in Malden, Massachusetts in 1922; in Mansfield and Richland counties of Ohio from 1922- 1925; in Fargo, North Dakota from 1923-1927;’ (pp8-10) and in other localities around the country.

The results of the demonstration studies sup- ported the contention that the level of health knowl- edge of school children could be improved through a planned health instruction program. Not only did the level of student health knowledge increase, but improvements in health practices and in general levels of health were observed among the students. In addition to aiding the children, teachers, and localities involved in the studies; a mass of data concerning health content and methodology was generated which had the potential for national ap- plication.

Based on the demonstration studies and other evaluative efforts of the early 19OOs, recent activ- ities have been concerned with either ( 1) evaluating the effectiveness of health instruction by assessing the level of health education of public school stu- dents, or ( 2 ) developing instruments or criteria by which the health instruction program may be eval-

THE JOURNAL OF SCHOOL HEALTH 585

uated as one area of the total school health program. Perhaps no other evaluative effort in recent years

had more influence on health instruction than did the School Health Education S t ~ d y ~ ~ c o n d u c t e d dur- ing the early 1960s. This wide-ranging study in- volved a number of private, official, and voluntary organizations. Data were collected from students, teachers, and administrators from 38 states to eval- uate the health practices of s tudents and to de- termine the quality of health education programs in American schools. Though a wealth of useful infor- mation was collected from the School Health Edu- cation Study, a major contribution of the evaluation was to create a national awareness of school health education. Following the study, a number of state and local educational agencies initiated programs and legislation to provide health education in the schools.

In addition to the School Health Education Study, other efforts to evaluate health instruction were con- ducted during the decade of the 1960s. In 1967, the Connecticut State Board of Education initiated a study to determine the health interests and concerns of students in grades K through 12. Released in 1969 under the title of Teach U s What We Want To

the study quantified in detail those health areas which were of interest or concern to students of various ages. Due to its thoroughness and rele vancy, the study continues to influence curriculum planning in school health education.

Besides conducting studies involving public school students, researchers engaged in the devel- opment of criteria which could be utilized to exten- sively evaluate the health instruction program as one area of the school health program. In the 1960s Wilson,’O Kilander,’6 (pp514-517) and Finnegan” prepared evaluation instruments of this nature which could be used in the evaluation of the health instruc- tion program. The instruments included criteria for evaluating the personal and .professional qualifica- tions of the school health educator, the school health curriculum, facilities for health instruction, methods of reporting pupil progress, and other areas. In 1971, Huntsinger4’ evaluated health instruction programs in Tennessee, and Carpenter4’ developed a detailed instrument for evaluating high school health in- struction programs which included and expanded upon the areas previously mentioned.

Clearly, evaluation of health instruction has in- cluded two distinct aspects. In one sense the eval- uation of health instruction has involved the de- termination of the level of health education of the student. In another sense, evaluation has involved the assessment of the health instruction program as

one area of the total school health program. Both approaches are acceptable and useful. In situations where evaluators are concerned with a complete evaluation of health instruction, both approaches can be employed by utilizing a general health in- struction program evaluation instrument in combina- tion with an acceptable health knowledge test, atti- tude scale, or practice inventory.

Total School Health Program Nowhere is the parallel between the development

of the total school health program and the develop- ment of efforts to evaluate the program more appar- ent than in those activities designed to evaluate all areas of the school health program collectively. Generally, efforts to evaluate the total school health program have been undertaken either by individuals or by committees of specialists in health education.

and Phelan45 produced instruments and standards designed to evaluate the total program, and during the 1940s various educa- tional agencies became involved in the evaluation process. In 1947, the Michigan Superintendent of Public Instruction prepared a check list to be uti- lized in the evaluation of secondary school health programs.46 Two years later, the Child Welfare Di- vision of the New York City Board of Education re- ported the results of an Evaluative Study of Health Education in the Public Schools of the City of New York. The extensive evaluation involved the total school health program and included analysis of the health education curriculum, facilities for the health program, qualifications of health personnel, and other areas.4 ’

Efforts to evaluate the total program displayed a marked increase during the 1950s. Both individuals and committees of health education specialists were active in either evaluating specific programs or in generating criteria-based instruments which could be utilized in evaluating specific programs. During this decade, Texas,’8 I l l i n ~ i s ? ~ Arkansas?O Ohio,” and California” were among those states that pro- duced or revised evaluation instruments to be uti- lized in determining the status of the school health programs within the respective states. In addition to state agencies, local organizations such as the Tulare County (California) School Health Advisory Board5’ produced criteria to be utilized in evaluating specific programs.

In a detailed s tudy entitled Evaluat ion of the Health Program in the Los Angeles City Schools ( 1954-1961 1, considerable attention was directed toward evaluating the areas of health services, the healthful environment, health instruction, and health

As early as 1934,

586 DECEMBER 1976 VOLUME XLVl NO. 10

coordination. Forty-one appraisal studies were con- ducted in the preceding four areas of the elementary, junior high, senior high, and junior college health programs in the h s Angeles area.”

In 1955, efforts were undertaken to initiate what was to become the Brookline (Massachusetts) School Health Study. Originally, school ruld public health personnel were concerned with reorganization of the school health service program in the Brookline schools. At the recommendation of the Superintend- ent of Schools, the study was expanded to include the total school health program for the purpose of collecting information about all aspects of the school health

During the 19608, health educators at various professional preparation institutions became in- volved in the construction of criteria-based instru- ments which could be universally applied in evalu- ating school health programs. In 1952, the State Uni- versity of New York at Albany prepared an “Eval- uation of School Health E d ~ c a t i o n . ” ~ ~ In 1959, Ore- gon State University produced a “School Health Program Evaluation S ~ a l e ” ~ ~ i n the form of a score card which assigned a total point value to each area of the program and specific point values to the in- dividual items comprising the area. During this period, Rash5* produced a work entitled Tentative Standards for School Health Surveys which pro- vided criteria for use in accomplishing a detailed evaluation of the total program. Following a series of subsequent revisions, the original work served as the basis for a 1973 instrument entitled School Health Program Evaluation 59 which includes pro- gram standards in score card form which can be used to evaluate the total school health program.

The 1960s witnessed a continuation of the growth experienced in the preceding decade. Individual r e searchers, such as Bryan?’ Granell:’ and Gentry62 continued to produce evaluation instruments which could be used in a variety of situations, and state departments of education displayed a continuing interest in producing criteria-based materials for use in evaluating and improving the school health programs within the state.

The California State Department of Education produced detailed instruments for use in evaluating elementary school health programsa and high school health programs.’” Both instruments employed a rating system which allowed the evaluator to indi- cate the degree to which the program conformed to the criteria which comprised the instrument. Based on the results of the evaluation, suggestions could be made for improving the program where deficien- cies were noted. In addition to individual evaluators

and state departments of education, professional organizations such as the Michigan School Health As~ocia t ion~~ and the Ohio Association for Health, Physical Education, and Recreation& produced in- struments to be used in evaluating health programs within the state.

Many of the evaluative efforts of the 1970s are a reflection of activities initiated in the preceding two decades. However, agencies such as the Illinois Superintendent of Public I n ~ t r u c t i o n ~ ~ continue to produce or revise evaluative criteria for state school health programs. In 1974, a comprehensive study entitled School Health Program which sought to synthesize and revalidate a maximum number of school health program evaluative criteria generated during the 20th century was completed. A total of 3,384 distinct guidelines was identified for use in establishing or improving school health programs.

Progress toward the acceptance of the school health program as a distinct entity is reflected in the desire of contemporary accrediting associations, such as the National Study of School Evaluation,?’ to evaluate health education as a separate program. The 1950s and 1960s were so active in generating evaluative materials for the total school health pro- gram that the direction for the 1970s remains un- clear. Perhaps the forthcoming period will serve as a time when health education practitioners can syn- thesize and utilize the work of the preceding two decades to improve existing programs.

Conclusion The increasing sophistication of school health

program evaluation procedures tended to parallel or reflect the development and maturation of the total school health program. I t might be said that evaluation in all areas of the program increasingly reflected the concept of total health as opposed to the earlier concept of health as a physical entity.

Beginning in 1950, specific attention was directed toward developing comprehensive evaluation pro- cedures for virtually every aspect of the total school health program. Since 1950, program evaluation has become a refined procedure reflecting the emerging autonomy of the school health program as a distinct area. The collective evaluation of health education and physical education programs is illustrative of the change in emphasis occumng since 1960. In 1940, D e a r b ~ r n ~ ~ produced a check list for evaluating secondary school health and physical education programs. During the 195Os, other evaluation in- s t r u m e n t ~ , ~ ~ ‘ ” including the La P ~ r t e ~ ~ s c o r e cards, were prepared which evaluated health education as

THE JOURNAL OF SCHOOL HEALTH 587

an aspect of the total physical education program. However, it is interesting to note since the 1950s efforts to jointly evaluate health education and physical education have not only subsided, but a situation now exists where a number of evaluation instruments evaluate physical education as a sub-

area under the area of the Healthful School Environ- ment. Such a diametric change not only illustrates a changing emphasis in evaluation procedures, but it reflects a growing autonomy for the school health movement.

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tion. Indiana University, Bloomington. 1974. 69. Dearborn TH: A Check List for the Survey of Health and

Physical Education Programs in Secondary Schools. Stanford University Press, 1940. 70. Criteria for Evaluating Junior High Schools: Health, Phys-

ical and Safety Education, Texas Junior High School Criteria Studv. 1956. 71. Nirril HR: A Score Card for Evaluating Canadian High

School Health and Physical Education Progmms, dissertation. Indiana University, Bloomington, 1959. 72. LaPorte WR: Health and Physical Education Score Card

Los Angeles. Parker & Co. 1961.

The author of this article is R. Morgan Pigg, Jr, HSD, Assistant Professor, Department of Health and Safety, The University of Georgia, Athens, G A 30602.

Call for Resolutions Annually the American School Health Association addresses itself to sig-

nificant problems in the field of child health and school health education. The full span of the discussion on many of these problems is made known through a series of Resolutions passed by the Governing Council.

The membership is invited to suggest problems which might serve as the basis for action of this sort. Such suggestions should be transmitted to the Chairman of the Resolutions Committee, American School Health Association, Kent, OH 44240.

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