Antony Card, Ed.D., Associate Director, Antony Card, Ed.D., Associate Director,

School of Human Kinetics and Recreation School of Human Kinetics and Recreation

Memorial University of NewfoundlandMemorial University of Newfoundland

1-709-737-8667 antonyc@mun.ca1-709-737-8667 antonyc@mun.ca

School Health Coordinators in Newfoundland & Labrador:

Initial Reflections

SHPLCs StudySHPLCs Study

The aim of this study is to assess the The aim of this study is to assess the effects of introducing school / community effects of introducing school / community health coordinators, to facilitate education-health coordinators, to facilitate education-health cooperation in promoting the health health cooperation in promoting the health of children and learning at the school of children and learning at the school board/health authority/community level. board/health authority/community level.

Other ResearchOther Research

Warwick et al. (2004), have provided an extensive Warwick et al. (2004), have provided an extensive evaluation of school health coordinators in England. evaluation of school health coordinators in England. The results were promising and funding has continued The results were promising and funding has continued as part of the National Health Service (NHS) reforms. as part of the National Health Service (NHS) reforms. The coordinators:The coordinators: Develop support networksDevelop support networks Share best practiceShare best practice Contribute to school accreditationContribute to school accreditation Develop local and strategic linksDevelop local and strategic links Provide a ‘coherent and coordinated’ to student well-Provide a ‘coherent and coordinated’ to student well-

being being

BackgroundBackground

What lead to the positions?What lead to the positions?

Provincial Wellness Council establishedProvincial Wellness Council established Other initiatives underway – SFG’s, Smoke Free Other initiatives underway – SFG’s, Smoke Free

Grounds, Physical Education funding, Active Grounds, Physical Education funding, Active Schools. Schools.

Provincial Healthy Schools Summit was held and Provincial Healthy Schools Summit was held and from this Healthy Students Healthy Schools was from this Healthy Students Healthy Schools was created and the SHPLCs were hired.created and the SHPLCs were hired.

Health Students Healthy Schools (HSHS) Health Students Healthy Schools (HSHS) Initiative:Initiative:

* joint initiative of the Department of Health * joint initiative of the Department of Health and Community Services and Education.and Community Services and Education.

- supports positive changes to school aged - supports positive changes to school aged children children

- creates school environments that support - creates school environments that support healthy living for childrenhealthy living for children

- the SHPLCs are one key element of the HSHS - the SHPLCs are one key element of the HSHS initiative.initiative. www.livinghealthyschool

s.com

The SHPLCsThe SHPLCs

BackgroundBackground

The SHPLCs work out of the school board The SHPLCs work out of the school board but are on the regional health payroll.but are on the regional health payroll.

Consultants report to both Education and Consultants report to both Education and Health.Health.

First position began November 2005.First position began November 2005.

BackgroundBackground

Funding for the positions is provided by Funding for the positions is provided by both the Department of Health and both the Department of Health and Community Services (and regional health Community Services (and regional health authorities) and the Department of authorities) and the Department of Education (and school boards).Education (and school boards). *salary-*salary- regional health authorities regional health authorities **traveltravel- department of education- department of education **office space & supplies-office space & supplies- school boards school boards **provincial meetings-provincial meetings- department of education department of education

MethodologyMethodology

The research design involves two phases: The research design involves two phases:

The first involves an analysis of the The first involves an analysis of the documents pertaining to the role of the documents pertaining to the role of the SHPLC’s. SHPLC’s.

The second phase involves a process of The second phase involves a process of semi-structured interviews and focus semi-structured interviews and focus groups with key informants. groups with key informants.

MethodologyMethodology

Documents reviewed: Documents reviewed: minutes from meetingsminutes from meetings annual workplansannual workplans results from surveysresults from surveys district improvement plansdistrict improvement plans reports prepared by the SHPLC’sreports prepared by the SHPLC’s results of evaluations on the results of evaluations on the

programs/activities conducted by the programs/activities conducted by the SHPLC’sSHPLC’s

costs associated with the positions, costs associated with the positions, newsletters, and feedback from newsletters, and feedback from teachers/principal’s.teachers/principal’s.

InterviewsInterviews Interviews (n=40) were conducted with Interviews (n=40) were conducted with

the following people from each district the following people from each district level:level:

SHPLCSHPLC Parent & child health coordinatorParent & child health coordinator PrincipalsPrincipals Program specialist responsible for the SHPLCProgram specialist responsible for the SHPLC Regional nutritionistRegional nutritionist Assistant director of programs (school board)Assistant director of programs (school board) Director of wellness and health promotion. Director of wellness and health promotion.

FindingsFindings

Emerging Themes:Emerging Themes:

Positions viewed as helpfulPositions viewed as helpful Effective ChangesEffective Changes Barriers/ChallengesBarriers/Challenges Evaluation of the positionsEvaluation of the positions Response from parentsResponse from parents Response from studentsResponse from students Ideas for the futureIdeas for the future

Findings - Are the positions helpful?Findings - Are the positions helpful?

Yes, definitely!Yes, definitely!

““We have seen massive gains in that area and normally it We have seen massive gains in that area and normally it takes a long time for change to occur so I don’t credit all takes a long time for change to occur so I don’t credit all the success just because we had health consultants, like I the success just because we had health consultants, like I said the ducks were all sort of in line for a positive change said the ducks were all sort of in line for a positive change to happen, but with that being said without those people to happen, but with that being said without those people focused to drive to continue the messages to continue to focused to drive to continue the messages to continue to come up with things we wouldn’t be nearly as along as we come up with things we wouldn’t be nearly as along as we are and we still have a long ways to go” (school board are and we still have a long ways to go” (school board official)official)

Yes, as a championYes, as a champion - Positions viewed as a needed champion for school health.- Positions viewed as a needed champion for school health.

Findings - Are these positions helpful?Findings - Are these positions helpful?

Yes, positive short term effectYes, positive short term effect

““Yes I believe they’re already having a difference, Yes I believe they’re already having a difference, but having said that, you cannot fix the problems but having said that, you cannot fix the problems associated with childhood obesity, and the problems associated with childhood obesity, and the problems associated with the lack of physical activity and all of associated with the lack of physical activity and all of those areas in a day or a month or a year” those areas in a day or a month or a year” (government official)(government official)

Too early to tellToo early to tell““That’s a good question, I mean, I don’t know, time That’s a good question, I mean, I don’t know, time will tell, I think it’s probably too early to tell yet”will tell, I think it’s probably too early to tell yet”

Findings- Effective ChangesFindings- Effective Changes

Communication between Health & EducationCommunication between Health & Education Most referenced when asked about effective Most referenced when asked about effective

changeschanges

““We don’t do a good job with communication, We don’t do a good job with communication, sometimes we tend to be doing our own thing and sometimes we tend to be doing our own thing and they are doing their own thing and if you find a they are doing their own thing and if you find a person that can go across both organizations or person that can go across both organizations or three or four organizations and being able to do that three or four organizations and being able to do that very successfully then that’s a big strength of the very successfully then that’s a big strength of the position.” (school board official).position.” (school board official).

Findings - Effective ChangesFindings - Effective Changes

Implementation of Provincial School Food Implementation of Provincial School Food GuidelinesGuidelines School Caterers’ In-ServicesSchool Caterers’ In-Services Student Poster ContestStudent Poster Contest New Cafeteria EquipmentNew Cafeteria Equipment

““In the last provincial budget there was $800,000 In the last provincial budget there was $800,000 targeted towards that so (the SHPLC) has met with the targeted towards that so (the SHPLC) has met with the caterers and talked to them about their needs and talked caterers and talked to them about their needs and talked to the principals about that and certainly (the SHPLC) to the principals about that and certainly (the SHPLC) knows where our greatest priorities are.” (health official)knows where our greatest priorities are.” (health official)

Active SchoolsActive Schools Smoke-Free School GroundsSmoke-Free School Grounds

Findings - Effective ChangesFindings - Effective Changes

Funding OpportunitiesFunding Opportunities

Living Healthy TeamsLiving Healthy Teams

““We’ve set up a healthy living team… which are We’ve set up a healthy living team… which are

very active in the school in terms of creating very active in the school in terms of creating

more of an awareness of healthy living, healthy more of an awareness of healthy living, healthy

eating and active living”. (principal)eating and active living”. (principal)

Teacher In-ServicesTeacher In-Services

Principals’ MeetingsPrincipals’ Meetings

Findings - Effective ChangesFindings - Effective Changes

Living Healthy CommotionsLiving Healthy Commotions

Findings – Barriers/ChallengesFindings – Barriers/Challenges

Geographical distanceGeographical distance

““I think I referred to the challenges for them is I think I referred to the challenges for them is going to be geography, its going to be size, the going to be geography, its going to be size, the number of schools you can get to the number of number of schools you can get to the number of teachers you can contact relationships you can teachers you can contact relationships you can build with people, the support you can provide to build with people, the support you can provide to teachers”. (school board official)teachers”. (school board official)

Status (non permanent).Status (non permanent). - - Commented on most when asked about Commented on most when asked about

barriers and challenges.barriers and challenges. More information/education for parents & More information/education for parents &

guardians guardians Children/youth bringing drugs into the Children/youth bringing drugs into the

schools or using drugs on school schools or using drugs on school property.property.

Findings - Barriers/ChangesFindings - Barriers/Changes

Culture changeCulture change Understanding the difference in Understanding the difference in

roles/positions. roles/positions. Some children still leaving school property to Some children still leaving school property to

purchase foodpurchase food““A lot of people go to the store and they (the stores) A lot of people go to the store and they (the stores) do really well but we’re (the school cafeteria) okay” do really well but we’re (the school cafeteria) okay” (principal)(principal)

Parents bringing in foods to students that do Parents bringing in foods to students that do not meet the School Food Guidelines (SFG’s).not meet the School Food Guidelines (SFG’s).““But we really do need to do a lot more, and that’s But we really do need to do a lot more, and that’s something that we’ve been talking about over the past something that we’ve been talking about over the past year, how do we get parents more involved, and that’s year, how do we get parents more involved, and that’s why we’re not, like the full implementation is the full why we’re not, like the full implementation is the full two years, cause we know we have all these different two years, cause we know we have all these different pieces we have to look at.” (health official)pieces we have to look at.” (health official)

Findings - Barriers/ChallengesFindings - Barriers/Challenges

Communication Communication

FundingFunding

More consultants neededMore consultants needed

““The challenges to the successes right now in our The challenges to the successes right now in our district (are associated with) the time for one district (are associated with) the time for one person to attack this issue” (school board official)person to attack this issue” (school board official)

Findings - Barriers/ChallengesFindings - Barriers/Challenges

Teachers not complying with School Food Teachers not complying with School Food GuidelinesGuidelines

Time constraintsTime constraints““Um, I guess one would be with all our positions Um, I guess one would be with all our positions is just the time restraints” (health official)is just the time restraints” (health official)

Rural vs UrbanRural vs Urban

Findings - Evaluation of PositionsFindings - Evaluation of Positions

Consultant BackgroundsConsultant Backgrounds- - Teacher, principal, dietician, social worker. Teacher, principal, dietician, social worker.

CommunicationCommunication““And I think the other thing that’s really helped And I think the other thing that’s really helped with the success is what they’ve learned from with the success is what they’ve learned from each other, what we’ve all learned from each each other, what we’ve all learned from each other, the building on ideas, and all the sharing, other, the building on ideas, and all the sharing, the development of policies, that’s been another the development of policies, that’s been another success, where we came up with the school food success, where we came up with the school food guidelines, each of the school districts had to guidelines, each of the school districts had to come up with their own healthy eating or come up with their own healthy eating or nutrition policies, and we all worked on those nutrition policies, and we all worked on those together, and I think that’s made them very together, and I think that’s made them very successful.” (health official)successful.” (health official)

Findings - Evaluation of the Findings - Evaluation of the PositionsPositions

LiaisonLiaison

ResourceResource““Its good to have somebody like that as a Its good to have somebody like that as a resource person, the SHPLC came in and resource person, the SHPLC came in and spoke to our student council and gave a spoke to our student council and gave a powerpoint presentation to them on the new powerpoint presentation to them on the new guidelines and where things were going and guidelines and where things were going and some educational pieces. It is good to have some educational pieces. It is good to have people like that, if that 10 people on the people like that, if that 10 people on the council go out and talk to their friends about council go out and talk to their friends about it, it spreads the word.” (principal)it, it spreads the word.” (principal)

Responses - ParentsResponses - Parents

Responses from parents have been optimistic Responses from parents have been optimistic towards the changes with regards to the SFG, towards the changes with regards to the SFG, active schools and the smoke free grounds active schools and the smoke free grounds policy.policy.

Some principals suggested that there will Some principals suggested that there will always be parents that you struggle to reach always be parents that you struggle to reach but the majority of parents are very supportive. but the majority of parents are very supportive.

There is still a need for further information to There is still a need for further information to

be available to parents.be available to parents.

Response - StudentsResponse - Students

Students responses have been encouraging Students responses have been encouraging towards the School Food Guidelines (SFG), towards the School Food Guidelines (SFG), active schools and smoke free grounds. active schools and smoke free grounds.

Like the parents, some students were initially Like the parents, some students were initially reluctant to change.reluctant to change.

Principals commented that students response to Principals commented that students response to the commotions, or any physical activity days the commotions, or any physical activity days are always overwhelmingly positive. are always overwhelmingly positive.

““Yeah, I think overwhelmingly positive, because, you Yeah, I think overwhelmingly positive, because, you know, I guess the change in the menu, I mean the know, I guess the change in the menu, I mean the children are still accessing it, in terms of the foods that children are still accessing it, in terms of the foods that we provide, and there’s still quite a bit of variety there we provide, and there’s still quite a bit of variety there that still allows them to balance out the type of foods that that still allows them to balance out the type of foods that they’re eating.” (principal)they’re eating.” (principal)

Findings - Ideas for the FutureFindings - Ideas for the Future

Active SchoolsActive Schools““Another big focus on the physical activity, I Another big focus on the physical activity, I would really like to next year have pilot schools would really like to next year have pilot schools and the following year look into having double or and the following year look into having double or triple that, ultimately with the goal in mind to triple that, ultimately with the goal in mind to have all the schools with the Quality Daily have all the schools with the Quality Daily Physical Activity (QDPA) focus.” (principal)Physical Activity (QDPA) focus.” (principal)

Additional PositionsAdditional Positions- - School board officials suggested having School board officials suggested having additional positions additional positions - “Another position to divide the district would be - “Another position to divide the district would be great” (shplc)great” (shplc)

Findings - Ideas for the FutureFindings - Ideas for the Future

Continued PositionsContinued Positions

““We need to recognize that this is a permanent We need to recognize that this is a permanent position in the school district office because you position in the school district office because you do need a champion … it needs to be sustained to do need a champion … it needs to be sustained to move onto the next stage” move onto the next stage”

(school board official)(school board official)

Living Healthy TeamsLiving Healthy Teams““You know I think that the best thing that the You know I think that the best thing that the consultant can do is to ensure that schools have consultant can do is to ensure that schools have functioning healthy living or nutrition or whatever functioning healthy living or nutrition or whatever you want to call them committees.” (principal)you want to call them committees.” (principal)

Findings - Ideas for the FutureFindings - Ideas for the Future

More Caterers SessionsMore Caterers Sessions““Food safety would be another issue, perhaps Food safety would be another issue, perhaps different recipes and menus, there is all kinds of different recipes and menus, there is all kinds of things that could be done at that in-service if we things that could be done at that in-service if we could get the funding” (shplc)could get the funding” (shplc)

More focus on High SchoolMore focus on High School- It was suggested by participants (principals) that - It was suggested by participants (principals) that there has been a lot of focus from the SHPLC on there has been a lot of focus from the SHPLC on primary/elementary school-aged children and there primary/elementary school-aged children and there needs to be a greater focus on high school students. needs to be a greater focus on high school students. - Often change is easier and more welcomed with - Often change is easier and more welcomed with the primary/ elementary schools. the primary/ elementary schools.

Findings - Ideas for the FutureFindings - Ideas for the Future

More Physical ActivityMore Physical Activity- Principals suggested a greater focus on physical - Principals suggested a greater focus on physical activityactivity

Other AreasOther Areas- Other areas of focus for the future that were - Other areas of focus for the future that were suggested were: suggested were:

- drug use- drug use

- body image- body image

- more physical activity - more physical activity

- violence in schools - violence in schools

- bullying- bullying

Current SHPLCs workCurrent SHPLCs work

Active SchoolsActive Schools Changes to Canteen/Cafeteria EquipmentChanges to Canteen/Cafeteria Equipment Professional Development DaysProfessional Development Days Hand washing Pilot ProjectHand washing Pilot Project Training Preschool StaffTraining Preschool Staff Pedometer ChallengePedometer Challenge

SHPLCs future workSHPLCs future work

After the full implementation of the After the full implementation of the School Food Guidelines, Physical Activity School Food Guidelines, Physical Activity & Smoke Free Grounds, the next focus & Smoke Free Grounds, the next focus areas for the consultants (based on the areas for the consultants (based on the provincial wellness plan) will be:provincial wellness plan) will be: ImmunizationsImmunizations Social behaviorsSocial behaviors Vulnerable populations Vulnerable populations Injury prevention Injury prevention

NL Government

Department of Health and Community Services Wellness Plan

Department of Education

Regional Health Authorities

Provincial Committee

School Districts

SHPLC

Regional Living Healthy Teams

Public Health School Administration

Parents Students

TeachersLiving Healthy

Committees

ConclusionConclusion

The findings have demonstrated the value of these The findings have demonstrated the value of these positions and the need for them to continue.positions and the need for them to continue.

These positions have built a great rapport between These positions have built a great rapport between health and education and have been successful in health and education and have been successful in their role as a liaison between the two. their role as a liaison between the two.

The SHPLC’s & other health officials needs to be The SHPLC’s & other health officials needs to be aware of their roles, responsibilities & boundaries.aware of their roles, responsibilities & boundaries.

The consultants have made significant changes The consultants have made significant changes (physical activity, school nutrition, smoke free (physical activity, school nutrition, smoke free schools) in a short period of time.schools) in a short period of time.