INDEPENDENT SCHOOL HEALTH ASSOCIATION

Building Programs in Health EducationThe ISHA Spring Meeting convenedat Phillips Exeter Academy on Friday, May 6, 1983 and was well attended by physicians and nurses,counselors, athletic trainers andcoaches, school administrators andstudents. John P. Allegrantepresented the keynote address; histopic "Using Concepts andStrategies in Health Promotion andDisease Prevention as a Basis forCreating Effective Programs inHealth Education" Dr. Allegrante is

^associate professor and chairman ofthe Department of Health Education and Co-Director of the Centerfor Health Promotion at TeachersCollege, the graduate school ofeducation at Columbia University. Apanel discussion on "The Reality ofHealth Education: Report on thescene at some member schools"followed. After lunch, participantsbroke into small group discussions.

Copies of Dr. Allegrante's keynoteaddress can be obtained fromClaudia Molinari at ChoateRosemary Hall. Further reading onthe topic is an article by DavidMechanic, "Disease, Mortality, andthe Promotion of Health," whichappeared in Health Affairs 1:3,Summer 1982.

Implementing HealthEducation Programsby Judith LaFountain

"Implementing Programs in Health'̂ Education" workshop at the May 6Conference was facilitated by AnnBliss, R.N., with Dr. Allegrante andLeslie Goldman from the N.Y.Academy of Medicine as resource

people. It is evident that healtheducation exists in each of ourschools in forms that range from theinformal one-to-one approach, tofull-day health fairs withworkshops, to formal classroom instruction. The content of theseeducational encounters is also variedand includes stress, alcohol, sexuaH-ty, peer counseling, health awarenessand behavior and ethics.

Barriers to developing a programwere discussed, with the most common being a lack of free time in thestudent's day that can be set asidefor health teaching. An attitudinalbarrier is the mostly unspoken beliefthat the affluent person doesn't needhealth education. A third barrier isthat health education is seen as not

a purely academic subject, andtherefore has no place in a collegeprep curriculum.

How can these barriers be overcome? The two keys are: 1) the administration must want a healtheducation program, and 2) thestudents must be allowed time offfrom other commitments to participate in health education. Wemust market a program to makehealth education acceptable toheads. Content that focuses on self-image and decision-making skillsrather than risk factors would reinforce positive attitude developmentrelated to increasing the quality oflife. This could be a verymarketable approach.

We must educate our colleagues tothe need and appropriateness ofhealth education. Integrating healtheducation into subjects already in

Newsletter

Fall 1983

the curriculum, taught by currentmembers of the faculty, will easetime and money constraints. Thebest health education will be thatwhich students will do and we

facilitate. A team approach to planning is desirable, and should includeteachers, students, the food servicedirector, administration and thehead. "Ownership" means that thoseinvolved in the planning will feel acommitment to the program.

Sports Medicine/AthleticTrainingby Lewis Flagg

Over a quarter of the registrants atthe spring meeting of ISHA held atPhillips Exeter Academy attendedthe afternoon session on sportsmedicine/athletic training. Includedwere school physicians, trainers,nurses and coaches. Stan Zalenski,Exeter's resident authority on weighttraining and conditioning, reviewedcurrent trends in technics and equipment, emphasizing values towardhealth and fitness. Using slides, healso offered comments about variousequipment and economicconsiderations.

An excellent presentation by Dr.Stephen Minaudo, podiatrist ofSports Medicine Associates of Exeter, demonstrated gait evaluation,foot balance and discussed problemsencountered by athletic participantsproviding suggested solutions. Dr.Sprague Hazard, as an evaluator,stated that Dr. Minaudo's presentation should be videotaped to enable

(continued on page 2)

Food for thought: Do independent schoolshave a legal and moral responsiblity toprovide adequate health insurancecoverage? And if so, should coverage be required of all members of the student body?

Is it best to have the fee for coverage included in tuition? YOU can help by sharing your information and proposals withother ISHA members.

(continued from page 1)

more member schools to take ad

vantage of his expertise.

Exeter's head football coach, Dr.Edward Frey, himself a specialist inhealth education, discussed nourishment, diet, supplements, food factsand fallacies toward the promotionof good health. Many felt we shouldcontinue to consider this subject inlight of concerns including "junkfood," high salt and cholesterolconsumption.

Returning the athlete to participation with adequate protection wasthe topic of a brief "hands-on" section by Lewis Flagg, also of PEA.Demonstrated was the use of C-splinting for protection of myositisossificajis traumatica, leg contusionsand protection to the forearm, backand renal areas. Mouldable vinyland the new Sorbothane were alsodemonstrated.

A question and answer period withthe program participants and aspecial foot taping technicdemonstration by Dr. Minaudo concluded the program. CEU's allowedfnr fhp Hay wa<; .05.

Editorial

John Allegrante referred in his introductory talk at the spring ISHAconference on "Building HealthEducation Programs," to "strategiesand health promotion." Under thisheading he referred to threecategories of strategies: 1) preventivehealth services; 2) health protectivelegislation and regulation; 3) encouraging health-promotingbehavioral and lifestyle changes.

How do these apply to the life ofour New England independentboarding school communities? Thelast of these strategies depends onvoluntary changes made by studentsand faculty. Many recent changesthat we have seen are the results offashion. For example, jogging hasnow become fashionable. "To bethin is to be beautiful" is a sloganbelieved by many of our teenagefemale students. It has becomefashionable to go on crash diets andmany other forms of diets. Alongwith this last fashion have appearedtwo diseases which have becomemuch more common; namely,bulimia and anorexia nervosa.However, most of the new interest

-in-good,^lourishing^UBprocessed

Figure 3: Levels of Intervention

1 2 3

The activities ofof the manu

facturers ofillness

A

behaviorsObservable

morbidity andmortality

A

TIntervention

with a politicaleconomic focus

Intervention

with a

preventive focus

Intervention

with a

curative focus

Source: John B. McKinlay, "A Case for Refocusing Upstream—The Political Economy ofIllness," Applying Behavioral Science to Cardiovascular Risk, ed. Allen J. Enelow andJudith B. Henderson (Dallas: American Heart Association, 1975), p. 13, Figure 1.

food and in holistic health care is auseful change.

Under the second strategy headingmight be considered school rules.What school rules do we have thatare helpful from a health pont ofview. Some that immediately leap tomind are those connected withcigarette smoking and alcohol consumption. On health grounds, isthere any justification for continuingto permit students to smoke cigarettes on campus? Are there any otherrules or regulations that we couldenact at school which would helpincrease the health of our

communities?

Under the first heading of strategies,namely "preventive health services"we can consider such things ashealth education and the school'smedical services. These includeregular physicals (perhaps) for bothstudents and faculty. There is alsothe question of such areas as theschool food service. It is recognizedthat additives to prepared food cancause problems to the health ofsome individuals. For example,sulphites-tised-to-preserve salads^fried potatoes and various otherfoods, and dyes used as colorings indrinks and jellies cause some peopleto react adversely. Monosodiumglutamate is used as a tasteenhancer in many prepared meatsand gravies. Are these substancesand others appearing in your schoolfoods? Has anyone talked over theuse of additives with the director ofthe school food service?

Professor Allegrante showed adiagram describing levels of intervention in a flow from 1 through3, 1 being the activities of the"manufacturers of illness," 2 being"various at-risk behaviors," 3 being"observable morbidity and mortality." Under 3 are the downstream

Food for thought: How do you educatefaculty with regard to drug use and abuse;their own health and their responsibility asrole models; when and how not to panic?

Food for thought: What is the health services staffs responsibility with regard to:messy rooms; kitchen cleanliness and foodservices practices?

factors and under 1 are theupstream factors. Dr. Allegrantepointed out that most of ourenergies in focus have been on thedownstream factors. Now we shouldbe considering the upstream factors.This necessitates an intervention ona political and economic level andinvolves the empowering of disad-vantaged population groups, often,but not always, minorities. For example, are medical services for theelderly equally available to allAmericans? Do we adequately empower the minority students in ourindependent schools? If you canthink of additional initiatives afterreading this, write to the ISHANewsletter editor.

' David Connell

St. Joseph College WorkshopsSt. Joseph College presents twoweekend workshops of interest toISHA members. January 27-29,1984, "Child Abuse: Investigationand Initial Management" andMarch 2-4, 1984, "Child SexualAbuse: Treatment for the Victim,Offender and Family." For information and registration, contact Sr.Marjorie Fallon, St. Joseph College,1678 Asylum Avenue, West Hartford, CT 06117 (203) 232-4571, ex.217.

Head Nurse VacancyThe head nurse position at ChoateRosemary Hall will be open for fall,1984. Candidate must have a B.S.degree and experience in workingwith adolescents. An interest ingynecology and nutrition would beuseful. This is a fulltime, facultystatus position, with faculty

/privileges and accommodationsavailable. For further information,please contact: Medical Director,Choate Rosemary Hall, R O. Box788, Wallingford, CT 06492.

The Evolution of CRSNA

by Theresa Malchodi, R.N.

In 1972, a group of residentialschool nurses, under the leadershipof Shirley Jefferson, R.N., B.S., metto share the mutual interests andconcerns of rendering health care toboarding school students.

With the encouragement and helpof Ms. Elizabeth Ahern, infirmarylicensing inspector for the Connecticut Department of Health, two experimental meetings were planned toestablish the need of a statewideorganization. Notices were sent toall schools in the state, and the firstmeeting was held in November,1972. The day-long program included a presentation by Dr. LouisHochheiser of the University ofConnecticut Health Center, concerning the "Role of the School Nurseand Primary Care in the HealthField," and an afternoon workshopwith discussion of continuing education for nurses. Future meetingswere planned for spring and fall.

In the spring of 1973, the electionof officers was held and dues wereestablished. A guest speakerpresented a seminar on "CounselingTechniques and the School NurseRole." At a later meeting the nameof the organization, ConnecticutResidential School Nurses Association (C.R.S.N.A.) was adopted bythe group.

Discussions at the meetings indicated that the lack of educationalopportunities relating directly to thiskind of nursing was one of the common difficulties encountered by theresidential school nurse. Thisthought was incorporated into theobjectives of the Association by-lawswhich were adopted in May, 1975.

As a result of this concern, the first

20-hour course in physical assessment was offered in spring, 1974with part two in 1975. Since thattime this course has been repeatedthree times for new members.C.R.S.N.A. has sponsored othercourses—in sexuality (6 hours);counseling Part I {18 hours), withPart II (18 hours) in progress.

Some of the programs presented atthe semi-annual meetings have been"Record Keeping and ProblemOriented Medical Records," "ChildAbuse," "Epilepsy," "New LegislationInvolving Nurses," "SexualityCounseling" and "Nutrition." Twodinner meetings have provenpopular, providing an other opportunity for exchaning ideas.

Salary and benefit surveys have beenconducted twice, with the resultsused as a tool for salary negotiations. Tours of health care facilitieson the campus where Associationmeetings are held have also been ofvalue. Membership in C.R.S.N.A.now numbers fifty with eighteenschools in Connecticut represented.

Useful Publications

Brittanica films introduces a newseries of videocassettes on sportsmedicine, averaging 24 mintueslong. These videocassette workshopsfeature practical demonstrations andguidance by nationally knowncoaches, trainers and physicians.Designed to assist coaches, physicaleducators and health personnel indeveloping a safe, healthy sportsprogram, emphasis is on diagnosis,treatment and prevention of injuries,as well as on pretraining and training practices that effectivelyminimize injuries. Specify U-matic or V2" VHS format. Each title$15.00.

Counseling SkillsWorkshop-December 2ISHA will sponsor a CounselingSkills Workshop at ChoateRosemary Hall on December 2.

Program1. The initial interview: to enablethe client to tell his/her story2. Interviewing a student withgrades that have suddenly dropped3. Interviewing a student who issuspected of using drugs4. Recognizing depression5. Assessment of suicide risk6. Possible pregnancy

Presentations will be made bymembers of the Choate RosemaryHall counseling team, and there willbe ample time for questions andanswers. Workshop registration islimited to 30—please contactClaudia Molinari at ChoateRosemary Hall, 203-269-7722, ex.203, if you are interested in attending. (A limited mailing will beorganized.)

Sports MedicineConference-January 20ISHA announces a Sports MedicineConference, co-sponsored with theConnecticut State Medical Society,to be held January 20, 1984 atChoate Rosemary Hall in Wall-ingford, Connecticut. This conference, which will take place from9 a.m. to 3 p.m., is aimed atcoaches, school nurses, athletictrainers in private and state highschools and colleges. Please save thedate: a conference registration formwill be sent to you under separatecover.

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ISHA Spring ConferenceThe Dodge Study:A Study of How FemalesMake Choices

April 27,1984 at Emma WillardSchool, Troy, NY

Dr. Nona Lyons will make a presentation on the results of the DodgeStudy, a research project undertakenby Dr. Carol Gilligan and her teamof psychologists at Harvard, fundedby the Geraldine R. Dodge Foundation, and conducted at EmmaWillard School.

The study, still in progress, focuseson the adolescent female, and thedefinition of "herself and thechoices she makes regarding allaspects of her life, particularly thosechoices involving moral dilemmas.The evaluation of how these twotopics are interrelated will be thecentral theme of-the conferencc:

Following Dr. Lyons' keynote address, participants will view the filmJury of Her Peers. After lunch,small discussion groups will be leadby Jack Stewart—athletics; Mr.Parker—counseling; Cathy Adair-Steiner—nursing; and TrudyHanmer and Mr. Parker—

administration.

Emma Willard is in Troy, New Yorkand is 3 hours' driving time fromBoston and New York City, 2 hoursfrom Hartford and IV2 hours fromSpringfield. Situated in the HudsonRiver Valley, the drive guaranteesunmatched scenery. Please reserveApril 27, 1984 for a day at EmmaWillard; a conference registration

flyer will be sent under separatecover. For homework reading, pleaserefer to "The Ethic of Justice, TheEthic of Care" by Trudy Hanmer inthe December 1982 issue of Independent School.

ISHA Council

PresidentDavid B. Connell, M.D.Choate Rosemary Hall

Vice President

Stephanie Perrin, Walnut Hill School

Secretary/TreasurerMary Anderson, R.N.Emma Willard School

Newsletter Editor

(Jarol L. Cheney ^Hamden, Connecticut

Executive SecretaryClaudia Molinari, Choate RosemaryHall

Ann Bliss, R.N., B.S.N., M.S.W.Choate Rosemary HallAnne Dunnington, R.N.Williston-Northampton SchoolLewis Hagg, Jr., R.RT, R.T., A.T.C.Phillips Exeter AcademySprague W. Hazard, M.D.Deerfield AcademyRobert P. Masland, Jr., M.D.The Children's Hospital Medical CenterJohn E. Ratte, Loomis Chaffee SchoolMarilyn Spencer, R.N.Loomis Chaffee School

Dagney St. JohnStratton Mountain School