I. ASCD's Health in Education Initiative: School-Community Partnerships for Problem-Based Learning

Presenters: Theresa C. Lewallen, ASCD, Alexandria, VA; Julie Gast, Utah State University, Logan, UT; Darren Perkes, Sky View High School, Smithfield, UT

This session is presented in separate parts. Use the buttons at the end of the transcription to navigate between each part.

THERESA LEWALLEN: Good morning. I'm Theresa Lewallen. I'm the Director of ASCD's Health in Education Initiative. I thank you for being with us today to hear about the Health in Education Initiative projects that are located in Logan, Utah; Philadelphia, Pennsylvania; and McLean County, Kentucky. I appreciate your being here.

The Health in Education Initiative was started four years ago, and is designed to help educators learn more about public health issues and careers, and in turn help their middle- and high-school students learn more about those things, too. Each of the programs is unique, and what you're going to hear today are three different ways of dealing with public health issues in school-based programs. Each of the communities has selected a unique public health problem to address in their program, or a set of problems. I appreciate your participation and I'm going to turn the microphone over to Julie Gast, who is co-director of the project in Logan, Utah.

I. Planned Approach to Healthier Schools (PATHS) — Logan, Utah

JULIE GAST: Thank you. In our project, there are three people involved — there are many people involved — but three people that I'm going to tell you about. I'm Julie Gast, and I'm at Utah State University, and I teach mostly community health. Monica Lownsbury, who couldn't be here today, is at UNLV, and she does teacher preparation and physical education. And Darren Perkes is doing the transparencies, and he is an English teacher at Sky View High School in Smithfield, Utah, and he's part of running the project in his classroom.

Our program is called Planned Approach to Healthier Schools, or PATHS. This is a two-year initiative. The first year we did mostly curriculum development, which I'll tell you about, and the second year we're actually doing the program in two schools. We're in Cache Valley, Utah, which is northern Utah, almost Idaho. Our problem, as we saw it in our schools, was really lack of access to quality health education, quality physical education. Our local health department didn't really have a presence in our schools. So we all had these common goals to improve the health of students, but we really weren't meeting that need. So that was what we saw as the problem.

So our purpose for our particular program was to develop a collaborative model. We didn't want to go in and say, "You teachers do this," or have the health department come in and take over the school. We wanted to collaborate together with teachers, public health department, university, and students — which is tricky, but that's what we wanted to do. We also wanted to use social marketing, because that's been shown to be very effective in influencing the social norms of the school. So just like McDonald's can come in and sell burgers to your students, we wanted to sell health to students. We developed a slogan and a logo to do that, and to brand the project. We think that was a really meaningful component of the project. And we hope through social marketing we can promote a healthful message and change the norm of the school to one of health instead of physical inactivity and poor nutrition. We also wanted to develop an integrated physical education and health and nutrition curriculum within the school. We wanted to do that through having classes that normally wouldn't talk about health talk about health. That's been challenging, but I think worthwhile.

The PATHS project's scope and sequence went like this: First, we wanted to collaboratively develop an integrated physical activity curriculum, with an emphasis on nutrition and to some degree tobacco education, that will require students to use the PATCH model, which I'll talk about in a minute, to target attitude and behavior change of the school community as it relates to physical activity. We self-selected physical inactivity and poor nutrition as our problems. We saw that as one of the most pressing issues in our school. Our students have very low smoking rates, they self-report, at least, low smoking rates, and not much drug use in our community, even though that's a drug problem. And so we wanted to select a problem that hit up many of our students. We did some data collection to see if we're effective after this second year, and we have two experimental schools and two control site schools. We also wanted to intimately involve our local professionals through the health department in working in the school, not just as an advisory board, but actually come in and work with the students, which they hadn't been able to do very much in the past. And again, we wanted to use social marketing approaches to brand our message. At the end of this year in May, we're going to collect post-test data and see if we made a difference in students' attitudes and behaviors toward physical activity, nutrition, and tobacco use.

When our mission was to expose students to public health, and when the grant was written, we conceptualized this as using the PATCH model. This is a Centers for Disease Control Model for community health. It's called Planned Approach to Community Health. It's been around since 1983, and it directly targets collaboration between the community and public health — because the traditional model of public health is the public health department goes out, does a needs assessment, says, "This is your problem and we're going to fix you." This is offensive to community members, as you can imagine, and it doesn't work.

Instead, the CDC said, you need to work collaboratively to help communities solve their own health problems and then we can empower communities to do better. We call that a bottom-up approach instead of a top-down approach. That sounded great for us in a school setting. Let's have the students learn public health skills and solve their own health problems. Let's empower them to do that. They learn real job skills, they get exposed to a real profession, and they know better than us how to solve those problems. I haven't been 14 years old for a very long time. I don't know how to approach those issues, but they do. They have good ideas. And PATCH, through evaluation, has been shown to be successful to do this. So we were lucky, and the CDC had all these materials to implement this plan — it's on their website. So if you're interested in ever looking at PATCH, they have lots of information on how to do that — http://www.cdc.gov/.

I'm going to go through this pretty quick, because, again, there's lots of information on PATCH available through the CDC, and I think there's lots of ways to interpret PATCH for your needs. But there's five phases, and for those of us who are in pubic health, these are the things that public health professionals do every day. But they're not unique to public health, either. They're skills that could apply to lots of different professions, so that's the beauty of it, as well. So, the first phase of PATCH is called Mobilizing the Community. We saw this as we needing to teach the students the importance of nutrition and physical activity. Now we hear a lot about the war on obesity, the epidemic of obesity — and it was interesting because our students weren't really keyed into that. We thought it was self-evident that they would know that poor nutrition was rampant and high-fat diets were rampant and students were sedentary. But they really didn't know that, so we had to teach them a lot about that, and we're still doing that. Then eventually we'd break the students into work groups and work on this problem.

The second phase of PATCH was Collecting and Organizing data. You can't just pick a topic because it's interesting to you. You have to show that it's a need. So we collect data in the school, we show the students their rates of physical inactivity, and nutrition (actually our data showed that students were quite active — even though the trend was that the longer they were in school, the less active they became, which is the national trend). But student nutrition was horrendous. Very poor. And I don't know if they knew that. So we showed them that data, we showed them state data and national data. We said, "Now, based on that data, we need to do step three, which is create interventions, and we wanted the students to create the interventions, with mentorship by health professionals." So that was key. You don't just throw them out there and say, okay, fix it. You give them mentorship by people that do this for a living. So we thought that was a really neat part of it in that how many does a junior high or a high school kid work directly with a public health professional, or any kind of professional. So we were excited about that.

Then they do the interventions, and for that we had a lot of goodies. We had a lot of incentive items that had our slogan on it — which was "Get Up, Get Out, Get Fit." The kids selected that. T-shirts and water bottles and key chains and all those kind of things that we all like to get for free — and that would be the draw to get kids to participate in the interventions. And then we would evaluate that. Why did some things not work? Why did things work? That's another presentation. But we learned a lot from that — how to work the school system better, how to get permission from the right person to do something. It was quite complicated to figure that out. So that was evaluation.

How we developed a collaborative model was pretty extensive. We wanted to establish an advisory board, and the purpose of that was to have the administrators buy into this process, because we knew that the kids were going to want to do a lot of things in the school, and we needed them to be on board. So we only met a few times with the advisory board, and that was Monica and myself, Bear River Health Department, and the principals. So that was an important step, just to get buy-in. Then the more important part was establishing the curriculum board and we did this all last year when we met with the teachers every other Saturday for about eight months, I think, and it was four teachers from the high school and two teachers from the 8-9 Center, and then myself and, at that time, just one student intern. And what we did at those meetings was quite varied. The teachers learned about PATCH, because none of the teachers that we worked with were health teachers. We had to teach them about public health. We had to teach them about health promotion and what health educators do. We had to develop resources for health information, so they could develop lessons. And we had to talk about physical activity and nutrition. And even our PE teachers needed new and updated information. So that was kind of an in-service for everybody.

Then we asked the teachers during those Saturdays to work in teams to integrate physical activity and nutrition in their classrooms. Initially, the first trimester we did this, we had the teachers team teach, and we're going away from that now. That meant, because they team taught, they had to make the lesson plans quite generic and what we heard from the students is they didn't why understand why they were learning about health in English class. Why were we doing that? They didn't understand why they were learning about health in sociology class. So we got away from the team teaching model so we could emphasize how health fits into their content area, or public skills fit into their content area — because the students weren't making that connection. So we got away from that approach. But initially, these were the teams that were together to teach.

After this year, about 430 students will be what we call PATHS students. Let me give you an example of how this works. In Darren's class, for example, this trimester, first hour English class once a week will be PATHS Day. That's the day that we'll have mini-lesson about health, we'll tell them how what they're learning is related to English — which sometimes is a stretch, but we've kind of figured out how to do it. They will get in work groups, health professionals or student interns will mentor them, they will plan interventions during that class period. We have some time for them to reflect on what they did and their progress. We have some time for them to write in reflective journals, because we think that's important. And we also provide incentive items for students that are really doing a good job. We need to reward them for all their hard work. So that would be a typical PATHS Day, and we do that throughout the whole trimester. So in our particular program, while over 400 students will actually do the program, everybody in the school will be part of the program, in terms of receiving interventions.

Just real quick — some of the pre-test data we collected at the 8-9 Center. We used the Youth Risk Behavior Survey, which is a great resource for teachers, I think. You can order the data right off the CDC website, and it has a wealth of information about your state and the nation — trend data over about 10 years' time, what's going on in our states and the nation related specifically to health. So we use certain items of that to ask about what was going on in our particular school, and we found that just half of girls reported exercising an average of five or more days per week. These are young, healthy kids, and they're not particularly active. Over 60 percent reported consuming less than one serving of fruit per day, which is quite under our goal of five a day. And at the high school, we found that milk consumption was quite less than what we needed. So we focused on some of those nutritional issues.

Right now, since we're not through with all our evaluation information, we've been collecting anecdotal data. We asked all the teachers and the Bear River Health Department staff and our student interns to keep journals during this process and we read the journals. They didn't like doing them but we asked them to do them anyway. And we learned a lot. This is not a self-selected staff, this is just part of the regular school day, so we're hitting a lot of different students — and so, as a consequence, because they have to work in teams throughout the whole trimester, we found that students were interacting across social groups that they wouldn't normally do. We didn't let the students pick their groups, the teachers picked their groups. So it wasn't all just friends working together, it was a cross-section of the class working together. We also heard from teachers that some students really kind of blossomed as a result of this, because they were leaders in the school. We gave them an opportunity to be leaders where they never had that opportunity before. They weren't the cheerleaders, necessarily, or on the sports team — yet they were doing an assembly for their whole school. So some of the students reported increased self-esteem because we gave them leadership responsibilities. Some students report that they think more about their nutrition habits and physical activity. I'll let Darren talk about that a little bit.

DARREN PERKES: A couple of great things with this is the students were starting to recognize things that they had never even thought about before — about how they were acting and what they were doing. Some of the quieter students in the classroom were coming out, in a sense. They were noticing things that they thought were important, and now, all of a sudden, they were finding the importance in our classrooms. It was very interesting to read their little journal entries, as well, because they would say these things about how they thought this was the greatest thing — when I thought, with them sitting in the corner all quiet and everything, they could care less. And in the school when they would have wear their t-shirts that would have our logo on them, kids would stop them in the halls and ask them, "Where did you get that t-shirt? What is that supposed to mean?" They were kind of joking around about it for a minute, but then they would get serious and start talking about what they were trying to do, what they were trying to promote in the schools, how it's working for them, and how they can get some of these incentive items. So it slowly started to spread throughout the school, and it really made a great difference with a lot of the students.

JULIE GAST: This wasn't our target audience, but it also had an impact on faculty in the schools — and so, as a result of this, one of the principals purchased pedometers for all the teachers and gave them a 10,000 steps a day challenge. And also as a result, in both schools, there's faculty wellness programming going on — that just didn't happen. So there's one, Race Across Utah, and the teachers track their miles, and they can win stuff, as well. So that's really exciting. We didn't even intend for that to happen, but it did happen. It also elevated the status of the PE teachers in the school — people understood what they did, and that wasn't just Coach Bob anymore, that was somebody who had value and importance in the school and presence in the school. So that was really exciting to see that — because a lot of times people think, well, if you integrate the curriculum, guess what? They're going to get rid of your health teacher, they're going to get rid of your PE teacher. But that wasn't our experience. No, now they're seen as more valuable. So that was really exciting.

For the PATH teachers, one of the things we joked about the first year was creating a club for the teachers. And one of our teachers came up with "For All Teachers Ain't Sitting Silly" — and if you can figure out the acronym, you can know why we thought that was funny. About the status elevation for PATH teachers within the school community, not just for the PE teachers — the teachers reported, we learned from one another, we built professional relationships with colleagues outside our subject area. Darren probably would have never worked that closely with our PE teacher or our sociology teacher. They reported feeling invigorated professionally, so that was great.

I had the opportunity to speak to the state legislature about this program, since we're always looking for ways to do things inexpensively to promote the health of our students, so that was interesting, too.

Just our conclusions: This program offered us a unique opportunity for collaboration between public health and public schools, which doesn't really often go on. Oftentimes a whole department comes in and then you never see them again. So this provided a sustained effort for public health to reach our young people. And we felt that these were issues that fit perfectly with Healthy People 2010 objectives, and that maybe we could make a difference with those kids. Thank you.

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