Today’s Education Policy Environment Candace Sullivan, James F. Bogden

Education reformers - who are shaping new kinds of schools for the future - and those promoting com- prehensive school health education understand little about each other’s ideas, although they share a desire to improve children’s success and well-being. If those concerned with school health education take a lead in working with education reformers, they can help to shape schools into places where health is integral to education. The powerful national move- ment to change the way schools operate presents an unprecedented opportunity to put health front and center.

he need for schools to implement effective programs T for student health and health education has never been stronger. The poor condition of many children and families seriously inhibits the ability of schools to educate.’ The health care financing crisis points directly to the need for increased health prevention efforts with young people to keep future costs under control. However, these pressures have not produced widespread support for school health education, despite focused efforts of the health education community to urge state and local policymakers to mandate K- 12 Comprehensive School Health Education. Though policymakers require targeted programs such as drug edu- cation or HIV/AIDS prevention to address issues that can- not be ignored by schools, they rarely require that these topics be addressed in a comprehensive context. Health education is among the courses considered by many policy- makers, educators, and voters to be less central to the main mission of school than academic disciplines and is thus typ- ically one of the first to be eliminated through budget reductions or pressures to increase academic performance.2

The nation’s schools are under unprecedented scrutiny and pressure to improve student performance in the acade- mic disciplines. Political, business, and education leaders recognize that the traditional structure and organization of schools, designed for an earlier time, no longer are ade- quate to ensure a prosperous f ~ t u r e . ~ A broad and deep education reform movement to thoroughly restructure the education system at all levels is now underway throughout the country. Though many of these efforts concentrate on students’ intellectual growth in “core” subject areas such as English and math, some policy tools being used to lever change also can be used to actively support students’ healthy social, emotional, and physical growth. We at the NASBE feel that education reform can achieve the goals of those concerned with child health, though not necessarily in ways familiar to proponents of Comprehensive School Health Education.

Among the reforms called for by various prominent school reformers and cognitive science researchers are student-centered learning environments that embody the philosophy that no two children are alike, greater use of

Candace Su“ivan, Director. and James F. Bogden, MPH, Project Associate, Center for Coordinated Services f o r Children, National Association of State Boards of Education, 1012 Cameron St., Alexandria, VA 22314.

active, “hands on” and cooperative activities instead of lec- tures and passive learning, and curricula that rigorously address meaningful content across di~cipiines.~ School character and climate have been found to exert a profound influence on school success in advancing student learning.’ The research is clear that successful schools are character- ized by a shared vision of school purpose and high expecta- tions for students.‘j Successful school communities concern themselves with the multifaceted needs of students and staff including their social, emotional, and physical health. Strong school connections with parents, families, and communities increasingly are considered essential.’ Schools that accept significant responsibility for students’ overall well-being will incorporate health education into their core curriculum albeit not necessarily in separate health courses.

A greater willingness now exists among policymakers to examine factors inhibiting effective learning, and to active- ly search for solutions. Educators are confronted with stu- dents coming to school with serious social, emotional, physical, and family problems that both interfere with their ability to achieve their academic potential and negatively influence the school environment for all. An increasing number of education policymakers are concluding that achieving their education objectives depends on students’ receiving a full array of services, and that schools must be partners with other agencies and organizations.*

The wider acceptance of school health education depends on these kinds of school reforms, in which broad health concerns are considered a precondition of learning. Adding a sequenced Comprehensive School Health Education curriculum to an alienating school culture that saps the creativity and dignity of children, or to a school which does not attend to troubled students’ personal and family crises, can accomplish little to encourage healthy behaviors.

At a time when policymakers are moving away from imposing top-down mandates in favor of local flexibility, it would be prudent for advocates of school health education to re-examine their assumptions and strategies. Nearly 10 years of experience working with education policymakers on health issues has convinced us that health education has a real chance to become an integral element of American education, but only if the advocacy community is broad- ened. Health educators need to work in tandem with main- stream school reformers and with others who care about children’s health and well-being to build a broad base of support for policies and programs supporting healthy students and health-enhancing schools.

Promoters of school health education who understand the school reform movement and are willing to work close- ly with its proponents can take advantage of the fact that schools are changing. The principles for change in educa- tion are being set now. If this chance is missed enormous investments in time, energy, and funding may soon be spent on school improvements that do not include attention to health education or the overall condition of students. Ultimately, meaningful education reform must occur

28 Journal of School Health January 1993, Vol. 63. No. 1

school-by-school, teacher-by-teacher, and family-by- family. But education policy does shape the environment in which grassroots reforms can blossom and to a large extent sets the parameters of discussion. Thorough reform of the education system will take decades and has barely begun, but the rules of the game are being written right now, in the various states, at the national level, and in local school dis- tricts. Health professionals and others concerned with the overall condition of children must help to write them.

The remainder of this paper describes five key trends in the ways the rules for education are changing, the potential implications of these changes and opportunities for propo- nents of school health education to help shape the new game to their advantage. One note of caution: This brief overview cannot hope to encompass the entire education reform movement, which also includes highly visible national initiatives, important research studies, and innu- merable local experiments. This paper serves as a spring- board for further study and action.

Reform Trend 1 : SETTING GOALS FOR EDUCATION Many state boards of education and education agencies

are establishing formal education goals for the children of the 21st Century, often with close involvement of gover- nors, state legislators, teacher and administrator organiza- tions, business leaders, and concerned citizens. Some directly address the health and well-being of students. For example, Massachusetts’ first goal says: “Education should contribute to the learner’s physical and emotional well- being and development, in a positive environment that fos- ters self-esteem.” Minnesota’s third goal is to: “Create comprehensive prevention and risk-reduction services for all learner^."^ However, other states have not yet explicitly acknowledged children’s nonacademic needs or the impor- tance of fostering health-enhancing behavior.

Implications The integration of health outcomes into education goals is powerful, both symbolically and operationally. Conversely, absence of health from a state’s vision for education allows schools to more easily argue that “health isn’t our responsibility.” A policy commitment to student health provides an impe- tus for educators to collaborate with other child and fami- ly-serving agencies to achieve common goals. Inclusion of health within education goals allows for interdisciplinary curriculum models which integrate health content and skills into other instructional areas.

Challenge Those wanting to promote school health education

should: Build coalitions among child health advocates, education organizations, health organizations, and the private sector to influence state policymakers to integrate health into state and local education goals. Advocate that the goal-setting process actively encour- ages wide public participation so that a broad consensus of support for addressing controversial topics can be built. Advocate that state education goals be consistent with Healthy People 2000: Health Objectives for the Nation by ensuring that education policymakers are aware of the

implications for education, and by suggesting ways the two sets of goals can work together to drive programs and benefits for children. Make available to those policymakers setting goals and shaping state and local plans the theory and practice knowledge base about effective strategies for fostering healthy behavior through education programs.

Reform Trend 2: MANAGEMENT THROUGH OUTCOMES

Traditionally, America’s schools have been managed through policies and regulations intended to assure mini- mum standards and achieve equity. Explicit mandates address school attendance, curricular materials, teacher preparation requirements, testing programs, and graduation requirements. Staff are provided cumcular frameworks for prescribed sequences of courses measured in units of time. Education policy administration has focused on manipulat- ing the inputs to learning, with the implied belief that if the correct processes are conscientiously applied, learning will occur for most students.

Two strategies for improving the system have gained wide acceptance. First, policies that decentralize authority - moving the education system toward “site-based deci- sion making” - are considered necessary to strengthen staff motivation and quality of work. Second, accountabili- ty can be assured if policymakers step back and focus on the outcomes of the education process, e.g., student perfor- mance as measured against high standards.’O The trend is for teachers and principals to be given more flexibility to exercise their art, be less constrained by prescriptive requirements, and be held more directly responsible for demonstrating results. New, more “authentic” instruments for measuring student progress are being developed that include writing samples and other performance assessments such as portfolios of student work, observations over time, and student projects that cross disciplines, rather than rely- ing primarily on multiple-choice tests.”

Some key education reformers endorse the “outcomes” approach but argue that each school also needs to be held to “school delivery standards” intended to assure school capacity to foster learning.I2 School delivery standards might include input issues such as adequately trained staff, high-quality cumculum materials, and adequate financial support. They could be in the form of expectations for schools rather than prescribed mandates, expressing a vision that encourages schools to operate effectively with- out inhibiting local flexibility.

Implications A focus on student learning outcomes can help direct attention to factors that interfere with student learning. School personnel and policymakers thereby become more sensitized to the necessity to attend to students’ nonacademic needs such as counseling. Allowing local school communities to determine their own instructional strategies creates “buy-in’’ and helps build grassroots support for Comprehensive School Health Education. By contrast, local school districts now often resist “top down” school health mandates from the state, especially when not accompanied by extra resource^.^^ Learning outcomes which include health elements help

Journal of School Health January 1993, Vol. 63, No. 1 29

ensure that health instruction is not squeezed out of a full school schedule, and promote the use of integrated, inter- disciplinary curriculum models. Richer types of assessment tools, designed to assess mul- tiple dimensions of student progress, can heighten atten- tion to students’ personal self-esteem and social behavior. An outcomes-driven system provides administrators encouragement to fold categorical health education efforts such as those focusing on nutrition, AIDS, or drugs, into research-based comprehensive health educa- tion strategies more likely to meet broadly written out- come standards. However, a danger exists that high academic standards and learning outcomes could be used to squeeze poorly performing students out of the education system.

Challenges Those wanting to promote school health education

should: Revise their advocacy strategies away from urging state- level boards of education to require K- 12 Comprehensive School Health Education, because the prescriptive man- date approach will not succeed in this atmosphere of reform. Instead, they should ... Work with state education agencies and state boards of education to ensure that officially adopted state student learning outcomes and their related assessment systems include measures of health knowledge and social, emo- tional, and physical health condition. Develop and promote broadened “school delivery stan- dards” that explicitly address such issues as safe school climate, student attendance, availability of high-quality physical education programs, linkages between school meals and nutrition education, school-linked services, and meaningful parendfamily involvement. Collaborate with other child-serving agencies to develop state and local level common data collection systems, such as “report cards” that assess the overall condition of children in terms of educational performance, health sta- tus, family income, housing, social problems, and juve- nile delinquency. Public awareness thereby can be stimulated about state and local needs, building support for comprehensive health and education programs.

Reform Trend 3: STRENGTHENING TEACHER SKILLS Changes in the ways students learn imply fundamental

changes in the roles and functions of school staff. The role of teachers is moving away from that of lecturer to passive students, in favor of becoming a skilled diagnostician of individual student progress and orchestrator of appropriate high quality learning experience^.'^

States are beginning to change policies and regulations for teacher training programs. As with schools, the move- ment is away from specific course requirements and instead the focus is on the skills and knowledge prospective teach- ers need to acquire. Similarly, the trend in certification and licensure is to move away from multiple subject-specific certification categories in favor of competencies which stress mastery of general principles of content knowledge, pedagogy, and child development. Teacher evaluation sys- tems are including more direct observation of classroom skills, often in “clinical practice” settings for new teachers.

Implications Taken together, these trends can help ensure that all teachers will be more sensitive to the nonacademic needs of students, as well as to the thinking processes and deci- sion-making skills integral to Comprehensive School Health Education. Existing teachers will need an extensive, on-going, teacher driven professional renewal process to meaning- fully change school learning environments and achieve teacher skill competencies. This change requires much more time and resources than traditional in-service train- ing: doing it right will be expensive. However, reforms in teacher training will not ensure that health will be addressed comprehensively if health issues are not explicitly included in state education goals, desig- nated learning outcomes, and student performance standards.

Challenges Those wanting to promote school health education

should: Assist state education policymakers with the develop- ment of state standards for teacher skill competencies so every teacher will be proficient at nurturing students’ social and emotional health development. Work with educational institutions that prepare school health educators to ensure their programs are consistent with the new learning strategies and school designs. Work to ensure that pre-service clinical practice settings for all prospective teachers are in schools that already pay attention to the nonacademic needs of their students. Develop a model of an effective professional develop- ment process in health education for the existing teaching force, as an alternative to typically brief in-servicing sessions.

Reform Trend 4: PROMOTING INNOVATIVE SCHOOLS

Across the country many demonstrations of new educa- tion models are underway. States are creating incentives that encourage schools and school districts to experiment with new learning strategies. A number of proposed school models focus exclusively on strengthening academic knowledge in the traditional core subject areas. However, some innovative school designs which are considered effec- tive implicitly and explicitly incorporate health promotion principles. For example, the Carnegie Corporation is spon- soring the establishment of more personally engaging, health-promoting middle schools. Yale University’s School Development Program headed by James Comer incorpo- rates collaborative decision-making and fully integrated parent and mental health team activities in elementary schools. Brown University’s Coalition of Essential Schools headed by Theodore Sizer aims to create intellectual atmos- pheres of personalized instruction in which secondary school students are encouraged to assume responsibility for their own learning. These new models of schools are struc- tured to foster healthy, self-confident, socially adept young people able to make responsible decisions and lead produc- tive lives.

Implications The current state of policy flux in the education arena

30 Journal of School Health January 1993, Vol. 63, No. 1

across the nation offers a unique opportunity for dynamic schools to push ahead and integrate health into their basic education programs. The demonstrated success of innovative education mod- els that incorporate health education principles will effec- tively promote the idea that such principles should saturate school organization and structure. A problem to consider is that past demonstration projects have typically not been widely adopted nor have their features been integrated into the education system in general. An undue amount of attention on establishing innovative schools may result in neglect of the pressing needs of students at risk of failure residing in traditional schools.

Challenges Those wanting to promote school health education

should: Draw the attention of state policymakers to the lessons gained from innovative schools that promote health with demonstrated effectiveness. Assist state and local education policymakers to develop policy frameworks for encouraging and supporting schools to try out reforms that incorporate health educa- tion principles and theories. Work with local restructuring teams to develop “break- the-mold” models of academically effective and health- promoting learning environments that exemplify the best of health education practice.

Reform Trend 5: INTERAGENCY COLLABORATION Policymakers in many states are discussing a new

“child-centered” vision in which families, the education system, and other human service agencies all share respon- sibility for overall child health, development, and well- being. In this vision, the institutional barriers that traditionally separate schools from their communities would be crossed as health and social service agencies approach schools and cooperate on ideas for collaborative activities. Education agencies would be encouraged to become more involved in the coordination of a wide range of child and family services attending to the various devel- opment needs of children. In some cases schools might actively refer children needing specialized services to com- munity agencies. In others, schools could become actual delivery sites for a range of human services.Is

These new education models call for new kinds of coor- dinating roles and functions which might be filled by a variety of people, not necessarily only by certified school health educators. School doors could be opened to nonedu- cators in an attempt to capitalize on the strengths of differ- ent professions in order to ensure that the various social, emotional, and physical health needs of children are fully met. For example, in Highland Park, Mich., medical stu- dents from Wayne State University visit elementary school classrooms on a regular schedule to engage in health educa- tion discussions with students. To help make the collabora- tive vision a practical reality, several graduate schools are pioneering organized programs of “Interprofessional Training” to help teachers and other professionals work effectively in an interdisciplinary, interagency context. For example, the Schools of Public Policy, Education, Social

Work, and Public Health at the University of Washington are developing an interdisciplinary training project with a clinical practice component to train new child-serving pro- fessionals in various fields to work together in settings such as schools.

Implications Shared responsibility for health outcomes could help to ensure that the goals of school health programs are achieved. The involvement of a range of human service agencies in school affairs can be expected to increase the number of advocates for Comprehensive School Health Education. Different types of professionals who are experienced and comfortable frankly discussing health issues with stu- dents can be brought into schools to provide instruction such as public health educators, medical students, or staff from community-based organizations. This practice is particularly helpful for topics teachers feel uncomfortable about.

Challenges Those wanting to promote school health education

should: Help state and local policymakers understand the benefits of collaboration and the idea of shared responsibility, and explain how health and other nonschool agencies can effectively work with the education system. School leaders will be particularly interested to know how non- education funding streams can be used to promote health education goals. Help to bridge the gap between education and other human service agencies by helping state policymakers identify and reduce practical barriers to collaboration. Help health educators reconceptualize their roles and assume greater responsibility for becoming school health program coordinators and brokers of interagency services.

SOME QUESTIONS TO CONSIDER Policy

How can organizations that advocate Comprehensive School Health Education and healthy schools get involved with national, state, and local efforts to encourage school reform efforts that foster healthy students and health- promoting schools? 0 What policy and program actions can be taken to

encourage the education system to accept shared responsi- bility for promoting student health? 0 How can policies, programs, and procedures foster

comprehensive child health and education programs that flexibly respond to locally determined needs?

Outcomes and Standards 0 Should health instruction and “Healthy School”

delivery standards be developed? E l If standards are desirable, should the school health

community develop them in an independent initiative or engage with one or more existing initiatives, such as with groups working on science or social studies standards? 0 How should a standards development process be

organized?

Journal of School Health January 1993, Vol. 63, No. 1 31

Professional Preparation and Practice 0 How can supporters of school health education pro-

mote state teacher competence standards that incorporate skills promoting healthy child development and skills that develop health knowledge, attitudes, skills, and behaviors in students? 0 How can higher education institutions be encouraged

and assisted to reshape their professional preparation pro- grams to incorporate essential skills and knowledge for the practice of school health education?

How can school districts be encouraged and assisted to provide effective professional development opportunities for currently employed teachers and staff to acquire essen- tial skills and knowledge for effective school health pro- grams and the practice of school health education?

Awareness 0 How can we transform public interest in health care

reform and healthy lifestyles into advocacy for school health programs and Comprehensive School Health Education? 0 How can lessons about the demonstrated effective-

ness of school health education be effectively communicat- ed to education policymakers and the general public? 0 How can we help assure that all health care system

reform proposals include support for prevention programs including Comprehensive School Health Education? 0 How do we ensure that Comprehensive School

Health Education programs take into account the different concerns of the diverse communities they intend to serve?

Parent and Community Involvement 0 In what ways can grassroots community groups

become engaged in designing and participating in systemic education reforms that address health? 0 How can concerned citizens and health professionals

usefully assist local schools to incorporate youth communi- ty service and meaningful parent involvement programs?

How can the concerns of parents and others about health education and service programs related to sexual behavior be effectively addressed?

Resources 0 How can we encourage schools, health and human

service agencies, and other public and private organizations concerned with children to cooperate so that together their resources can significantly advance student health?

0 How can funds be precisely targeted to promote sys- temic reforms in education and health programs? 0 How can funds be precisely targeted so that underly-

ing causes of poor school performance and health risk- takmg behavior are effectively addressed? 0 How can we make the case for the long-term cost-

effectiveness of prevention programs including Compre- hensive School Health Education? rn

References 1 . Beyond Rhetoric: A New American Agenda for Children

and Families. Washington, DC: National Commission on Children; U.S. Government Printing Office, 1991.

2. Governali JF. Health education and the ‘Back to Basics’ movement. J Sch Health. 1983;53(9):564-567.

3. Cohen M. Restructuring the Education System: Agenda for the 1990s. National Governor’s Association; 1988.

4. Thinking about Thinking. Educ Week Special Report. October 9, 199 1 .

5. Carnegie Council on Adolescent Development. Turning Points: Preparing American Youth for the 21st Century. New York, NY: Carnegie Corp; 1989.

6 . What Works: Research About Teaching and Learning. Washington, DC: US Dept of Education; 1986.

7. First J, Gray R. The Good Common School: Making the Vision Work for All Children. Boston, Mass: National Coalition of Advocates for Students; 1991. See also Carlson CG. The Parent Principle: Prerequisite for Educational Success. Educational Testing Service; 199 1 .

8. Usdan MD. Restructuring American educational systems and programs to accommodate a new health agenda for youth. J Sch Health. 1990;60(4):139-41.

9 . Commonwealth of Massachusetts, Board of Education. Renaissance - Setting New Goa l s f o r Education in Massachusetts; Minnesota Dept of Education, Challenge 2000: Success for All Learners. 1990.

10. Foster JD. If I Could Make a School. Lexington, Ky: Diversified Services; 199 1 .

1 1 . Darling-Hammond L. The implications of testing policy for quality and equality. Phi Delta Kappan. 1991;11:220. See also Mitchell R. Beyond the verbal confusion over ‘tests.’ Educ Week. 1992;11(32):36.

12. Raising Standards for American Education: A Report to Congress, the Secretary of Education, the National Education Goals Panel, and the American People. Washington, DC: National Council on Education Standards and Testing; 1992.

13. School Health: Helping Children Learn. Alexandria, Va: National School Boards Association; 199 1.

14. Fiske EB. Smart Schools, Smart Kids: Why Do Some Schools Work? New York, NY: Simon & Schuster; 1991.

15. Schorr LB. Within Our Reach: Breaking the Cycle of Disadvantage, New York, NY: Anchor Press; 1988.

Statement of Purpose The Journal of School Health, an official publication of the American School Health Association, publishes material related to health promotion in school

settings. Journal readership includes administrators, educators, nurses, physicians, dentists, dental hygienists, psychologists, counselors, social workers, nutritionists, dietitians, and other health professionals. These individuals work cooperatively with parents and the community to achieve the common goal of providing children and adolescents with the programs, services, and environment necessary to promote health and to improve learning.

Contributed manuscripts are considered for publication in the following categories: general articles, research papers, commentaries, teaching techniques, and health service applications. Primary consideration is given to manuscripts related to the health of children and adolescents, and to the health of employees, in public and private pre-schools and child day care centers, kindergartens, elementary schools, middle level schools, and senior high schools. Manuscripts related to college-age young adults will be considered if the topic has implications for health programs in preschools through grade 12. Relevant international manuscripts also will be considered.

Prior to submitting a manuscript, prospective authors should review the most recent ”Guidelines for Authors.” The guidelines are printed periodically in the Journal; copies also may be obtained from the Journal office, P.O. Box 708, Kent, OH 44240.

32 Journal of School Health January 1993. Vol. 63, No. 1