5

Lessons Learned from State and Local Experiences

Important Points Made by Individual Speakers

  • Despite limited budgets and other constraints, states and localities have exerted strong leadership in integrating nutrition education and food literacy into classrooms.
  • Nutrition education standards need to be comprehensive, sequential, and skill-based and include food literacy, food preparation skills, and physical activity.
  • Nutrition standards could be both integrated into other content areas and serve as the basis for stand-alone courses.
  • A good starting point for teachers is to approach health and nutrition from a personal perspective, which helps them serve as role models for students.
  • Support from principals is critical and is augmented when principals seek out external partners.

Though national nutrition education curriculum standards do not yet exist, some states have extensive experience with implementing standards, benchmarks, or expectations in nutrition education. Presenters from California, Wisconsin, and Washington, DC, described the development of nutrition education standards in their jurisdictions, some of the barriers they encountered, and what their experiences might mean for national standards.



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5 Lessons Learned from State and Local Experiences Important Points Made by Individual Speakers • Despite limited budgets and other constraints, states and lo- calities have exerted strong leadership in integrating nutrition education and food literacy into classrooms. • Nutrition education standards need to be comprehensive, se- quential, and skill-based and include food literacy, food prepa- ration skills, and physical activity. • Nutrition standards could be both integrated into other con- tent areas and serve as the basis for stand-alone courses. • A good starting point for teachers is to approach health and nutrition from a personal perspective, which helps them serve as role models for students. • Support from principals is critical and is augmented when principals seek out external partners. Though national nutrition education curriculum standards do not yet exist, some states have extensive experience with implementing standards, benchmarks, or expectations in nutrition education. Presenters from Cali- fornia, Wisconsin, and Washington, DC, described the development of nutrition education standards in their jurisdictions, some of the barriers they encountered, and what their experiences might mean for national standards. 43

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44 NUTRITION EDUCATION IN THE K-12 CURRICULUM EXPERIENCES IN CALIFORNIA Carol Chase Huegli, associate division director of the Nutrition Ser- vices Division at the California Department of Education, reported that California has nearly 10,000 public schools, more than 1,000 school dis- tricts, and 58 counties, each with an office of education. Its 6.3 million students are exceptionally diverse, with Hispanics representing 52 percent of the student body, whites 26 percent, Asian Americans 8.6 percent, Af- rican Americans 6.5 percent, and the remainder consisting of a very wide range of ethnic groups. California schools serve 238 million breakfasts a year, 600 million lunches per year, and 2.7 million suppers for at-risk chil- dren per month, and the majority of its students are eligible for free and reduced-price meals. Budgets for education in California have been severely restricted, ob- served Chase Huegli, yet the state has exerted strong leadership in integrat- ing nutrition education and food literacy into classrooms. California has developed a Nutrition Education Resource Guide that integrates nutri- tion into the curriculum, both during the school day and in before- and afterschool programs (California Department of Education, 2011). The guide includes nutrition competencies that are aligned with the California health education content standards (see Table 5-1). The competencies were reviewed by national, state, and local experts in nutrition, education, and food service, and they underwent a field review and survey by California public school teachers in 250 schools. The guide also includes recom- mended nutrition curricula resources, supplemental instructional materials, and guidance on implementing a nutrition education program. TABLE 5-1 Nutrition Competencies Aligned with California Health Education Content Standards Health Education Standards Nutrition Competencies Essential Health Concepts Essential Nutrition Concepts Analyzing Health Influences Analyzing Nutrition Influences Accessing Valid Health Information Accessing Valid Nutrition Information Interpersonal Communication to Enhance Interpersonal Communication About Health Nutrition Decision Making About Health Decision Making for Nutrition Choices Goal Setting Goal Setting for Nutrition Practicing Health-Enhancing Behaviors Practicing Nutrition-Enhancing Behaviors Health Promotion Nutrition Promotion SOURCE: Chase Huegli, 2013.

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LESSONS LEARNED FROM STATE AND LOCAL EXPERIENCES 45 The competencies support programs that are sustainable, comprehen- sive, sequential, and culturally relevant, said Chase Huegli. They enhance the curriculum, strengthen teacher skills, and link the cafeteria and the classroom. Materials included in the curriculum section have to be stan- dards based and grade level appropriate. The Nutrition Education Resource Guide is currently being updated to include food literacy and preparation skills and an online search function. It also will include additional reviewed curricula, several of which have been very successful in California public schools. Chase Huegli mentioned in particular Power Play, Linking Science and Nutrition, Linking Math and Nutrition, Linking Language Arts and Nutrition, and Nutrition to Grow On, all of which were developed through effective partnerships among organizations. In turn, some of these partners, such as the Dairy Council of California, have developed materials based on the health education stan- dards and nutrition competencies. The Child Nutrition Advisory Council, which reports to the California Board of Education, has been exceptionally active and has made nutrition education a priority. The council also has sent a letter to the committee chairs of the Common Core initiative with recommendations to incorpo- rate nutrition competencies into the Common Core standards. In addition, California has a Healthy Kids Resource Center, which provides online resources, teacher training, and expertise in curriculum design.1 Based on the experiences in California, Chase Huegli offered several recommendations that would pertain to national nutrition education cur- riculum standards. Experiences in California have demonstrated the impor- tance of partnerships, a regional infrastructure with funding and support for districts, and training and support for schools. California’s experience also has demonstrated the importance of leadership by the state superinten- dent of public instruction and by district officials. Development of the stan- dards would need to be inclusive, with teachers, superintendents, principals, nutritionists, researchers, and parents all involved. Draft standards should undergo state and local peer evaluation and field testing at each stage. Nutrition standards would need to be aligned with national health education content standards and frameworks and with the Common Core standards. They would need to be comprehensive, sequential, and skill based and include food literacy, food preparation skills, and physical activ- ity. They also should address food insecurity and obesity prevention and make connections to the cafeteria and meal programs. A standards development effort would need to provide recommended curricula or the funding to develop such curricula. Standards should both be integrated into other content areas and stand alone. They should incor- 1 See http://californiahealthykids.org/index.

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46 NUTRITION EDUCATION IN THE K-12 CURRICULUM porate a multilevel approach, be experiential, and provide culturally com- petent materials. They also should provide guidance on implementation in such areas as recommended hours of nutrition education, integration with other subjects, and professional development. Standards would need to allow for flexibility at the state and local levels. They also need to be sustainable. Multiyear funding to state de- partments of education would help states implement a regional technical assistance model with nutrition specialists at county offices of education or similar entities. Districts also could receive funding and technical support such as nutrition specialists or resource teachers. An issue that arose during the discussion session was linking physical education standards with nutrition standards. The programs tend to be separated, said Chase Huegli. “We have to find a way to somehow bring us together.” EXPERIENCES IN WISCONSIN The development of model nutrition education standards in Wisconsin was a multiyear process, explained Susan Nitzke, professor emeritus and extension specialist in nutrition sciences at the University of Wisconsin– Madison. First, statewide leaders in nutrition education in Wisconsin, after extensive discussion about the need for nutrition standards in the state, secured support and expert assistance from the U.S. Department of Agri- culture, the Centers for Disease Control and Prevention, a variety of other state and federal agencies, the Wisconsin university system, and other orga- nizations to work on obesity prevention, nutrition education, and physical activity. Existing practices, gaps, and needs were identified, and a core team was put together to develop the standards. The team set “SMART” objectives, which stands for specific, measur- able, achievable, realistic, and time sensitive. It consulted with experts and involved a wide range of stakeholders. Then, as Nitzke put it, the team “drafted, reviewed, revised, reviewed, revised, et cetera.” Both the develop- ment team and the reviewers included a wide range of stakeholders from the public and private sectors. The model standards were published by the Wisconsin Department of Public Instruction in print and online in 2009 (Wisconsin Department of Public Instruction, 2009). The target audience for the document was wide ranging, including stu- dents, parents, educators, administrators, policy makers, and community members. The team worked hard to make the guidance age appropriate, sequential, and complementary to existing curricula. That was not easy be- cause of the differences among schools in Wisconsin, said Nitzke. “Still, a 10-year-old is a 10-year-old,” and the team drew on developmental experts to verify what was age appropriate.

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LESSONS LEARNED FROM STATE AND LOCAL EXPERIENCES 47 The goal of the standards was that “students will gain the knowledge and skills to select foods for a healthy diet that supports health and reduces the risk of illness and future chronic diseases.” The simplicity of that goal belies the many hours that went into establishing it. For example, the writ- ers chose “foods for a healthy diet” rather than “healthy foods.” “That sounds like a trivial wording change, but it’s actually a big deal,” Nitzke said. Providing the knowledge and skills to select foods for a healthy diet supports health and reduces the risk of illness and future chronic diseases. The purposes established for the document were to support state and local school district nutrition education by • Setting expectations at fourth, eighth, and twelfth grades; • Suggesting a framework for effective and comprehensive nutrition education; • Augmenting core academic standards and integrating across disciplines; • Defining methods, goals, and outcomes; and • Highlighting cultural diversity. In establishing these purposes, the writing group examined all the core academic standards related to nutrition and sought to align its standards with the existing curricula. For example, when students are learning about the historical link between cranberries and other fruits and Native Ameri- cans, they also can learn about the nutritional value of cranberries. At the same time, the group emphasized diversity to counter the middle-class and white orientation of some existing lessons. As key concepts to target for each lesson recommendation, the group identified • Nutrition for growth and energy, • Food safety, • Critical thinking and practical reasoning, • Healthy behaviors, • Diversity, and • Identification and classification of foods. The standards defined both the content that should be mastered by the fourth, eighth, and twelfth grades and the performance standards that provide evidence of learning the content embodied in the standards. The writing group also defined a set of applications to which the content can be applied:

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48 NUTRITION EDUCATION IN THE K-12 CURRICULUM • Global awareness; • Financial, economic, and business literacy; • Health literacy; • Learning, innovation, and creativity skills; and • Information, media, and technology literacy. The writing group devoted considerable time to deciding which guiding theories and models it would use in organizing the information in the guide. It chose two: a cognitive development model that defines preoperational, concrete operational, and formal operational levels of learning, and an experiential learning model that emphasizes experiencing or doing some- thing, sharing what you have learned, processing what it means, develop- ing generalizations, and applying new knowledge and skills to your life. It also recognized a socioecological context incorporating food concerns, other health concerns, and concerns over the availability and accessibility of food, which overlap with nutrition education, health promotion, and public health nutrition. As an example of a standard, Nitzke cited the following standards in the area of energy and growth performance for the fourth, eighth, and twelfth grades: • A.4.1. Identify why people need to eat different kinds of foods. •  .8.1. Explain the concepts of variety, moderation, and balance, A and balancing caloric intake and energy expenditure. •  .12.1. Describe the nutritional needs associated with life stages A (prenatal through adulthood). The standards at each grade level build on preexisting knowledge, said Nitzke, so that students have enough information to build on previous concepts. Many groups are using the standards, including not just schools but also the SNAP-Ed program, the Wisconsin Department of Health Services, farm-to-school programs, and others. The Wisconsin Department of Public Instruction (2011) also has developed a companion document, Nutritious, Delicious, Wisconsin: Connecting Nutrition Education and Local Foods, which recommends lessons to teach the standards at various grade levels. It also was finalizing a new unit connecting the model academic nutrition standards to state family and consumer science standards. EXPERIENCES IN WASHINGTON, DC In 2010 the Washington, DC, City Council passed the Healthy Schools Act (DC Law 18-029), which was designed to build on school health

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LESSONS LEARNED FROM STATE AND LOCAL EXPERIENCES 49 policies that had been established to respond to child obesity, said Stacy Snelling, associate professor and associate dean in the School of Education, Teaching, and Health at American University. The act encouraged schools to serve a vegetarian option each week and required that they serve a differ- ent vegetable and fruit each day. It established a preference for unprocessed foods grown in Washington, DC, and surrounding states along with grants to develop curriculum-coordinated school garden programs. It mandated annual assessments and reports on student achievement according to health and physical education standards as well as profiles detailing health, nutri- tion, and physical education programs and wellness policies. The act also required that students receive 75 minutes of health educa- tion for elementary and middle schools per week by the school year 2014- 2015. Nutrition education is a component of this health education, and knowledge of health is measured in Washington, DC, along with knowledge of mathematics and reading. “DC has been out in front in looking at this,” said Snelling. As an example of the act’s effects, Snelling described the example of Kelly Miller Middle School. The school is one of about 200 in Washington, DC. About 45 percent of DC schools are public charter schools, and the system serves about 77,000 students altogether. Kelly Miller Middle School is in Ward Seven at the eastern corner of Washington. Of Ward Seven’s 71,000 residents, 73 percent are overweight or obese, 25 percent live in poverty, and 20 percent are unemployed. The school has approximately 325 sixth-, seventh-, and eighth-graders. Ninety-nine percent are African American, 86 percent are eligible for free and reduced-price lunch, and 25 percent receive special education. Kelly Miller Middle School was a school that needed improvement, said Snelling. In 2010 only 19 percent of its students were reading at grade level, and only 18 percent were doing mathematics at grade level. In 2011-2012, an 8-hour intervention for teachers was integrated into existing professional development over an 8-month period. The intervention included reflection on personal health habits, a school nutrition assessment, and provision of introductory health and nutrition information followed by a demonstra- tion of how teachers could align these themes with the learning standards in the core and elective courses. Innovations included quick “fit breaks,” a pedometer program for teachers, one-on-one grade-level instruction and discussion, and adaptation of existing nutrition curricula. The intervention also included a comparison of the Common Core standards with the health and nutrition curriculum, which at Kelly Miller Middle School included the establishment of a school garden. For example, the mathematics standard on estimating the results of computations was matched with laying out and estimating the costs of the garden. A survey of teachers’ beliefs about health education found significant

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50 NUTRITION EDUCATION IN THE K-12 CURRICULUM increases in the rate at which teachers approved of the following three statements: 1. The health of students is an important issue to teachers. 2. It is my responsibility as a teacher to address health issues in the classroom. 3. As a teacher, I feel prepared, empowered, or able to integrate health education into my current curricula. Teachers also demonstrated significantly improved self-efficacy in an- swering the following questions: • How much can you do to get students to believe they can engage in health habits? • How much can you do to help your students value health habits? • How much can you do to motivate students to engage in healthy behaviors? • How much can you do to improve the health status of a student who is engaging in unhealthy behaviors? • How much can you do to help your students think critically about their health-related behaviors? “That survey was very encouraging to us,” said Snelling. The program did not detract from improvements in academic per- formance at the school. During the 2-year period when the program was implemented, the number of students reading at grade level improved from 19 to 24 percent, and the number doing mathematics at grade level rose from 18 to 39 percent. “We still have a long way to go,” Snelling observed. Every student deserves to be reading and doing mathematics at least at grade level. But “we have learned we have to work with teachers in order for us to reach the students.” Washington received a Team Nutrition grant in partnership with Amer- ican University to expand the program to 15 middle schools. The program plans to continue to work to engage teachers in healthy lifestyles and inte- grate the health curriculum across the schools. Snelling drew several lessons from the experience in Washington, DC. First, approaching health from a personal perspective appears to be a good starting point for teachers. Also, time is a barrier for successful implementa- tion. Support from principals is critical and is augmented when principals seek out external partners. Matching learning standards with nutrition and curriculum ideas fa- cilitates implementation for teachers. Finally, teachers have an opportunity to be role models for nutrition and health concepts. “It would be good

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LESSONS LEARNED FROM STATE AND LOCAL EXPERIENCES 51 business for us to first take care of our teachers so that we can serve [their] students.” An issue that arose during the discussion session that pertained to each of the three programs was the extent to which nutrition education is being implemented in individual classrooms. These data have not been compiled in a comprehensive fashion, the speakers pointed out, though many schools and teachers cover nutrition to some extent. Chase Huegli said that she would love to work with an academic partner to derive such results.

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