APPENDIX G-2
The West Virginia Experience: An Infrastructure Model

West Virginia Department of Education and West Virginia Bureau for Public Health, 1993–1995

Lenore Zedosky, M.N.

Director, Office of Healthy Schools

West Virginia began to build an infrastructure for comprehensive school health programs (CSHPs) in the mid-1980s, when business leader C. E. ''Jim" Compton urged Governor Gaston Caperton to appoint a blueribbon School Health Task Force. The Task Force's report became the framework for the development of a multicomponent program with multiagency program implementation responsibility.

Ten demonstration school districts received training and technical assistance to begin to design and implement programs at the local level, while state and private agency individuals continued to develop law, policy, and other necessary support for effective program delivery. In 1992, West Virginia was selected as an "Infrastructure Demonstration State" by the Division of Adolescent and School Health at the Centers for Disease Control and Prevention, which provided funds to place senior-level staff responsible for CSHP coordination in the state Departments of Education and Health. These individuals have been responsible for assessing policy and fiscal and manpower resources in their respective agencies, and for planning program expansion into additional school districts. CSHP training was jointly designed and funded by several offices in each agency and was delivered to "infrastructure" teams from 90 percent of the state's school districts.



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School & Health: Our Nation's Investment APPENDIX G-2 The West Virginia Experience: An Infrastructure Model West Virginia Department of Education and West Virginia Bureau for Public Health, 1993–1995 Lenore Zedosky, M.N. Director, Office of Healthy Schools West Virginia began to build an infrastructure for comprehensive school health programs (CSHPs) in the mid-1980s, when business leader C. E. ''Jim" Compton urged Governor Gaston Caperton to appoint a blueribbon School Health Task Force. The Task Force's report became the framework for the development of a multicomponent program with multiagency program implementation responsibility. Ten demonstration school districts received training and technical assistance to begin to design and implement programs at the local level, while state and private agency individuals continued to develop law, policy, and other necessary support for effective program delivery. In 1992, West Virginia was selected as an "Infrastructure Demonstration State" by the Division of Adolescent and School Health at the Centers for Disease Control and Prevention, which provided funds to place senior-level staff responsible for CSHP coordination in the state Departments of Education and Health. These individuals have been responsible for assessing policy and fiscal and manpower resources in their respective agencies, and for planning program expansion into additional school districts. CSHP training was jointly designed and funded by several offices in each agency and was delivered to "infrastructure" teams from 90 percent of the state's school districts.

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School & Health: Our Nation's Investment FUNDING, PLANNING, AND TRAINING RESOURCES Department of Education Department of Health Office of Healthy Schools (CSHP office) Office of Health Promotion; AIDS/HIV Division Drug-Free Schools Project Office of Primary Care and Recruitment Office of Child Nutrition Office of Maternal and Child Health Office of Evaluation and Research Office of Local Health The local teams had the following configuration: Local education agency administrator Local health agency administrator Local school board member Local primary care center director Education agency health coordinator (health educator, school nurse) Parent Community business representative One or two others as determined by the community Each team developed an action plan with priority objectives for beginning program implementation. School reform legislation in West Virginia, which emphasized increased local planning and decisionmaking, created School Senates in each school and set aside specific time during the instructional calendar (one-half to one day per month) for school-based groups to meet for curricular planning and teacher staff development. In addition, each school must have a school improvement team with both school and community representation. These provisions have been most helpful in promoting school and community communication about CSHP and providing time for health team members to meet. Examples of infrastructure accomplishments in an eight-component comprehensive school health program are described as follows. COMPREHENSIVE SCHOOL HEALTH PROGRAM INFRASTRUCTURE ACCOMPLISHMENTS Health Education During the spring and summer of 1994, the West Virginia Department of Education and the West Virginia Bureau for Public Health jointly

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School & Health: Our Nation's Investment planned and delivered infrastructure training for 10-member teams from 50 of the 55 school districts in the state. A total of 500 school and health department administrators, primary care center directors, local board of education members, business representatives, social service agency staff, and parents participated in the training sessions. Each team began the development of an action plan for implementing a comprehensive school health program in their local school district. Grants of $5,000 were given to each district for further planning and teacher training based on an assessment of needs identified during the training. During the 1994–1995 school year, approximately 1,000 teachers participated in training to strengthen classroom delivery of health education. Additional training has been provided by the State AIDS Task Force, comprised of representatives from the Department of Education, the Bureau for Public Health, community health providers, and others. This Task Force sponsors an annual AIDS conference and develops strategies for implementing AIDS prevention education in schools and communities throughout the state. An HIV/AIDS Higher Education Consortia was formed following training conducted at Rutgers University. One goal of the consortia is to determine preservice and inservice teacher training needs so that appropriate staff development programs and educational programs can be developed. Training needs are identified and delivered in a coordinated fashion by these groups. Health Services The West Virginia Department of Education (Office of Healthy Schools) and the Bureau for Public Health (Office of Primary Care and Recruitment) recently received funding from the Claude Worthington Benedum Foundation for development of school-based health centers and Healthy Schools initiatives. The foundation provided $950,000 to be used over a period of two years to plan and implement school-based health centers in 14 new sites across the state. In three of the sites, a comprehensive school health program is also in place that will be closely aligned with the health centers. One aspect of the grant is to evaluate the effectiveness of the health centers and compare results in schools that have a traditional health education program with those that have the expanded Healthy Schools program model. The Office of Maternal and Child Health at the Bureau for Public Health and the Office of Healthy Schools at the Department of Education have collaborated on the development of a manual entitled Guidelines for Developing and Implementing School-Based Early Periodic Screening, Detection

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School & Health: Our Nation's Investment and Treatment (EPSDT) Services. The Superintendent of Schools, the Commissioner of Health and Human Services, and the Director of Public Health have approved the distribution of this document. The Department of Education (Office of Child Nutrition), in collaboration with the Department of Human Resources, received permission from the U.S. Department of Agriculture to place an affirmative checkoff section on the free and reduced meal application form that allows parents to indicate their interest in being reviewed for Medicaid eligibility. This has resulted in a significant number of additional children being identified as eligible and being provided with primary care health services. The State Maternal and Child Health Program, in collaboration with the West Virginia Healthy Schools Program, has entered into a written agreement to provide for the development of a dental health initiative in a Regional Education Service Agency. The Office of Maternal and Child Health provides funds to employ a dental hygienist, who develops teaching modules and other educational materials that promote prevention practices and the use of oral health care services. The curriculum and services developed through this venture may be used as a model for other regions in the state. Physical Education The Physical Education Program of Study Instructional Goals have been revised to reflect a focus on lifetime fitness activities. The goals were jointly reviewed by physical educators in the field and by members of the staff at the Bureau for Public Health who have expertise in the area. A statewide physical education summit was held in the summer of 1995 to introduce the new program to physical educators and to assess future training needs. The summit was a collaborative effort of the Department of Education, the Institutions of Higher Education, and the Bureau for Public Health. More than 300 physical educators participated in the summit. In 1990, the West Virginia Legislature passed a law requiring that all children in grades K–9 be given the President's Physical Fitness Test. Many teachers in the elementary grades indicated that they were not familiar with this test. The Department of Education, in collaboration with the Office of the Governor, has developed a videotape that demonstrates the correct administration of this test. The children in the video are students from three school districts in the state who all qualified for the Physical Fitness Award. This renewed emphasis on the importance of physical fitness has resulted in a significant increase in the number of students who pass the fitness test.

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School & Health: Our Nation's Investment School Counseling, Psychological, and Social Services A new program entitled the "Responsible Students Program" was initiated in middle schools within the past two years. The program emphasizes personal responsibility for students, and it has resulted in a significant decrease in student discipline problems and a significant increase in student preparedness for class. In addition, students receive one lesson weekly related to the importance of taking personal responsibility for behaviors and performance. The Office of Student Services and Assessment has been primarily responsible for helping to spread this program to schools throughout the state. Because of the strong relationship between responsible behavior and good health outcomes, a student assignment book and accompanying video that correlate good study habits and good health and physical fitness habits were jointly developed by the two offices and distributed to more than 1,000 students. School Environment The West Virginia Board of Education has adopted two very significant policies that reflect the importance of sending the correct messages about the importance of good health habits. The Child Nutrition Policy requires that all meals served as part of the school foodservice program meet the new national Dietary Guidelines in 1995. In addition, the policy requires that snack foods sold in vending machines must have limited fat and sugar content. No soft drinks may be sold to students during the school day. The Tobacco Control Policy prohibits the use of any tobacco products, by any individual, at any time on school property. The West Virginia Tobacco Control Coalition has offered assistance in developing educational programs to encourage compliance with this policy. Recently enacted legislation is providing for the construction of many new school facilities and has also provided an opportunity to ensure that these facilities provide space for school-based health centers and/or full-service facilities for community members. Staff from the Adolescent Health Initiative Program is working with numerous school systems across the state in conducting Teen Issue Forums, which address such issues as stress, conflict resolution, teenage pregnancy, and other topics selected by the students in participating schools. Child Nutrition Services The Child Nutrition Policy is one of the first in the nation to require that foods served in school meet the national Dietary Guidelines. The

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School & Health: Our Nation's Investment original policy was developed by a committee comprised of members of the West Virginia University School of Medicine, the West Virginia School Health Committee, the Dairy and Nutrition Council, the Nutrition and Education Trainees Program Cadre, and agency staff. Training for policy implementation is taking place throughout the state. Teacher and Staff Wellness The West Virginia School Health Committee is one of five member organizations of the Healthy West Virginia Coalition. The goal of the coalition is to increase the capacity of participating groups and organizations to sustain and enhance their roles in promoting health and preventing disease in the state. The five member organizations and the groups they represent are as follows: Organization Representing West Virginia School Health Committee All education employees West Virginia Bureau for Public Health All other state employees West Virginia State Medical Society All health care providers Wellness Council of West Virginia Private industry wellness programs West Virginia State Health Education Coalition All other state residents Numerous school districts have initiated staff wellness programs and are reporting significant improvements in physical activity, dietary habits, and other health-promoting activities. Community Involvement During the local infrastructure training held in 1994, representatives from the community attended as members of each team. They represented parents, health care providers, Chambers of Commerce, and other interested or influential groups. Action planning has resulted in involvement of community members in the development and implementation of Healthy Schools programs. In addition, a resource manual was prepared for each participant that listed all of the regional specialists and training opportunities that were available to schools. The lists included adolescent health specialists, com-

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School & Health: Our Nation's Investment munity development specialists for substance abuse prevention, regional health educators, and others who have expertise in a variety of areas that are useful to schools. West Virginia is the only state with a statewide Education Fund that assists in the development of school–business partnerships. Recently, members of the staff of the Office of Healthy Schools and the West Virginia Education Fund received funding from the Public Education Funds Network to help local school improvement councils develop Healthy Schools programs. The previously mentioned Benedum Foundation initiative is linking primary care centers and federally qualified health centers with school-based health centers. The foundation is supporting this initiative as one of a series of activities that bring better health care to rural communities. The West Virginia Tobacco Control Coalition staff has worked with local community leaders in successfully passing clean indoor air policies for public facilities in numerous counties. The Adolescent Health Initiative is working with approximately 30 community groups in improving parenting education skills. The training is modeled after the How to Live with 10–15 Year Olds curriculum, developed in North Carolina.