Eat Healthy and Get Active - Using the School Health Index to Create Healthy School Environments in

Rhode Island Elementary Schools

Two schools in one Rhode Island school district collaborated to implement two of their policies (hand-washing and healthy snacks). The hand-washing policy, addressed in School Health Index Module 1, was incorporated into the schools’ handbooks. The handbook now states that all children will sanitize their hands before any activity that involves food (i.e. breakfast, lunch, snacks, and in classroom parties/activities). The policy on healthy snacks in all school venues grew out of the district Food Service Director’s success in forging relationships with vendors to provide healthy snacks daily to all district elementary schools. The healthy snacks policy was incorporated into the School Improvement Plan, giving the team greater visibility and acceptance. The drafting and implementation of the hand-washing and healthy snacks in school policies was a testament to the true essence of an SHI team – collaboration. The superintendent supported the team’s efforts and viewed team members’ accomplishments as a model for all schools. An interview with the school principal in April 2005 confirmed that both policies continue to be implemented successfully by administrators and teachers and are widely accepted by children and parents. Eat Healthy and Get Active was a pilot intervention to help schools develop policies and environmental supports that promote lifelong physical activity and healthy eating using the School Health Index (SHI). In phase 1, we analyzed the RI Needs Assessment Tool (RINAT) (RINAT), a telephone survey administered to principalsprincipals prippropr in approximately 50% of all RI public elementary schools in the state during the 2001-2002 school year. In phase 2, process and outcome evaluation data (October 2002) to end-of first year (June 2003) effectivenessevaluated the use of the School Health Index (SHI) in creating healthier environments in four inner-city elementary RI elementary schools.

Policy Initiation

Key leaders, partners and best practice advice from Centers for Disease Control (CDC) generated this idea for the intervention.

Public Health Agency Roles

The Rhode Island Department of Health Initiative for a Healthy Weight (IHW) Program designed RINAT to assess environmental and policy supports for healthy eating and physical activity in the state’s elementary schools.

The RI health department selected the non-profit agency, Kids First, Inc. (Kids First) through a competitive request for proposal process to implement the intervention. Of the 35 RI elementary schools with family centers, four were invited to be part of the Eat Healthy and Get Active project. All four participated in RINAT. Each school was given $500 to participate, provided through the contract with Kids First. In addition to the SHI guide, teams received the USDA Changing the scene: Improving the School Nutrition Environment, A Guide to Local Action.

Process evaluation measures were designed by IHW to assess implementation of the intervention and environmental factors that may mediate intervention impact on study outcomes. Methods for monitoring implementation of the intervention included (1) evaluations of facilitator trainings on childhood obesity and the use of the SHI, (2) discussion and planning questions from the SHI modules, (3) facilitator meeting notes and observations of team meetings, and (4) pre- and post-test interviews with members serving on SHI teams. Process evaluation methods for monitoring external influences that may affect program implementation included an Activity Report Form for tracking school-based healthy eating and physical activity educational activities outside of the jurisdiction of the intervention, and a form to record observations of the school environment (e.g., posting of the food pyramid in the cafeteria; plate waste during lunch time; advertisements for tobacco or fast foods within a one mile radius of the school).

Major Partners

Major partners in this effort included Kids First, a non-profit agency; statewide school districts; PTO; and School staff.

Official Support

Official support came from School superintendents.

Results from the Policy

We are not tracking the impact and outcome of this policy and environmental changes. Funding for the Eat Healthy and Get Active project was not available after year one. Nevertheless, we believe that the successful school teams established as part of our intervention would build on their accomplishments and address more controversial and high-impact policies. The political climate in the state is ever more receptive to the concept of policy and environmental change to support healthy eating and physical activity at the school level. The frontline for real change remains at the school level.

However, the Eat Healthy and Get Active project spawned a broader initiative in RI schools. The project served as a model for the RI Healthy Schools Coalition, the state’s coalition, initially proposed in the Rhode Island Department of Health’s obesity prevention plan and supported by the national Healthy Schools Summit. The RI Healthy Schools Coalition consists of over 30 education and health-related organizations, including the Rhode Island Department of Health. Its mission is to promote policy and environmental changes that support healthy eating and physical activity in Rhode Island schools. Ninety participants, from 24 districts and 46 schools, attended workshops on changing their school’s nutrition and physical activity policies and environment using the USDA Changing the Scene toolkit and the SHI.

Opposition

In one of the schools that we worked with, we found that opposition came from the school principal. Parents and teachers on the SHI committee felt that selling ice cream and other high fat "junk" food was not healthy and that the school should look for other fund-raising items but the principal was against this and even thought the parents and teachers all vote to look at other fund-raising, the principal was against it and the idea was killed. What we found out from this process was that even when we found friends and allies on the committee to help forward our agenda, however, if the principal or vice principal was against an idea, it was not going to go forward even if we have a majority support.

Lessons Learned

Survey data found that high minority student schools offered few programs supporting healthy eating and physical activity. No differences were found between low and high minority student enrollment schools on offering non-nutritious foods and beverages in school venues. Process evaluation data also revealed that: (1) principals played a pivotal role on SHI school teams; (2) school-wide validation of a team’s small successes was crucial for to sustaining interest in and commitment to healthy lifestyle policies and programs; and (3) external facilitators were essential to implementation success. Outcome data also showed that all schools developed at least one policy or environmental strategy to create a healthy school environment. Only two schools implemented immediate changes.

Needs assessment, external facilitation, and evaluation aare key for laying theessential to sustainable foundation for school-based policies. Although the SHI was universally perceived as a “user-friendly” assessment tool, implementation is likely to be less successful in schools with low staff morale, budgetary constraints, and inconsistent administrator support.

Submitted By

Toushoua Xiong

Program Manager, Initiative for a Healthy Weight

Rhode Island Dept. of Health

3 Capitol Hill

Providence, RI 02908

401-222-1087

401-222-4415 FAX

Toushoua.Xiong@health.ri.gov