Developing a K-12 Rural School System Wellness Policy through Community Engagement

The Education Strategic Plan of the American Physical Therapy Association (APTA) outlines initiatives for professional practice, including enhancing physical therapists’ roles in: 1) social, governmental, and regulatory practices and policies, 2) health promotion and wellness, and, 3) assessment of societal needs and health disparities. In this paper we describe a community partnership that involved development and implementation of a wellness policy for a rural public school system. A partnership was established to achieve compliance with government mandates for physical activity, nutrition standards, and school-based activities. Collaborative meetings with stakeholders identified the following issues: limited school expertise and resources, community awareness, resistance to change, and sensitivity of dealing with childhood obesity. A comprehensive wellness policy was developed and implemented. Opportunities were found to exist in local communities for health professionals and students to use their intellect, talents, and skills to meet educational objectives related to social responsibility, advocacy, disease prevention, and wellness. Service-learning experiences provided leadership opportunities to promote the role of physical therapists beyond traditional settings through community engagement. Introduction The APTA 2006 Education Strategic Plan outlines initiatives that are crucial to realizing practice opportunities for physical therapists as delineated by Vision 2020 (APTA Vision Statement, 2009). Selected goals of this strategic plan include increased physical therapist (PT) involvement in social, governmental, and regulatory practices and policies, further enhancement of PT’s knowledge, skills, and public recognition in areas of health promotion and wellness, and PT contributions to the assessment of societal needs and health disparities. Furthermore, the priority goals of APTA promote PTs as the universally recognized provider of fitness, health promotion, wellness, and risk reduction programs to enhance quality of life for persons across the life-span (APTA Priority Goals, 2009). Effectively achieving these goals requires PT educational programs to explore ways of providing learning experiences in these areas. Service-learning can be a means for providing student experiential learning opportunities through the development and implementation of partnerships between universities and community-based entities. In addition to community goals, these partnerships may support the development of professional skills and behaviors in student PTs associated with the APTA Education Strategic Plan and Priority Goals. The purpose of this article is to describe one such community partnership 1 Brosky and Wiegand: Developing a K-12 Rural School System Wellness Policy through Com Published by Nighthawks Open Institutional Repository, 2010 Page 32—JOURNAL OF COMMUNITY ENGAGEMENT AND SCHOLARSHIP—Vol. 3, No. 2 with a rural school corporation that involved the development and implementation of a wellness policy necessary to comply with new educational regulations (IDOE/SNP Policy 87 Public Law 108-265). An important objective for this wellness policy was to address the growing problem of school age obesity. Physicians, health policy experts, and health-care providers and wellness advocates see childhood obesity as a multi-factorial epidemic with serious implications for health-care delivery systems and society now and in the future. The effects of obesity in children include chronic illness, disability, low self-esteem and economic hardship for individuals, families, schools, communities, employers, and nearly all facets of the health-care system (Koplan, Liverman, & Kraak, 2005; Thompson, Brown, Nicholos, Elmer, & Oster, 2001; Finkelstein, Fiebelkorn, & Wang, 2004; Thompson, Edelsberg, Kinsey, & Oster, 1998; Tucker & Friedman, 1998; U.S. Department of Health and Human Resources, 2001). Children and adolescents are especially likely to develop serious health and psychosocial problems related to obesity, which may impair academic performance and social functioning (Schwartz & Puhl, 2003). Perhaps the most significant component of the obesity epidemic in children is the likelihood of early development of adult associated health problems and risks. Obesity among young people is associated with increased risk for type 2 (formerly called adult-onset) diabetes mellitus (T2DM), high blood pressure, sleep apnea, and musculoskeletal problems (Koplan et al., 2005). Nearly 60 percent of overweight or obese 5-10 year-olds have at least one cardiovascular disease risk factor (e.g., high cholesterol or high blood pressure) (Freedman, Dietz, Srinivasan, & Berensen, 1999). Type 2 diabetes has become increasingly prevalent among children and adolescents as overweight and obesity rates rise (Rosenbloom, Joe, Young, & Winter, 1999). One study estimated that one in three American children born in 2000 will develop diabetes in their lifetime (Venkat Narayan, Boyle, Thompson, Sorensen, & Williamson, 2003). Ferraro, Thrope, and Williamson (2003) reported that children overweight by age eight were more likely to be morbidly obese as adults. Furthermore, it has been reported that overweight children and adolescents are likely to become obese adults (Freedman, Khan, Dietz, Srinivasan, & Berensen, 2001). Recently, it has been suggested that children in rural areas are particularly susceptible to obesity and increased risk for the development of T2DM (Yousefian, Ziller, Swarts, & Hartley, 2009; Adams & Lammon, 2007). Physical therapists are uniquely qualified to embrace active roles in community health and disease prevention by providing consultative and intervention services for health and wellness issues to individuals of all ages (APTA Priority Goals, 2009). Opportunities in disease prevention exist in local communities and allow PTs and student PTs to use their intellectual property, talents and skills to meet professional objectives related to social responsibility, advocacy, and prevention and wellness. Community-campus partnerships are recognized in the health professions as an effective strategy in addressing many community health issues through servicelearning experiences (Seifer, 1998; Seifer, 2000). Service-learning is an educational strategy that combines community service with structured experiences, specific learning objectives, and directed student reflection (Seifer, 1998; Community Campus Partnerships for Health [CCPH], 2006). Successful service-learning emphasizes clear open commmunication between involved parties and balanced responsibilities and outcome benefits, mutually shared goals, accountability, respect and commitment (CCPH, 2006). In addition to supporting curricular objectives and skill development, service-learning can be a useful tool to develop professional behaviors and attitudes that are often considered part of the hidden curriculum of professional education (Hafferty, 2006; Stern & Papakakis, 2006). Service-learning experiences using the world as the classroom can be an effective way to provide real world training and leadership opportunities and promote physical therapy outside of traditional settings. The primary and secondary education system offers a readily accessible network to provide information and intervention on two important factors associated with obesity: nutrition and physical fitness. Primary and secondary education systems should play an important part in a national effort to prevent childhood obesity. However, there are challenges facing educators 2 Journal of Community Engagement and Scholarship, Vol. 3, Iss. 2 [2010], Art. 4 https://digitalcommons.northgeorgia. edu/jces/vol3/iss2/4 Vol. 3, No. 2—JOURNAL OF COMMUNITY ENGAGEMENT AND SCHOLARSHIP—Page 33 promoting health and physical education in our school systems. For instance the 2002 federal “No Child Left Behind” legislation (U.S. Department of Education, 2001) mandated that all children pass standardized educational testing by 2014 placing greater emphasis on meeting academic measures and not physical fitness and wellness standards. As states and school districts rely on standardized tests to hold schools and students academically accountable, physical activity and health-related education have become a lower priority (Collins, 2007, p. 383). There exists an opportunity for PTs to help schools improve student performance in physical activity and health education (School Health Policies and Program Study [SHPPS], 2006). Elementary and secondary education facilities, in conjunction with academic institutions and community groups, can promote good nutrition, physical activity, and healthy lifestyles in children through health and wellness education, encouraging physical activity, and providing school health services (Michael, Dittus, & Epstein, 2007). In fact, results from SHPPS 2006 suggests improvements and initiatives are needed to increase collaborations with families and community-based organizations to support school health programs nationwide (Michael et al.). The Community Partnership Two student PTs interested in rural health and concerned about current health disparities in rural school-aged children fostered a community partnership with an Indiana public school corporation. The school system needed to achieve compliance with new government mandates (IDOE/SNP Policy 87 Public Law 108265) for nutrition standards, physical activity, and other school-based activity programs. The school superintendent was contacted and a meeting was held to discuss current health promotion and physical fitness programming for the system. In this initial meeting, existing resources and needs related to the development of health and wellness initiatives were identified. The highest perceived need was the actual development of a school wellness policy to bring the school in compliance with IDOE/ SNP Policy 87 Public Law 108-265. Accordingly the school-based w