Showing papers in "Journal of School Nursing in 2009"
TL;DR: Insight gained from this investigation can help school nurses better understand the affect of autism on families, identify specific needs, and address these needs by advocating for appropriate supportive programs.
Abstract: Autism is a developmental disability increasing in incidence over the past decade. Parents of children with autism experience prolonged levels of stress and isolation. Using qualitative research design, nine parents of children with autism participated in this study that focused on the effect of autism on the family, coping styles, and support systems. The target population was first-generation Southeast Asian American parents. Results revealed nine coping style patterns: (a) denial/passive coping, (b) empowerment, (c) redirecting energy, (d) shifting of focus, (e) rearranging life and relationships, (f) changed expectations, (g) social withdrawal, (h) spiritual coping, and (i) acceptance. The school was considered the primary supportive entity. Although findings may not be unique to the Southeast Asian group, the research provides an in-depth perspective on their lived experience, their struggles, and strengths. Insight gained from this investigation can help school nurses better understand the affect of autism on families, identify specific needs, and address these needs by advocating for appropriate supportive programs.
98 citations
TL;DR: The BEM is a useful tool for assisting in the development of more comprehensive programs to influence anti-bullying intervention in school-based nursing practice and can be applied to the school-setting.
Abstract: This article presents a conceptual strategy which uses the Behavioral Ecological Model (BEM) as a health promotion framework to guide school-based bullying awareness programs and subsequent anti-bullying strategies for school nursing practice. Anti-bullying frameworks and tools are scarce despite the extent of the problem of bullying. This article reviews existing literature centered on the BEM and illustrates how the model can be applied to the school-setting. This is the first time that a multilevel framework has been proposed for school-based anti-bullying in the form of a model. The BEM is a useful tool for assisting in the development of more comprehensive programs to influence anti-bullying intervention in school-based nursing practice.
65 citations
TL;DR: Current use of EBP among school nurses attending a national school nurse conference is described, demographic, individual, and organizational factors associated with EBP use are described, and resources needed to enhance E BP use are identified.
Abstract: Primary and acute care settings are the focus of a concerted effort to implement evidence-based practice (EBP) in health care; yet, little attention has been given to use of EBP among school nurses. The aims of this study were to (a) describe current use of EBP among school nurses attending a national school nurse conference, (b) describe demographic, individual, and organizational factors associated with EBP use, and (c) identify resources needed to enhance EBP use. A survey designed for this study was distributed during a national school nurse conference. Descriptive statistics, correlations, and independent t tests were used to analyze respondent data regarding the current level of EBP use, awareness, skills, and information sources. Respondents also identified resources needed to increase use of EBP, which included networking opportunities, predeveloped EBP guidelines, and education on outcome evaluation. The results from this study will be used to develop strategies to increase the use of EBP in the school setting.
50 citations
TL;DR: Students in states with policies promoting students' health demonstrated higher academic scores and higher rates of high school completion and state-level data indicated that components of a CSHP had statistically significant relationships with academic achievement.
Abstract: The study was conducted to determine whether there is a relationship between the Coordinated School Health Program (CSHP) and student academic performance. Data were collected from schools and the community for three reports for 50 states and the District of Columbia (DC). The School Health Policies and Programs Survey (SHPPS), the National Assessment of Educational Progress (NAEP), and the U.S. Census 2000 Profile were used to study the relationships among three parameters: (a) The intervention called a CSHP: (b) Student achievement; and (c) Rate of poverty in each state. A stepwise regression analysis was conducted, controlling for poverty using state-level data. Components of a CSHP had statistically significant relationships with academic achievement. Students in states with policies promoting students' health demonstrated higher academic scores and higher rates of high school completion.
47 citations
TL;DR: Information is provided about the challenges families face and the psychosocial developmental needs of children and families during the five stages of military deployment: prede deployment, deployment, sustainment, redeployment, and postdeployment.
Abstract: Members of the Armed Services and Reserve Unit Members, both male and female, are being deployed to distant lands for long periods of time, disrupting family life and causing stressful times for the adults and children in the family. Traditionally, the mother of the military family was left to be the caregiver after the deployment of the husband/father. Today, extended family members as well as mothers or fathers are asked to serve as caregivers for dependent children of deployed servicemen and servicewomen. This article provides information about the challenges families face and the psychosocial developmental needs of children and families during the five stages of military deployment: predeployment, deployment, sustainment, redeployment, and postdeployment. School nurses can offer children and families support and link them with available resources and networks that will assist them with their needs.
46 citations
TL;DR: The findings indicate that Color My Pyramid can be successfully employed in school settings and thus support school nursing practice and the need for successful nutrition interventions increases.
Abstract: The need for successful nutrition interventions is critical as the prevalence of childhood obesity increases. Thus, this pilot project examines the effect of a nutrition education program, Color My Pyramid, on children's nutrition knowledge, self-care practices, activity levels, and nutrition status. Using a pretest-posttest, quasiexperimental design, 126 fourth- and fifth-grade students from experimental and control schools are compared. The intervention program incorporates an online component www.MyPyramid.gov, Orem's Self-Care Deficit Nursing Theory, and consists of six classes taught over a 3-month period. Results indicated that the program increased nutrition knowledge in the control group. Furthermore, it increased activity time from pretest to posttest and decreased systolic blood pressure for children in both groups; however, there were no significant differences in BMI percentiles. The findings indicate that Color My Pyramid can be successfully employed in school settings and thus support school nursing practice.
45 citations
TL;DR: Research studies that describe the care of the student with type 1 diabetes at school and interventions to improve care identified needed improvement in the following areas: communication, after-school support, education of staff and peers, school nurse availability and lunch choices.
Abstract: This integrative literature review examines research studies that describe the care of the student with type 1 diabetes at school and interventions to improve care. Participants of the studies include school nurses, counselors, staff, administrators, parents, and students with diabetes. The studies reviewed use a descriptive approach in examining care delivered with one study adding a qualitative approach for validation of results. The findings identified needed improvement in the following areas: communication, after-school support, education of staff and peers, school nurse availability, and lunch choices. The school nurse must advocate for the student with type 1 diabetes in each area of concern, especially in ensuring education of school staff who often provide care to these students.
43 citations
TL;DR: Recommendations are offered for successful physical activity and nutrition health promotion programs for children in one public urban school serving a predominantly low-income, Hispanic population.
Abstract: Physical inactivity and lack of nutritious diets increase children’s risk of obesity, especially children from low-income and ethnic minority groups. To address this risk, the school-based TAKE 10! program was implemented to increase the physical activity and improve the nutrition of K-6th grade students in one public urban school serving a predominantly low-income, Hispanic population. In this study the researchers (a) evaluated the program outcomes using the physical activity and nutrition questionnaires provided with the TAKE 10! curriculum material, teacher surveys, observations, and interview data; (b) evaluated the questionnaires provided with the TAKE 10! curriculum material and provided suggestions for modification; and (c) described the experience of a positive partnership among school, university, and community agencies implementing the TAKE 10! curriculum. Based on the findings, recommendations are offered for successful physical activity and nutrition health promotion programs for these children.
41 citations
TL;DR: There is a need for school nurses to enhance their knowledge of ASD, to familiarize themselves with the policy and health care networks that they collaborate with, and to communicate effectively with students, parents, educators, and community members in dealing with ASD.
Abstract: The purpose of this study was to determine school nurses' working knowledge of autism spectrum disorders (ASDs). The current knowledge of school nurses was investigated by means of a mixed-method exploratory descriptive pilot study. Instrumentation included a scale that measured the knowledge of school nurses in regard to ASD, including medication usage and side effects, communication skills, safety issues, collaboration skills, and community resources. Survey results indicated that the majority of school nurses are knowledgeable about ASD, including symptomology and related medications. Results also suggested that school nurses are not as knowledgeable concerning communication skills, behavioral therapies, and safety issues. This study confirms a need for school nurses to enhance their knowledge of ASD, to familiarize themselves with the policy and health care networks that they collaborate with, and to communicate effectively with students, parents, educators, and community members in dealing with ASD.
39 citations
TL;DR: This study compared school administrator and school nurse perceptions of the role of the school nurse using a tool based on the National Association of School Nurses’ “Advocacy Talking Points” and identified specific areas in which schools could improve their school nurse program and enhance school administrators’ understanding of theschool nurse role.
Abstract: The current tenuous status of public education funding requires that school nurses be proactive in advocacy efforts on behalf of their school nursing programs. Advocating for nursing practice within an educational setting presents unique challenges. Lack of state or national consensus for support of school nurse services creates an opportunity for school nurse advocates to develop quantitative tools to evaluate their school nurse program. Identifying commonalities and differences between school administrators' and school nurses' perceptions of the school nurse role will provide information that can be used to strengthen programs and facilitate the understanding of school personnel about what school nurses do. This study compared school administrator and school nurse perceptions of the role of the school nurse using a tool based on the National Association of School Nurses' "Advocacy Talking Points." Analysis of responses identified specific areas in which schools could improve their school nurse program and enhance school administrators' understanding of the school nurse role.
33 citations
TL;DR: Incidence of reported MRSA infections among football players and wrestlers was substantially higher during 2007–2008, compared with 2006–2007, and differences in distribution on the basis of grade, school enrollment, location, or number of participants per team were identified.
Abstract: Methicillin-resistant Staphylococcus aureus (MRSA) is an emerging cause of skin and soft-tissue infections among athletes. To determine statewide incidence among high school athletes, we surveyed all 312 Nebraska high schools regarding sport programs offered, program-specific participation numbers, number of athletes with physician-diagnosed MRSA infections, and athlete's sport at infection onset. Among 271 (86.9%) schools responding, MRSA infections were reported among one or more athletes by 4.4% (12/270) and 14.4% (39/271) during school years 2006-2007 and 2007-2008, respectively. From 2006-2007 to 2007-2008, MRSA incidence per 10,000 wrestlers increased from 19.6 to 60.1, and incidence per 10,000 football players increased from 5.0 to 25.1. We did not identify differences in distribution of MRSA infections on the basis of grade, school enrollment, location, or number of participants per team. Incidence of reported MRSA infections among football players and wrestlers was substantially higher during 2007-2008, compared with 2006-2007.
TL;DR: This study was conducted to document mothers’ experiences of the care their CSHCN receive across health care and educational settings and revealed five themes: communication, communication, educational system issues, mother as a caregiver and expert, navigating the system, and strategies and coping.
Abstract: The numbers of children with special health care needs (CSHCN) have increased in schools. This study was conducted to document mothers’ experiences of the care their CSHCN receive across health care and educational settings. Data were collected during standardized, open-ended, one-on-one interviews with 10 mothers of CSHCN in urban, suburban, and rural areas in a Midwestern state. Interviews were transcribed and content analysis revealed five themes: (a) communication, (b) educational system issues, (c) mother as a caregiver and expert, (d) navigating the system, and (e) strategies and coping. Describing and understanding experiences of mothers of CSHCN is important to developing appropriate supportive interventions.
TL;DR: It is important that school nurses are up-to-date on current concussion information to allow for optimal care following injury and during the recovery process.
Abstract: The school nurse plays a dynamic role in the care and treatment of a concussed athlete. Concussions in the adolescent populations are of special concern due to their potential impact on mental development and cognitive function, as well as an increased risk of serious complications including second impact syndrome. The complexity of a concussion requires collaboration between of a variety of health care and school personnel to create an optimal situation for the student-athlete and their family. As the primary health care provider for students during the school day, school nurses can help ensure all necessary steps are taken to aid the recovery of an injured student-athlete. It is important that school nurses are up-to-date on current concussion information to allow for optimal care following injury and during the recovery process.
TL;DR: The need to develop male- and female-specific interventions to promote healthy body images and body weight in South Korean adolescents is suggested.
Abstract: This study examines relationships among weight status, weight perceptions, and dieting behaviors in South Korean adolescents. As perceptions of an ideal body for teens in Korea have changed over time, it is important for school nurses to understand these relationships to help students achieve health. A cross-sectional survey of 3,191 8th and 2,252 11th-grade students from 21 middle and high schools across Korea completed a self-administered questionnaire. The prevalence of overweight among adolescents was 17.5% in males and 6.0% in females. Overall, 65.9% of students perceived their weight status accurately. Females overestimated their weight status 2.3 times more often than males. Male students underestimated their weight status 2.7 times more frequently than females. Approximately one third of participants misperceived their weight status, with variations existing between males and females. Study results suggest the need to develop male- and female-specific interventions to promote healthy body images a...
TL;DR: A pilot parent-directed trial with 46 parents of overweight and obese elementary school students was conducted at two ethnically diverse public schools in Framingham, Massachusetts, and results are encouraging.
Abstract: Childhood obesity may be lessened by parent-focused interventions. A pilot parent-directed trial with 46 parents of overweight and obese elementary school students was conducted at two ethnically diverse public schools in Framingham, Massachusetts. Parents were randomly assigned to either the Materials Group, which received mailed educational materials, or the Materials plus Personal Encounters Group, which received educational materials through interactions with community health workers (CHWs). Parents completed baseline and post-intervention surveys; children's body mass index (BMI) percentiles were measured at baseline and post-intervention. There were no differences in the reduction of children's BMI between groups. However, the mean BMI percentile for all children dropped from 94.1 to 90.6 (p = .005), while there was no change in BMI among a nonrandomized contemporaneous control group. Findings are limited by the lack of a true control group and small sample size. Results from this school nurse and CHW outreach program to parents are encouraging.
TL;DR: School officials need to realize children are individuals and should not be expected to empty their bowels and bladders according to a set, rigid schedule and school officials should not expect children to use dirty, unsafe bathrooms that they themselves would not tolerate.
Abstract: Lack of privacy, risk of bullying, limited access, lack of essential products for good hygiene, and dirty bathrooms can all contribute to encouraging a child to withhold urine and stool while in school. Withholding behaviors over time can create a condition known as dysfunctional elimination syndrome (DES). DES is any pattern of voiding or stooling that varies from the developmental norm. These abnormal patterns of elimination can eventually lead to complications of urinary tract infection, vesicoureteral reflux, and incontinence of urine and/or stool. School officials (teachers, school nurses, and school administrators) can help in the prevention of learned behaviors that lead to DES in school-age children. School officials need to realize children are individuals and should not be expected to empty their bowels and bladders according to a set, rigid schedule. In addition, school officials should not expect children to use dirty, unsafe bathrooms that they themselves would not tolerate. School nurses can be a powerful force in protecting children's health by participating in research and developing evidence-based guidelines to improve bathroom access and conditions.
TL;DR: Developmental changes were reported among the school nurses in this study as they reflected on how they perceived their nursing career over time and during different seasons of their lives.
Abstract: This is a phenomenological study of 25 school nurses employed in a large, urban school district in the midwestern section of the United States. In addition to school nursing, the participants also had professional work experience in other nursing specialties. Thematic analysis of the data focused on the challenges faced by the school nurses, their views of school nursing success, and elements of job satisfaction. Overall, the school nurses reported the positive aspects of school nursing outweigh the negative aspects of their jobs. Developmental changes were reported among the school nurses in this study as they reflected on how they perceived their nursing career over time and during different seasons of their lives.
TL;DR: Funding per pupil unit in general and support services and laws mandating school nurse ratios were some of the factors found to be associated with school ratios.
Abstract: Despite the recognized importance of school nurses, the ratios of nurse to pupil are insufficient in many states across the country. The purpose of this study was to describe school nurse-to-pupil ratios by state and to statistically identify factors that may influence these ratios. Funding per pupil unit in general and support services and laws mandating school nurse ratios were some of the factors found to be associated with school ratios. Although the study has significant limitations, this is the first study of its kind to examine factors associated with ratios using secondary databases that are state-specific. Data such as this provide a context for studying those factors potentially influencing ratios. Further studies are needed to explore the numerous potential determinants described in the literature. Once key factors are identified, school nurses can effectively focus their efforts to lower school nurse-pupil ratios.
TL;DR: Using a capacity-building approach, the Case Management Project (CMP) developed a definition of case management and a set of baseline and outcome measures to assist school nurses to become effective case managers and track their outcomes.
Abstract: Case management is a component of school nurse practice that provides an opportunity to demonstrate the contribution that school nurses make to the health and academic success of children, particularly children with chronic health conditions However, case management programs vary in their mission and scope, leading to confusion about what it means to be a case manager Many programs acknowledge the difficulty in tracking outcomes and sustaining results Using a capacity-building approach, the Case Management Project (CMP) developed a definition of case management and a set of baseline and outcome measures to assist school nurses to become effective case managers and track their outcomes
TL;DR: It is imperative school nurses are aware of this condition, its symptoms, and treatments and techniques to help students with OCD cope effectively.
Abstract: Obsessive-compulsive disorder (OCD) is an anxiety disorder characterized by disturbing thoughts, impulses, or images (obsessions); repetitive or ritualistic behaviors (compulsions); or the presence of both. Although some may believe this disorder is isolated to the adult population, it affects anywhere from 1% to 4% of children in the United States. However, symptom presentation of this psychiatric condition may be different in the pediatric population. School-age children who are affected by the condition or their parents may attempt to hide these behaviors due to embarrassment or fear of peer victimization. If left untreated, OCD can interfere with the ability to play, socialize, attend school, and function as a part of a family, ultimately affecting success not only in school but in life. It is imperative school nurses are aware of this condition, its symptoms, and treatments and techniques to help students with OCD cope effectively.
TL;DR: A greater understanding of HPV disease and prevention among school nurses, students, and parents may lead to greater reductions in the burden of cervical and other HPV-related diseases.
Abstract: Oncogenic human papillomavirus (HPV) causes 99.7% of all cervical cancers. HPV Types 16 and 18 are responsible for approximately 77% of cases, and peak prevalence occurs in females younger than 25 years of age. The recent implementation of HPV vaccination provides females with the opportunity to prevent infection. School nurses are advocates of student health and often a primary source of information. Therefore, they can play a key role in promoting vaccination prior to sexual debut. They can also promote regular cervical screening postvaccination, which may not be apparent to many students and parents. To deal with such issues, school nurses need a firm understanding of HPV and its role in cervical cancer. A greater understanding of HPV disease and prevention among school nurses, students, and parents may lead to greater reductions in the burden of cervical and other HPV-related diseases.
TL;DR: A violence Prevention program for 9th and 10th graders was developed, implemented, and evaluated at a local urban charter school and provides a blueprint for an adolescent violence prevention program that school nurses could adopt in their communities.
Abstract: Youth violence in the city of Philadelphia, PA, has reached epidemic proportions. The majority of homicides related to gun violence is most prevalent among African American males aged 19 to 24 years. Therefore, it is essential to implement youth violence prevention programs to a target population several years younger than this age group to decrease teen violence in the city. A violence prevention program for 9th and 10th graders was developed, implemented, and evaluated at a local urban charter school. Presentations were given on gun and gang violence, dating violence, and anger management/conflict resolution as well as role playing, group activities, and a field trip to a trauma program for youth at a local hospital. Posttest scores showed an increase in knowledge and skills in several areas, such as therapeutically resolving violent disputes and methods to prevent different types of dating violence. This program provides a blueprint for an adolescent violence prevention program that school nurses could adopt in their communities.
TL;DR: PDV was strongly associated with SDV among high school students in 2005 and 2007 and school nurses should be actively involved in promoting healthy lifestyles and healthy choices among highSchool students through interdisciplinary efforts with parents, teachers, school districts, and communities.
Abstract: Adolescents are a high-risk group for dating violence. Using the Youth Risk Behavior Survey data, this study examined the associations among dating violence (including physical dating violence [PDV] and sexual dating violence [SDV]) and selected health risk behaviors among 375 and 372 high school students, in 2005 and 2007, respectively, in southeastern North Carolina. The findings indicate PDV increased slightly from 2005 (11.6%) to 2007 (12.5%), while SDV remained approximately the same (10.4% in 2005 and 10.3% in 2007). PDV was strongly associated with SDV among high school students in 2005 and 2007. Significant associations also exist among dating violence and sexual behavior, substance use, violence, psychological health, and unhealthy weight control. School nurses should be actively involved in promoting healthy lifestyles and healthy choices among high school students through interdisciplinary efforts with parents, teachers, school districts, and communities.
TL;DR: Rules and regulations governing school nursing practice in the United States are presented, with Departments of Education being the most frequent authorizing agency and the majority of states credential school nurses for practice.
Abstract: The purpose of this article is to present a state-by-state summary of rules and regulations governing school nursing practice in the United States. Official government and agency sites were reviewed to determine providers of services in schools, criteria for becoming a school nurse, protection of titling, mandates for school nursing, and the requirements for continuing to practice as a school nurse. Trends were identified after verifying regulatory information. The majority of states credential school nurses for practice, with Departments of Education being the most frequent authorizing agency. Almost half (n = 23, 45%) of the states refer to the role of licensed practical nurses in the school setting. Requirements for becoming a school nurse range from licensed practical or vocational nurse (LPN) to registered nurse-bachelor of science degree in nursing with additional education and experience. Limitations related to data collection issues and implications for practice, education, and leadership are discussed.
TL;DR: Improvements in many school policies and programs are needed so that students have a safe and supportive school environment to help them control their asthma while away from home.
Abstract: School health policies and programs provide the framework for a safe and supportive environment for students with asthma. School Health Policies and Programs Study 2006 data were examined to assess whether schools nationwide have policies and programs consistent with the “How Asthma-Friendly Is Your School?” checklist from the National Asthma Education and Prevention Program. Adherence to some of the recommendations on the checklist was high. For example, 80% or more of schools allowed students to carry and self-administer asthma medications, and obtained and kept asthma action plans. For other recommendations, however, far fewer schools had the recommended polices or programs; most notably, less than one third of schools had a full-time Registered Nurse. Improvements in many school policies and programs are needed so that students have a safe and supportive school environment to help them control their asthma while away from home.
TL;DR: This article will further provide school nurses with information about the etiology of the bedbug, mode of transmission, and eradication options for the school and community setting.
Abstract: Currently there is a rise in bedbugs seen in schools. The wingless, blood-sucking insects can arrive at school via student book bags, student clothing, or other personal items. If a student presents in the health office with a bite mark, the school nurse will need to differentiate between a bedbug bite and other insect bites, such as fleas, spiders, and scabies in order to provide the most accurate and appropriate intervention measures. This article will further provide school nurses with information about the etiology of the bedbug, mode of transmission, and eradication options for the school and community setting.
TL;DR: A case study is presented that demonstrates the steps in the integration process, the roles of the team members, and implications for school nursing practice.
Abstract: Advances in medicine have increased the survival rates of children with complex medical conditions, including those who are dependent on technology such as ventilators and tracheostomies. The process of integrating children dependent on medical technology into public schools requires the collaboration of a multidisciplinary team to ensure that both their educational and health care needs are met. As coordinator of the school health program, the school nurse plays a vital role throughout the integration process and during the time the student is enrolled in the school. This article presents a case study that demonstrates the steps in the integration process, the roles of the team members, and implications for school nursing practice.
TL;DR: The work of school nurses who care exclusively for children with special health care needs is explored, nurses' interaction with parents, staff, or providers, and the challenges, benefits, and support for their role are described.
Abstract: Published qualitative studies have not focused on nurses who solely care for children with special health care needs. The purpose of this study was to explore and describe (a) the work of school nurses who care exclusively for these children, (b) nurses' interaction with parents, staff, or providers, and (c) the challenges, benefits, and support for their role. Data from on-site observation and in-depth interviews with experienced, long-term employed nurses (n = 13) were analyzed using qualitative descriptive inquiry. Performing a personally satisfying clinical role, school nurses adapted to a “teachers world” by working alone, feeling responsible; begging, bartering, and subsidizing; and embracing school as family. They bridged home and school by doing for children, building relationships with parents, and knowing the child. Nurses need to be supported through peer supervision and adequate resources to provide family-centered care to students in a setting dominated by education professionals.
TL;DR: Values guiding delegation were comprehensive knowledge, trust, and empowerment that provided a framework for guiding the delegation process in school settings from the perspective of the school nurse.
Abstract: As health care institutions in the United States respond to shrinking budgets and nursing shortages by increasing the use of unlicensed assistive personnel (UAP), school nursing practice is changing from providing direct care to supervising activities delegated to UAP. Therefore, delegation is a critical area of concern for school nurses. The purpose of this qualitative research study was to explore values guiding the delegation of health care tasks to UAP in school settings from the perspective of the school nurse. An inquiry focus group was conducted with 64 Florida school nurses. Values guiding delegation were comprehensive knowledge, trust, and empowerment. These values provided a framework for guiding the delegation process.
TL;DR: The results suggest that an intervention to increase school districts’ infrastructure for CSHP show promise and provide an impetus for continued efforts at national, regional, and local levels.
Abstract: Coordinated school health programs (CSHPs) provide an organizational framework for school health practice by combining health education, health promotion, disease prevention, and access to health services in an integrated, systemic manner. This project examined the effects of a regional 2-year training program to increase local school districts’ CSHP infrastructure as measured by the establishment of four structures essential to the CSHP model. These structures include a (a) school health advisory council, (b) school health coordinator, (c) school-based health teams, and (d) school board policy. Nine participating school districts were compared to seven nonparticipating districts. The nine participating districts demonstrated a significant increase in school health services and their infrastructure for CSHP as measured by the establishment of the four essential structures. Academic and physical fitness gains were noted for both the participating and nonparticipating districts. These results suggest that a...