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CSHP At-A-Glance Making Health Academic Home CSHP At-A-Glance

What Is a Coordinated School Health Program (CSHP)?

Why Do Schools and Communities Need CSHPs?

What Key Strategies Should Guide Your Approach?

Frequently Asked Questions About

This section provides an introduction to the basics of coordinated school health programs (CSHPs), including a summary of their components, a rationale for their importance, and an overview of the steps required to establish these programs in your schools and communities.

What Is a Coordinated School Health Program (CSHP)?

Health is not just the absence of disease – it is complete physical, mental, and social well-being. A school health program that effectively addresses students’ health, and thus improves their ability to learn, consists of many different components. Each component makes a unique contribution while also complementing the others, ultimately creating a whole that is more than just the sum of its parts. CSHPs traditionally include eight components:

  1. Family and community involvement in school health: Partnerships among schools, families, community groups, and individuals. Designed to maximize resources and expertise in addressing the healthy development of children, youth, and their families.

  2. Comprehensive school health education: Classroom instruction that addresses the physical, mental, emotional, and social dimensions of health; promotes knowledge, attitudes, and skills; and is tailored to each age/developmental level. Designed to motivate and assist students in maintaining and improving their health and to reduce their risk behaviors.

  3. Physical education: Planned, sequential instruction that promotes lifelong physical activity. Designed to develop basic movement skills, sports skills, and physical fitness as well as to enhance mental, social, and emotional abilities.

  4. School health services: Preventive services, education, emergency care, referral, and management of acute and chronic health conditions. Designed to promote the health of students, identify and prevent health problems and injuries, and ensure appropriate care for students.

  5. School nutrition services: Integration of nutritious, affordable, and appealing meals; nutrition education; and an environment that promotes healthy eating habits for all children. Designed to maximize each child’s education and health potential for a lifetime.

  6. Counseling, psychological, and social services: Activities that focus on cognitive, emotional, behavioral, and social needs of individuals, groups, and families. Designed to prevent and address problems, facilitate positive learning and healthy behavior, and enhance healthy development.

  7. Healthy school environment: The physical, emotional, and social climate of the school. Designed to provide both a safe physical plant and a healthy and supportive environment that fosters learning.

  8. Health promotion for school personnel: Assessment, education, and fitness activities for school faculty and staff. Designed to maintain and improve the health and well-being of school staff who serve as role models for the students.

These components encompass a school's instruction, services, and physical and social environments. Leadership, partnerships, and coordination serve as the "glue" that holds the different pieces together to form a coherent whole. Because individuals, institutions, needs, and resources differ from community to community, no two CSHPs are expected to look exactly alike. Each new setting will bring together a unique group of people and agencies to determine the specific needs facing young people in their schools and build on the many resources that are already in place to support positive youth development.

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Why Do Schools and Communities Need CSHPs?

Six behaviors account for most of the serious illnesses and premature deaths in the United States:

  • Tobacco use
  • Abuse of alcohol and other drugs
  • Poor eating habits
  • Physical inactivity
  • Behaviors that result in intentional and unintentional injury
  • Sexual behaviors that result in HIV infection, other sexually transmitted diseases, or unintended pregnancy

All of these are preventable, as are a vast array of associated social, emotional, and physical ailments. When schools, families, and the broader community work together to support positive youth development, risk behaviors are reduced and student’s health and academic achievement are promoted. CSHPs provide a framework for creating essential linkages among diverse individuals and activities, within and beyond school walls, to improve youth outcomes.

Read on to learn more about the consequences and outcomes associated with the following:

High-risk behaviors compromise emotional well-being, physical health, peer and familial relationships, and performance in school:

  • Physical inactivity among young people has contributed to an epidemic of childhood obesity. The percentage of young people who are overweight has more than doubled in the past 20 years. Among 5 to 15-year-old children, 60 percent have at least one and 27 percent have two or more risk factors for cardiovascular disease (U.S. Department of Health and Human Services and U.S. Department of Education, 2000).

  • Approximately 20 percent of young people ages 9-17 are diagnosed with a mental disorder. A subset of 9-13 percent experiences a serious emotional disturbance. Most (70 percent) school-age children with a diagnosable mental disorder do not receive any mental health services (U.S. Department of Health and Human Services, 1999).

  • About 80 percent of tobacco users begin before the age of 18; about 5 million children now under age 18 will die prematurely as adults because they began to smoke cigarettes during adolescence. Smoking among U.S. high school students increased from 27.5 percent in 1991 to 34.8 percent in 1999 (Centers for Disease Control and Prevention, October, 2000).

  • By eigth grade, 52 percent of young people have consumed alcohol (more than just a few sips); by the end of high school, the number rises to 80 percent. Prevalence rates for marijuana use among youth in grades 8, 10, and 12 are 17 percent, 32 percent, and 38 percent, respectively (Johnston, O’Malley, & Bachman, 2000).

  • Approximately half of all high school students have had sexual intercourse, and 16.2 percent have had sex with four or more partners. Among sexually active youth, more than 40 percent did not use a condom during last sexual intercourse (Centers for Disease Control and Prevention, 2000).

  • Approximately 40,000 new HIV infections occur in the United States every year, and half of those being infected are young people between the ages of 13 and 24 (Office of National AIDS Policy, 2000).

  • In 1999, 35.7 percent of high school students had participated in a physical fight and, during the month preceding survey administration, 17.3 percent had carried a weapon (Centers for Disease Control and Prevention, 2000).
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Health and learning are profoundly connected.

  • One child in four – approximately 10 million – is at risk of school failure due to social, emotional, and/or physical health problems. Every school day, more than 3,000 students drop out of high school (Dryfoos, 1998).

  • Students with serious emotional disturbances fail more classes, miss more days of school, have lower grades and retention levels, and have higher drop-out rates than students without such problems (Woodruff et al., 1999).

  • Asthma is the most common chronic illness among children, and the leading cause of absenteeism. Combined with allergic rhinitis, it accounts for more than 8 million lost days of school every year (Martella, 2001).

  • The overall death rate for those with less than 12 years of education is more than twice that for people with more education (Office of Disease Prevention and Health Promotion, 2000).

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School-based efforts to promote student health have demonstrated success:

  • Students who participate in intense physical activity programs at school demonstrate increased concentration; improved mathematics, reading, and writing test scores; and reduced disruptive behavior (U.S. Department of Health and Human Services and U.S. Department of Education, 2000).

  • Schools with breakfast programs see increases among their students in academic test scores, daily attendance rates, and class participation (NGA Center for Best Practices, 2000).

  • School-based drug and violence prevention programs are capable of promoting the skills that students need to avoid risk behaviors (Dusenbury & Falco, 1995; Dusenbury, Falco, Lake, Brannigan, & Bosworth, 1997).

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School-family-community partnerships improve outcomes for all involved:

  • Strong school-family-community connections enhance teacher morale, parent ratings of teachers, support from families, student achievement, and school reputation (North Central Regional Education Laboratory, 2001).

  • Schools can provide a forum for a variety of health-related, educational, political, and recreational opportunities for community members, including community meetings, adult education, candidate nights, theatrical productions, health screenings, and physical fitness classes (North Central Regional Education Laboratory, 2001).

  • Frequent and positive school-home communication and parental involvement in children’s education increase parents’ self-confidence, comfort with the school, and willingness to become or stay involved (North Central Regional Education Laboratory, 2001).

  • Young people who attend schools that have strong connections to their families and the larger community demonstrate higher test scores and grades, better attendance, more homework completion, fewer placements in special education, more positive attitudes and behavior, higher graduation rates, and greater enrollment in higher education (North Central Regional Education Laboratory, 2001).

    Back to Consequences & Outcomes

Young people today confront numerous challenges to their social, emotional, and physical well-being. Together with families and the overall community, schools are responsible for reducing obstacles to health and learning and for promoting positive development and achievement among students. Schools are, in fact, very well situated to serve as a hub for risk prevention and health promotion activities. Approximately 95 percent of the 50 million young people in the United States attend elementary, middle, or secondary schools, which represent the largest recipient of public spending for children and adolescents (Hawkins, Catalano, & Associates, 1992; Perry, 1999).

Most schools have some programs and services in place to address student health, but few have integrated or coordinated these typically discrete elements into an intentionally cohesive and coherent whole. More often, their efforts look something like this:

Uncoordinated School Health System

A coordinated approach to school health makes order from energy-draining disorder. It provides the "glue" necessary to organize diverse components in the areas of curriculum, services, and the environment so that they work together in a systematic way to improve health and academic outcomes for students.

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What Key Strategies Should Guide Your Approach?

In the previous section, you saw an image of an uncoordinated system in which fragmented programs and services branched off from the school. Each is intended to support and assist young people; however, in the absence of institutional coherence and collaboration, these health promotion efforts are likely to be more time-consuming and less effective than they would be in a more coordinated environment.

Coordinated School Health System

This section expresses the value of coordination, partnerships, and leadership as broad and ongoing strategies that are essential to the development and functioning of a CSHP. It also provides an overview of more specific action steps associated with each of the eight components.

Read on to learn more about:


Coordination involves the organization of multiple elements – such as the educational program, education-related services, and the school environment – into an integrated and harmonious operation. It is the "glue" that connects diverse initiatives designed to reduce risk and promote health and achievement, and it will facilitate the creation of a school-community system that truly supports students and their families.

One way to promote coordination among health promotion activities, health and education programs, and community initiatives is to appoint a professional at the school or district level who is responsible for accomplishing these objectives (American Cancer Society, Inc., 1999a). This coordinator should provide leadership for the school health team in a variety of areas:

  • Assessment
  • Advocacy
  • Planning
  • Fiscal management
  • Training
  • Resource identification
  • Evaluation

An additional strategy for improving coordination is through the creation of a school or district health council. This is advisory group, comprised of individuals who represent key segments of the school and community, supports the coordinator in executing the activities listed above (American Cancer Society, 1999b).


Partnerships are relationships between two or more people or groups in which members contribute their distinctive assets to the resolution of problems and the advancement of shared interests. The best partnerships are mutually beneficial and often lead to outcomes that members could not have achieved alone. They are structured to connect individuals – not just their groups or institutions – and built to last. School-community partnerships involve relationships between elementary, middle, or secondary schools and the range of community initiatives and systems that promote the well-being of youth. These include families, social services, government agencies, law enforcement, religious groups, universities, colleges, media, and local businesses. School-community partnerships build on the strengths of both the school and community, foster the exchange of expertise and resources, promote shared accountability for results, and ensure that progress is made toward the goal of creating an effective CSHP.

The aforementioned advisory group is one school-community partnership that is essential for CSHP development and implementation. This type of partnership has an inclusive and broad-based membership, a strong core of committed partners with concrete roles and responsibilities, a clear vision, and a mission to advise the school on how to improve school health. Another type of school-community partnership is the coalition. Similar to an advisory group in membership, it may take on multiple specific projects to stimulate change both inside and outside the school.


To create an effective CSHP, or to even get schools and communities to consider the idea, it is essential that stakeholders in key positions provide public and consistent support. Such leaders are persons with stature in the executive branch of state government, in the legislature or judiciary, in prominent statewide and community-based organizations, in the business and civic communities, and in school systems. These individuals are capable of commanding attention, making decisions, recruiting others, and providing access to valuable resources. Effective leadership increases the likelihood that a CSHP initiative will gain broad-based support and successfully navigate the challenging path toward implementation.

Roles for All and Action Steps

A successful CSHP requires the commitment and participation of diverse individuals, groups, and institutions, each taking on multiple, yet specific, roles and responsibilities. For ideas about roles that each participant can carry,
click here.

There are also specific action steps associated with each of the eight CSHP components:

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References and Resources

American Cancer Society, Inc. (1999a). Improving School Health: A Guide to the Role of the School Health Coordinator. Atlanta, GA: American Cancer Society.

American Cancer Society, Inc. (1999b). Improving School Health: A Guide to School Health Councils. Atlanta, GA: American Cancer Society.

Centers for Disease Control and Prevention. (June 2000). Youth Risk Behavior Surveillance—United States, 1999. In CDC Surveillance Summaries. Morbidity and Mortality Weekly Report 2000; 49 (No. SS-5). Available online at

Centers for Disease Control and Prevention. (October 2000). Youth Tobacco SurveillanceUnited States, 1998?.  In CDC Surveillance Summaries. Morbidity and Mortality Weekly Report 2000; 49 (No. SS-10). Available online at

Dryfoos, J. (1998). Safe Passage: Making It Through Adolescence in a Risky Society. New York: Oxford University Press.

Dusenbury, L. & Falco, M. (1995). Eleven components of effective drug abuse prevention curricula. Journal of School Health, 65, 420?.

Dusenbury, L., Falco, M., Lake, A., Brannigan, R., & Bosworth, K. (1997). Nine critical elements of promising violence prevention programs. Journal of School Health, 67, 409?.

Hawkins, J. D., Catalano Jr., R. F., & Associates. (1992). Communities that Care: Action for Drug Abuse Prevention. San Francisco: Jossey-Bass Publishers.

Johnston, L. D., O'Malley, P. M., & Bachman, J. G. (2000). The Monitoring the Future National Results on Adolescent Drug Use, Overview of Key Findings, 1999 (NIH Publication No. 00-4690). Bethesda, MD: National Institute on Drug Abuse.

Martella, J. (March 2001). A is for asthma. In Gaining Ground Newsletter: Achieving Excellence in High-Poverty Schools. Washington, DC: CCSSO Resource Center on Educational Equity.

National Commission on the Role of the School and the Community in Improving Adolescent Health (1990). Code Blue: Uniting for Healthier Youth. Washington, DC: American Medical Association and the National Associate of State Boards of Education.

NGA Center for Best Practices (October 2000). Improving Academic Performance by Meeting Student Health Needs.  Washington, DC: National Governors' Association, NGA Center for Best Practices, Education Division. Available online at,1188,C_ISSUE_BRIEF^D_976,00.html.

North Central Regional Educational Laboratory (2001). Parent and Family Involvement. Available online at

Office of Disease Prevention and Health Promotion, U.S. Department of Health and Human Services (2000). Health People 2010. Washington, DC: U.S. Department of Health and Human Services, U.S. Government Printing Office. Available online at

Office of National AIDS Policy (September 2000). Youth and HIV/AIDS 2000: A New American Agenda. Washington, DC: The White House.

Perry, C. L. (1999). A Conceptual Approach to School-Based Health Promotion. pp. 33?.

U.S. Department of Health and Human Services (1999). Mental Health: A Report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services; National Institutes of Health, National Institute of Mental Health. Available online at

U.S. Department of Health and Human Services & U.S. Department of Education (Fall 2000l). Promoting Better Health for Young People Through Physical Activity and Sports. Silver Spring, MD: Centers for Disease Control and Prevention, Healthy Youth. Available online at

Woodruff, D. W., Osher, D., Hoffman, C. C., Gruner, A., King, M. A., Snow, S. T., & McIntire, J. C. (1999). The role of education in a system of care: Effectively serving children with emotional or behavioral disorders. Systems of Care: Promising Practices in Children’s Mental Health, 1998 series (vol. 3). Washington, DC: Center for Effective Collaboration and Practice, American Institutes for Research.


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