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SchoolBased Wellness Programs: A Model from Chicago

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Title: SchoolBased Wellness Programs: A Model from Chicago


1
School-Based Wellness Programs A Model from
Chicago
  • AJFCA Annual Meeting
  • May 5, 2009
  • Dana Rhodes, MSW
  • Jewish Federation of Metropolitan Chicago
  • Maureen Benjamins, PhD
  • Sinai Urban Health Institute
  • Debbie Cardash, MSW
  • Associated Talmud Torahs

2
Background
  • Phase 1 (2003-2004) A population-based health
    survey was conducted in a densely populated
    Jewish community in Chicago (West Rogers
    Park/Peterson Park)
  • Phase 2 (2005-2006) Data from the survey was
    analyzed and then disseminated through a series
    of community meetings and published reports
  • Phase 3 (2006-2008) Childhood obesity,
    identified by community members as the most
    critical health problem, was addressed through a
    school-based pilot intervention

3
Partnerships and Funding
  • Project directed by a steering committee that
    includes members from
  • Jewish Federation of Metropolitan Chicago
  • Associated Talmud Torahs
  • Sinai Urban Health Institute
  • The overall initiative has been funded by many
    local foundations. The school wellness program
    was generously funded by
  • The Michael Reese Health Trust
  • The Polk Bros. Foundation

4
Survey Overview
  • West Rogers Park and Peterson Park (WRP/PP) are
    among the most heavily concentrated Jewish areas
    in Chicago (est. 23,000 Jewish residents)
  • Survey initiated by the Jewish Federation
  • Project management done by the Sinai Urban Health
    Institute (SUHI)
  • Data collection conducted by UICs Survey
    Research Laboratory

5
Survey Methodology
  • Conducted face-to-face interviews with 201 Jewish
    adults and 57 with caretakers of Jewish children
  • Data collected between Aug 2003-Jan 2004
  • Questionnaire included 475 adult and 100 child
    questions
  • Adult interview took about 1 hour and child
    interview about 15 minutes
  • Incentives 20 per adult, 10 per child interview

6
Key Findings
  • The survey was perhaps the most in-depth health
    survey ever done within a Jewish community in the
    U.S.
  • The prevalence rates for most health conditions
    and behaviors are similar to, or better than,
    rates for other groups
  • However, some major areas for concern are still
    found
  • Moreover, certain groups within this community
    may be especially vulnerable, such as single
    parents, the elderly, and immigrants

7
Areas of Concern
  • Over half of both adults and children are
    overweight or obese
  • 1 in 5 individuals has been diagnosed with
    depression and almost as many screen positive for
    current depression
  • Insufficient funds limit individuals access to
    health care (as well as other related needs such
    as food)
  • One-quarter of individuals have witnessed
    domestic violence, and nearly one-third have a
    victim of violence in their household

8
Obesity-Related Findings
  • Over half of both adults and children in WRP are
    overweight or obese
  • A Jewish child living in WRP/PP is approximately
    twice as likely to be obese as the average
    American child
  • Over one-third of children 2-5 years of age are
    obese
  • Similarly, over one-third of girls (2-12 years)
    are obese
  • Of parents with overweight and obese children,
    less than 25 recognize that their child has a
    weight problem

9
Dissemination
  • Published full report of findings and several
    peer-reviewed articles
  • Journal of Jewish Communal Service
  • Journal of Community Health
  • Journal of School Health (under review)
  • Had 2 feature stories in local Jewish newspaper
  • Presented findings to community groups
  • Including ATT principals, local physicians,
    social workers, mental health professionals,
    rabbis, and lay audiences
  • Consensus Childhood obesity should be addressed
    through day schools

10
School-Based Wellness Programs A Model from
Chicago Developing the School-Based Model
11
Pilot Project Overview
  • Purpose To develop and implement a
    culturally sensitive childhood wellness
    pilot program for a Jewish school system
  • Pilot schools Yeshivas Tiferes Tzvi
  • Joan Dachs Bais Yaakov
  • (Chicago, IL)
  • Grant period July 1, 2006 June 30, 2008
  • Personnel Director, dietitian, part-time
    mental health consultant

12
Planning Considerations
  • No obesity interventions focusing on Jewish
    children or schools were found
  • Many day schools are not mandated to follow
    recent wellness requirements
  • Schools have a dual-curriculum in which secular
    subjects have to fit into one half of the day
  • Schools are part of a network of schools, not a
    formal school system, so policies have to be made
    at the school-level
  • Larger than average family size, so families have
    substantial time and money constraints

13
Pilot Project Overview
Goals for Year 1 1. Evaluate individual- and
school-level factors related to
nutrition and physical activity 2. Form
school wellness council 3. Write school
wellness policy 4. Implement activities in
each of the five areas of focus nutrition
education, physical education, school
environment, parent education, and staff
wellness
14
Pilot Project Overview
  • Goals for Year 2
  • Fully implement the new health curriculum in
    grades 1-8
  • Partner with JCFS to address mental health
    issues, including disordered eating behaviors
  • Increase sustainability by developing parent
    leadership and integrating changes into school
    policies, events, and norms
  • Reach more parents by increasing the frequency
    and variety of educational activities
  • Continue implementing activities in each of the
    focus areas

15
Intervention Activities
  • Nutrition Education
  • Examples of project activities
  • Curriculum guides purchased (and adapted lesson
    plans made available)
  • Teachers oriented to new curriculum
  • All grades taught at least 2 lessons a month
  • Project health educator offers to teach one
    lesson per grade at each school

16
Intervention Activities
Physical Education
  • Examples of project activities
  • Activity-based field trips
  • Improvements to existing gym program
  • Weekend sports programs
  • Purchase of PE activity kit and new equipment

17
Intervention Activities
  • School Environment
  • Examples of project activities
  • Removal of soda vending machines
  • New schools policies against serving soda in
    classrooms and using food as a reward
  • Provision of water bottles and healthy food
    options at all school events
  • Fruit of the Week program at both schools

18
Intervention Activities
  • Family Involvement
  • Examples of project activities
  • Parent leadership of wellness council
  • Womens wellness event each spring
  • Father-son sporting event
  • Nutrition information in weekly parent newsletter
  • Health information provided during orientation
    and parent-teacher conferences

19
Intervention Activities
  • Staff Wellness
  • Examples of project activities
  • Nutrition education during staff meetings
  • Individual consultations with dietitian offered
    to all staff
  • Healthy bulletin board in staff lounge, includes
    recipes and other ideas
  • Healthier foods provided in lounge and at staff
    meetings

20
Intervention Activities
  • Mental Health (started in Year 2)
  • Many body image and dieting problems identified
    by baseline surveys
  • Also, schools and parents concerned about
    existing eating disorder problems and possible
    new problems caused by BMI measurements
  • A mental health consultant hired through Jewish
    Child and Family Services
  • Consultant is member of community, school parent
  • Still some obstacles to implementation, but great
    reviews

21
Intervention Activities
  • Mental Health (continued)
  • JCFS consultant held 6-week classes by grade for
    girls (grades 5-8)
  • Focuses on self-esteem, bullying, body image,
    stress management, eating disorders, and other
    related topics
  • Teachers encouraged to participate
  • Alternates between Judaic and secular classes
  • She also eats lunch with the girls to model
    healthy eating attitudes and behaviors

22
Evaluation
Purpose of Evaluation 1. To gain baseline data
to guide project development 2. To measure
potential changes in knowledge, attitudes, and
behaviors of students, parents,
and staff 3. To determine if all of the school
changes will result in lowering the
percentage of overweight children
  • Evaluation Tools
  • Body Mass Index
  • School Health Index
  • Health Surveys

23
Evaluation
  • Body Mass Index (BMI)
  • All students in grades 1-8 were weighed and
    measured by a nurse at baseline (Fall 2006)
  • Measurements taken again at the end of the pilot
    (Spring 2008)
  • Measurements to be taken in Spring 2009 will be
    used for final BMI calculations

24
Evaluation
  • School Health Index
  • Tool created by CDC to assess a broad range of
    health-related policies, structures, and programs
    within schools
  • Identifies existing strengths and areas most in
    need of change
  • Helpful to guide wellness council activities
  • Used to document school-wide changes and other
    process objectives

25
Evaluation
  • Health surveys
  • Four different surveys
  • Younger students (grades K-4)
  • Older students (grades 5-8)
  • Staff
  • Parents
  • Questions cover knowledge, attitudes, and
    behaviors related to diet and physical activity

26
School-Based Wellness Programs A Model from
Chicago Results
27
  • School Health Index JDBY (girls)

Light yellow for 2006, darker shading for 2008
28
  • School Health Index YTT (boys)

Light yellow for 2006, darker shading for 2008
29
Pilot Results
Student Health Survey (Grades 1-4) Baseline
  • Low levels of health knowledge
  • 25 thought white bread was healthier than whole
    wheat
  • 2. Food preferences and behaviors generally
    unhealthy
  • 27 drink soda more often than juice
  • 76 would choose a candy bar instead of fruit for
    a snack
  • 3. Positive attitudes toward physical activity,
    though low confidence in skills

30
Pilot Results
  • Student Health Survey (Grades 1-4) Changes
  • Knowledge
  • Significant increases in nutrition knowledge,
    especially for girls

31
Pilot Results
  • Student Health Survey (Grades 5-8) Baseline
  • Students lack a supportive environment for
    healthy behaviors
  • No encouragement to exercise from parents, few
    limits on unhealthy foods
  • Levels of nutrition knowledge are low
  • 70 dont know which food group they should
    have the most servings from each day
  • Body image problems evident
  • In the past month, 50 have exercised or dieted
    to lose weight or prevent weight gain
  • Almost no students meet activity recommendations
  • Only 9 are active for at least an hour during 5
    or more days of the week

32
Pilot Results
  • Student Health Survey (Grades 5-8) Changes
  • Knowledge
  • Knowledge of how many servings of
    fruits/vegetables to eat daily more than tripled
    for girls 15 to 49
  • Boys knowledge stayed the same for most items
  • Attitudes
  • Slight decrease in percentage unhappy with their
    bodies
  • Attitudes such as the importance of specific
    behaviors related to health and perceived
    barriers to being healthier did not change
    significantly

33
Pilot Results
  • Student Health Survey (Grades 5-8) Changes
  • Behaviors
  • Percent getting an hour or more of exercise daily
    more than doubled
  • - BUT still low, especially for girls (4 to
    14)
  • Some improvements in consumption of fruits and
    vegetables, fast food, and soda
  • - Still, one third of boys drink soda daily and
    eat fast food weekly
  • Percent trying to lose weight stayed the same
    (50 girls and 25 boys)

34
Pilot Results
Parent Surveys
  • Knowledge
  • Percentage who knew how much exercise children
    need and who understand current nutritional
    guidelines increased
  • Attitudes
  • Importance of health and physical education
    increased
  • Strong support for healthy policies
  • Behaviors
  • Eating fast food once a week or more decreased
    from 25 to 19
  • Average number of days get 20-30 minutes of
    exercise increased

35
Pilot Results
Teacher Surveys
  • 40 have policies on allowable snacks, compared
    to only 24 at baseline
  • 80 reported that the foods served at class
    parties improved in nutritional value over the
    past year
  • Only 29 never use food as a reward, and 10 do
    it weekly or more
  • Most supportive of banning soda and having
    healthy snack policy. Less supportive of banning
    use of food as rewards.

36
Summary of Pilot Results
  • Substantial changes at the school-level
  • Several significant changes in student knowledge
  • Few changes (yet) in reported behaviors
  • Still much room for improvement

37
Other Accomplishments
  • School and Community Perspective
  • Cultural shift in what is normal or cool
  • Program helpful for moving schools toward
    compliance with existing state laws

38
Challenges
  • Rough start
  • Perception that program was focused on making
    kids lose weight
  • Parent concerns of the food police
  • Difficulty of getting parents to attend events,
    get involved
  • Competing needs and other issues that limited
    what administrators could/would do
  • Reluctance of some teachers to add new lessons
    and to consider new policies

39
School-Based Wellness Programs A Model from
Chicago Expanding the Model
40
Year 3 The Expansion
  • 2008-09 School Year
  • 3 additional day schools are added to the program
  • Akiba Schechter
  • Arie Crown
  • Hillel Torah
  • Kindergarten included for all 5 schools
  • Total Over 2,000 students
  • Schools now reflect broader range of affiliations

41
Year 3 The Expansion
Goals for Year 3
  • 1. Two pilot schools increase sustainability
  • Keep making changes with minimal funding
  • Build changes into existing structures/activities
  • 2. Three new schools follow model created for
    pilot schools
  • 3. Capitalize on addition of new schools by
    creating ways to share successes and lessons
    learned
  • Ex New monthly updates for all staff at project
    schools

42
Year 3 Progress
  • All 5 Schools
  • Wrote a wellness policy
  • Formed a wellness council
  • Implemented new health curriculum
  • Had mental health consultant teach classes for
    all 8th grade girls
  • Give monthly newsletter (Healthy News You Can
    Use) to all staff members

43
Year 3 Progress
  • Arie Crown
  • Formed a large, well-represented wellness council
    over the summer, and continues to meet regularly
  • Made changes to school lunch menus
  • Enacted new birthday party guidelines
  • Formed student Walking Club for 8th grade girls
  • Soda no longer served at any school events
  • Yoga offered for staff and for kindergartners

44
Year 3 Progress
  • Hillel Torah
  • Invited project health educator to introduce
    program to parents on both orientation nights
  • Had a 5K walk/run for all students and their
    families. Followed event with healthy
    refreshments.
  • Kindergarten classes do one-minute workouts every
    morning
  • Working on improving the nutritional value of
    foods offered at breakfast and lunch

45
Year 3 Progress
  • Akiba Schechter
  • Use PE Fund to double amount of gym classes
    students receive
  • Group of parents raised money to replace one meal
    a week with a healthy meal provided by a local
    caterer
  • Include health information in weekly parent
    newsletter

46
Year 3 Progress
  • Yeshivas Tiferes Tzvi
  • Starting a new year of the Sunday Swim and Gym
    program
  • Now charging a fee in an effort to make program
    self-sustaining
  • A YTT teacher continues to write The Wellness
    Word for the weekly school newsletter
  • Books related to health and wellness were
    purchased for the library and a list of the books
    was given to parents so they can check them out
  • A YTT teacher is doing one-minute exercises with
    1st and 2nd graders during recess and
    distributing the exercises to all teachers weekly
  • Implemented new snack policy and soda-free
    school policy

47
Year 3 Progress
  • Joan Dachs Bais Yaakov
  • A JDBY parent planned a parent education event,
    A Wealth of Health, bringing in a nationally
    known rabbi (attendance 50)
  • Fruit of the week program
  • Teachers trained in CPR and in issues related to
    diabetes
  • Increased number of field trips that are
    activity-based

48
Year 3 Summary
  • Challenges
  • More schools less hands-on
  • Need for greater school initiative and
    independence
  • Less control of health education
  • Less direct interaction with administration,
    staff, and parents
  • Opportunities
  • New schools bring new energy and ideas to the
    project
  • Variation in school size and composition allow
    for greater range of projects
  • New health educator is increasing the quality and
    amount of health materials available to the
    schools
  • Beginning to provide religiously-based health
    materials

49
School-Based Wellness Programs A Model from
Chicago Building on this Model
50
Future Plans
  • Goals for Year 4
  • Continue building on progress in currently
    participating schools
  • Expand to include at least one high school and
    invite all other elementary day schools in
    Chicago area
  • Add planning component to determine best way to
    organize, fund, and manage all health-related
    services within the ATT system
  • Find ways to share culturally-relevant health
    materials with new schools and other Jewish
    communities across the country
  • Pending funding

51
Tips for Other Communities
  • Use or adapt existing models and materials
  • Spend the time and effort to build support at the
    beginning
  • Provide education before making changes
  • Make sure focus is positive (i.e. promoting
    wellness instead of reducing obesity)
  • Have some way for all teachers, parents, and
    students to give their opinion and to get
    involved
  • Take advantage of the numerous groups and
    websites dedicated to school wellness
  • For example, these can keep schools updated on
    the large amount of money available for
    wellness-type programs

52
Acknowledgements
  • Project steering committee
  • Maureen Benjamins, PhD, Sinai Urban Health
    Institute
  • Debbie Cardash, MSW, Associated Talmud Torahs
  • Joel Carp, ASCW, Jewish Federation
  • Dana Rhodes, MSW, Jewish Federation
  • David Rubovits, PhD, Jewish Federation
  • Steve Whitman, PhD, Sinai Urban Health Institute
  • Generously funded by
  • Michael Reese Health Trust
  • Polk Bros. Foundation

53
Acknowledgements
  • Participating School Administrators
  • Mrs. Miriam Schiller, Akiba Schechter
  • R. Eli Samber, Arie Crown
  • Mrs. Ellen Wigoda, Arie Crown
  • R. Yaakov Dvorin, Hillel Torah
  • Mrs. Helene Levine, Hillel Torah
  • Mrs. Beverly Reinglass, Joan Dachs Bais Yaakov
  • Mrs. Ahuva Wainhaus, Joan Dachs Bais Yaakov
  • R. Zev Meisels, Yeshivas Tiferes Tzvi
  • Project Manager/Health Educator
  • Ashley Biscoe, MPH, Sinai Urban Health Institute

54
Contact Information
  • More questions or comments?
  • Please contact the Project Director, Maureen
    Benjamins,
  • at benmau_at_sinai.org or by phone at
    773-257-2324.
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