Assess Conditions for Wellness
Before taking action, it’s crucial to identify the conditions for wellness among the people you serve and the available resources to create them. Through assessments, you ensure a cross representation of your community to uncover gaps between the current and ideal state. Conducting assessments offers a deeper understanding of critical social conditions and risks children and families face that could impact health and education. Assessments can also describe the rich and vibrant threads unique to each community, and the factors responsible for building healthy, strong, communities. With these data, school wellness teams can establish priorities and actions for school-wide wellness. Hallways to Health SBHC staff mapped community resources and assets, and conducted school-wide needs assessments to identify current and needed conditions for student and school employee health. School wellness teams then prioritized and strategized how to tackle those needs.
Beginning your work with a thorough assessment allows you to:
- Save time and resources by identifying priority needs, root causes of health issues, and opportunities to improve your school and community. Without assessments, you may invest in school wellness efforts where the need, interest, or impact is low.
- Determine available resources for school wellness teams to utilize for school-wide health efforts without recreating the wheel or operating in silos.
- Access useful data for advocacy and grant writing.
1. Determine the objectives of the assessment.
What do you want to learn about your school and the students it serves? How will your school wellness team use and share the data? What do the students and staff want and need to be well? What does wellness mean to them?
2. Involve parents and guardians, teachers, and youth to represent community voices. They can also lead the assessment and mapping processes.
- Stakeholder involvement will build community investment and support for actions that result from the assessments.
- Have a plan in place to share the data back with stakeholders.
- To ensure next steps are reflective of community goals, include these stakeholders in the action planning as well.
3. Review and identify existing data on the student and staff populations.
- Find publicly available school data on graduation rates, suspensions, absenteeism, academic success, and existing school policies and practices.
- This process can also reveal existing health resources, services, and capacities in your community– illustrating existing conditions and illuminating opportunities to create other conditions for wellness.
- Determine if there are additional data your team needs to better understand trends, plot your actions, and achieve your vision.
4. Identify and/or design appropriate data collection tools with your school leadership.
- Select tools that include items to assess both physical and social-emotional health, as well as identifying social determinants of health (root causes).
- Consider using tools that identify the conditions needed for healthy school climate. This will provide a fuller understanding of the opportunities for positive change.
- Choose widely accepted evidence-based tools. Determine if Institutional Review Board (IRB) approval is necessary for using the tool you select. Institutional review boards are committees who determines if research proposal methods are ethical for human subject research. [x] If you plan to disseminate or publish any of the data as research, [xi] IRB approval is required. However, if the assessment is strictly for public health practice, IRB approval might not be necessary. [xii]
- Identify tools that have low or zero cost, fit with your school’s existing and available technology, have limited barriers for data collection or data input, and allow for secure storage of private data.
- Select tools that are age-appropriate in content and language, and if needed, have translations available for non- English speaking students.
- Consider whether the school staff or the SBHC staff will administer the assessment or own the data, depending on state and local level HIPPA/FERPA considerations.
5. Obtain approval for implementation of the assessment.
Before beginning the assessment, identify the approval process in your school/district. Determine which stakeholders need to be informed, and the process and timeline for getting an assessment approved. Consider what messages you will share with stakeholders to get them on board.
- Seek approval from administrators and other school leaders.
- Explain that your wellness team shares goals with the school staff [xiii] and wants to work with the school to address academic and educational challenges. By identifying root causes of health issues, the school can develop school-wide approaches to tackle simultaneous barriers to academic achievement and health, such as housing, food security, neighborhood safety, and the presence of caring adults [xiv], [xv]
- Use scientific literature to show the link between social determinants of health and academic outcomes, especially for low-income students.
- Share stories about how other SBHCs used data to identify strategic approaches, propose system changes, and institute new policies in their schools.
6. Seek approval from parents through consent forms--especially if the data are identifiable.
- Explain why you are collecting data from their child, how you will use it, and how it will help the school.
- Decide whether you need to use an opt-in/opt-out consent process and determine a process to get consent forms completed and returned. Consider sending letters home and using email as well.
- If it is important to guarantee that parents/guardians provide explicit permission for their student to complete the assessment, choose an opt- in consent form.
- Allow enough time to collect parental consent forms– at least a month– before administering an assessment instrument. This will increase the chances of reaching parents who move frequently or have disconnected numbers.
7. Plan and implement the needs assessment.
- Schedule sufficient time to assess all students/your sample, and provide enough staff resources to explain directions, the purpose of the assessment, and how the school will use the information. Survey administration is a team effort.
- Determine what sample you will survey if you can’t assess whole school. Think about assessing younger students so you can follow them over a few years. Don’t forget to translate, or obtain translated versions of your tools in appropriate languages for your students and staff.
- Make sure there is enough staff on hand to provide services in case mental health crises appear in assessment.
- Continue to assess on a yearly basis to track needs/met needs and to identify any shifts in needs.
8. Analyze the assessment data.
- Work with your school wellness team to summarize the data. What stories are the data telling? What could deepen your understanding?
- Make sure you have enough support to analyze the data. Some assessments come with technical support for this purpose.
Every Student Succeeds Act (ESSA)
There are federal regulations that require population-level health assessments; conducting health assessments and collecting data prepare SBHCs to meet these requirements. Under Every Student Succeeds Act (ESSA) [xvi], states are encouraged to support healthy schools and student health and wellness. Beginning in the 2017-2018 academic year, local education agencies (LEAs) are required to report on accountability measures for school quality and student success. States can report on school climate items like chronic absence, academic performance, and school discipline. Schools identified for improvement in these areas are required to complete a school- level comprehensive needs assessment to identify and prioritize areas for use of Title I funds. Other states and/or school districts may already require health-related assessments for the school population.
Further Tools and Resources
Here are some examples of tools Hallways to Health sites used to determine what prevented or enabled conditions necessary for student health and wellness.
- California Healthy Kids Survey [xvii]
- Rapid Assessment for Adolescent Preventative Services-Public Health (RAAPS-PH) [xviii].*Requires licensing fee
- Roosevelt Middle School in Oakland, CA
Other tools are available to screen individual youth and adolescents for social determinants of health in clinical settings. This chart shows a comparison of various Social Determinants of Health screening tools:
Alliance for a Healthier Generation and Healthy Schools Campaign offer guidance on data sources, additional assessment tools like the School Health Index, and questions to include on health and wellness assessments.
- Using Needs Assessments to Connect Learning and Health: Opportunities in the Every Student Succeeds Act
- Framework of Best Practices
Hallway to Health sites also surveyed school employees about their health and wellness. Here is the tool to assess school employee needs.
National Association of Chronic Disease Directors Guide
National Association of Chronic Disease Directors created a guide for public health professionals who work in the education sector. [xiii] The guide provides recommendations for working and communicating effectively with educators on school health issues, and advises on what pitfalls to avoid when working with the education sector. See more here.
Stories from the Field
Identify student social-emotional needs, and act on them.
At Rea Elementary, Costa Mesa, CA the staff at the HOPE clinic implemented the California Healthy Kids Survey (CHKS) [xvii] to obtain population-level health data from their students and to build the case for improved student support services at Rea Elementary. The SBHC staff members originally proposed another assessment tool, but the administrator expressed concern that the tool’s questions about inappropriate touch would raise parental opposition. The evidence-based tool could not be modified, and the wellness team worked with the administrator to identify the California Healthy Kids Survey instead. If they selected the initial tool without administrator buy-in, conflicts may have arisen among SBHC staff, school leadership, and the community.
The wellness team determined that students’ ability to demonstrate empathy and use interpersonal problem-solving skills were important conditions to achieve school success and student wellness. The CHKS data revealed that only 44 percent of students had high empathy scores, and only 33 percent had strong problem solving skills. Only a small percentage of students said they try to understand how other people feel and a smaller percent reported trying to work out problems by talking or writing their feelings. Teachers and administrators agreed with this self-assessment based on observed behavioral issues. In their action plan, the school wellness team selected the Second Step Curriculum and Classroom Dinosaur for social and emotional learning throughout the school. They hope to see increases in student empathy and problem solving as a result.
Tailor your assessments for your school needs and capacity.
At San Fernando High School, San Fernando, CA the wellness team used an aggregated, de-identified version of the Rapid Assessment for Adolescent Preventative Services-Public Health (RAAPS-PH) RAAPS-PH to survey a sample of the school, their ninth and tenth graders. While the principal supported the idea of conducting an assessment, school and district leaders worried that the small SBHC staff would not be able assess the whole school population or have the capacity to meet all of the needs that arose from identifiable surveys. The school wellness team worked with the RAAPS administrators to create a de-identified version. They also created a translation of the tool for Spanish-speaking students. To alleviate concerns about surveying students without parental consent, the district leaders provided a parent opt-out form to mail home and required the school to wait at least two weeks for responses before administering the assessment.
Continuously administer needs assessments.
At Roosevelt Middle School, Oakland, CA, the wellness team created and administered its own needs assessment to students and school employees. They administer the student assessment three times a year to monitor and track progress on student wellness. The student wellness assessment asks about student perceptions of school climate, neighborhood safety, and presence of adult support. It includes items on nutrition and physical activity and addresses bullying, violence, reasons for absenteeism, and student happiness and future aspirations. The Coordination of Services Team (COST) meets to analyze the data and determine the best approaches for school-wide wellness. Check out the Roosevelt Middle School Student Wellness Assessment and the Roosevelt Middle School Staff Wellness Assessment.
Assessing school-wide conditions for wellness: Roosevelt Middle School, Oakland CA
[x] The Office of Human Research Protection. Institutional Review Board Guidebook. “Chapter 3, Section A: Risk/Benefit Analysis.” pp. 1-10  Retrieved March 30, 2018.
[xi] FAQ for Academic Assessment Research. Virginia Tech Website. http://www.irb.vt.edu/pages/assessment.htm. Accessed March 26, 2018.
[xii] DeHart MP, VanEenwyk J. Human Subjects and Public Health Practice. Department of Health Website. Revised December 11, 2008. Accessed March 26, 2018.
[xiii] Chiang RJ. Speaking Education’s Language: A Guide for Public Health Professionals Working in the Education Sector. National Association of Chronic Disease Directors. American School Health Association Website. http://www.ashaweb.org/wp-content/uploads/2014/08/nacdd_educationsector_guide_.pdf. Accessed March 26, 2018.
[xiv] Schott 25: Healthy Learning Initiative, Education Commission of the United States. Progress of Education Reform.
Basch CE. Healthier students are better learners: a missing link in school reforms to close the achievement gap. J School Health 2011; 81(10):593–598.
[xv] Taras H, Potts-Datema W. Chronic health conditions may also impact children’s development and educational performance. J School Health 2005; 75(7):255–66.
[xvi] Every Student Succeeds Act (ESSA). U.S. Department of Education Website. www.ed.gov/esea. Accessed April 3, 2018.
[xvii] California Healthy Kids Survey: Building Healthy Communities Module. California Department of Education Website. http://chks.wested.org/wp-content/uploads/hs-bhc-1718_watermark.pdf/. Updated 2017. Accessed March 26, 2018.
[xviii] RAAPS Public Health (PH): Identifying Risk Factors to Prevent School Dropout. American Public Health Association Website. http://www.possibilitiesforchange.com/casestudy/RAAPS%20Public%20Health-2.pdf. Accessed March 26, 2018.