SchoolBased Wellness Programs: A Model from Chicago

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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

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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

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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

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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

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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

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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

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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

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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

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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

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School-Based Wellness Programs A Model from
Chicago Developing the School-Based Model
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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

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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

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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
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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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

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

Light yellow for 2006, darker shading for 2008
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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

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Pilot Results

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

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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

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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

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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)

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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

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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.

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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

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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

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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

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School-Based Wellness Programs A Model from
Chicago Expanding the Model
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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

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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

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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

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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

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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

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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

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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

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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

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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

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School-Based Wellness Programs A Model from
Chicago Building on this Model
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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

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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

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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

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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

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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.