"Healthy School Aged Children"
CHAMPLAIN CVD PREVENTION STRATEGIC PLANNING 2013-2016 EXPERT TASK GROUP RECOMMENDATIONS REPORT HEALTHY SCHOOL-AGED CHILDREN FINAL REPORT JUNE 2012 EXPERT TASK GROUP MEMBERSHIP A multi-sectoral Expert Task Group representing stakeholders from school, health, and community settings across the Champlain region was assembled to frame and validate the vision and blueprint for action for “healthy school-aged children” in the Champlain region. The Task Group met three times between April and May 2012. Name Title & Organization Sherry Nigro (Co-chair) Manager, Health Promotion & Disease Prevention, Ottawa Public Health Lorne Keon (Co-chair) Former Director of Education, Renfrew County Catholic District School Board Lysanne Trudeau Acting Program Manager, Eastern Ontario Health Unit Lynne Giroux Dietitian, Eastern Ontario Health Unit Meena Parameswaran Dietitian, Leeds, Grenville & Lanark District Health Unit Tawnya Boileau School Health Coordinator, Leeds, Grenville & Lanark District Health Unit Brian Brohart Health Promoter, Renfrew County & District Health Unit Shawna Babcock Executive Director, KidActive André Larouche Principal, Conseil des écoles publiques de L’est de L’Ontario Caretta Williams DeAveiro Vice-Principal, Ottawa-Carleton District School Board Bob Thomas Consultant, Ottawa Catholic School Board Jackie Stadnyk Consultant, Renfrew County District School Board Jeannie Armstrong Principal, Renfrew County Catholic District School Board Jennifer Harris Regional Manager, Prevention & Rehabilitation, University of Ottawa Heart Institute Dr. Pat Longmuir Scientist, Healthy Active Living and Obesity (HALO) Research Group, Children’s Hospital of Eastern Ontario (CHEO) Dr. Laurie Clark Psychologist, Centre for Healthy Active Living (CHAL), Children’s Hospital of Eastern Ontario (CHEO) Tosha Rhodenizer Vice President, Membership, Health, Fitness and Recreation, National Capital Region YMCA-YWCA Wallace Beaton Coordinator, School Travel Planning Ottawa & Eastern Ontario, Green Communities Canada Jama Watt Director, Growing Up Great Partnerships, United Way Andrea Tomkins Freelance Writer, Ottawa Laurie Dojeiji Health Promotion Manager, CCPN Micheline Turnau Community Mission Specialist, Heart and Stroke Foundation Danielle Simpson Analyst, CCPN Marie-Claude Lang Écoles en santé 2020 Facilitator, CCPN/Ottawa Public Health 1 EXPERT TASK GROUP RECOMMENDATIONS REPORT – HEALTHY SCHOOL-AGED CHILDREN TABLE OF CONTENTS 1.0 The Case for Action .............................................................................................................................. 3 2.0 Methodology .......................................................................................................................................... 6 3.0 Environmental Scan .............................................................................................................................. 6 5.0 Performance Management Plan ........................................................................................................ 12 6.0 Leadership & Partner Roles ............................................................................................................... 14 7.0 Resource Requirements & Plan ........................................................................................................ 15 8.0 Impacts & Return on Investment ....................................................................................................... 17 9.0 Risk Assessment ................................................................................................................................ 18 Appendix A: The Local Context ............................................................................................................... 20 Appendix B: Detailed Environmental Scan ............................................................................................ 23 Appendix C: Partner Letters of Commitment ......................................................................................... 24 Appendix D: Performance Management Plan – Healthy Schools 2020 ............................................... 25 References ................................................................................................................................................. 26 2 EXPERT TASK GROUP RECOMMENDATIONS REPORT – HEALTHY SCHOOL-AGED CHILDREN HEALTHY SCHOOL-AGED CHILDREN 1.0 THE CASE FOR ACTION BACKGROUND Over the past few decades, dramatic shifts in lifestyle trends related to diet and physical activity have changed the nature of cardiovascular disease (CVD). The twin epidemics of physical inactivity and unhealthy eating are putting the health of our children at risk. They are threatening the gains made in child health over several decades through public health and medical interventions. Over the past 25 years, the rate of overweight and obesity among Canadian children aged 2 to 17 years i has grown from 15% to 26% and in Ontario, the current rate of overweight and obesity is at 26.5% . This number is staggering, considering most obese children and youth do not outgrow their weight problem ii and will continue to gain weight as they age . There are also serious and complex health-related issues associated with increasing obesity rates; youth are now experiencing at least one risk factor for CVD, with iii one in four having two risk factors . Research has identified a number of determinants associated with obesity, including physical activity, iv diet, socio-economic status, ethnicity, immigration, and environmental factors . This confirms the need to take a population health approach focused on the immediate factors such as diet and physical activity as well as community and socio-economic characteristics to address this issue in the Champlain region. With health care costs estimated to rise and consume up to 70% of provincial budgets, the urgency of v finding ways to adjust the health care cost curve is apparent . Working from a regional perspective will ensure a common vision and approach for healthy eating and physical activity. The Champlain Healthy School-aged Children Strategy offers a unique opportunity for leadership and collaboration that goes beyond the impact of each individual organization. STRATEGIC ALIGNMENT National Context The Canadian Ministers of Health declaration and framework for action entitled Curbing Childhood vi Obesity outlines the need to effectively address this complex problem with a sustained and multi- sectoral response involving public, private, health professional and non-governmental sectors. The Heart vii and Stroke Foundation Position Statement on Physical Activity, Heart Disease and Stroke also recommends comprehensive strategies that address school health programs, quality daily physical education, community use of schools, and healthy community design that supports active transportation and accessible recreational infrastructure. Provincial Context In the 2012 Ontario budget, the government committed to setting up a panel of advocates, health care leaders, non-profit organizations and industry partners to develop a Childhood Obesity Strategy that will viii reduce childhood obesity by 20% over five years . The Ontario Healthy Kids Panel will be co-chaired by Mr. Alex Munter, CEO of the Children's Hospital of Eastern Ontario, and Kelly Murumets, President & CEO of ParticipACTION. In the education setting, the Ontario School Food and Beverage Policy (P/PM 150), Daily Physical Activity (DPA) policy, and Health & Physical Education curriculum are ongoing initiatives within the context of the ix Ministry of Education’s Foundations for a Healthy Schoo l. These areas are very well aligned to the proposed Healthy School-aged Children recommendations. Also key to our recommendations is the 2011 Ontario Report Card Supplement from Active Healthy Kids x Canada that identifies the need for all stakeholders to commit efforts to target the most inactive 3 EXPERT TASK GROUP RECOMMENDATIONS REPORT – HEALTHY SCHOOL-AGED CHILDREN populations as part of the overall population-based physical activity promotion efforts, as well as to implement qualitative and quantitative evaluations of policies and programs, including the surveillance of physical activity levels. Local Context Physical activity and healthy eating behaviours among children and youth in school and community settings continue to be key priority areas among our four regional public health unit partners, as well as among the local Healthy Communities Partnerships which have formed to support regional action on physical activity and healthy eating. Please refer to Appendix A for more details in this regard. CCPN The proposed Strategy builds on the existing Champlain Healthy School-aged Children (CHSAC) Initiative, one of the six original priority initiatives identified as part of the 2007-12 CCPN Strategy. This initiative focused specifically on the physical activity and eating behaviours of school-aged children (i.e. children and youth between the ages of four and 18 years) from across the Champlain region. Partners from health, education, and community settings came together to lead this important work. The 2007-12 CHSAC initiative included the following four action areas: 1. Create progressive, supportive school policies across the nine Champlain School Boards (The Champlain Declaration); xi 2. Develop a regional communication campaign (i.e. Know More Do More ) to promote healthy eating and physical activity; 3. Develop an evaluation tool for tracking progress (i.e. Champlain Report Card); and, 4. Facilitate opportunities for skills development among teachers, parents, children, and youth. The Champlain Declaration/ Healthy Schools 2020 One of the most significant achievements occurred in April 2009 when the Directors of Education of the nine school boards and Medical Officers of Health of the four public health units in the Champlain region signed the Champlain Declaration: A Call to Action for xii Physically Active & Healthy Eating Environments in Schools . This formalized the commitment to work in partnership to establish healthy school environments so that school-aged children can be physically active and make healthy food choices on a daily basis. Since the signing of the Declaration, the school boards have been working with public health and the CCPN on the Healthy Schools 2020 initiative, which is the Champlain Declaration in action. The current emphasis of Healthy Schools 2020 is on improving the school nutrition environment with a particular focus on three priority areas: 1. Healthy catered lunches and food service contracts; 2. Healthy fundraising; and, 3. Healthy classroom rewards. To support schools in making these important changes, a series of school board workshops have been co-hosted in partnership with public health over the course of 2010 to 2012 to provide school communities with the knowledge, skills, and tools to implement these nutrition priorities. To date, more than 1,300 superintendents, principals & vice-principals, teachers, parents, and public health staff have attended a Healthy Schools 2020 workshop or presentation. 4 EXPERT TASK GROUP RECOMMENDATIONS REPORT – HEALTHY SCHOOL-AGED CHILDREN Enhanced Support: Facilitation Program in Francophone Schools The Écoles en santé 2020 school facilitation program launched in 2010 with the three Francophone school boards in the Champlain region, thanks to funding received from the Société Santé en français in collaboration with Health Canada. The program includes a full-time project coordinator/ facilitator as well as seed funding (ranging from $500 to $1,100 based on size) for every participating school. Funding for this program remains in place until the end of March 2013. The Écoles en santé 2020 facilitation program is grounded in a Comprehensive School Health approach and uses the following seven steps to guide the planning process and to develop individual school action plans: 1. Take up the Healthy Schools 2020 challenge! (schools commit to developing an action plan within the three nutrition priority areas for action) 2. Form a school committee (if one does not already exist) 3. Assess strengths and needs of the school community and prioritize areas to address 4. Develop a plan 5. Implement the plan 6. Evaluate and celebrate success 7. Maintain the momentum (start planning for next year) Role of the Facilitator Role of the School Support the development of strategies at the Actively participate in Écoles en santé 2020. school board level. Support development of individual school action Complete the associated facilitation documents at plans. the beginning and end of the school year (action plan, progress report, etc). Facilitate access to resources, supports and Evaluate progress during the school year. trained professionals depending on the needs of the school. Support partnership between the schools and the Share successes with the CCPN (pictures, regional public health units/CCPN partners. testimonials from students, parent and teacher etc.) 76 schools participated in the program in the 2011-12 school year. The amount/ level of support provided by the project facilitator (currently 1.0 FTE) is therefore dependent on the number of schools enrolled. With the current ratio of 1 facilitator for 76 schools, the facilitator is able to make one (possibly two) in- person visits to each school. Her primary role is to mobilize the school community and establish a plan of action (within the three nutrition priority areas) for initiating change at the level of the school environment. Also key to this facilitation model is the collaboration and coordination with the regional public health units; the facilitator engages the school health nurse/ promoter who is “assigned” to that school to ensure he/ she is informed of the school’s action plan, and to link the school to resources within public health. This relationship enhances the capacity to support schools in implementing their action plan by allowing public health to complement the efforts of the facilitator. Champlain Report Card – School Survey To better understand our starting point, we invited all school principals in the Champlain region to complete a brief baseline survey regarding their current school nutrition environment. Specific emphasis was placed on our three nutrition priority areas. The baseline survey was completed in 2010 (n=298 schools or 54.7%) and informed the Champlain Report xiii Card , a summary of findings for the Champlain region. To monitor and evaluate our progress, a one-year follow-up survey was completed in April 2012 with a response rate of 76%. Results of the follow-up survey will be released shortly. 5 EXPERT TASK GROUP RECOMMENDATIONS REPORT – HEALTHY SCHOOL-AGED CHILDREN 2.0 METHODOLOGY In developing the Healthy School-aged Children Strategy, the Expert Task Group undertook the following activities: 1. Environmental scan (existing assets, levers, and promising practices); 2. Identification of opportunities (common areas of priority across partners; brainstorming and prioritization of potential priority areas); and, 3. Developing a blueprint of recommendations for the Champlain region. 3.0 ENVIRONMENTAL SCAN Our environmental scan revealed a number of areas of alignment with local and regional assets that will serve to enable the proposed Healthy School-aged Children Strategy. The following summary highlights the most relevant themes that emerged from the scan (please refer to Appendix B for a detailed summary of findings): SUSTAIN HEALTHY SCHOOLS 2020 We received tremendous feedback and support from partners to continue our work with the Champlain Healthy School-aged Children initiative and Healthy Schools 2020 in the future. At our first Expert Task Group meeting, members highlighted the critical connecting and coordinating role of the CCPN Project Management Team and how the Champlain Declaration/ Healthy Schools 2020 initiative represents the collective activity – as a region – in moving towards our vision of school-aged children being physically active and making healthy food choices every day. The group expressed that the key base resource of this initiative is having a regional coordinator in place to maintain the existing infrastructure alongside some level of collaboration and exchange among school board and health partners. As a demonstration of their support, a number of partners submitted a letter of commitment to demonstrate their ongoing support of the Healthy School-aged Children initiative and the proposed recommendations. The letters are found in Appendix C. TARGET SCHOOL ENVIRONMENTS USING A COMPREHENSIVE APPROACH Healthy Schools 2020 and other public health school-based programs in the Champlain region are grounded in a whole-school or Comprehensive School Health (CSH) approach as defined in the Ontario Foundations for a Healthy School framework. This approach fosters supportive physical and social environments that facilitate children’s healthy eating and physical activity behaviours. Task Group members agreed that mobilizing and supporting change at the level of the school environment (as opposed to targeting individual behaviour change) is an impactful, sustainable endeavour. A systematic review of CSH programs by the World Health Organization found that health promotion in schools can improve children’s health and well-being. Among the most effective programs are those that promote mental health, healthy eating, and physical activity. It was also identified that programs should xiv be sustained, multi-factorial, and provide appropriate training . School facilitation models can be an effective way to support a CSH approach. One such example is the APPLE Schools program in Alberta which started in 2008 and has demonstrated improved nutrition habits, increased physical activity levels, reduction in obesity levels, and positive, healthy environments in xv all participating school communities . In the Champlain region, success in mobilizing partners to support healthy nutrition environments in schools has been demonstrated through our Francophone facilitation program as well as our series of partner-supported school board workshops. The Task Group identified both of these areas – school facilitation and training opportunities for school communities – as high priority recommendations for the 6 EXPERT TASK GROUP RECOMMENDATIONS REPORT – HEALTHY SCHOOL-AGED CHILDREN 2013-16 strategy. There was also a clear emphasis to move forward on the physical activity aspect of our mandate; specifically, Active & Safe Routes to School/ School Travel Planning and increasing active play (DPA, playgrounds). MAKE THE LINK TO STUDENT SUCCESS Along with supporting a CSH approach, it was also identified that there should be a stronger emphasis in xvi our collective work on making the link between physical activity, healthy eating, and Student Success . Student Success “is motivated by a belief that every student deserves a good outcome from his or her education, that the outcome should be the best fit possible for each student’s potential, willingness and capacity for further learning, and that all students should have a core of common knowledge, skills and values”. This would include building a case for healthy active living outcomes as a measure of student success that would also include metrics for monitoring and evaluation. This could link to the Ontario Ministry of Education policies and curriculum including the K-12 School Effectiveness Framework: A support for school improvement and student success which identifies evidence-based indicators of successful practice in a number of components of effective schools. EMPHASIZE MONITORING AND EVALUATION The final theme that emerged from our environmental scan was the emphasis on monitoring and evaluation. The Expert Task Group highlighted various assets in our region with regards to research and evaluation of school-based environments. Partners were interested in pulling together a group focused on developing a comprehensive evaluation tool that will build on our current assets and evaluation initiatives including the Champlain Report Card, School Health Action Planning and Evaluation System xvii xviii xix (SHAPES) , School Travel Planning , and the Canadian Assessment of Physical Literacy . Positive change can happen in schools! In 2006, the World Health Organization found that the most effective school-based health promotion programs for changing behaviour were those focused on positive social behaviour, physical activity, and healthy eating. Healthy school communities promote wellness and strive to create environments that foster lifelong health and wellness. The approach used to create active, healthy school communities is known as the health-promoting school or Comprehensive School Health (CSH) approach. 7 EXPERT TASK GROUP RECOMMENDATIONS REPORT – HEALTHY SCHOOL-AGED CHILDREN 4.0 SUMMARY OF RECOMMENDED STRATEGY VISION Healthy eating and physical activity are part of our children and youth’s daily lives in the Champlain region. MISSION Health, education, and community partners will come together and take action to foster supportive physical and social environments that facilitate children’s health and well-being with an emphasis on healthy eating and physical activity. This will be achieved through a comprehensive, multi-faceted approach targeting home, school, and community environments. TARGET POPULATION Children and youth aged four to 18 years living in the Champlain region (Note: certain initiatives could target a specific age range within this target population) STRATEGY COMPONENTS The proposed Healthy School-aged Children Strategy includes the following components: Governance & Regional Coordination Maintain the Healthy Schools 2020 infrastructure and branding Establish a comprehensive funding strategy School Facilitation & Skills Training Establish a school facilitation model across the nine Champlain school boards Increase knowledge and skills among school communities (principals, teachers, parents, children, and youth) that support implementation of the priority areas for action Monitoring & Evaluation Develop and implement a robust evaluation plan for school-based healthy eating and physical activity environments across the Champlain region Advocacy & Communications Build a business case to support the integration of physical activity and healthy eating (Healthy Schools 2020) with Student Success Develop an advocacy/ communications strategy to support the business case aligned with Student Success OUR GUIDING PRINCIPLES Build on current partnerships and collaboration with the nine school boards, four public health units, and CCPN partners in the Champlain region. Emphasize approaches that focus on the benefits of healthy behaviours (vs. weight-centered outcomes) and that promote positive mental health Shift the focus to creating supportive environments vs. targeting individual behaviour change (social determinants of health). Align approaches to Student Success, recognizing that children's health status affects ability to learn and educational attainment affects health status. Recognize that parent and student engagement are key factors in the enhancement of health, well- being and achievement. xx Ensure a Community Assets Based approach that recognizes diverse community strengths, supportive environments and accessible programs. 8 EXPERT TASK GROUP RECOMMENDATIONS REPORT – HEALTHY SCHOOL-AGED CHILDREN PROPOSED RECOMMENDATIONS RECOMMENDATIONS ACTIVITIES KEY PARTNERS FUNDING PRIORITY (KEY RESOURCES) RANK STRATEGY COMPONENT: Governance & Regional Coordination 1. Maintain the Healthy Continue the existing Healthy Schools infrastructure, inclusive of: CCPN Staff time Very high Schools 2020 Steering Committee (nine school boards, four public (regional infrastructure and health units, other health partners) to provide leadership School boards coordinator) branding and oversight to the Healthy School-aged Children Strategy; and (at minimum) to maintain an opportunity for Health and In-kind time from regional partners to exchange successes; community partners partners Planning Committee (CCPN, public health) to provide planning and implementation support to execute the Strategy; and, Regional Coordinator (CCPN) to facilitate ongoing committee operations. Develop a three-year operating plan to lead the implementation of the Strategy (recommendations 2-7). Seek new partners/ champions as required to execute the Strategy. 2. Establish a Develop a comprehensive strategy for securing overall funding CCPN Staff time Very high comprehensive funding for the three-year operating plan. (regional strategy Private donor sponsorship was identified as an coordinator) “untapped” opportunity for emphasized exploration. Shared partner funding models also to be explored. Present current Report of Recommendations to newly established Ontario Healthy Kids Panel (co-chaired by Alex Munter and Kelly Murumets). STRATEGY COMPONENT: School Facilitation & Skills Training 3. Establish a school Establish a multi-year plan to support expansion of the Healthy CCPN Staff time (school High facilitation model Schools 2020/ Écoles en santé 2020 school facilitation program coordinator(s)/ across the nine across all nine school boards, based on available resources. Public health units facilitator(s)) Champlain school While efforts will be made to maintain the existing Francophone boards program, emphasis will be placed on initiating in the English School boards setting. Validate priority areas for action (Steering Committee). The Green Communities recommendation is to: Canada Maintain focus on healthy school nutrition environments 9 EXPERT TASK GROUP RECOMMENDATIONS REPORT – HEALTHY SCHOOL-AGED CHILDREN and three nutrition priorities (catered lunch programs, fundraising, classroom rewards); and, Expand to physical activity areas – Active & Safe Routes to School/ School Travel Planning, active play (DPA, school playgrounds), and/or physical literacy. 4. Increase knowledge Develop a series of school board/ school training opportunities CCPN Staff time High and skills among (i.e. workshops, presentations, communications) to support (regional school communities implementation of the priority areas for action. Training Public health units coordinator) (principals, teachers, opportunities will complement the proposed facilitation program parents, children, and but may also serve as a standalone activity. School boards Funds to develop youth) that support Develop relevant tools and resources to complement training training implementation of the sessions (Planning Committee) Green Communities resources priority areas for action Maximize public health and school board partner channels to Canada disseminate resources. In-kind time from partners STRATEGY COMPONENT: Monitoring & Evaluation 5. Develop and implement Establish a team of regional and multi-sectoral evaluation CCPN Staff time High a robust evaluation specialists. (evaluation plan for school-based Revisit and revise the current Champlain Report Card (school HALO–CHEO specialist) healthy eating and survey – completed in 2010 & 2012). physical activity Develop a common evaluation tool that will support the overall Evaluation staff from In-kind time from environments across assessment of the Healthy Schools 2020 initiative, inclusive of partner organizations partners the Champlain region the agreed-upon priority areas for action (noted in (evaluation recommendation 3) and others as permitted, e.g.: specialists) Monitoring of existing Ministry of Education policies (P/PM 150, DPA) Physical literacy assessments Qualitative measures (e.g. supports & barriers, student culture) Consider the use and/or inclusion of other established evaluation tools, such as: School Health Action, Planning and Evaluation System (SHAPES) Canadian Assessment of Physical Literacy (CAPL) 10 EXPERT TASK GROUP RECOMMENDATIONS REPORT – HEALTHY SCHOOL-AGED CHILDREN STRATEGY COMPONENT: Advocacy & Communications 6. Build a business case Build the case for healthy active living outcomes as a measure of CCPN Staff time High to support the Student Success by showing the link between physical activity, (regional integration of physical healthy eating, and Student Success. This includes identifying School Boards coordinator) activity and healthy relevant policy, program or curriculum levers related to healthy eating (Healthy active living that could support the business case (e.g. mental Evaluation Partners In kind time from Schools 2020) with health, resiliency). partners Student Success. Establish a metric to demonstrate the link between physical HSF activity, healthy eating, and Student Success: Link to Education Quality and Accountability Office (EQAO) results and common evaluation tool. Test/ evaluate the approach in a number of schools in the Champlain region. 7. Develop an advocacy/ Develop an advocacy/ communication strategy to achieve buy-in CCPN Staff time High communications and increased support for physical activity and healthy eating in (regional strategy to support the Champlain region schools. HSF (link to coordinator) business case aligned Present the business case (recommendation 6) to key decision- Spark Advocacy with Student Success. makers at various levels (Principals, Parent Councils, Directors of Grant) Education, School Board Trustees, MPPs, and Ministries of Education/Health and Long-term Care). Solicit advocacy champions (student/ parent engagement). RECOMMENDATIONS BEYOND 2016 The Expert Task Group also identified the following areas that, while beyond the scope of the current Strategy, could be explored for 2017 and beyond: 1. Explore integration of healthy food and beverage environments to other settings that serve children & youth. Conduct an environmental scan of policy supports for healthy food and beverage environments in major settings (after school, sport associations, municipalities) serving children and youth in the Champlain region. 2. Execute mapping of physical activity programs for children & youth in the Champlain region during the critical hours period. Conduct community mapping of physical activity programs and their availability during the critical hours period (after school, playground) in the Champlain region. Look for innovative ways to address barriers such as accessibility, equipment, funding, insurance, transportation, supervision, and full-day learning. 11 EXPERT TASK GROUP RECOMMENDATIONS REPORT – HEALTHY SCHOOL-AGED CHILDREN 5.0 PERFORMANCE MANAGEMENT PLAN As per recommendation 5, we will seek to establish a team of regional and multi-sectoral evaluation specialists to monitor the implementation of the Healthy Schools 2020 initiative. This group will look at developing a common evaluation tool that will be used to track implementation activities as well as to monitor progress and outcomes of the Healthy Schools 2020 initiative. A logic model and performance measurement framework was developed as part of the Healthy Schools 2020 initiative (Appendix D). This previous work will help to shape the overall evaluation framework and common evaluation tools. A baseline (2010) and one-year follow-up school survey (2012) have been conducted to date and served to inform the Champlain Report Card, a summary of findings for the Champlain region. Other Evaluation Tools to Consider: School Health Action, Planning and Evaluation System (SHAPES) Canadian Assessment of Physical Literacy (CAPL) PERFORMANCE METRICS Process Indicators Process indicators will be captured by the CCPN as part of regional coordination activities. The following indicators are proposed: Participation from school board, health and community partners at Healthy Schools 2020 Steering Committee Meetings Number (%) of school board administrators/ principals/ teachers aware of the Champlain Declaration and Healthy Schools 2020 priority areas for action Number (%) of schools registered for facilitation program Number (%) of schools with a health/ nutrition committee Number (%) of schools that have completed a School Action Plan (related to the priority areas for action) Number of complementary community activities (programming, policies, communications, planning) to show engagement of other children- and youth-serving organizations Outcome Indicators Outcome indicators will be captured in the proposed common evaluation tool. As a result of our existing Champlain Report Card (School Survey), we are currently capturing self-report data related to the following school nutrition environment indicators: Healthy School Nutrition Environments Number (%) of schools placing high priority on Healthy School Nutrition Environments Number (%) of schools indicating they have noticed healthier food offerings in the past year Number (%) of schools rating their school nutrition environment as "very healthy" Number (%) of schools with less than 10 special event days (as defined by PPM 150) Number (%) of schools with nutrition policy beyond PPM 150 Number (%) of schools engaging in fundraising initiatives that utilize non-food items or that do not use "not permitted for sale" items (as defined by PPM 150) Number (%) of schools that do not use food as classroom rewards 12 EXPERT TASK GROUP RECOMMENDATIONS REPORT – HEALTHY SCHOOL-AGED CHILDREN Number (%) of elementary schools with catered lunch programs emphasizing "sell most" items (as defined by PPM 150) Number (%) of secondary school cafeterias emphasizing "sell most" foods (as defined by PPM 150) Revenue generated from lunch cafeteria sales Newly proposed indicators include: Number (%) of schools with a breakfast/ healthy snack program Number (%) of schools that provide food skills education (identify curriculum) Number (%) of community agencies, organizations that adopt P/PM 150 guidelines for children and youth programming Physical Activity Environments The CCPN has not currently been capturing data surrounding Physical Activity or Overweight/Obesity but will seek to include these in our common evaluation tool. Many of our partner organizations are currently collecting data in many of the areas listed below so we will seek to consolidate and coordinate the outcome and impact evaluation Proposed indicators include: Number (%) of schools placing high priority on Physically Active School Environments Number (%) of schools actively promoting active transportation to and from school (policy, programming, education, school-based facilitator for Active & Safe Routes to School and/or School Travel Planning) Number (%) of schools who actively limit prolonged screen time Number (%) of schools who assess physical literacy at school entry Number (%) of schools that have physical activity/ sports equipment available at break times (lunch, recess, before and after school) to encourage active play Number of steps taken by all children and youth per day Impact Indicators (long-term) Impact indicators are aligned to the long-term health goals of the CCPN but may not be within scope of measurement as part of the proposed 2013-16 Healthy School-aged Children Strategy. The proposed evaluation team will assess the potential for measurement and methodology related to such impact indicators as: Prevalence of children who are physically active (60 minutes daily) Prevalence of children with screen time hours <2 hours per day Prevalence of children actively communing (walking, cycling, rolling) to and from school Prevalence of children consuming >5 fruits and vegetables per day Prevalence of children consuming breakfast Prevalence of children meeting physical literacy “target” (indicator/ targets TBD) Prevalence of overweight in school-aged children Prevalence of obesity in school-aged children 13 EXPERT TASK GROUP RECOMMENDATIONS REPORT – HEALTHY SCHOOL-AGED CHILDREN 6.0 LEADERSHIP & PARTNER ROLES The following is a list of partners who will be involved in the Champlain Healthy School-aged Children Strategy (please refer to the recommendations table in section 4.0 for specific partner roles). Health & Community Partners Champlain Diabetes Network Eastern Ontario Health Unit Green Communities Canada Healthy Active Living and Obesity (HALO) Research Group, CHEO Heart and Stroke Foundation of Ontario KidActive Leeds, Grenville and Lanark District Health Unit YMCA-YWCA National Capital Region Ottawa Public Health Renfrew County and District Health Unit University of Ottawa Heart Institute School Boards Partners Catholic District School Board of Eastern Ontario Conseil des écoles catholiques du Centre-Est Conseil des écoles publiques de l'Est de l'Ontario Conseil scolaire de district catholique de l'Est ontarien Ottawa Catholic School Board Ottawa-Carleton District School Board Renfrew County Catholic District School Board Renfrew County District School Board Upper Canada District School Board 14 EXPERT TASK GROUP RECOMMENDATIONS REPORT – HEALTHY SCHOOL-AGED CHILDREN 7.0 RESOURCE REQUIREMENTS & PLAN RED = Conservative (Partner Resources only) Year 1 Year 2 Year 3 TOTAL BLACK = Realistic (Mid-range) $ $ $ $ BLUE = Optimistic (Sky’s the Limit) STAFFING COSTS Regional Coordinator (CCPN PMO) 0.2 FTE 16,000 16,000 16,000 48,000 0.6 FTE 48,000 48,000 48,000 144,000 1.0 FTE 80,000 80,000 80,000 240,000 School Coordinator(s)/ Facilitator(s)* 1.0 FTE 70,000 70,000 70,000 210,000 2.0 FTE 140,000 140,000 140,000 420,000 8.0 FTE 560,000 560,000 560,000 1,680,000 Evaluation Specialist 0.2 FTE 16,000 16,000 16,000 48,000 0.6 FTE 48,000 48,000 48,000 144,000 1.0 FTE 80,000 80,000 80,000 240,000 OPERATING COSTS (req’d in parallel with staffing above) Healthy Schools 2020 Committee Operations (Steering Committee and planning groups) Meeting costs (venue, catering, parking), travel 2,000 2,000 2,000 6,000 (mileage); materials & supplies; other services 5,000 5,000 5,000 15,000 (translation, graphic design) 10,000 10,000 10,000 30,000 School Facilitation Program Costs 41,000 41,000 41,000 123,000 Travel (mileage),School Seed Funding** 82,000 82,000 82,000 246,000 575,000 575,000 575,000 1,725,000 Skills Training for School Community 5,000 5,000 5,000 15,000 Venue, catering, AV rentals 10,000 10,000 10,000 30,000 20,000 20,000 20,000 60,000 Tools & Resources 5,000 5,000 5,000 15,000 Translation, graphic design, production, website 10,000 10,000 10,000 30,000 20,000 20,000 20,000 60,000 Evaluation Activities 1,000 1,000 1,000 3,000 Assessment tools (online, other), report 2,000 2,000 2,000 6,000 production & dissemination costs 5,000 5,000 5,000 15,000 Advocacy Strategy 0 500 500 1,000 Development and implementation costs (support 0 2,000 2,000 4,000 tools) 0 5,000 5,000 10,000 GRAND TOTAL 156,000 156,500 156,500 469,000 345,000 347,000 347,000 1,039,000 1,360,000 1,390,000 1,390,000 4,140,000 * School Facilitators: Level of facilitation support to be explored through resourcing strategy as well as in-kind partner support from regional public health units. Conservative: 1.0 FTE would cover 65-75 schools Realistic: 2.0 FTE would cover 150 schools Optimistic: 8.0 FTE would cover all 547 schools in the Champlain Region. The above ratios are based on the current Écoles en santé 2020 model but are not necessarily optimal. A smaller number of schools per facilitator is preferred. **School Facilitation Program Cost estimates are also based on the current Écoles en santé 2020 model. Conservative budget assumes $500 per school x 75 schools + $3500 for travel x 1.0 FTE 15 EXPERT TASK GROUP RECOMMENDATIONS REPORT – HEALTHY SCHOOL-AGED CHILDREN Realistic budget assumes $500 per school x 150 schools + $3500 for travel x 2.0 FTE Optimistic budget assumes $1000 per school x 547 schools + $3500 for travel x 8.0 FTE 16 EXPERT TASK GROUP RECOMMENDATIONS REPORT – HEALTHY SCHOOL-AGED CHILDREN Current Funding Model: Écoles en santé 2020 Facilitation Program Level of Support Budget 1 Program Coordinator/Facilitator $65,000-$85,000/year + in-kind funding from Ottawa Public Health for 2 years. 76 participating schools within the 3 Francophone Seed Funding: $500- $1100/school (depending on school boards in the Champlain Region the size of the school) 1 to 3 school facilitation visits/year Travel: $3,500- $5,000 8.0 IMPACTS & RETURN ON INVESTMENT EXPECTED REACH As highlighted in our vision, we are seeking to ensure healthy eating and physical activity are part of our children and youth’s daily lives in the Champlain region. Our target population is children and youth aged four to 18 years in the Champlain region. Our proposed efforts to target all 547 schools in the Champlain region have the potential to reach the close to 208,000 students collectively enrolled in Champlain schools. While data does not exist regionally with respect to return on investment for healthy eating and physical activity initiatives, there is body of literature which estimates the cost-benefit of investing in health promotion as a means of curbing long-term incidence of chronic disease. POTENTIAL FOR IMPACT WITH IMPROVED EATING AND PHYSICAL ACTIVITY It has been estimated that obesity cost the Canadian economy approximately $4.6 billion in 2008, up xxi $735 million or about 19% from $3.9 billion in 2000 . The 2009 estimates for the total annual economic burden of physical inactivity in Canadian adults xxii was $6.8 billion, which represented 3.8% of the overall health care costs . If the number of physically inactive Canadians were to decrease by 10% over a 5-year period, this xxiii would result in a savings of 5 billion dollars in lifetime costs for the Canadian economy . The TD Bank observes that a healthier population is less costly to serve, and prevention is the key to xxiv a more sustainable health system in Ontario . A study conducted by Kirk et al. suggests that healthy eating habits established in childhood may be xxv associated with lower health-care utilization . In line with recommendation 6 (building the business case), there are a number of potential academic and school-related impacts that may be derived as a consequence of increasing physical activity and healthy eating, such as improved academic and student success, improved mental health/ self- xxvi xxvii esteem, and improved school community engagement . 17 EXPERT TASK GROUP RECOMMENDATIONS REPORT – HEALTHY SCHOOL-AGED CHILDREN 9.0 RISK ASSESSMENT Risk or Barrier Mitigation Strategy(ies) Lack of confirmed/secured resources Recommendation 2: Establish a comprehensive strategy for overall resourcing of priority areas for action. Seek to secure resources from private donors, Network partners, government, and industry sources. In-kind opportunities to be explored within partners. Creative volunteer opportunities to be explored. Competing demands within the school P/PM 150 has been an effective lever in accessing environment and in particular, for school our target audiences, as schools are seeking principals supports to comply with the new regulations. The workshop/training content and resources will facilitate compliance and should be linked with existing school principal meetings. A web-conference option could be made available to facilitate participation. Variety of options to access workshop/training resources – CD format, web-based, newsletters. Significant variability across schools in Approaches will be as flexible as possible to the terms of capacity for action plan varying needs across school settings. implementation. Resource intensity of facilitator role and Recommendation 3: public health capacity to support the Role of the facilitator position will augment implementation at the school level capacity to implement activities at the school level. Clarity of roles and responsibilities with potential facilitator including CCPN hired staff, school teachers/volunteers, school board employees, health unit staff or dedicated School Travel Planning facilitators. The secondment of a public health staff member (school public health nurse, dietitian or health promoter) is particularly beneficial, as it brings an existing expertise of nutrition and physical activity issues as well as knowledge of the school setting and the CSH approach. Securing skilled facilitators across the Clarity of roles and responsibilities, consistent Champlain region training Underestimation of the role of physical Recommendations 6 & 7: activity and healthy eating in Student Show the link between physical activity, healthy Success. eating and student success. Identify policy levers that can assist with the integration of physical activity and healthy eating into other areas of school curriculum. Build on current curriculum emphasis on mental health, assets and resiliency. Develop an advocacy strategy to present, educate and influence decision makers at various levels. 18 EXPERT TASK GROUP RECOMMENDATIONS REPORT – HEALTHY SCHOOL-AGED CHILDREN 19 EXPERT TASK GROUP RECOMMENDATIONS REPORT – HEALTHY SCHOOL-AGED CHILDREN APPENDIX A: The Local Context Population health data for children and youth in the Eastern Ontario Region is presented in a working 1 document of the Child and Youth Health Network for Eastern Ontario (CYHNEO) . This document was developed in response to the identified need for a tool to help agencies use a population health approach for planning services for children and youth. The report include Approximately 23.8% of children and youth aged 12 to 19 years reported that they were physically inactive during their leisure time. This compares to Canadian Accelerometer Data that demonstrate 93% of children and youth are not meeting the physical activity amount recommended by the Public Health 2 Agency of Canada and the World Health Organization , which is 60 minutes of moderate to vigorous 3 physical activity every day . Also alarming is how Canadian children and youth report spending twice as 4 much time in front of a screen (computer and/or Television) as they do engaged in physical activity . Fruit and Vegetable Consumption About half of children and youth aged 12 to 19 years reported that they eat fruits and vegetables five or more times a day. Ottawa Public Health data also display a large portion of youth exhibiting unhealthy 5 eating behaviours such as not eating breakfast and regularly consuming sugar-sweetened beverages . 1 Using Population Health Data to Profile the Health and Well-Being of Children and Youth in Eastern Ontario: A Working Document of the Child and Youth Health Network for Eastern Ontario (CYHNEO), 2010. 2 Colley RC, Garriguet D, Janssen I, Craig CL, Clarke J, Tremblay MS. Physical activity of Canadian children and youth: Accelerometer results from the 2007 to 2009 Canadian Health Measures Survey. Statistics Canada. 3 August 2011 3 Canadian Centre for Exercise Physiology: Canadian Physical Activity Guidelines, 2011 Scientific Statements, 3 August 2011. 4 Canadian Society for Exercise Physiology. Canadian Sedentary Behaviour Guidelines for Children and Youth. 18 August 2011 5 Ottawa Public Health. Healthy Eating, Active Living, Healthy Weights, 2012. Ottawa, ON; Eastern Ontario Health Unit. Youth Risk Behaviour Survey, 2011. 20 EXPERT TASK GROUP RECOMMENDATIONS REPORT – HEALTHY SCHOOL-AGED CHILDREN Body Mass Index (BMI) The self-reported BMI data was such that 17.9% of children and youth aged 12 to 17 years in the Champlain region were overweight or obese. The rate varied across counties from 15.4% in the City of Ottawa Health Unit area to 23.4% in the Leeds, Lanark and Grenville District Health Unit area.One bias with self-reported BMI data is that people tend to underestimate their weight and overestimate 6 their height, resulting in lower estimates of the prevalence of obesity compared with measured data . 6 Connor Gorber S, Tremblay M, Moher D, Gorber B. A comparison of direct vs. self-report measures for assessing height, weight and body mass index: a systematic review. Obes Rev. 2007; 8(4): 307-26. 21 EXPERT TASK GROUP RECOMMENDATIONS REPORT – HEALTHY SCHOOL-AGED CHILDREN EXISTING REGIONAL ASSETS • Ottawa Public Health recently released their 2012 Healthy Eating, Active Living and Healthy Weights report which outline’s the prevalence of healthy weights as well as the determinants and impacts of some of its causes and contributors including healthy eating, and active living. From this report Ottawa Public Health has developed a Healthy Eating, Active Living (HEAL) Strategy that focuses on three determinants of healthy weights: poor nutrition, inactivity and the cultural pre-occupation with weight. • Regional data trends on physical and mental health and wellbeing have also been highlighted in local public health unit reports including Mental Health & Wellbeing of Students in Leeds, Grenville & Lanark (2009) and Eastern Ontario Health Unit’s 2011Youth Risk Behaviour survey. • The Ottawa School Travel Planning (STP) project is facilitated by Green Communities Canada, a non-profit organization with many years of experience working with schools across Ontario to promote active transportation (walking, cycling). It is approved and supported by all four Ottawa school boards, the City of Ottawa, Ottawa Police Service and the Ottawa Safety Council. The Renfrew County Public Health Unit has recently introduced STP to two schools in Pembroke and stakeholders in Lanark Leeds Grenville are also working to introduce STP to schools in their area. • The Healthy Communities Framework was established to support communities to plan and deliver integrated programs that improve the health of Ontarians. Local Healthy Communities partnerships play a key role in supporting local action on physical activity and healthy eating initiatives. This includes the Renfrew County Healthy Community Partnership and Physical Activity Network made up of stakeholders committed to improving the quality of life and health of communities and residents in Renfrew County. The focus of the initiative is on the development of policy and collaborative community efforts around the physical, mental, social, environmental and economic health and the Renfrew County Community Partnership: Community Picture Report outlines key regional data, assets and recommended actions. • The United Way Ottawa Growing Up Great initiative is working with key stakeholders in developing the Critical Hours Strategies, which are focused on bringing business leaders, community agencies and other stakeholders together to help create more social recreation opportunities for children and youth outside of school hours. • YMCA-YWCA Y Kids Academy program provides kids with instruction on strength training complimented by interactive healthy living lessons to highlight the benefits of being active and making positive, healthy choices. Once successfully completed, the grade six students will receive a complimentary membership to the Y for one year, so they can stay active and practice their newly learned skills. • Canadian Assessment of Physical Literacy (CAPL) research project, which is being led by the CHEO Healthy Active Living and Obesity (HALO) Research Group. • School Health Action, Planning and Evaluation System (SHAPES) developed by the Propel Centre for Population Health Impact and colleagues at the University of Waterloo. Gathers data at both student and school levels to assess the health of their school and build a plan for improvement. Currently covers three topic areas: physical activity, healthy eating, and tobacco use. 22 EXPERT TASK GROUP RECOMMENDATIONS REPORT – HEALTHY SCHOOL-AGED CHILDREN APPENDIX B: Detailed Environmental Scan (Click on the icon to access the file) Environmental Scan June 2012 23 EXPERT TASK GROUP RECOMMENDATIONS REPORT – HEALTHY SCHOOL-AGED CHILDREN APPENDIX C: Partner Letters of Commitment (Click on each of the icons to access the file) LGLDHU EOHU RCDSB RCCDSB 24 EXPERT TASK GROUP RECOMMENDATIONS REPORT – HEALTHY SCHOOL-AGED CHILDREN APPENDIX D: Performance Management Plan – Healthy Schools 2020 (Click on each of the icons to access the file) Logic Model Performance Measures 25 EXPERT TASK GROUP RECOMMENDATIONS REPORT – HEALTHY SCHOOL-AGED CHILDREN REFERENCES ii Tremblay M. (2010). Fitness of Canadian children and youth: Results from the 2007-2009 Canadian Health Measures Survey. Statistics Canada Health Reports. Cat no. 82-003-X ii Deckelbaum, R.J.,& Williams, C.L. (2001). Childhood Obesity: The Health Issue. Obesity Research 9: 239s-243s. iii Public Health Agency of Canada (2009). Tracking Heart Disease and Stroke in Canada. iv A joint report from the Public Health Agency of Canada and the Canadian Institute for Health Information (2011). Obesity in Canada. v Kuhle, S., et al. (2010). Use and cost of health services among overweight and obese Canadian children. International Journal of Pediatric Obesity; Early Online, 1-7. vi Public Health Agency of Canada (2010). Curbing Childhood Obesity: A Federal, Provincial and Territorial Framework for Action to Promote Healthy Weights. vii Heart and Stroke Foundation (2012). Heart and Stroke Position Statement: Physical Activity, Heart Disease and Stroke. viii Ontario Budget (2012): Budget Papers Chapter I: Transforming Public Services. ix Ontario Ministry of Education, Foundations for a Healthy School http://www.edu.gov.on.ca/eng/healthyschools/foundations.html x Active Healthy Kids Canada (2011). Ontario Report Card Supplement: Active Healthy Kids Canada Report Card on Physical Activity for Children and Youth. http://dvqdas9jty7g6.cloudfront.net/resources/ONRC_ShortForm_singles_26SE11.pdf xi Know More Do More http://www.knowmore-domore.ca/ xii Champlain Declaration: A Call to Action for Physically Active & Healthy Eating Environments in Schools http://www.ccpnetwork.ca/pdf/CCPNDeclaration-SCREEN.pdf xiii Champlain Report Card http://www.healthyschools2020.ca/pdf/Champlain%20Report%20Card%20FINAL.pdf xiv Stewart-Brown S (2006). What is the evidence on school health promotion in improving health or preventing disease and, specifically, what is the effectiveness of the health promoting schools approach? Copenhagen, WHO Regional Office for Europe. http://www.euro.who.int/document/e88185.pdf xv Wu X.Y., Ohinmaa A., Veugelers P.J. (2012) Diet quality, physical activity, body weight and health- related quality of life among grade 5 students in Canada. Public Health Nutrition; 15(1): 75-81. xvi Ontario Ministry of Education, Student Success http://www.edu.gov.on.ca/studentsuccess/ xvii School Health Action, Planning and Evaluation System http://www.shapes.uwaterloo.ca/ xviii School Travel Planning: Active and Safe Routes to School http://www.saferoutestoschool.ca/oldsite/schooltravel.html 26 EXPERT TASK GROUP RECOMMENDATIONS REPORT – HEALTHY SCHOOL-AGED CHILDREN xix Canadian Assessment of Physical Literacy http://www.haloresearch.ca/blog/2011/08/03/dr-pat-longmuir-develops-kids-fitness-test/ xx Foot, J. & Hopkins, T. (2010) A glass half full: how an asset approach can improve community health and well-being. Improvement and Development Agency (IDeA) www.idea.gov.uk. xxi A joint report from the Public Health Agency of Canada and the Canadian Institute for Health Information (2011). Obesity in Canada. xxii Janssen, I. (2012). Health Care Costs of Physical Inactivity in Canadian Adults. Appl. Physiol. Nutr. Metab. 37: 1–4. xxiii Public Health Agency of Canada (2011) Healthy Living Unit: Frequently asked questions. xxiv TD Economics (2010). Charting a Path to Sustainable Health Care in Ontario. Special Report: 10 proposals to restrain cost growth without compromising quality of care. xxv Health behaviours and health-care utilization in Canadian school children. Public Health Nutrition. May 2012 xxvi Active Healthy Kids Canada (2009). The Active Healthy Kids Canada Report on Physical Activity for Children and Youth xxvii Ontario Society of Nutrition Professionals in Public Health School Nutrition Workgroup Steering Committee - Call for Action, 2004 27 EXPERT TASK GROUP RECOMMENDATIONS REPORT – HEALTHY SCHOOL-AGED CHILDREN