Implementation of an evidence-based coordinated school health program in a large urban county supported by a community coalition: Lessons from school district leaders

The Steps to a Healthier Houston-Harris County Consortium disseminated a coordinated school health program (CATCH) between Spring 2006 and Fall 2007, training 488 elementary schools in 19 districts in Harris County, Texas. In May 2007, a focus group was conducted to explore institutionalization of the CATCH project. Twenty people, representing 12 school districts, participated: Coordinators of Health Services, Directors of Physical Education, and District Dietitians. Themes evolved regarding benefits and improvements due to the implementation of CATCH. Organizational changes demonstrated increased administrative support for health related activities, more department collaboration, and heightened community and family support. At the school level, cafeterias began offering and identifying healthy choices. Students were observed enjoying classroom health lessons, and eating more fruits and vegetables at meal times. Many activities were started at the schools and districts, including structured recess, family fun nights, and district wide athletic events. Barriers that persisted in further institutionalization of CATCH included personnel, policies, and priorities. At the personnel level, barriers included the absence of district wellness coordinators and instructional specialists to continue implementation, along with a lack of certified PE teachers, and staff to visit and observe classes. Wellness Policies were problematic, if money to maintain CATCH could not be tied to the wellness policy, and wellness policies were not well understood or disseminated by the schools and districts. Problematic priorities included the lack of importance placed on health at the school level, along with no uniform evaluation measures for coordinated school health. Lessons learned generate discussions of sustainability.