Indicators for School Health Programs: to support Coordinated School Health Programs (CSHPs) and to address Physical Activity, Nutrition, and Tobacco Use (PANT) Fiscal Year: March 1, 2006 – February 28, 2007 Division of Adolescent and School Health Program Announcement No. 03004: Improving the Health, Education, and Well-Being of Young People Through Coordinated School Health Programs I. JOINT ACTIVITIES OF THE STATE EDUCATION AGENCY (SEA) AND STATE HEALTH AGENCY (SHA) 1.During FY 2006, did the SEA and SHA have a formal agreement to collaboratively develop a state plan to support implementation of CSHP in school districts (e.g., a current memorandum of understanding or contract)? YES NO 2.During FY 2006, did the SEA and SHA partnership plan include specific activities to: A.Seek additional funding YES NO B.Market or communicate about CSHP (i.e. create awareness or interest in new or on-going CSHP with the general public or partners) YES NO C.Develop or implement CSHP activities YES NO D.Develop or implement PANT activities YES NO E.Develop or change CSHP policy (e.g., statute, model policy, etc.) YES NO F.Develop or change PANT policy YES NO G.Share CSHP resources (e.g., databases, information, programs, etc.) YES NO H.Share PANT resources YES NO I.Provide CSHP professional development YES NO J.Provide PANT professional development YES NO K.Evaluate CSHP activities YES NO L.Evaluate PANT activities YES NO II. ACTIVITIES OF STATE-LEVEL COALITIONS TO SUPPORT CSHPs 3.Does your state currently have a state-level coalition to support CSHPs? YES NO Skip to 8 4.If so, how many CSHP state-level coalitions does your state currently have? 1 2 or more 5.Do any of your state’s CSHP state-level coalitions have a written plan (e.g., strategic plan, state blueprint, etc.) to develop or strengthen school health programs statewide? YES NO Skip to 7 6.How many CSHP state-level coalitions have written plans to develop or strengthen school health programs statewide? 1 2 or more 7.During FY 2006, in which of the following activities have any CSHP state-level coalitions been involved? A.Implement a CSHP state-level coalition written plan YES NO B.Seek additional funding YES NO C.Market or communicate about CSHP programs (i.e. create awareness or interest in new or on-going CSHP programs with the general public or partners) YES NO D.Develop or implement CSHP activities YES NO E.Develop or implement PANT activities YES NO F.Develop, change, or advise on CSHP policy (e.g., statute, model policy, etc.) YES NO G.Develop, change, or advise on PANT policy (e.g., statute, model policy, etc.) YES NO H.Share CSHP resources (e.g., databases, information, programs, etc.) YES NO I.Share PANT resources (e.g., databases, information, programs, etc.) YES NO J.Provide CSHP professional development YES NO K.Provide PANT professional development YES NO L.Provide incentives (including financial) to develop or implement CSHP activities YES NO M.Provide incentives (including financial) to develop or implement PANT activities YES NO III. POLICY 8.During FY 2006, did your project to support CSHP participate in any of the following activities on policy for CSHP, physical activity, nutrition, or tobacco-use prevention? A.DEVELOP (or revise or assist in developing) model policies, policy guidance, or other policy materials to inform policy direction? YES NO B.DISTRIBUTE to district or school staff established or model policies, policy guidance, or other policy materials to inform policy direction. CSHP YES NO—we have such policies, but have not distributed them this fiscal year.  Skip to 8C NO—we do not have such policies.  Skip to 8C. If YES to any category, provide the total: 1.Number of schools reached directly 2.Number of districts reached directly 3.Number of regional support units reached directly (if applicable) 4.Number of hits on policy web pages (if applicable) 5.Number of listservs, Internet mailing lists, or discussion boards used (do not list number of e-mails posted but the number of electronic distribution lists used) 6.Number of external partners reached directly 6A.Please specify type, e.g., CBO, Health Agencies PHYSICAL ACTIVITY YES NO—we have such policies, but have not distributed them this fiscal year.  Skip to 8C NO—we do not have such policies.  Skip to 8C. If YES to any category, provide the total: 1.Number of schools reached directly 2.Number of districts reached directly 3.Number of regional support units reached directly (if applicable) 4.Number of hits on policy web pages (if applicable) 5.Number of listservs, Internet mailing lists, or discussion boards used (do not list number of e-mails posted but the number of electronic distribution lists used) 6.Number of external partners reached directly 6A.Please specify type, e.g., CBO, Health Agencies NUTRITION YES NO—we have such policies, but have not distributed them this fiscal year.  Skip to 8C NO—we do not have such policies.  Skip to 8C. If YES to any category, provide the total: 1.Number of schools reached directly 2.Number of districts reached directly 3.Number of regional support units reached directly (if applicable) 4.Number of hits on policy web pages (if applicable) 5.Number of listservs, Internet mailing lists, or discussion boards used (do not list number of e-mails posted but the number of electronic distribution lists used) 6.Number of external partners reached directly 6A.Please specify type, e.g., CBO, Health Agencies TOBACCO USE YES NO—we have such policies, but have not distributed them this fiscal year.  Skip to 8C NO—we do not have such policies.  Skip to 8C. If YES to any category, provide the total: 1.Number of schools reached directly 2.Number of districts reached directly 3.Number of regional support units reached directly (if applicable) 4.Number of hits on policy web pages (if applicable) 5.Number of listservs, Internet mailing lists, or discussion boards used (do not list number of e-mails posted but the number of electronic distribution lists used) 6.Number of external partners reached directly 6A.Please specify type, e.g., CBO, Health Agencies C.Provide PROFESSIONAL DEVELOPMENT to district or school staff on established or model policies, policy standards, or other policy materials to inform policy direction. CSHP YES NO Skip to 8D If YES to any category, provide the total: 1.Number of professional development events including policy issues 2.Number of participants in professional development events including policy issues 3.Number of schools reached directly 4.Number of districts reached directly 5.Number of regional support units reached directly (if applicable) 6.Number of external partners reached directly 6A.Please specify type PHYSICAL ACTIVITY YES NO Skip to 8D If YES to any category, provide the total: 1.Number of professional development events including policy issues 2.Number of participants in professional development events including policy issues 3.Number of schools reached directly 4.Number of districts reached directly 5.Number of regional support units reached directly (if applicable) 6.Number of external partners reached directly 6A.Please specify type NUTRITION YES NO Skip to 8D If YES to any category, provide the total: 1.Number of professional development events including policy issues 2.Number of participants in professional development events including policy issues 3.Number of schools reached directly 4.Number of districts reached directly 5.Number of regional support units reached directly (if applicable) 6.Number of external partners reached directly 6A.Please specify type TOBACCO USE YES NO Skip to 8D If YES to any category, provide the total: 1.Number of professional development events including policy issues 2.Number of participants in professional development events including policy issues 3.Number of schools reached directly 4.Number of districts reached directly 5.Number of regional support units reached directly (if applicable) 6.Number of external partners reached directly 6A.Please specify type D.Provide INDIVIDUALIZED TECHNICAL ASSISTANCE to district or school staff on established or model policies, policy standards, or other policy materials to inform policy direction. CSHP YES NO  Skip to 8E If YES to any category, provide the total: 1.Number of schools reached directly 2.Number of districts reached directly 3.Number of regional support units reached directly (if applicable) 4.Number of external partners reached directly 4A.Please specify type PHYSICAL ACTIVITY YES NO  Skip to 8E If YES to any category, provide the total: 1.Number of schools reached directly 2.Number of districts reached directly 3.Number of regional support units reached directly (if applicable) 4.Number of external partners reached directly 4A.Please specify type NUTRITION YES NO  Skip to 8E If YES to any category, provide the total: 1.Number of schools reached directly 2.Number of districts reached directly 3.Number of regional support units reached directly (if applicable) 4.Number of external partners reached directly 4A.Please specify type TOBACCO USE YES NO  Skip to 8E If YES to any category, provide the total: 1.Number of schools reached directly 2.Number of districts reached directly 3.Number of regional support units reached directly (if applicable) 4.Number of external partners reached directly 4A.Please specify type E.Assist district or school staff in policy development or policy implementation on the following topics. (Assistance to districts or schools may be through distributing materials on policy, professional development, or providing individualized technical assistance.) Coordinated School Health Programs 1.Implementation of CSHP YES NO 2.Integration of the school health plan into the overall school improvement plan YES NO 3.Creation, improvement, or maintenance of school health councils and school health teams YES NO 4.Establishment of, qualifications for, and duties of local district CSHP coordinators YES NO 5.Implementation of required federal wellness policies YES NO Health Education 1.Requirements for K-12 health education classes YES NO 2.Certification requirements for teachers of health education YES NO 3.Nutrition education for students YES NO 4.Physical activity for students as a regular topic within health education YES NO 5.Tobacco-use prevention education for students YES NO 6.Other health education topics YES NO 6A.Please specify Physical Education Policies 1.Requirements for K-12 physical education YES NO 2.Certification requirements for physical education teachers YES NO 3.Prohibiting use of physical activity as a punishment during physical education class YES NO 4.Other physical education topics YES NO 4A.Please specify Physical Activity Policies 1.Daily recess or physical activity breaks for elementary students YES NO 2.Prohibiting denying recess as a punishment YES NO 3.After-school physical activity and/or intramurals and/or sports clubs YES NO 4.Other physical activity topics YES NO 4A.Please specify Healthy Eating Policies 1.Access to school meals for all students YES NO 2.Nutritional quality of all foods and beverages available on school campuses YES NO 3.Limiting student access to foods or beverages outside of the federally regulated school meals program YES NO 4.Promoting school fund-raising campaigns that consist of non-food items or healthful foods YES NO 5.Classroom guidelines that discourage the use of food as a reward or punishment YES NO 6.Other healthy eating topics YES NO 6A.Please specify Tobacco-use Prevention Policies 1.Prohibiting use of tobacco products by students, staff, parents, and visitors on school property, in school vehicles, and at school-sponsored functions away from school property YES NO 2.Prohibiting tobacco advertising in school buildings, at school functions, or in school publications YES NO 3.Tobacco-use cessation programs or referrals for students or staff YES NO 4.Enforcing tobacco-use prevention policies YES NO 5.Other tobacco-use prevention/cessation topics YES NO 5A.Please specify IV. CURRICULA & INSTRUCTION 9.During FY 2006, did your project to support CSHP participate in any of the following activities on curriculum and instruction for physical education? A.DEVELOP (or revise or assist in developing) physical education curricular standards, frameworks, instructional strategies, or other guidance? YES NO B.DISTRIBUTE to district or school staff physical education curricular standards, frameworks, instructional strategies, or other guidance. (Choose one.) YES NO—we have physical education curricular standards, frameworks, instructional strategies or other guidance, but have not distributed them this fiscal year.  Skip to 9C NO—we do not have physical education curricular standards, frameworks, instructional strategies, or other guidance.  Skip to 9C If YES, provide the total: 1.Number of schools reached directly 2.Number of districts reached directly 3.Number of regional support units reached directly (if applicable) 4.Number of external partners reached directly 4A.Please specify type 5.Number of listservs, Internet mailing lists, or discussion boards used (do not list number of e-mails posted but the number of electronic distribution lists used) C.Provide PROFESSIONAL DEVELOPMENT to district or school staff on physical education curricular standards, frameworks, or instructional strategies. YES NO Skip to 9D If YES, provide the total: 1.Total number of professional development events including curricula, curricular standards, frameworks, instructional strategies, or other guidance 2.Total number of participants in professional development events including curricula, curricular standards, frameworks, instructional strategies, or other guidance 3.Number of schools reached directly 4.Number of districts reached directly 5.Number of regional support units reached directly (if applicable) 6.Number of external partners reached directly 6A.Please specify type D.Provide INDIVIDUALIZED TECHNICAL ASSISTANCE to district or school staff on physical education curriculum or instruction (e.g., help in reviewing, revising, developing, or selecting instructional materials). YES NO Skip to 10 If YES, provide the total: 1.Number of schools reached directly 2.Number of districts reached directly 3.Number of regional support units reached directly (if applicable) 4.Number of external partners reached directly 4A.Please specify type 10.During FY 2006, did your project to support CSHP participate in any of the following activities on curriculum and instruction to address content areas of physical activity, nutrition, or tobacco-use prevention in health education? A.DEVELOP (or revise or assist in developing) health education curricula, health education standards, frameworks, instructional strategies, or other guidance? YES NO B.DISTRIBUTE to district or school staff health education curricula, health education standards, frameworks, instructional strategies, or other guidance. PHYSICAL ACTIVITY YES NO—we have curricular standards, frameworks, instructional strategies or guidance, but have not distributed them this fiscal year.  Skip to 10C NO—we do not have such curricular standards, frameworks, instructional strategies, or guidance  Skip to 10C If YES for any category, provide the total: 1.Number of schools reached directly 2.Number of districts reached directly 3.Number of regional support units reached directly (if applicable) 4.Number of external partners reached directly 4A.Please specify type 5.Number of listservs, Internet mailing lists, or discussion boards used (do not list number of e-mails posted but the number of electronic distribution lists used) NUTRITION YES NO—we have curricular standards, frameworks, instructional strategies or guidance, but have not distributed them this fiscal year.  Skip to 10C NO—we do not have such curricular standards, frameworks, instructional strategies, or guidance  Skip to 10C If YES for any category, provide the total: 1.Number of schools reached directly 2.Number of districts reached directly 3.Number of regional support units reached directly (if applicable) 4.Number of external partners reached directly 4A.Please specify type 5.Number of listservs, Internet mailing lists, or discussion boards used (do not list number of e-mails posted but the number of electronic distribution lists used) TOBACCO USE YES NO—we have curricular standards, frameworks, instructional strategies or guidance, but have not distributed them this fiscal year.  Skip to 10C NO—we do not have such curricular standards, frameworks, instructional strategies, or guidance  Skip to 10C If YES for any category, provide the total: 1.Number of schools reached directly 2.Number of districts reached directly 3.Number of regional support units reached directly (if applicable) 4.Number of external partners reached directly 4A.Please specify type 5.Number of listservs, Internet mailing lists, or discussion boards used (do not list number of e-mails posted but the number of electronic distribution lists used) C.Provide PROFESSIONAL DEVELOPMENT to district or school staff on health education curricula, health education standards, frameworks, instructional strategies, or other guidance. PHYSICAL ACTIVITY YES NO Skip to 10D If YES in any category, provide the total: 1.Number of professional development events including curricular standards, frameworks, instructional strategies, or other guidance…………………………………………… 2.Number of participants in professional development events including curricular standards, frameworks, instructional strategies, or other guidance…………………………………….. 3.Number of schools reached directly 4.Number of districts reached directly 5.Number of regional support units reached directly (if applicable) 6.Number of external partners reached directly 6A.Please specify type NUTRITION YES NO Skip to 10D If YES in any category, provide the total: 1.Number of professional development events including curricular standards, frameworks, instructional strategies, or other guidance…………………………………………… 2.Number of participants in professional development events including curricular standards, frameworks, instructional strategies, or other guidance…………………………………….. 3.Number of schools reached directly 4.Number of districts reached directly 5.Number of regional support units reached directly (if applicable) 6.Number of external partners reached directly 6A.Please specify type TOBACCO USE YES NO Skip to 10D If YES in any category, provide the total: 1.Number of professional development events including curricular standards, frameworks, instructional strategies, or other guidance…………………………………………… 2.Number of participants in professional development events including curricular standards, frameworks, instructional strategies, or other guidance…………………………………….. 3.Number of schools reached directly 4.Number of districts reached directly 5.Number of regional support units reached directly (if applicable) 6.Number of external partners reached directly 6A.Please specify type D.Provide INDIVIDUALIZED TECHNICAL ASSISTANCE to district or school staff on health education curriculum or instruction (e.g., help in reviewing, revising, developing, or selecting instructional materials). PHYSICAL ACTIVITY YES NO Skip to 11 If YES in any category, provide the total: 1.Number of schools reached directly 2.Number of districts reached directly 3.Number of regional support units reached directly (if applicable) 4.Number of external partners reached directly 4A.Please specify type NUTRITION YES NO Skip to 11 If YES in any category, provide the total: 1.Number of schools reached directly 2.Number of districts reached directly 3.Number of regional support units reached directly (if applicable) 4.Number of external partners reached directly 4A.Please specify type TOBACCO USE YES NO Skip to 11 If YES in any category, provide the total: 1.Number of schools reached directly 2.Number of districts reached directly 3.Number of regional support units reached directly (if applicable) 4.Number of external partners reached directly 4A.Please specify type V. ASSESSMENT OF STUDENT PERFORMANCE 11.During FY 2006, did your project to support CSHP participate in any of the following activities on the assessment of student performance for physical education? A.DEVELOP (or revise or assist in developing) physical education frameworks or guidelines for district or school staff about how to assess or measure students’ knowledge, skills, and physical activity behaviors? YES NO B.DISTRIBUTE to district or school staff physical education frameworks or guidelines about how to assess or measure students’ knowledge, skills, and physical activity behavior? (Do not include materials on how to conduct the Youth Risk Behavior Survey or the School Health Profiles or materials on height or weight measurements.) YES NO—we have physical education frameworks or guidelines about how to assess or measure students’ knowledge and skills, but have not distributed them.  Skip to 11C NO—we do not have physical education frameworks or guidelines about how to assess or measure students’ knowledge and skills.  Skip to 11C If YES, provide the total: 1.Number of schools reached directly 2.Number of districts reached directly 3.Number of regional support units reached directly (if applicable) 4.Number of external partners reached directly 4A.Please specify type 5.Number of listservs, Internet mailing lists, or discussion boards used (do not list number of e-mails posted but the number of electronic distribution lists used) C.Provide PROFESSIONAL DEVELOPMENT to district or school staff on how to assess or measure in physical education students’ knowledge, skills, and physical activity behavior. YES NO Skip to 11D If YES, provide the total: 1.Number of professional development events including curricula, instructional strategies, content standards, or programmatic strategies 2.Number of participants in professional development events including curricula, instructional strategies, content standards, or programmatic strategies 3.Number of schools reached directly 4.Number of districts reached directly 5.Number of regional support units reached directly (if applicable) 6.Number of external partners reached directly 6A.Please specify type D.Provide INDIVIDUALIZED TECHNICAL ASSISTANCE to district or school staff on how to assess or measure in physical education students’ knowledge, skills and physical activity behavior. YES NO Skip to 12 If YES, provide the total: 1.Number of schools reached directly 2.Number of districts reached directly 3.Number of regional support units reached directly (if applicable) 4.Number of external partners reached directly 4A.Please specify type 12.During FY 2006, did your project to support CSHP participate in any of the following activities on the assessment of student performance for physical activity, nutrition, or tobacco-use prevention in health education? A.DEVELOP (or revise or assist in developing) health education frameworks or guidelines about how to assess or measure students’ knowledge and skills to district or school staff for physical activity, nutrition, or tobacco-use prevention? YES NO B.DISTRIBUTE to district or school staff health education frameworks or guidelines about how to assess or measure students’ knowledge and skills for physical activity, nutrition, or tobacco-use prevention? (Do not include materials on how to conduct the Youth Risk Behavior Survey or the School Health Profiles.) YES NO—we have health education frameworks, guidelines, or strategies about how to assess or measure students’ knowledge and skills but have not distributed them this fiscal year.  Skip to 12C NO—we do not have health education frameworks, guidelines, or strategies about how to assess or measure students’ knowledge and skills.  Skip to 12C If YES in any category, provide the total: 1.Number of schools reached directly 2.Number of districts reached directly 3.Number of regional support units reached directly (if applicable) 4.Number of external partners reached directly 4A.Please specify type 5.Number of listservs, Internet mailing lists, or discussion boards used (do not list number of e-mails posted but the number of electronic distribution lists used) C.Provide PROFESSIONAL DEVELOPMENT to district or school staff on how to assess or measure students’ knowledge and skills relevant to physical activity, nutrition, or tobacco-use prevention in health education. YES NO Skip to 12D If YES in any category, provide the total: 1.Number of professional development events including curricula, instructional strategies, content standards, or programmatic strategies to assess students’ knowledge 2.Number of participants in professional development events including curricula, instructional strategies, content standards, or programmatic strategies to assess students’ knowledge 3.Number of schools reached directly 4.Number of districts reached directly 5.Number of regional support units reached directly (if applicable) 6.Number of external partners reached directly 6A.Please specify type D.Provide INDIVIDUALIZED TECHNICAL ASSISTANCE to district or school staff on assessment or measurement of students’ knowledge and skills for physical activity, nutrition, or tobacco-use prevention in health education. YES NO Skip to 13 If YES in any category, provide the total: 1.Number of schools reached directly 2.Number of districts reached directly 3.Number of regional support units reached directly (if applicable) 4.Number of external partners reached directly 4A.Please specify type VI. HEALTH PROMOTION AND ENVIRONMENTAL APPROACHES 13.During FY 2006, did your project to support CSHP participate in any of the following activities to help district or school staff to assess, plan, or coordinate school health programs? A.DEVELOP (or revise or assist in developing) model programs, guidance, implementation strategies, or other resource materials (not to include policy materials) for district or school staff to promote CSHPs or PANT through any of the following: A.District-level school health councils YES NO B.School-level school health councils YES NO C.School health coordinators YES NO D.How to secure administrative support for CSHP YES NO E.How districts or schools can collaborate with community partners YES NO F.How to develop new health-related policies in the context of CSHP YES NO B.DISTRIBUTE to district or school staff model programs, guidance, implementation strategies, or other resource materials (not to include policy materials) to promote CSHPs through any of the following: (Choose one for each program topic) A. District-level school health councils YES NO—we have model programs, guidance, implementation strategies, or other resource materials, but have not distributed them this fiscal year NO—we do not have model programs, guidance, implementation strategies, or other resource materials B. School-level school health councils YES NO—we have model programs, guidance, implementation strategies, or other resource materials, but have not distributed them this fiscal year NO—we do not have model programs, guidance, implementation strategies, or other resource materials C. School health coordinators YES NO—we have model programs, guidance, implementation strategies, or other resource materials, but have not distributed them this fiscal year NO—we do not have model programs, guidance, implementation strategies, or other resource materials D. How to secure administrative support for CSHP YES NO—we have model programs, guidance, implementation strategies, or other resource materials, but have not distributed them this fiscal year NO—we do not have model programs, guidance, implementation strategies, or other resource materials E. How districts or schools can collaborate with community partners YES NO—we have model programs, guidance, implementation strategies, or other resource materials, but have not distributed them this fiscal year NO—we do not have model programs, guidance, implementation strategies, or other resource materials F. How to develop new health-related policies in the context of CSHP. YES NO—we have model programs, guidance, implementation strategies, or other resource materials, but have not distributed them this fiscal year NO—we do not have model programs, guidance, implementation strategies, or other resource materials (If NO to all of the above, skip to 13C) If YES to any of the above, provide the total: 1.Number of schools reached directly 2.Number of districts reached directly 3.Number of regional support units reached directly (if applicable) 4.Number of external partners reached directly 4A.Please specify type C.Provide PROFESSIONAL DEVELOPMENT to district or school staff on model programs, guidance, implementation strategies, or other resource materials (not to include policy materials) to promote CSHPs through any of the following: A.District-level school health councils YES NO B.School-level school health councils YES NO C.School health coordinators YES NO D.How to secure administrative support for CSHP YES NO E.How districts or schools can collaborate with community partners YES NO F.How to develop new health-related policies in the context of CSHP YES NO (If NO to all of the above, skip to 13D) If YES to any of the above, provide the total: 1.Number of professional development events including model programs, guidance, implementation strategies, or other resource materials 2.Number of participants in professional development events including model programs, guidance, implementation strategies, or other resource materials 3.Number of schools reached directly 4.Number of districts reached directly 5.Number of regional support units reached directly (if applicable) 6.Number of external partners reached directly 6A.Please specify type D.Provide INDIVIDUALIZED TECHNICAL ASSISTANCE to district or school staff to promote CSHPs (i.e. developing model programs or selecting resource materials) through any of the following: A.District-level school health councils YES NO B.School-level school health councils YES NO C.School health coordinators YES NO D.How to secure administrative support for CSHP YES NO E.How districts or schools can collaborate with community partners YES NO F.How to develop new health-related policies in the context of CSHP YES NO (If NO to all of the above, skip to 14) If YES to any of the above, provide the total: 1.Number of schools reached directly 2.Number of districts reached directly 3.Number of regional support units reached directly (if applicable) 4.Number of external partners reached directly 4A.Please specify type 14.During FY 2006, did your project in support of CSHP participate in any of the following activities to help district or school staff to assess, plan, or coordinate school health programs? A.DISTRIBUTE to district or school staff the School Health Index or similar tool to help assess and plan school health programs. YES NO Skip to 14B If YES, what tool(s) were distributed? (Choose all that apply.) 1.The School Health Index YES NO 2.A modified version of the School Health Index YES NO 3.Other YES NO 3A.Please specify B.Provide PROFESSIONAL DEVELOPMENT to district or school staff on the School Health Index or similar tool to help assess and plan school health programs. YES NO Skip to 14C If YES, provide the total: 1.Number of professional development events 2.Number of participants in professional development events 3.Number of schools reached directly 4.Number of districts reached directly 5.Number of regional support units reached directly (if applicable) 6.Number of external partners reached directly 6A.Please specify type C.Provide INDIVIDUALIZED TECHNICAL ASSISTANCE to district or school staff on the School Health Index or similar tool to help assess and plan school health programs. YES NO Skip to 15 If YES, provide the total: 1.Number of schools reached directly 2.Number of districts reached directly 3.Number of regional support units reached directly (if applicable) 4.Number of external partners reached directly 4A.Please specify type 15.During FY 2006, did your project in support of CSHP engage in any of the following activities to help district or school staff promote physical activity? A.DEVELOP (or revise or assist in developing) model programs, guidance, implementation strategies, or other resource materials (not to include policy materials) for district or school staff to promote physical activity through any of the following: A.Increasing physical activity opportunities during school-day breaks, recess, or in the classroom YES NO B.Planning or implementing walk-to-school initiatives YES NO C.Planning or implementing organized physical activity programs beyond physical education or competitive athletics (e.g., intramural sports, physical activity clubs, and other after school activities) YES NO B.DISTRIBUTE to district or school staff model programs, guidance, implementation strategies, or other resource materials (not to include policy materials) to promote physical activity through any of the following: (Choose one for each program topic) A.Increasing physical activity opportunities during school-day breaks, recess, or in the classroom YES NO—we have model programs, guidance, implementation strategies, or other resource materials, but have not distributed them this fiscal year NO—we do not have model programs, guidance, implementation strategies, or other resource materials B.Planning or implementing walk-to-school initiatives YES NO—we have model programs, guidance, implementation strategies, or other resource materials, but have not distributed them this fiscal year NO—we do not have model programs, guidance, implementation strategies, or other resource materials C.Planning or implementing organized physical activity programs beyond physical education or competitive athletics (e.g., intramural sports, physical activity clubs, and other after school activities) YES NO—we have model programs, guidance, implementation strategies, or other resource materials, but have not distributed them this fiscal year NO—we do not have model programs, guidance, implementation strategies, or other resource materials (If NO to all of the above, skip to 15C) If YES to any of the above, provide the total: 1.Number of schools reached directly 2.Number of districts reached directly 3.Number of regional support units reached directly (if applicable) 4.Number of external partners reached directly 4A.Please specify type C.Provide PROFESSIONAL DEVELOPMENT to district or school staff on model programs, guidance, implementation strategies, or other resource materials (not to include policy materials) to promote physical activity through any of the following: A.Increasing physical activity opportunities during school-day breaks, recess, or in the classroom YES NO B.Planning or implementing walk-to-school initiatives YES NO C.Planning or implementing organized physical activity programs beyond physical education or competitive athletics (e.g., intramural sports, physical activity clubs, and other after school activities) YES NO (If NO to all of the above, skip to 15D) If YES to any of the above, provide the total: 1.Number of professional development events including model programs, guidance, implementation strategies, or other resource materials 2.Number of participants in professional development events including model programs, guidance, implementation strategies, or other resource materials 3.Number of schools reached directly 4.Number of districts reached directly 5.Number of regional support units reached directly (if applicable) 6.Number of external partners reached directly 6A.Please specify type D.Provide INDIVIDUALIZED TECHNICAL ASSISTANCE to district or school staff to promote physical activity (i.e. developing model programs or selecting resource materials) through any of the following: A.Increasing physical activity opportunities during school-day breaks, recess, or in the classroom YES NO B.Planning or implementing walk-to-school initiatives YES NO C.Planning or implementing organized physical activity programs beyond physical education or competitive athletics (e.g., intramural sports, physical activity clubs, and other after school activities) YES NO (If NO to all of the above, skip to 16) If YES to any of the above, provide the total: 1.Number of schools reached directly 2.Number of districts reached directly 3.Number of regional support units reached directly (if applicable) 4.Number of external partners reached directly 4A.Please specify type 16.During FY 2006, did your project in support of CSHP engage in any of the following activities to help district or school staff promote healthy eating? A.DEVELOP (or revise or assist in developing) model programs, guidance, implementation strategies, or other resource materials (not including policy materials) for district or school staff to promote healthy eating through any of the following: A.Improving nutritional quality of school meals YES NO B.Marketing healthy school meals YES NO C.Improving the nutritional quality of school food and beverages outside of school meals (e.g., vending machines and a la carte) YES NO D.Marketing healthy school food and beverage choices outside of school meals (e.g., vending machines, classroom snacks, a la carte) YES NO B.DISTRIBUTE to district or school staff model programs, guidance, implementation strategies, or other resource materials (not including policy materials) to promote healthy eating through any of the following: (Choose one for each program topic) A.Improving nutritional quality of school meals YES NO—we have model programs, guidance, implementation strategies, or other resource materials, but have not distributed them this fiscal year NO—we do not have model programs, guidance, implementation strategies, or other resource material B.Marketing healthy school meals YES NO—we have model programs, guidance, implementation strategies, or other resource materials, but have not distributed them this fiscal year NO—we do not have model programs, guidance, implementation strategies, or other resource material C.Improving the nutritional quality of school food and beverages outside of school meals (e.g., vending machines and a la carte) YES NO—we have model programs, guidance, implementation strategies, or other resource materials, but have not distributed them this fiscal year NO—we do not have model programs, guidance, implementation strategies, or other resource material D.Marketing healthy school food and beverages outside of school meals (e.g., vending machines, classroom snacks, a la carte) YES NO—we have model programs, guidance, implementation strategies, or other resource materials, but have not distributed them this fiscal year NO—we do not have model programs, guidance, implementation strategies, or other resource material (If NO to all of the above, skip to 16C) If YES to any of the above, provide the total: 1.Number of schools reached directly 2.Number of districts reached directly 3.Number of regional support units reached directly (if applicable) 4.Number of external partners reached directly 4A.Please specify type C.Provide PROFESSIONAL DEVELOPMENT to district or school staff on model programs, guidance, implementation strategies, or other resource materials (not to include policy materials) to promote healthy eating through any of the following A.Improving nutritional quality of school meals YES NO B.Marketing healthy school meals YES NO C.Improving the nutritional quality of school food and beverages outside of school meals (e.g., vending machines and a la carte) YES NO D.Marketing healthy school food and beverages outside of school meals (e.g., vending machines, classroom snacks, a la carte) YES NO (If NO to all of the above, skip to 16D) If YES to any of the above, provide the total: 1.Number of professional development events including model programs, guidance, implementation strategies, or other resource materials ______ 2.Number of participants in professional development events including model programs, guidance, implementation strategies, or other resource materials ____ 3.Number of schools reached directly 4.Number of districts reached directly 5.Number of regional support units reached directly (if applicable) 6.Number of external partners reached directly 6A.Please specify type D.Provide INDIVIDUALIZED TECHNICAL ASSISTANCE to district or school staff to promote healthy eating (e.g., developing model programs or selecting resource materials) through any of the following: A.Improving nutritional quality of school meals YES NO B.Marketing healthy school meals YES NO C.Improving the nutritional quality of school food and beverages outside of school meals (e.g., vending machines and al a carte) YES NO D.Marketing healthy school food and beverages outside of school meals (e.g., vending machines, classroom snacks, a la carte) YES NO (If NO to all of above, skip to 17) If YES to any of the above, provide the total: 1.Number of schools reached directly 2.Number of districts reached directly 3.Number of regional support units reached directly (if applicable) 4.Number of external partners reached directly 4A.Please specify type 17.During FY 2006, did your project in support of CSHP engage in the following activities to help district or school staff promote a tobacco-free lifestyle? A.DEVELOP (or revise or assist in developing) model programs, guidance, implementation strategies, or other resource materials (not to include policy materials) for district or school staff to plan and implement tobacco-use prevention programs for students. YES NO B.DISTRIBUTE to district or school staff model programs, guidance, implementation strategies, or other resource materials (not to include policy materials) to help plan and implement tobacco-use prevention programs for students. YES NO—we have model program, guidance, implementation strategies or other resource materials but we have not distributed them Skip to 17C NO—we do not have model programs, guidance, implementation strategies or other resource materials Skip to 17C If YES to any of the above, provide the total: 1.Number of schools reached directly 2.Number of districts reached directly 3.Number of regional support units reached directly (if applicable) 4.Number of external partners reached directly 4A.Please specify type C.Provide PROFESSIONAL DEVELOPMENT to district or school staff on model programs, guidance, implementation strategies, or other resource materials (not to include policy materials) to help plan and implement tobacco-use prevention programs for students. YES NO Skip to 17D If YES to any of the above, provide the total: 1.Number of professional development events including model programs, guidance, implementation strategies, or other resource materials 2.Number of participants in professional development events including model programs, guidance, implementation strategies, or other resource materials 3.Number of schools reached directly 4.Number of districts reached directly 5.Number of regional support units reached directly (if applicable) 6.Number of external partners reached directly 6A.Please specify type D.Provide INDIVIDUALIZED TECHNICAL ASSISTANCE to district or school staff (for example in developing model programs or selecting resource materials) to help plan and implement tobacco-use prevention programs for students. YES NO Skip to 18 If YES, provide the total: 1.Number of schools reached directly 2.Number of districts reached directly 3.Number of regional support units reached directly (if applicable) 4.Number of external partners reached directly 4A.Please specify type VII. EXTERNAL COLLABORATION 18.During FY 2006, did your project in support of CSHP COLLABORATE with any of the following external partners? (Choose YES or NO for each topic.) CSHP A.Agencies serving primarily African American youth YES NO B.Agencies serving primarily Hispanic youth YES NO C.Agencies serving primarily American Indian/Alaskan Native youth YES NO D.Agencies serving primarily Asian/Pacific Islander youth YES NO E.Businesses YES NO F.Community-based organizations (CBOs) YES NO G.Education organizations (e.g., advocacy, service, professional, or membership associations) YES NO H.Faith-based organizations YES NO I.Foundations (private or non-profit) YES NO J.Governor’s appointed council to improve the health of youth (this can include overall health of youth or individual health topics) YES NO K.Health organizations (e.g., advocacy, service, professional, or membership associations) YES NO L.Local education agencies YES NO M.Local health agencies YES NO N.State health coalitions or networks YES NO O.Universities and other institutions of higher education YES NO P.National non-governmental organizations,including state and local affiliates YES NO Q.Parents/parent groups YES NO R.School-aged youth YES NO S.Others YES NO S1.Please Specify PHYSICAL ACTIVITY A.Agencies serving primarily African American youth YES NO B.Agencies serving primarily Hispanic youth YES NO C.Agencies serving primarily American Indian/Alaskan Native youth YES NO D.Agencies serving primarily Asian/Pacific Islander youth YES NO E.Businesses YES NO F.Community-based organizations (CBOs) YES NO G.Education organizations (e.g., advocacy, service, professional, or membership associations) YES NO H.Faith-based organizations YES NO I.Foundations (private or non-profit) YES NO J.Governor’s appointed council to improve the health of youth (this can include overall health of youth or individual health topics) YES NO K.Health organizations (e.g., advocacy, service, professional, or membership associations) YES NO L.Local education agencies YES NO M.Local health agencies YES NO N.State health coalitions or networks YES NO O.Universities and other institutions of higher education YES NO P.National non-governmental organizations, including state and local affiliates YES NO Q.Parents/parent groups YES NO R.School-aged youth YES NO S.Others YES NO S1.Please Specify NUTRITION A.Agencies serving primarily African American youth YES NO B.Agencies serving primarily Hispanic youth YES NO C.Agencies serving primarily American Indian/Alaskan Native youth YES NO D.Agencies serving primarily Asian/Pacific Islander youth YES NO E.Businesses YES NO F.Community-based organizations (CBOs) YES NO G.Education organizations (e.g., advocacy, service, professional, or membership associations) YES NO H.Faith-based organizations YES NO I.Foundations (private or non-profit) YES NO J.Governor’s appointed council to improve the health of youth (this can include overall health of youth or individual health topics) YES NO K.Health organizations (e.g., advocacy, service, professional, or membership associations) YES NO L.Local education agencies YES NO M.Local health agencies YES NO N.State health coalitions or networks YES NO O.Universities and other institutions of higher education YES NO P.National non-governmental organizations, including state and local affiliates YES NO Q.Parents/parent groups YES NO R.School-aged youth YES NO S.Others YES NO S1.Please Specify TOBACCO USE A.Agencies serving primarily African American youth YES NO B.Agencies serving primarily Hispanic youth YES NO C.Agencies serving primarily American Indian/Alaskan Native youth YES NO D.Agencies serving primarily Asian/Pacific Islander youth YES NO E.Businesses YES NO F.Community-based organizations (CBOs) YES NO G.Education organizations (e.g., advocacy, service, professional, or membership associations) YES NO H.Faith-based organizations YES NO I.Foundations (private or non-profit) YES NO J.Governor’s appointed council to improve the health of youth (this can include overall health of youth or individual health topics) YES NO K.Health organizations (e.g., advocacy, service, professional, or membership associations) YES NO L.Local education agencies YES NO M.Local health agencies YES NO N.State health coalitions or networks YES NO O.Universities and other institutions of higher education YES NO P.National non-governmental organizations, including state and local affiliates YES NO Q.Parents/parent groups YES NO R.School-aged youth YES NO S.Others YES NO S1.Please Specify VIII. TARGETING YOUTH DISPROPORTIONATELY AFFECTED BY CHRONIC DISEASE 19.In FY 2006, did your project in support of CSHP implement PANT programmatic activities (e.g., distributing materials, providing professional development, or individualized technical assistance) specifically focused on any of the following youth disproportionately affected by chronic disease? (Choose YES or NO for each topic.) A.African American youth 1.MATERIALS DISTRIBUTION YES NO 2.PROFESSIONALDEVELOPMENT YES NO 3.INDIVIDUALIZED TECHNICAL ASSISTANCE YES NO B.Hispanic youth 1.MATERIALS DISTRIBUTION YES NO 2.PROFESSIONALDEVELOPMENT YES NO 3.INDIVIDUALIZED TECHNICAL ASSISTANCE YES NO C.American Indian/Alaskan Native youth 1.MATERIALS DISTRIBUTION YES NO 2.PROFESSIONALDEVELOPMENT YES NO 3.INDIVIDUALIZED TECHNICAL ASSISTANCE YES NO D.Asian/Pacific Islander youth 1.MATERIALS DISTRIBUTION YES NO 2.PROFESSIONALDEVELOPMENT YES NO 3.INDIVIDUALIZED TECHNICAL ASSISTANCE YES NO E. Other youth disproportionately affected by chronic disease 1.MATERIALS DISTRIBUTION YES NO 2.PROFESSIONALDEVELOPMENT YES NO 3.INDIVIDUALIZED TECHNICAL ASSISTANCE YES NO 4. Please specify name of Other youth disproportionately affected by chronic disease IX. PROJECT PLANNING 20.In FY 2006, what evaluation activities did you conduct? A.Conducted formative evaluation YES NO B.Created a logic model YES NO C.Wrote SMART objectives YES NO D.Conducted process evaluation YES NO E.Conducted outcome evaluation YES NO F.Other YES NO F1.Please specify 21.During FY 2006, did your project in support of CSHP have any funding other than DASH funding that supported state-wide activities consistent with those planned by the CSHP state-wide coalition? (May include federal, state, or private funding) (Choose one.) YES NO Skip to 22 If YES: a.What is the total dollar amount of the funding you received other than DASH funding that supported state-wide activities consistent with those planned by the CSHP state-wide coalition? (Please include federal, state, and private funding) 22.How many school districts do you have in your state? 23.How many regional support units do you use in support of CSHP project activities? (If applicable) X. OTHER INFORMATION & ACTIVITIES 24.In FY 2006, did you make PRESENTATIONS that focused on policy, curriculum, student assessment, or environmental interventions related to physical activity, physical education, nutrition, tobacco-use prevention, health education, or CSHP? YES NO Skip to 25 If yes: A.How many presentations did you make focused on policy, curriculum, student assessment, or environmental interventions related to physical activity, physical education, nutrition, tobacco-use prevention, health education, or CSHP? B.Please check all the topics on which you presented in FY 2006: 1.Physical activity YES NO 2.Physical education YES NO 3.Nutrition YES NO 4.Tobacco-use prevention YES NO 5.Health education YES NO 6.CSHP YES NO 7.Other YES NO 7A.Please specify C.Please check all audiences to whom you presented in FY 2006: 1.District-level staff or administrators YES NO 2.School-level staff or administrators YES NO 3.Staff or students at universities or other institutions of higher education YES NO 4.Community-based organization staff YES NO 5.State or local health agency staff YES NO 6.Legislators YES NO 7.Parents/parent groups YES NO 8.School-aged youth YES NO 9.Other YES NO 9A.Please specify 25.In FY 2006, did you provide PRE-SERVICE LEARNING events that focused on policy, curriculum, student assessment, or environmental interventions related to physical activity, physical education, nutrition, tobacco-use prevention, health education, or CSHP? YES NO Skip to 26 If yes: A.How many pre-service learning events did you provide focused on policy, curriculum, student assessment, or environmental interventions related to physical activity, physical education, nutrition, tobacco-use prevention, health education, or CSHP? B.Please check all the topics on which you provided pre-service learning events in FY 2006: 1.Physical activity YES NO 2.Physical education YES NO 3.Nutrition YES NO 4.Tobacco-use prevention YES NO 5.Health education YES NO 6.CSHP YES NO 7.Other YES NO 7A.Please specify 26.Is there information that we asked for in this year’s Indicators that you estimated or guessed at? YES NO Skip to 27 A.What kind of information did you estimate or guess at? 1.Distribution of print materials YES NO 2.Distribution of electronic materials YES NO 3.Professional development events YES NO 4.Individualized technical assistance YES NO 5.Funding dollar amounts YES NO 6.Presentations YES NO B.On what topics did you estimate or guess at information? 1.Policies YES NO 2.Curricula and instruction YES NO 3.Assessment of student performance YES NO 4.Health promotion and environmental approaches YES NO 5.Project planning YES NO 27.Is there information that we asked for in this year’s Indicators that you did not collect at all? YES NO Skip to 28 A.What kind of information did you not collect at all? 1.Distribution of print materials YES NO 2.Distribution of electronic materials YES NO 3.Professional development events YES NO 4.Individualized technical assistance YES NO 5.Funding dollar amounts YES NO 6.Presentations YES NO B. On what topics did you not collect information at all? 1.Policies YES NO 2.Curricula and instruction YES NO 3.Assessment of student performance YES NO 4.Health promotion and environmental approaches YES NO 5.Project planning YES NO 28.During FY 2006, did your project to support CSHP conduct any additional, noteworthy, major activities to improve physical activity, nutrition, tobacco-use prevention policies, curriculum, instruction, assessment, collaborations, or CSHP at the local level? Did these activities focus on improving the quality of PANT programs for African American, Hispanic, American Indian/Alaskan Native, Asian/Pacific Islander youth, or other youth disproportionately affected by chronic disease? Please describe in an attached narrative. 29.Please describe in an attached narrative, one specific improvement to your state project to support CSHP during FY 2006 that occurred as a result of your evaluation activities. 30.Please provide information about any additional professional development events or materials distribution activities not captured by the questions above. In particular, please report on activities in meetings or conferences not sponsored by your agency and for which you could not collect information on participants or recipients of materials. 31.Please provide any additional general comments or information in the space below.