CHL’s Ecological Model graphic shows the key elements of an ecological model which, philosophically, recognizes the dynamic inter-relatedness among personal and environmental factors in individual and social life. Its ecological approach fosters connectedness across multiple levels of the system—state, community, and individual and promotes coordination across sectors including health, education, justice and others.
At the state level, the model is driven by a population-based approach to enhancing the health and well-being of all. A population-based approach includes assessment of the needs of a population, implementation of evidence-based approaches to address those needs, and tracking results over time to see if targeted health outcomes have improved.
The model also calls for promoting health in all state policy, including health and mental health,
education, transportation and environmental policy. This means that, for every policy or program
decision made, the implications for health will be considered. By coordinating their efforts and pooling their funding sources, state agencies can strengthen their capacity to provide cross-sector training; create a statewide clearinghouse where examples, evidence-based tools and other resources can be shared; and leverage financial and other support to local communities, especially those whose population is at greater risk due to poverty and other factors.
Finally, by creating and strengthening public-private partnerships and mobilizing statewide
networks, states can maximize knowledge sharing, expand existing resources and generate costeffective
models for cross-sector and cross-site collaboration.
• Health in All Policies
• Agency Coordination & Support
• Funding Sources
• Business & Private Partnerships
• Statewide Networks
Within the community, the model seeks to develop a coordinated and well-managed system that expands and formalizes the links between education, health and other community service providers. The ultimate goal is to develop a case-managed approach that guarantees children and families easy access to a continuum of services that foster health and well-being In addition, local select boards and school boards are expected to consider the health impact of their programmatic and policy decisions.
Research shows that when children’s basic nutritional and health needs are met, they achieve at higher levels. School-based and school-linked health centers that provide access to needed physical, mental and oral health care, for example, are associated with improved attendance, behavior and achievement. That is why integrating health promotion and multi-tiered system of support are essential for ensuring both the academic success and health of children.
The Center for Disease Control’s Division of Adolescent and School Health has long promoted a coordinated school health program that includes a safe and healthy school environment, academic support; counseling, psychological and social services, health education, physical education, nutrition education and services (CDC, 2014). After-school and weekend extension activities also foster greater attachment to school and prevent risky behaviors during the many hours that children are not in class.
At the community level, the model includes all components of the traditional health care system, including public health and health care providers, including hospitals and health care organizations, community health agencies, private medical practices and patient centered medical homes. All of these organizations and individuals must coordinate their efforts if children and their families are to receive efficient and effective health care. Another critical feature of the community health care system is health education and health coaching, so that children and their families understand the importance of healthy behaviors and how to implement them. Finally, creating a safe and healthy community environment that minimizes crime and violence, provides clean air and water and provides opportunities for sports and recreation is an essential component of the model.
While often overlooked, these are also a key element in the ecological model. These include mental health services, social services, and juvenile justice and community coalitions that bring together business, government, philanthropy, investors, the faith community, community planners, community development, law enforcement, etc. As the Robert Wood Johnson Commission (2014) notes, “Meaningful, needle-moving outcomes will not be achieved without these kinds of efforts. While some effective cross-sector collaboration is beginning to occur, much more is needed.”
Finally, the model includes children and their families. Since children’s early experiences and environmental influences have a significant impact on their cognitive, mental and physical health well into adulthood, a top priority is on prevention strategies that engage families in creating safe and stable environments and promote the use evidence-based parenting practices that support mental health and reduce trauma. Families themselves need to be actively engaged in their children’s education, encouraged to get access to services and lead healthy lifestyles and supported with a host of wrap-around services.
The graphic also highlights another key feature of the model: a continuum of care that spans promotion, prevention, early intervention, intervention, treatment and recovery. Today, most health care resources are devoted to treatment and recovery services, which often come too late to make a real difference and are prohibitively expensive. To achieve a dramatic improvement in health outcomes at an affordable price requires a greater emphasis on mental health wellness and the implementation of “upstream approaches” that offset critical health problems before they develop.
Recognizing that payment reform is central to health care reform, CHL expects that implementing this ecological model will also provide an opportunity for trying out innovative funding approaches that support key elements of the model.
What CHL can do: Our national contributions to the field of school health, ideally position CHL to facilitate these connections among a broad scope of service providers. CHL’s overriding goal is to develop the model and facilitate its implementation, evaluation, dissemination and replication, remaining fully aware and adhering to the politics of process.
In order to achieve this goal, CHL will:
- work with state policymakers to conduct statewide needs assessments to inform state policy
- facilitate statewide networking and help create local coalitions bridging schools, communities and families to facilitate health outcomes and promote the role that good health plays in academic success
- develop tools and resources to support the comprehensive model
- provide training and technical assistance to build state and local workforce capacity
- develop public information campaigns that support key health care messages that are evidence-based and engage families, schools and communities
- design and conduct an in-depth demonstration project in one or two communities as an example of collaborative and coordinated care that focuses on enhancing health and learning
- develop tools and programs for parents so they not only feel engaged, educated and supported, but also have the knowledge and skills needed to prevent health and learning problems and promote resiliency
- explore and recommend innovative funding models that support implementation of evidence-based strategies for prevention and incentivize families and partners to participate in them
- identify and evaluate expected outcomes
- engage in ongoing monitoring and evaluation, including tracking and disseminating agreed upon population-based and community measures and evaluating services on their ability to meet the needs of all clients regardless of race, creed, religion, sexual identity and physical and mental status.