My Time for Health!

“My Time for Health!”

A Community Health Promotion Program for Improving Nutrition, Exercise, and Reducing Stress in Elementary School Educators in the Saint Paul School District

Allison Erickson

December 17, 2013

MPH 585 Programming and Evaluation in Public Health Dr. Madeline Angela Meyer Introduction

Education in America has continued to be used as a platform for political agendas, unionization, and standardization. Today, political leaders across the nation and throughout small communities continue to seek academic success for every student in the American school system. This academic success is continuing to be measured through assessment based results.

According to the Minnesota Department of Education (MDE) (n.d.), “The Minnesota K-12

Academic Standards define expectations for the educational achievement of public school students across the state in grades K-12.” These standards are used to identify knowledge and skills students must be achieving per grade level and help define course credit requirements for graduation. Additionally, educational standards are used for adopting new or using existing curriculum for school districts to use in the classroom. As aforementioned, a student’s mastering of the standards set by the MDE is done primarily through testing and assessments.

The increased need for testing and assessments for outcome based results in the education community has been a topic of debate and frustration for educators across the country. Teachers now need to teach not just for knowledge and understanding, but for a score that will represent the academic achievement of a student and a school. In a research study conducted by Herman and Golan (1991), teachers are continuing to feel an increased pressure from administration, media personnel, and political leaders to improve student test scores.

Continuing, teachers who teach in schools with consistently high assessment scores feel more pressure to maintain those high scores than teachers who teach in schools with consistently low assessment scores (Herman & Golan, 1991). Other concerns that come from the increased need for teaching to standards for assessment purposes are the amount of time that educators have during the day. Herman and Golan (1991) report,

Even though teachers report substantial pressure to improve test scores, spend substantial classroom time on test preparation activities, and give more than a moderate amount of their attention to drilling students in basis skills; they still report giving at least moderate classroom attention to non-tested subjects, such as fine arts, science, and higher order thinking skills. (p. 31).

With the amount of time educators dedicate to teaching the standardized requirements, as well as extra non-tested subjects, there is little time to engage in healthy behaviors before, during, and after school hours. In addition, the pressure that teachers experience on a daily basis leads to an immense amount of stress affecting the teacher’s health and student learning outcomes.

Needs Assessment

Identifying the Population and the Problem

The population of interest for the development, implementation, and evaluation of the public health program is elementary educators in the Saint Paul School District (SPSD).

Currently, this school district is employing 5,376 full-time K-12 staff members, serving over

39,000 students (SPSD, 2012). In the SPSD there are 43 elementary schools with approximately

2500 elementary educators. Health problems that affect this particular population include stress, lack of physical activity, and reduced opportunity for healthy eating behaviors during the working hours. For example, although teachers have a scheduled lunch period to eat, many use that time for extra lesson planning, catching up on emails, and other distractions. This leads to reduced time to eat the food, as well as little time to make meals that need extra preparation.

Another problem that many educators face is stress, as aforementioned. The pressure to have exceeding and achieving student performance creates increased stress level for the educator. According to The American Institute of Stress (n.d.) stress affects almost all systems in the body including the nervous, musculoskeletal, respiratory, cardiovascular, endocrine, and gastrointestinal systems. Additionally, stress is known to be a risk factor for many chronic and acute diseases like heart disease, hypertension, and obesity.

Resources Available and Supporting Data

The high risk of disease, both chronic and acute, that is the result of high stress levels, lack of physical activity, and healthy eating behaviors in elementary educators is a problem that must be addressed. One such resources that will be utilized to promote and implement the program is partnering with the SPSD Wellness Program offered through Health Partners, titled

Choose Well, Live Well. This program (2011) aims to invest in the well-being and health of the employees and retirees of the SPSD. The vision for the program states, “The SPPS Choose Well,

Live Well Wellness program promotes a healthful and positive work environment and fosters a culture that supports healthful decisions through programs, courses, presentations and resources” (Employee Wellness Program, 2011). Therefore, because this program is already in existence, the program being developed will partner and use Choose Well, Live Well as a resource for developing, promoting, implementing, and evaluating the program. Another resource that will be utilized is the Minnesota Department of Health and the School Health department to utilize information and techniques this department uses for implementing healthy living in schools. Although most of the techniques are for student health improvement, this department will already have established resources and techniques that can be translated to educator health. Finally, the program development will utilize the success of the ACTION!

Worksite Wellness Program. This program was specifically developed for elementary school worksite health. In fact, according to Webber et al. (2012), elementary educators make up 14.5 percent of labor in the United States. Therefore, impacting the health of this population using

ACTION! Worksite Wellness Program as a resource, will not only impact stakeholder involvement and support, but will allow for the program developer to use a program that has been shown successful.

After evaluating the ACTION! Worksite Wellness Program, Webber et al. (2012) conclude that educators are rarely the focus for school health promotion programs. Webber et al. (2012) indicates,

Adult school personnel represent an important target for wellness interventions. They constitute a very large portion of the work population and are often called upon to promote health for the children and adolescents they teach. If they are to be successful in this role, their health and wellness must be considered. (p. 415).

Also, Webber et al. (2012) states that the health and wellness of elementary educators is critical to the achievement of students. “The findings of this study suggest that school personnel have very low levels of physical activity and exhibit adverse cardiovascular risk factors at all ages” (Webber et al., 2012, p. 415). Continuing, Eaton, Marx, and Bowie (2007) indicate that school employees are susceptible to many of the same health concerns as employees in other worksites. However, one area that other worksites may not experience on the same level is stress. Eaton et al. (2007) share, “Studies of employee wellness programs in private business and industry have shown positive outcomes on employee health and wellbeing, and it is likely that the findings from these studies are generalizable to schools” (p. 558).

Finally, there is evidence to support that staff health promotion is one of eight component of school health programming. These efforts for staff health promotion improve the quality of life, productivity, and health of school employees, thus impacting the overall health of the school environment and students (Eaton et al., 2007).

Program Strategic Plan

Mission, Vision, and Values

Mission

The purpose of the My Time for Health program is to create and engage elementary educators in becoming healthier individuals physically, mentally, and emotionally through physical activity, healthy eating, and stress reduction tools, techniques, and skills. This will be accomplished through providing adequate environments and resources to learn, implement, and practice healthy living both in and out of the school setting.

Vision

The Saint Paul School District will be known for valuing the health of its educators through the promotion of healthy living physically, mentally, and emotionally in school environments conducive to reducing chronic disease, increasing job satisfaction, and resulting in positive assessment and test scores from students.

Values

The My Time for Health program designed for Elementary Educators in the Saint Paul

School District believes in…

Identify values, beliefs and guiding principles that either do or should Identify behaviors that should be in practice every day guide interactions with internal and to support the values, beliefs and guiding principles. external stakeholders . - Every educator will have a set amount of time Creating healthy work environments dedicated to eating lunch, free from work responsibilities. - Teachers will have access to yoga classes, boot that promote physical, emotional, camps, and other physical activity offered after and mental health. school. - The school will recommend and/or highly advise teachers to take two, five minute breaks during the workday. - Administration will praise and honor teachers Valuing every educator’s time and on a weekly basis for the work and dedication energy put into each student’s given on a daily basis. success.

- Teachers have the opportunity to teach Maintaining positive job satisfaction curriculum in the ways that best suit their that reflects in teacher mentality and student’s achievement and utilize skills that engagement in the classroom often times go unnoticed.

- Teachers will have limited opportunity to go to Promoting and encouraging a healthy the school building on weekends and over work-life balance. holiday breaks to reduce job stress and improve rest and relaxation. Adapted from the National Association of County & City Health Officials (2010)

SWOT Analysis

Strengths, Weaknesses, Opportunities and Threats (SWOT Analysis) What are the strengths will contribute to planning and What weaknesses exist for your planning and program program success? success?

- Current use of Choose Well, Live Well health - Time. Due to the limited amount of time programming developed though Health teachers have currently, a weakness will be to Partners Insurance. add more to the schedule in regards to the - Administration support for improving health promotion program. and wellness of educators - There are 43 elementary schools in the SPSD; - Desire for students to succeed through therefore, reaching all 43 schools evenly will improved test scores. result in a challenge. - Teachers readiness to make changes with - Accessing health promotion personnel to their personal health through improved distribute the program to 43 elementary physical activity, healthy eating, and stress schools poses a weakness due to funding reduction. concerns and available bodies.

What are the opportunities your planning and What are the threats to your planning and program program will create? success? - Educator autonomy in creating schedules - Competition with Choose Well, Live Well that aid in reduction of stress, while still program where teachers may only see the educating their group of students in ways that need for one program. best support their needs. - Educators and administration that may feel - More funding to be used for other school the program is intrusive and not helpful. programming from the reduction of time lost - Online availability for dedicated health plans due to teacher absence. that are easier and more convenient to use - An increase in positive test scores that reflect than participating in a health promotion a positive reputation on the SPSD simply program. based off educator health improvement. - Money saved for health care services due to less chronic and acute disease.

Adapted from the National Association of County & City Health Officials (2010)

Program Objectives and Priorities

Because the program development is following the MAP-IT model, formally used to address objectives for Healthy People 2020 (2013), some of the objectives developed will be used in conjunction to objectives formally established by Healthy People 2020 (2013).

Process Objectives

 By the end of the school year, program planners will have conducted educational

sessions with elementary educators from 20 of the 43 elementary schools in the SPSD to

inform about the development of the It’s My Time for Health program.

 By the beginning of next school year, It’s My Time for Health will be communicated to all

43 elementary schools in the SPSD through educational sessions, email communications,

and in-service presentations.  During the initial stages of program implementation within 10 schools, program

developers will receive a positive rating for program implementation from selected

educators participating in the program.

 At the end of the school year, the program will have liaison personnel dedicated to

three schools in the district to filter questions, offer support, and communicate barriers

for better program results.

Behavioral Objectives

 Within six weeks of program implementation, 30% of teachers will have increased

physical activity from less than 60 minutes per week to 150 minutes per week of

moderate anaerobic exercise.

 Within one year of program implementation, 50% of program participants will be

getting 150 minutes of moderate exercise per week.

 After one year of program implementation, 40% of participants will be engaging in at

least 2 days of strength training activities.

 Within six months of program implementation, 30% of program participants will be

taking a full 30 minute lunch break free from emails and work-related activities to enjoy

a healthy meal.

 By holiday break in December, 40% of educators will be practicing deep breathing

exercises at least one time per day to reduce stress levels.  Within one year of program implementation, 60% of educators will practice deep

breathing at least two times per day.

 Within six months of program implementation, 30% of participants will have increased

water consumption to four, eight ounce glasses during the workday.

Learning Objectives

 During mid-point program evaluation, one of four educators will be able to report

having an increased understanding of the importance of taking five minute breaks

throughout the day for stress reduction.

 Six months into program implementation, 40% of program participants will have the

knowledge and understanding of what a healthy, balanced lunch meal consists of.

 Before the beginning of the next school year, 50% of elementary educators will feel

confident in knowing how to implement physical activity into a busy work and week

schedule.

Environmental Objectives

 By the beginning of the next school year, 25 of the 43 elementary schools in the SPSD

will have improved lunch and break rooms that offer healthy snacks and stress relief

areas.  Six months into program implementation, 15 of the 43 elementary schools will have

dedicated space for before and after school physical activity and healthy eating classes

such as yoga, boot camp, and “how-to” classes for healthy eating.

Outcome Objectives

 By program completion, the SPSD will see a 10% reduction in elementary educator sick-

 Three years after program implementation, the SPSD will begin to see a 5%

improvement in elementary student assessment scores.

 After program completion, elementary educators will have a 20% reduction in obesity

rates resulting in less clinic visits, sick-days, and improved employee satisfaction.

Logic Model Development

The purpose of a logic model is to link program inputs with program outputs to obtain short term, intermediate, and long term outcomes (Centers for Disease Control and Prevention

(CDC), 2013). In essence, this model is created to show stakeholders and other decision makers the importance of developing, implementing, funding, and promoting the program. For It’s My

Time for Health program development, this logic model chart recognizes the inputs that will aid in the program’s development, but also addresses gaps that exist that my create barriers to program success. Below is the chart that was developed. This program’s logic model was has taken into account aspects of the strategic plan, such as resources, SWOT analysis, and development of objectives. In essence, the objectives aforementioned relate to the initial, intermediate, and long term outcomes that the model suggests. The problem that this logic model aims to address is the health disparities that elementary educators face due to stress and limited time for self-care. Inputs, added with activities and outputs also helps create the outcomes. For example, if one staff member from each school takes on being a school spokesperson, and if that person helps coordinate onsite wellness classes, then there will be an improvement in educator BMI over the course of one to three years. Essentially, this logic model lays out the program plan in a way that a road map helps someone travel to a new destination. Of course, throughout development and implementation, the use of effective evaluation will allow the team of developers to make changes to aim for the outcomes discussed.

Outputs Outcomes – Impact Inputs Activities Participation Short . Choose Well, Live Well . Dedicated wellness . Engage 10 schools . A fourth of the health promotion professional to a in the program elementary schools program provided by group of 5 schools in implementation by in the district will the educator’s health the district for the first 3 months have a dedicated insurance implementation & . Have a least one wellness . Minnesota Department evaluation school professional of Health School Health . Coordinate goals and representative Division objectives with the from each . Increase in educator . ACTION! Worksite existing Choose Well, elementary school awareness about the Wellness Program Live Well program to aid in health concerns that initiative . Onsite physical implementing the exist across the . Educators in the SPSD activity classes program; program school district that are seeking provided at a set spokesperson improved physical, number of schools . One district level . Every district mental, and emotional throughout the administrator elementary school health within their district participating in will have school . Ongoing evaluation of communicating information about . Physical education and teacher and program to school the program emailed health educators within administration administration and and displayed in the SPSD to assist in satisfaction with educators teacher workrooms implementing the program for . Form a committee and teach lounges program in every stakeholder support represented by . Recognition from school . Once a week, onsite educators, upper district . CDC’s Healthier mental health and school-level administration about Worksite Initiative practitioner to administration, the short term and . SPSD Wellness Policy provide 15 minute program long term health Steering Committee sessions with developers, effects on teachers (2007) educators individually representative . Integrative Surveillance or with others from the SPSD . Increased System to track data . Development and Wellness Policy engagement in from measurement distribution of Committee, and sitting down with tools and evaluation pamphlets, reading one or two mental health . Funding from the SPSD material, and “how- members of the professionals to for program to” brochures for School Health discuss stress implementation (GAP) implementing physical Division from the management . Workload and mental health MDH. requirements; into daily routine standardization and assessment (GAP)

Adapted from The University of Wisconsin-Extension (2012)

Assumptions: External Factors: We assume that school administration will support the funding for These factors will include physical space designated for program the program given the return anticipated (i.e. less sick days, developers and workshops, exercise classes, and counseling. In improved assessment scores, improved teacher job satisfaction). addition, the environment that the educators are in outside of the Additionally, we assume that educators will appreciate and take school (i.e. home, gym, additional activities for children, etc.) that can action with the program to improve physical, emotional, and mental impact the success of program implementation. health. Adapted from The University of Wisconsin-Extension (2012) Specific Objectives and Measureable Outcome Indicators

Short Impact Outcomes

GOAL 1: Increase the number of schools, administration, and educators that are ready for implementation of My Time for Health. . Not-so-SMART objective 1: A fourth of the elementary schools in the district will have a dedicated wellness professional

Key Component Objective Specific – What is the specific task? Implement My Time for Health into dedicated schools within the district to begin the program. Measurable – What are the standards or 25% of schools in the district will be part of the initial implementation parameters? of the program. Achievable – Is the task feasible? Yes – we are starting small and will make necessary changes or keep aspects that are working well for other schools in the district. Realistic – Are sufficient resources available? Yes – the school district has approved a grant for implementing the program in 25% of the elementary schools to start. Additional funding will depend on preliminary evaluation after implementing in these schools. Time-Bound – What are the start and end The implementation will begin at the start of the school year 2014 with dates? an “end date” being represented by evaluation after four months. However, we hope to continue program implementation after preliminary evaluation, therefore, there will be no hard end date for this objective.

SMART objective 1: By the beginning of the 2014 school year, 25% of elementary schools in the SPSD will have begun implementing My Time for Health and preliminary evaluation will occur four months after implementation.

. Not-so-SMART objective 2: Increase in educator awareness about the health concerns that exist across the school district

Key Component Objective Specific – What is the specific task? Provide education and awareness to educators and administration regarding the health concerns that are presented. Measurable – What are the standards or 75% of the elementary educators in the SPSD will have increased parameters? awareness Achievable – Is the task feasible? Yes – Increased awareness can come from multiple sources such as email updates, flyers and other materials throughout the school, and face to face announcements in teacher meetings. Realistic – Are sufficient resources available? Yes – These materials are inexpensive to produce and there is no cost to spreading the awareness at a meeting from an organizer’s verbal communication. Time-Bound – What are the start and end Start date will begin at start of 2014 school year and end date for this dates? objective will be by December of 2014.

SMART objective 2: At the beginning of the 2014 school year, 75% of the educators and administration in the SPSD working in an elementary school will have an increased awareness of the health concerns existing across the district by December 2014. . Not-so-SMART objective 3: Every district elementary school will have information about the program emailed and displayed in teacher workrooms and teacher lounges

Key Component Objective Specific – What is the specific task? Produce materials for program promotion and set up in all teacher workrooms and teacher lounges Measurable – What are the standards or All 43 elementary schools in the district will have promotional materials parameters? in their school Achievable – Is the task feasible? Yes – producing the same information through mass production will be feasible and packets will be sent to the dedicated wellness professional (dedicated to 5 schools) to distribute and set up. Realistic – Are sufficient resources available? Yes – mass production of materials (all the same) will be cheaper and provide for consistency throughout the schools. Time-Bound – What are the start and end September 2014 – May 2015 dates?

SMART objective 3: By September 2014 through May 2015, all 43 elementary schools in the district will have information about the program emailed and displayed in teacher workrooms and lounges to promote the program and share important information.

. Not-so-SMART objective 4: Recognition from district administration about the short term and long term health effects on teachers

Key Component Objective Specific – What is the specific task? Develop communication and presentation for presenting the program’s need to school and district administration. Measurable – What are the standards or 70% of all school district administration (both school and district) parameters? verbally acknowledging the problem Achievable – Is the task feasible? Maybe – This will require a program developer to present the problem at an administration meeting and provide rationale for the program’s need. With multiple responsibilities on the agenda of administration, this may seem unneeded at the time. Realistic – Are sufficient resources available? Yes – this objective requires the time and energy of the program staff without needing a lot of resources and funding from upper stakeholders. Time-Bound – What are the start and end July 2014 through December 2014 dates?

SMART objective 4: Starting July 2014 through December 2014, the team of developers will present information to 70% of district and school administration to increase recognition of the short and long-term health concerns of educators.

GOAL 2: Increase recognition and taking action in utilizing mental health practitioners for stress management.

Not-so-SMART objective 5: Increased engagement in sitting down with mental health professionals to discuss stress management Key Component Objective Specific – What is the specific task? Connect with mental health professionals across the Twin Cities to provide access to mental health services within the school environments. Measurable – What are the standards or 15 out of the 43 elementary schools will have onsite mental health parameters? services 2 days per week after school hours and out of those 15 schools, teacher engagement for utilizing the services will be 20%. Achievable – Is the task feasible? Yes – when partnering with the Choose Well, Live Well (2011) to access contracted mental health practitioners for in-school work. Realistic – Are sufficient resources available? Yes – by utilizing resources from the Choose Well, Live Well (2011) program, the resources have already been allocated for mental health services. This objective will use the existing resources allocated for Choose Well, Live Well, but will now be putting those resources into the school setting. Time-Bound – What are the start and end Starting: March 2015 Ending: June 2015 (will continue to be dates? implemented depending on evaluation in June)

SMART objective 5: Beginning March 2015, 15 of the 43 elementary schools in the district will have a 20% engagement in utilizing onsite mental health practitioners and will end with evaluation of this objective in June 2015.

Medium Impact Outcomes

GOAL 3: Changes in school policy that enforces and recognizes the importance of self-care and appropriate work/life balance.

Not-so-SMART objective 6: Increased engagement in sitting down with mental health professionals to discuss stress management Key Component Objective Specific – What is the specific task? Connect with mental health professionals across the Twin Cities to provide access to mental health services within the school environments. Measurable – What are the standards or 15 out of the 43 elementary schools will have onsite mental health parameters? services 2 days per week after school hours and out of those 15 schools, teacher engagement for utilizing the services will be 20%. Achievable – Is the task feasible? Yes – when partnering with the Choose Well, Live Well (2011) to access contracted mental health practitioners for in-school work. Realistic – Are sufficient resources available? Yes – by utilizing resources from the Choose Well, Live Well (2011) program, the resources have already been allocated for mental health services. This objective will use the existing resources allocated for Choose Well, Live Well, but will now be putting those resources into the school setting. Time-Bound – What are the start and end Starting: March 2015 Ending: June 2015 (will continue to be dates? implemented depending on evaluation in June)

SMART objective 6: Beginning March 2015, 15 of the 43 elementary schools in the district will have a 20% engagement in utilizing onsite mental health practitioners and will end with evaluation of this objective in June 2015.

GOAL 4: Increase in access, understanding, and self-implementation activities of program promotional materials and actions for increasing healthy eating, physical activity, and reducing stress.

. Not-so-SMART objective 7: Educators across the district will have access to the program materials, classes, etc.

Key Component Objective Specific – What is the specific task? Make all materials (i.e. flyers, “how-to,” posters) available and have all in-school health classes implemented. Measurable – What are the standards or 100% of the elementary schools in the district for print material parameters? 60% of the schools for classes/in person trainings Achievable – Is the task feasible? Yes/No – this is a lofty task that will be difficult to achieve due to lack of resources in regards to classes, but will be achievable will print materials Realistic – Are sufficient resources available? Yes/No – this objective will become expensive in regards to classes in all 43 schools, but resources have already been allocated appropriately for print materials in all elementary schools. Time-Bound – What are the start and end September 2015 through Program End Date dates?

SMART objective 7: By September 2015, 100% of the elementary schools in the SPSD will have program print materials (booklets, flyers, posters, and how-to books) accessible and 60% of the schools will have onsite health classes available.

. Not-so-SMART objective 8: Educators will be able to implement tools and resources for managing stress without the ongoing support of wellness staff

Key Component Objective Specific – What is the specific task? Onsite wellness staff will lessen the number of days and times available for ongoing support. Educators will be implementing stress management skills without ongoing support. Measurable – What are the standards or 70% of elementary educators will report having a higher ability to parameters? manage stress through learned skills Achievable – Is the task feasible? Yes – utilizing the expertise of mental health practitioners and physical activity classes, the educators will be able to manage stress more effectively through the learned skills. Realistic – Are sufficient resources available? Yes – this will not cost any additional resources than what has already been allocated for mental health support and class availability. Time-Bound – What are the start and end Begin January 2016 – End December 2016 dates?

SMART objective 8: Beginning in January 2016, 70% of elementary educators will report having higher confidence and ability in managing ongoing stress through skills learned by December 2016. . Not-so-SMART objective 9: Teacher satisfaction will improve compared to initial measurements before program implementation

Key Component Objective Specific – What is the specific task? Improve teacher satisfaction Measurable – What are the standards or Teachers will report an increase of job satisfaction by 30% from parameters? baseline measurement Achievable – Is the task feasible? Yes – using preliminary measurement prior to implementation, this will be feasible to measure after program implementation is complete. Realistic – Are sufficient resources available? Yes – the resources needed for achieving this objective will be similar to the resources needed when obtaining baseline measurement. The data collection will require time, but very little monetary resources Time-Bound – What are the start and end May 2017 (end date as this will be an ongoing objective) dates?

SMART objective 9: By May 2017, educators will report a 30% increase in job satisfaction than when measured at the beginning of the program implementation.

. Not-so-SMART objective 10: Improvement in educator BMI

Key Component Objective Specific – What is the specific task? Decrease initial BMI biometric numbers taken initially before program implementation through physical activity, healthy eating, and stress reduction. Measurable – What are the standards or 50% of educators will see a decrease in BMI by 5-8 numbers. (Example: parameters? If preliminary BMI was 39.2, we would seek a decrease to 33.2, which would meet the objective) Achievable – Is the task feasible? Yes – through the designated program activities, educators that actively participate and make changes will result in desired outcome. Realistic – Are sufficient resources available? Yes – resources have already been allocated to support this objective through program activities Time-Bound – What are the start and end Beginning September 2014 through September 2016. dates?

SMART objective 10: By September 2016, 50% of actively participating educators in the program will report a decrease in BMI by 5-8 points.

Long Impact Outcomes

GOAL 5: Improve student assessment scores and decrease lost productivity throughout the school district, while increasing resources and personnel dedicated to schools in the district.

. Not-so-SMART objective 11: The SPSD will have dedicated worksite wellness staff supporting elementary, middle, and high schools

Key Component Objective Specific – What is the specific task? Assign permanent staffing for wellness initiatives in schools across the district. Measurable – What are the standards or 30% of schools across the district parameters? Achievable – Is the task feasible? Yes – with success from implementing the program in elementary schools, this will give support and evidence for dedicating wellness staff for educator health and wellness Realistic – Are sufficient resources available? Maybe – depending on budgets in the next few years, as well as needs of more staff, the school district administration may delay this implementation. Time-Bound – What are the start and end September 2018 dates?

SMART objective 11: By September 2018, 30% of all schools in the SPSD will have a dedicated wellness professional for implementing and promoting wellness initiatives.

. Not-so-SMART objective 12: The SPSD will see a decrease in the number of sick days taken by educators

Key Component Objective Specific – What is the specific task? Decrease sick days taken Measurable – What are the standards or 20% decrease in sick days over the course of the program parameters? implementation (5 years) Achievable – Is the task feasible? Yes – with an increase in physical activity and healthy eating, as well as stress management skills, there will be evidence that less teachers are out sick Realistic – Are sufficient resources available? Yes – this will improve resources available for wellness programming due to a decrease in lost productivity. (“A study conducted in the Washoe County School District in Nevada found a cost savings of $15.60 for every dollar spent on a school employee wellness program as a result of reduced staff absenteeism” (Eaton et al., 2007, p. 558)). Time-Bound – What are the start and end September 2014 through May 2018. dates?

SMART objective 12: Beginning September 2014 through May 2018, the SPSD will see a 20% decrease in number of sick days taken by elementary educators.

. Not-so-SMART objective 13: SPSD elementary assessment scores will increase when comparing to 2012 assessment scores

Key Component Objective Specific – What is the specific task? Increase in applicable assessment scores from students in elementary schools Measurable – What are the standards or Assessment scores will increase by 30% from initial measurements prior parameters? to program implementation Achievable – Is the task feasible? Yes – teacher wellness will result in more positive classroom experiences and improved learning by students Realistic – Are sufficient resources available? Yes – this objective will increase resources available for the district rather than use resources Time-Bound – What are the start and end September 2014 through May 2018 dates?

SMART objective 13: Starting September 2014 through May 2018, the SPSD will see a 30% increase in assessment scores from elementary students when comparing to initial assessment scores prior to program implementation.

. Not-so-SMART objective 14: Wellness programming will be implemented for administration, school-level and district-level

Key Component Objective Specific – What is the specific task? Implementation of the program in all schools and district-wide administration. In other words, all employees of the SPSD will have access to this program. Measurable – What are the standards or 80% of all SPSD staff and administration will have access to this parameters? program Achievable – Is the task feasible? Yes – as the program specifically for elementary educators proves effective, stakeholders (administration) will see the importance of implementing this district-wide. Realistic – Are sufficient resources available? Maybe – this will depend on funding and grant opportunity for implementation across a larger platform, which increases demand, yet creates difficulty in funding. Time-Bound – What are the start and end September 2017 dates?

SMART objective 14: Beginning September 2017, program implementation will begin across the school district for 80% of school and district employees including educators, administration and other staff.

Refined Program Implementation Plan

With the development of SMART objectives aforementioned, this will lead to redefining the short, medium, and long-term outcomes from the Logic Model above. Please see below for the refinement of the Logic Model.

 By the beginning of  Beginning March 2015,  By September 2018, the 2014 school year, 15 of the 43 elementary 30% of all schools in the 25% of elementary schools in the district SPSD will have a schools in the SPSD will have a 20% dedicated wellness will have begun engagement in utilizing professional for implementing My onsite mental health implementing and Time for Health and practitioners and will promoting wellness preliminary end with evaluation of initiatives. evaluation will occur this objective in June  Beginning September four months after 2015. 2014 through May 2018, implementation.  By September 2015, the SPSD will see a 20%  At the beginning of 100% of the elementary decrease in number of the 2014 school year, schools in the SPSD will sick days taken by 75% of the educators have program print elementary educators. and administration in materials (booklets,  Starting September the SPSD working in flyers, posters, and 2014 through May 2018, an elementary school how-to books) the SPSD will see a 30% will have an accessible and 60% of increase in assessment increased awareness the schools will have scores from elementary of the health onsite health classes students when concerns existing available. comparing to initial across the district by  Beginning in January assessment scores prior December 2014. 2016, 70% of to program  By September 2014 elementary educators implementation. through May 2015, will report having higher  Beginning September all 43 elementary confidence and ability in 2017, program schools in the district managing ongoing implementation will will have information stress through skills begin across the school about the program learned by December district for 80% of emailed and 2016. school and district displayed in teacher  By May 2017, educators employees including workrooms and will report a 30% educators, lounges to promote increase in job administration and the program and satisfaction than when other staff. share important measured at the information. beginning of the  Starting July 2014 program through December implementation. 2014, the team of  By September 2016, developers will 50% of actively present information participating educators to 70% of district and in the program will school report a decrease in BMI administration to by 5-8 points. increase recognition of the short and long-term health concerns of educators.  Beginning March 2015, 15 of the 43 elementary schools in the district will have a 20% engagement in utilizing onsite mental health practitioners and will end with evaluation of this objective in June 2015. Program Pro Forma

Budgetary Needs When preparing the budget for My Time for Health, the program developers sought sponsorship and grant funding from multiple sources. Sources included local YMCA clubs that would support and sponsor onsite wellness programming and healthy eating seminars for the elementary educators, Health Partners Choose Well, Live Well program that also assisted in supplying wellness print material previously developed for the SPSD, and a grant from the

Minnesota Department of Health to help support healthy educators. The program developers found it important to rely little on the school district itself due to already limited funding for other programming in the schools, primarily for the children. As noted in the budget plan, the participating educators will only pay $10 per year for participation. Due to the high number of educators, the developer estimates that about 1500 of the estimated 2500 elementary educators will participate. Nonetheless, this participation fee will serve as an important aspect of the program’s total funding. Important to note, the $5000 in gifts has come from individual and other corporate donors who were sought out for additional support. These included local health businesses and gyms, as well as individual health consultants. With the support of those donors, the program developers agreed to print the name of the business or individual on promotional and educational material as an advertisement.

In regards to personnel, this program has been determined to not be a source of yearly income for program developers. Instead, the 25 individuals assisting in the development, implementation, and evaluation, will be paid approximately $3192 for a commitment of three to five years. Although this may not seem like a lot of money, the program will rely on the work and volunteerism of college level students from the multiple universities and colleges in the

Twin Cities area. With this assistance, personal trainers, nurses, dieticians, and psychology students from the local schools will be able to receive training or practicum hours for assisting with the in-school programs. Consultants will include certified personal trainers, psychologists, and nutritionists for special programming throughout the course of the year. Incentives that will be provided over the course of the program will include supplies and give-away items like water bottles, yoga mats, and cookbooks. Finally, the program development team has purposely and consciously left over $5000 that has not been designated for any particular purpose as a form of safety. Budgeting often times needs flexibility and opportunity for fluctuation through the course of the whole program. Also, the program development team will also rely on continued donation and support as the years move forward that may impact the overall budget of the program.

Program Implementation Plan

Marketing Strategies

Implementing My Time for Health in the arena of elementary educators requires becoming acutely aware of the needs, wants, attitudes, and beliefs of that particular population. Utilizing qualitative and quantitative data gathered during preliminary stages of program development, the development team will determine the appropriate marketing strategies for different sub-populations within the larger elementary educator population.

Because this is a population that is not a county, city, or state, the marketing strategies will be contained primarily within the schools themselves. The first set of marketing tools will be with school administration. These individuals will also be part of the stakeholder community; therefore, the marketing strategy will be significant to the program’s success. Instead of using electronic media or flyers with information about the program, the program’s development team will personally meet with school administration to market the program. Using past research and literature on educator health will be a foundation for marketing. Also, with the assistance of educators in the district who are seeking better health, their testimonies will also be used for marketing to school administration. The development team recognizes the impact of personal story in marketing and will use that to advance the program to implementation.

Next, when the program is in its initial stages of implementation, the development team will use similar tactics as with school administration in personally attending the staff meetings of the five chosen schools to pre-test the program. Using personal story and data to reflect the importance of educator health will be the main messages. Additionally, the team will aim to share outcomes that reflect personal values, one such being personal freedom and autonomy. Instead of just stating the benefits of being healthy as educators, marketing to the educators that they deserve a right to be healthy, just like their students. This message will be shared with the hope that the educators will see the need physically, mentally, and emotionally for the My Time for Health program. Additionally, the program aims to have most of the activities right at the school location. This marketing technique will aim at being convenient for the educator. Such activities that will be marketed will include yoga classes, boot camps, packing a healthy lunch class, mindfulness training, and sitting down one-on-one with a mental health professional. Instead of having to drive somewhere or add one more thing to the teacher’s list, these activities will be such that the educator can attend easily.

As the program implementation continues through the pretesting stages, the development team will be continually emailing healthy tips and techniques to the educators as promotional materials for the program. Additionally, developers will be attending staff meetings on a monthly basis to answer questions, promote new classes, and share success stories. In the educator lunch rooms and work rooms, there will be “table tents” and flyers promoting new classes and times for the classes. These marketing techniques will be ongoing throughout the life of the program to continue support and reminder that the program is occurring. An important aspect of the marketing of the program will be evaluation of the marketing tools. Periodically throughout the program, the development team will survey select educators about the program marketing techniques and tools. This information will aid in continuing with current techniques or provide feedback in how the educators would like to be communicated to regarding the program’s marketing techniques. Finally, using success stories throughout the program will be a marketing technique. Bi-monthly, one to three educators who have been participating in the program will be asked to share their experience and what benefits they have gained and successes they have had. Using successes from the target population throughout the program will show the continued need for the program to stakeholders and engage and encourage other educators to join and participate.

Tasks and Timelines for Program Implementation

Year 1 of Program Implementation

Adopted from McKenzie, Neiger, &(2013 )

Adopted from McKenzie et al. (2013)

The models shown above represent three years of program implementation. As indicated, it is important for program evaluation and communication with stakeholders to occur on a yearly basis to ensure continued support, financially and administratively. Every year, there are similar tasks, which have been set up to reach the goals and objectives indicated in the logic model aforementioned. Seeking the feedback from the development team, volunteers, and the educators throughout the program will also aid in ensuring My Time for

Health is reaching its full potential effectively and efficiently. These models may change overtime and as the program is implemented, but the usefulness of the models will assist the development team in staying on task and using resources wisely.

Program Evaluation Plan

Justification aims at receiving approval from stakeholders. Using data from literature obtained during the needs assessment, along with personal testimony from educators, justification will be accomplished. For example, Webber et al. (2012) share, "Adult school personnel represent an important target for wellness interventions. They constitute a very large portion of the work population and are often called upon to promote health for the children and adolescents they teach. If Justification they are to be successful in this role, their health and wellness must be considered" (p. 415). This information, when shared with school administration and financial donors and sponsors, gives justification to the need for educator health and wellness opportunities. Not only will teacher health improve, but the results will show in the classroom, as well.

This element seeks to suggest that My Time for Health will produce positive results and impact overall educator health. Similarly to justification, the evidence will come from literature and the needs assessment. Eaton et al. (2007) states, "…many school employees lack adequate physical activity and proper nutrition; are asthmatic, diabetic, or obese; distracted by family or financial problems; and experience high levels of stress. Teachers, in particular identify stress as a primary concern" (p. 558). Evidence This is a population that requires additional programming based on the high risk of disease due to lack of physical activity, healthy eating deficiency, and high stress levels. All these factors are known to create chronic health conditions both in and out of the educator community. The element of capacity evaluates the knowledge, skills, and abilities of the program development team. With the assistance of stakeholders, the My Time for Health program will network with local health companies and utilize the support and resources of Health Partner's Choose Well, Live Well program. Expertise from professionals specializing in healthy eating, physical activity, and stress management, will only add to the extent of knowledge and expertise of the development team. Capacity Additionally, the development team will consist of leadership focusing solely on one or two aspects of the program development and implementation (i.e. finances, volunteers, marketing and communication, etc.) By designating specific leadership personnel to a part of the program, there will be enough capacity to meet all the needs of the program.

Resources refer to the budget, building availability, time, and assets of the program. With a budget prepared alongside stakeholders, much of the financial resources have been established. Also, due to the fact that the program is being implemented within elementary schools in the SPSD, there is building availability. For example, there are specific physical activity classes, like yoga, that will be offered at a number of schools after the school day. The school's administration has approved the use of Resources the gymnasium for such classes after students leave for the day. Additionally, the educator's time will be respected by offering classes and stress management sessions in the school, rather than having to drive to a different location. Other resources that will be utilized will be college level volunteers to teach classes and offer program support both with and without the educators. The Twin Cities area is a hub for public and private colleges and universities that are available in providing student volunteers. Using surveys and questionnaires prior to program implementation will aid in understanding the target population. Questions will be asked to determine readiness to change, major stressors, abilities to cope with stress, current physical activity practices, and biometric data (i.e. height, weight, blood pressure, etc.). This element ensures that the program is tailored to fit the needs of the priority population. Similar surveys and questionnaires will be distributed throughout the life of the Consumer-Orientation program to gather both qualitative and quantitative data. These data will allow the program development team to make necessary changes and address barriers, or continue with program successes. Also, throughout the program's life, the development team will hold focus groups and interviews with a select number of educators to understand needs that still need to be addressed or areas of the program that their peers are enjoying. Multiplicity Due to the fact that the My Time for Health program is focusing on changing physical activity, healthy eating, and stress management behaviors, there are multiple components built in. Therefore, the program development team aims to include different intervention strategies that focus on changing attitudes, behaviors, and environment. One such intervention to change stress management tools and techniques will be onsite mental health professionals to hold group seminars and individual meetings with educators after school hours and/or during staff meetings. Another component will be onsite exercise classes taught by personal trainers and exercise physiologists. These classes will include boot camp, yoga, and stretching. For healthy eating, select schools will have cooking demonstrations and meal planning seminars to assist in making healthier meal choices. All interventions will include educational materials that the educators can use for personal use such as yoga pose manuals, making a healthy lunch diagrams, and 10 Ways to Reduce Stress in 5 Minutes.

Support involves how the educators will be encouraged and assisted throughout the program. This support will come from different areas within the program development. First, all educators participating in the program will have access to a webpage that will include different class schedules, how-to posts, and articles that support healthy living. On this website, the educators will have access to directly emailing program development staff or consultants with questions or concerns. The Support web page will include a direct phone number to the office of the program staff for urgent issues and will be available Monday through Friday. With stakeholder approval, the elementary schools will have onsite programming and activities to encourage activity and healthy behaviors without needing to leave the school building. Finally, one large area of support will be the onsite mental health professionals that will attend the school on weekly that will support educators in balancing stress. This element involves the partners, organizations, and consultants that will allow the program to function at its best. For the My Time for Health program, these groups will greatly assist in ensuring the best results. One such partnership will be with local colleges and universities in arranging student volunteers to help with onsite classes and organization. Other partnerships will come from Health Partners Choose Well, Live Well program that is currently being offered to all SPSD employees for health Inclusion and wellness. A benefit of partnering with the Choose Well, Live Well program is that this is a program that educators are currently aware of and has supported educator health for numerous years. This partnership will also add credibility to My Time for Health. Consultants for this program will come from local gyms and health clubs, as well as dieticians from local hospitals that will provide onsite activities support.

Accountability Keeping the program staff and external partners accountable means that we are all fulfilling the duties set out for us. This also requires careful evaluation and examination periodically throughout the life of the program; from development through final evaluation. For the program development staff, accountability will be upheld by stakeholders and their expectations for the staff. Staff evaluations will be completed by a group of selected stakeholders to reduce bias. Opportunities and successes will be communicated in a timely manner for both the staff and external partners. Evaluations will also aid in keeping external partners accountable to their duties and responsibilities. These evaluations will come from stakeholders, program staff, and the target population. For example, after educators participate in a class for about eight weeks, they will be asked to evaluate the class instructor. Questions that will be asked will reflect the duties and responsibilities that the instructor was given prior to teaching the class. This will allow for staff to communicate changes that need to made or take appropriate action to terminate their services.

Similar to accountability, this element uses information from evaluation of program developers, volunteers, and external partners to make necessary changes and ajust when there are challenges, while moving forward with successes. Two key populations will affect the adjustment of the program: stakeholders and the elementary educators. As mentioned in the element of accountability, stakeholders will handle the evaluation of the program development staff. Stakeholders also hold expectations for the program's implementation and evaluation. Therefore, the timelines developed show continual stakeholder meetings every year of the Adjustment program. These meetings will be an opportunity to communicate successes, as well as address challenges and opportunities. During these meetings, the stakeholders and development team will make adjustments necessary to ongoing success. The elementary educators are the voice of the program. Their voice must be listened to and heard. Without their evaluations of the program, classes, seminars, and educational materials, the staff will have no knowledge of where to make adjustments. These evaluations will also occur through the life of the program and the development staff will make appropriate adjustments with the educator's approval. In the element of recruitment, the program staff utilizes necessary and appropriate channels to engage the educators, while being sensitive to cultural differences and demographic preferences. The recruitment process will begin within five selected schools. These schools will be introduced to the program during staff meetings and emails regarding features of the program, as well as communicating an understanding of the challenges and stressors an educator experiences. Essentially, one such recruitment technique will be to empathize and express knowing that Recruitment teacher health and wellness should be an important aspect of overall well-being. Understanding how the educators communicate will be a large factor in determining the best recruitment strategies. Much of the recruitment will take place face to face and over email, as well as primarily be centered in the school. This is an important factor because the development team aims to bring the program to them, where the educators do not have to go anywhere to receive My Time for Health. For additional information on specifics regarding recruitment, please refer to the section about the marketing tactics. The reach of the program will be the number of individuals within the target population that have the opportunity to participate in the program. Essentially, this will be all of the elementary educators in the SPSD, however, as the budget projection estimates, the program expects about 1500 of the 2500 educators to participate. Nonetheless, all of the recruitment tactics will be focused on all elementary educators in the school district. This will save resources, both time and Reach money. One note on the reach of My Time for Health is that the five schools designated for piloting the program will be determined via baseline data, surveys, and questionnaires given to the educators prior to program implementation. The data that the team will look at is readiness to change and interest in the program. This qualitative data will give the development team an understanding of which five schools will be best suited and appropriate for piloting. As aforementioned in the reach element, the program development team and stakeholders are estimating about 1500 elementary educators to participate over a three to four year span of the program. There is expectation that drop out and new attendance will occur through the life of the program, therefore, 1500 is a generalized number of estimation. Response will be measured on a bi-monthly basis through new attendance (those paying $10/year for the first time) and through Response dropout rates (educators who have requested to be taken off email lists or who no longer attend classes or seminars). This data will be compiled on the program's designated website where new participants pay their yearly $10 or decide to drop out of the program. To make calculation simpler, every teacher that creates a profile on the webpage and pay the $10 per year will be assigned a number 1-2500. This will be anonymous to the program's development team, but will give a number of the total participation every two months when calculated. Interaction involves the amount of professionalism, personal interaction, and instructions communicated between the program staff, volunteers, and consultants and the program participants. The most appropriate ways of monitoring the interactions will be through observation by stakeholders and leadership on the program development team. Additionally, program participants will be encouraged to report any behavior that is not professional by program staff, volunteers, or Interaction consultants to leadership and/or school administration. Importantly to note, the interactions of those on the webpage will also be evaluated. There will be a standard established that gives criteria that can and cannot be posted on the webpage. If inappropriate material is posted, the one who posted the information will be dealt with appropriately. On the other hand, if a program participant posts anything inappropriately, action will be taken through school administration or with the teacher directly. This element is essential to the success of a program. Participant satisfaction results in positive results during summative evaluation. As aforementioned, the participant's satisfaction will be evaluated throughout the life of the program. An example of this will be after a class is offered or on a bi-monthly basis to evaluate marketing and communication strategies. On the timelines represented, at the end of every school year, participants will be asked to fill out a survey/questionnaire that examines Satisfaction personal successes (including biometric data), improvements for the program, and aspects of the program that are appreciated. These questions will be using Likert scales, True/False, and free writing. To engage educators in providing feedback related to their own satisfaction, the program staff will offer incentives for grocery gift cards, yoga mats, and other tools to assist in living healthy lifestyles in and out of the school. Definitions for each element obtained and referenced from McKenzie et al. (2013)

Ensuring My Time for Health is implemented as planned per protocol will require careful and frequent communication with stakeholders. This means that stakeholders and program development staff will share new data, changes in consultants, and concerns from participants. The Gantt charts provided give the foreseen timeline of program development, implementation, and evaluation. Also, Fidelity with a budget projection, this will allow resources to be used appropriately, efficiently, and effectively to maximize the program. Establishing inputs, outputs, and outcomes in the logic model above will also ensure the program is meeting desired outcomes using the resources available.

The dose examines the number of different services, products, classes, and presentations given throughout the life of the program. For ease, the program will break down dose by year, with subsequent years being similar. The first year will include three fitness classes running for eight weeks, three healthy eating seminars running for eight weeks, and one seminar per month around stress management. These large group sessions will be divided among the elementary schools to ensure Dose there is at least two sessions occurring during a two month time frame at one school or another. Every month, a person or team of people from the development team will share updates and upcoming events at monthly staff meetings across the district. Therefore, there will be a total of around 40 presentations given during the school year. Finally, there will be weekly emails sent out to program participants with quick tips, success stories, and other information regarding the program; this will total about 40 to 50 different emails. This element examines other competing factors that may influence program results. In other words, we examine competition. Factors that may compete with My Time for Health included external wellness programs that fit into the participant's schedule more appropriately, educator's entering data into biometric questions that do not reflect the truth, and lack of time. Lack of time refers to educators not having Context enough time in the day to participate in the program due to family or personal life responsibilities. In terms of untruthful data obtained, the participant may put down numbers or answers that they believe the program evaluators are looking to see. External wellness programs, both physical and mental, are competing factors if educators are presently involved with them prior to program implementation. Definitions for each element obtained and referenced from McKenzie et al. (2013)

Program Strategies Summary Today’s educational arena is becoming increasingly focused on student achievement through the use of assessment and standardization. Additionally, school-aged children are the focus of many health interventions with the increasing prevalence of childhood obesity.

Although student achievement and student health and wellbeing are important to our societies as a whole, educator health and wellbeing is rarely taken into consideration. Therefore, the development of My Time for Health aims to create a school environment that honors the health and balance of the elementary educator in the SPSD. Educators have been shown to have high risk factors of cardiovascular disease. Such risk factors include high stress levels, low physical activity, and unhealthy eating habits. Interventions will be focused in the school, creating accessibility for all interested and engaged educators. These interventions will include onsite physical activity classes like yoga and boot camps, as well as onsite healthy eating seminars focusing on packing healthy lunches and choosing healthy snacks throughout the work day.

Stress management interventions will include onsite mental health professionals available for group and individual sessions through the course of the program. Also, mental health professionals will attend staff meetings to perform quick presentations about ways to manage stress in and out of the classroom on a regular basis. Objectives that the My Time for Health program aims at achieving include decreasing BMI on a yearly basis for program participants, increasing job satisfaction, reduction in overall educator stress levels, reducing the number of sick-days that the educators take on a yearly basis, and, long-term, changes in assessment scores from the elementary students in the SPSD. These objectives seek to show both quantitative and qualitative data per stakeholder expectation. With the expectation of success,

My Time for Health will seek to be implemented across the SPSD at the middle and high school level, as well across other school districts in the state of Minnesota. The need is great for such a program and we, as a development team, seek to improve the wellbeing and health of the educators of the SPSD in Minnesota for long-term, positive change.

References

Centers for Disease Control and Prevention. (2013). Logic model steps. Retrieved from: http://www.cdc.gov/oralhealth/state_programs/pdf/logic_models.pdf

Eaton, D.K., Marx, E., & Bowie, S.E. (2007). Faculty and staff health promotion: Results from the school health policies and programs study of 2006. Journal of School Health. 77(8), 557- 566.

Healthy People 2020. (2013). Topics and objectives. Retrieved from: http://www.healthypeople.gov/2020/topicsobjectives2020/default.aspx

Herman, J.L. & Golan, S. (1991). Effects of standardized testing on teachers and learning – Another look. National Center for Research on Evaluation, Standards, and Student Testing. Retrieved from: https://www.cse.ucla.edu/products/reports/Tech334.pdf

National Association of County and City Health Officials. (2010). Developing a local health department strategic plan: A how-to guide. Retrieved from: https://content2.learntoday.info/cune/MPH585_2013/media/Developing%20a%20Local %20Health%20Department_READING.pdf

McKenzie, J.F., Neiger, B.L., & Thackeray, R. (2013). Planning, implementing, & evaluating health promotion programs: A primer, 6th edition. Glenview, IL: Pearson Education, Inc.

Minnesota Department of Education. (n.d.) Standards, curriculum, and instruction. Retrieved from: http://education.state.mn.us/MDE/EdExc/StanCurri/index.html

Saint Paul Public Schools. (2012). District at a glance. Retrieved from: http://www.spps.org/uploads/sppsprofilefinal-1_2.pdf

Saint Paul Public Schools. (2011). Employee wellness program: Choose well, live well. Retrieved from: http://wellness.spps.org/home

Saint Paul Public Schools. (2007). Wellness policy champions implementation manual. Retrieved from: http://studentwellness.spps.org/sites/f726831c-be85-4bf7-b7b0- a4630db315a0/uploads/spps_champions_toolkit_withoutppt.pdf

The American Institute of Stress. (n.d.) 50 common signs and symptoms of stress. Retrieved from: http://www.stress.org/stress-effects/

The University of Wisconsin-Extension. (2012). Program development and evaluation: Logic model. Retrieved from: http://www.uwex.edu/ces/pdande/evaluation/evallogicmodel.html Webber, L.S., Rice, J.C., Johnson, C.C., Rose, D., Srinivasan, S.R., & Berenson, G.S. (2012). Cardiovascular risk factors and physical activity behavior among elementary school personnel: Baseline results from the ACTION! Worksite wellness program. Journal of School Health. 82(9), 410-416.