BY: JIM TEHAN, J.D., M.P.H., and JESSICA GREENE
Walk across the blacktop at Kornblum Elementary School in Hawthorne, Calif., on any given school day and you are bound to see a sight rare for most urban public elementary schools in the state: The schoolyard is filled with physically active students.
Upon closer observation, you notice this is not recess or free play, but rather students who are moving purposefully, using low-cost equipment, and they are actively involved in a lesson. Who leads this phenomenon? If you are a Californian, the answer may surprise you: classroom teachers.
This scene comes from Creating Opportunities for Physical Activity (COPA), a community benefit initiative of Providence Little Company of Mary Medical Centers in Torrance and San Pedro, Calif., part of Los Angeles County's South Bay region. The medical centers' triennial needs assessments showed the communities' ever-increasing number of overweight children, the absence of physical education training for public school teachers and a lack of after-school activity options for children.
In the cash-strapped California public schools, physical education teachers typically have been eliminated unless the district encompasses wealthy communities where there is support from parents. Although California has a longstanding state law that mandates 200 minutes of physical education instruction every 10 days at the elementary level, the simple reality is that classroom teachers typically get little to no training in physical education. Their expertise in motor skills, outdoor classroom management and academic content standards is limited to whatever a school district provides as staff development — generally, nothing systematic. As a result, the extent to which a classroom teacher takes his or her students outdoors is linked to the teacher's personal experience and interest in physical activity and fitness. Even those who have the interest often are not clear on their students' developmental needs and the skills they should be able to execute at their grade level. Yet daily moderate to vigorous physical activity is associated with a decrease in a child's likelihood to develop heart disease, type 2 diabetes and obesity.
PUTTING A FACE ON THE MISSION OF THE SISTERS IN UNDERSERVED COMMUNITIES
As members of Providence Health & Services, the medical centers' mission gives voice to the hopes and aspirations of the Sisters of Providence and the Sisters of Little Company of Mary: "As people of Providence, we reveal God's love for all, especially the poor and vulnerable, through our compassionate service." Our community benefit programs seek out the most underserved communities in the South Bay area to address the greatest health care needs identified by the triennial needs assessment and ultimately demonstrate that our efforts have a positive impact.
Students at urban schools like Kornblum Elementary have few structured opportunities to get them moving. Budget cuts eliminated phys ed classes, many schools lack safe areas for outdoor play and the communities don't have resources to offer free or low-cost after-school programs, where children can be physically active.
The medical centers in Torrance and San Pedro already had built strong relationships with local school districts thanks to a school-based pediatric mobile clinic program. It was logical and easy for school district leaders to tap their partners for ideas about how the medical centers could help overcome the lack of school physical education programs — thus addressing the observed community need to fight childhood obesity. The result was COPA, initiated and developed to help classroom teachers learn the skills for teaching physical education to elementary school students and boost their activity level.
The COPA program is based on the principle of moving teachers through a modeling, team teaching, then independence-in-instruction process. The medical centers employ five full-time physical education specialists at 13 schools in three school districts to work as peer coaches and mentors. Together they see 250 teachers and their students every other week during the school year, meeting outdoors and working through a set of lessons for the specific grade level. The specialists also hold 14 follow-ups during the year with their teachers.
Pre- and post-program surveys indicate the COPA curriculum has helped teachers gain new levels of self-confidence in both physical education instruction and activism to create a culture of daily physical activity at their schools. Most teachers are ready to be independent of coaching in two years; our most enthusiastic continue as "teacher champions" to lead activities and plan phys ed special events.
The medical centers and the related Little Company of Mary Community Health Foundation provided start-up funding for the COPA program delivered by a physical education specialist at two pilot schools. Over time, a COPA after-school program at two sites received seed funds from Healthy Tomorrow, a collaboration of the federal Health Resources and Services Administration and the American Academy of Pediatrics for nonprofits working on children's health issues. Then, COPA received an expansion grant through the United States Department of Education, which allowed for a consolidated school day and after-school program at 13 schools. Since the program's beginning, the COPA staff, along with teachers' desire to make a change, have produced a solid foundation of physical activity across the communities of Hawthorne, Lawndale and the Los Angeles neighborhoods of San Pedro and Wilmington.
HOW COPA WORKS
Armed with a staff of five physical education specialists and a batch of simple, low-cost equipment for 13 schools, COPA staff embarked on a mission to build a culture of physical education and wellness. The program set a goal to boost physical education and activity with phys ed during the school day, after-school programs and community special events.
During the school day, the five specialists serve as peer coaches for classroom teachers. They draw on an easy-to-use classroom teacher guide developed by COPA staff as a best practices curriculum according to the California State Physical Education Standards. It teaches a full range of motor skills, physical fitness and cooperative skills. Lessons are broken down for each grade level and use a common, four-part structure that is amenable to partner teaching. The curriculum also emphasizes outdoor class management techniques for each lesson, because most teachers have little or no training in creating a safe outdoor teaching environment.
Following the COPA curriculum for 14 units spanning the course of two school years, classroom teachers move across a learning progression that starts with modeling, then co-teaching with the specialist and finally, independence in teaching physical education.
In the modeling phase, teachers watch or act as participants with their students as the specialist delivers the lesson. The teacher and the specialist discuss the lesson and develop a game plan for the teacher to repeat all or part of a lesson before the specialist returns two weeks later. This every-other-week frequency also allows the specialist to work with 50 teachers per two-week period, which promotes cost effectiveness.
In the co-teaching phase, teachers have formed a collegial relationship with their specialist and start leading parts of the COPA lesson. After class, the pair debriefs about the lesson, the specialist gives advice/praise on the teacher's progress and they discuss and set a new individualized challenge for the next time.
In the independence phase, teachers become comfortable leading a complete COPA lesson. The relationship between the specialist-teaching pair is one of full trust and often is a friendship, allowing for open dialogue about lessons. The specialist functions in a support role during class, giving attention to specific students seeking to master movement skills and backing up the teacher to strengthen a lesson. Also, during the independence phase, specialists enlist teachers to improve the overall culture of physical activity at their school site.
At every school, a group of three or four highly motivated teachers typically emerges who are eager to work with their peers to promote physical activity. These "COPA Teacher Champions" lead projects ranging from activity clubs and access to phys ed equipment to planning school-wide physical activity special events. COPA Teacher Champions are a sustainable resource within the schools that promotes a culture of daily physical activity.
COPA RESULTS
Independent program evaluation has confirmed COPA's success. The results document dramatic improvements on multiple levels:
- 85 percent of teachers volunteer to participate; 90 percent of them stay in the program through the two-year curriculum
- Highly significant increases in teacher confidence measures
- 99 percent of teachers cite relationship with specialist as most important change factor in the frequency of their physical education instruction
- Statistically significant increases in the frequency and duration of physical education instruction from little to no phys ed to an average of 30-minute sessions, multiple times per week
We are currently working on a way to incorporate short bursts of physical activity during the school day ("instant recess") as a strategy to add minutes of phys ed instruction. The goal is to reach California's state standard of 200 minutes of physical education instruction every 10 days for elementary students.
PEER COACH MODEL
In focus groups, teachers tell us they view their partnership with the specialist as COPA's critical ingredient. The peer coach model is probably the most effective strategy for sustaining improvement in instructional quality and frequency. The model assesses each teacher individually at the start of the relationship and sets realistic, but challenging, goals and objectives for each teacher.
This model contrasts with traditional professional development training. After-school, weekend or away-from-school conferences certainly provide basic knowledge and information in physical education content and methods. However, when the teacher goes back to his or her students, the assessment, skills practice, constructive feedback, individualized support and personal communication that are part of the peer coach model are missing.
COPA offers all these components along with an innovative curriculum and a safe, non-threatening environment that promotes teacher learning and student enjoyment. COPA also recognizes classroom teachers usually have little training and affinity for movement education and offers teachers the opportunity to grow and evolve with their specialist. For the school, teachers at all experience levels acquire competency in a developmentally appropriate, standards-based physical education curriculum that promotes a culture of daily physical activity.
For students, COPA is an invaluable resource that provides practice in movement skills and the foundation for lifelong fitness. Most of all, to students, COPA is safe and fun. Students look forward to innovative games with the specialist and their classroom teacher that leave no student standing on the sideline. This is not a class students want to miss and, in many cases, is the highlight of their day.
Students' enthusiasm for physical education has been an eye-opener for teachers — they are able to interact with their students in a different, more relaxed setting than the classroom. Additionally, because COPA means no one is waiting in lines and everyone has a piece of equipment, there are fewer behavior issues. Fewer behavior issues equate to higher motivation for both students and teachers. COPA becomes a positive phys ed experience for all.
Teachers also learn firsthand that dedicating school time to physical education does not negatively affect academics. Seeing positive changes in students' classroom concentration furthers teacher advocacy for the program. Teachers also have shared stories of how COPA has helped to improve student self-esteem and social interaction. All of these positive side effects are common to quality physical education and activity programs.
AFTER-SCHOOL PROGRAMS AND SPECIAL EVENTS
By expanding COPA to after-school programs in the same 13 school sites, the students gained more opportunities for physical activity. The curriculum is a social-health, physical-activity-rooted program that teaches students personal and social responsibility. The activities emphasize development of interpersonal skills students need to participate in physical education, team sports, recess and ultimately, everyday life. Data collected from the after-school programs has confirmed a pre-post increase in students' moderate to vigorous activity, increased knowledge in health-related fitness and nutrition topics and higher confidence in joining group games without embarrassment.
Through special events both during the school day and after school, COPA carries its physical wellness message to families and the community. COPA uses a variety of such event offerings as cardio carnivals, health fairs, family fitness festivals, after-school family nights and parent training sessions. These events focus on increasing family knowledge and awareness of health issues and connect families to resources such as health clinics, wellness classes and future COPA events.
The medical centers know that in order to create a healthy culture around schools, the parents, school personnel and community partners must be involved in the process. The medical centers' community health departments are a connected web of resources that often come together during community-wide special events, supporting each other to contribute to a program's visibility and success. For example, in the time that COPA has been present in Hawthorne schools, there has been a 60 percent increase in patient visits to Providence Little Company of Mary's Vasek Polak Health Clinic, an innovative fixed-price, low cost primary care clinic for uninsured adults. The clinic, located within a mile of all Hawthorne schools, has greatly improved access to a medical home and provides free health screenings and health education.
In this way, the communication and overlap between the units of the Providence Little Company of Mary medical centers' community health departments has improved access to health care and promoted wellness education, the top two priorities identified by the medical centers' triennial needs assessment.
NEW DIRECTIONS: GETTING PARENTS INVOLVED
Our success with teachers has caused a move forward to offer a parent physical activity training program at Kornblum School, with Community Development Block Grant funding from the city of Hawthorne. This "family trainer" program allows up to four adults associated with each child in after-school COPA to participate in free activities. Moms, dads, aunts, uncles, neighbors and even a few grandparents signed up to get into the action.
While the children are in their after-school COPA program, the adults can participate with their own instructor in such classes as aerobic dance, yoga, strength training and walking groups. The family trainer program reaches out to community members, school site teacher champions and medical center employees who volunteer their time to teach the activity classes. The family trainer model provides a no-cost, safe environment for all to exercise.
Adults are able to be physically active and form a positive social network with their peers. By keeping activity logs and receiving exercise tips and information from instructors, adults in the program report they are more active at home and it feels great. They talk about making healthy food choices and even set goals for such things as weight loss, running a 5K race and getting more friends and family involved in an activity routine. Most of all, they say, the COPA program brought them closer to their children through physical activity.
As families learn that physical activity is not only important but also fun, COPA serves as a catalyst for healthy change.
JIM TEHAN is service area director, community partnerships and JESSICA GREENE is a physical education specialist at Providence Little Company of Mary, Torrance, Calif.
COPA RESULTS
Independent program evaluation has confirmed COPA's success. The results document dramatic improvements on multiple levels:
85 percent of teachers volunteer to participate; 90 percent of them stay in the program through the two-year curriculum.
Highly significant increases in teacher confidence measures.
99 percent of teachers cite relationship with specialist as most important change factor in the frequency of their physical education instruction.
Statistically significant increases in the frequency and duration of physical education instruction from little to no phys ed to an average of 30-minute sessions, multiple times per week.