Move Into a SHAC: Physicians Make School Health Advisory Councils Better

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Public Health Feature - August 2010

Tex Med. 2010;106(8):35-38.


By Crystal Conde
Associate Editor

Last year, when the legislature stopped requiring Texas high school students to complete one semester of health education and reduced the number of physical education (PE) semesters from three to two to graduate, the Austin Independent School District (AISD) School Health Advisory Council (SHAC) took action.

"Our SHAC recommended the school district maintain the requirements that all high school students take a semester of health and a year-and-a-half of PE, and the school board agreed," said Tracy Lunoff, AISD's health services coordinator. "Once other school districts heard what AISD was doing, many of them followed suit."

The school district can enforce the health and PE curricula because the school board voted to require one semester of health and a year-and-a-half of PE, making it a district policy.

The Austin SHAC also persuaded the school board to add PE and health education to its five-year strategic plan, implemented nutrition requirements for healthier vending machine snacks, and developed a wellness policy for students and staff members.

Ms. Lunoff says the Austin SHAC's success in maintaining the health and PE criteria is a prime example of what a SHAC can accomplish. SHACs, which advise Texas school districts on coordinated health programming and its impact on students' health and learning, can be models for school campuses and instrumental in shaping school health policy.

For example, Marissa Rathbone, the Texas Education Agency's director of School Health and Safety, says Humble school district SHAC members submitted FitnessGram results to the school board. Public schools use the FitnessGram program to measure the fitness levels of all of their students in grades 3 through 12.

Alarmed by the students' below-average results, the board started a wellness program to encourage school board members and teachers to eat healthier and exercise more.

"The adults decided to lead by example to encourage the students to model their behavior," Ms. Rathbone said.

In El Paso, the school district encourages community involvement in its SHAC by providing a Spanish language interpreter at its meetings.

To help influence policymakers, educators, and school board members, Ms. Lunoff encourages physicians to become members of their local school district SHAC. Texas law requires all school districts to have a SHAC.

Al Lindsey, MD, a family physician, has been on Austin's SHAC for about 10 years. He was on the SHAC's PE committee and now is a member of the committee responsible for nominating officers.

"I am very enthusiastic about participating on the SHAC," he said. "The group makes pertinent, well-thought-out recommendations to the school board, which usually takes our advice seriously. I'd encourage all physicians to be involved with their local SHAC."

He adds that in addition to physicians, members of the council include nutritionists, health educators, and other health care professionals.

"As the name implies, a SHAC is an advisory group focused on health. Physicians have a unique role in vetting health-related issues that have clinical implications. We can ask questions that others might not think are important to ask," he said.

SHACs Need Physician Voices

Ms. Rathbone says SHACs are among the most important school health mandates.

"School districts have so few resources available that SHACs help to ensure health policies are implemented effectively and efficiently. SHACs reflect community values and are critical in making sure things get done," she said.

Senate Bill 19, authored by Sen. Jane Nelson (R-Flower Mound), chair of the Senate Health & Human Services Committee, in 2001, requires all Texas school districts to have a SHAC. Last year, she authored Senate Bill 283, which addresses SHAC infrastructure. (See "SB 283 Strengthens SHAC Accountability.")

SHACs are critical in developing and implementing coordinated school health programs, Ms. Rathbone says. The Centers for Disease Control and Prevention's (CDC's) eight components of coordinated school health programming are the basis for SHAC activity.

Areas that SHACs focus on include health and physical education; health and nutrition services; counseling, psychological, and social services; healthy school environment; health promotion for staff; and family and community involvement.

SHAC members provide a community voice that school board members are likely to listen to, Ms. Rathbone says. She adds that physician members can lend credibility and a wide knowledge base to SHACs.

Stephen Pont, MD, MPH, medical director of the Texas Center for the Prevention and Treatment of Childhood Obesity, has been a member of Austin's SHAC for two years. He says AISD values health as an important aspect of education and school performance.

Dr. Pont also is the medical director of AISD's student health services program. He oversees the more than 120 AISD student health service staff - nurses, school health assistants, and administrative staff. They are employees of Dell Children's Medical Center. 

Dr. Pont attends monthly SHAC meetings that last about an hour-and-a-half and provides his medical expertise. He says the SHAC is instrumental in advocating for adequate physical activity and nutritional changes for students to prevent obesity and promote healthy eating.

"The council is proactive in working to advocate for the healthiest food options to be served during the school day. The SHAC is also trying to improve the quality of food available during sporting events and other extracurricular activities," he said.

Dr. Pont recognizes the value in having physicians and other health care professionals serve on local SHACs.

"Doctors are health leaders in the community. They can have a great impact on the health of children. People look to physicians for health information because doctors can supply them with accurate information from reliable sources," he said.

Physicians interested in joining their local SHAC can visit the school district's website for information or contact the school superintendent. Dr. Pont suggests physicians attend a meeting to get an idea of what's involved in membership and to see that it's a nonintimidating, collaborative atmosphere.

SHAC Membership Has Benefits

In addition to physicians, the school board can appoint teachers, administrators, district students, other health care professionals, businesspeople, law enforcement officers, senior citizens, clergy, and nonprofit health organization members to a SHAC. Fifty percent of the SHAC members must be parents of students enrolled in the school district. In addition, parents can't be employed by the school district.

Besides shaping school health policy, SHAC membership brings together a diverse group of like-minded individuals. Dr. Pont says his membership on the Austin SHAC gives him a rich opportunity to interact with community groups, nonprofit organizations, health educators, parents, clergy, and other groups interested in improving students' health.

"Through my participation on the AISD SHAC, I've learned about all the opportunities to have a meaningful impact at the school level by collaborating with community members who have a common goal," Dr. Pont said.

Dr. Pont encourages physicians and other health care professionals to get involved in their local SHACs.

"Being part of a SHAC is a great way to have an impact on the children in your community. It's rewarding community service, and I highly recommend it," he said.

Crystal Conde can be reached by telephone at (800) 880-1300, ext. 1385, or (512) 370-1385; by fax at (512) 370-1629; or by e-mail at  Crystal Conde.


SB 283 Strengthens SHAC Accountability

The 81st Texas Legislature passed Senate Bill 283, authored by Sen. Jane Nelson (R-Flower Mound), chair of the Senate Health and Human Services Committee. Marissa Rathbone, Texas Education Agency's (TEA's) Director of School Health and Safety in the Division of Educator and Student Initiatives, says the legislation infuses organization and accountability into the infrastructure of school health advisory councils (SHACs), making them more effective in implementing coordinated school health programs.

SB 283 adds additional provisions relating to the membership and activities of SHACs. Now, SHACs must:

  • Appoint at least five members, one of whom serves as chair or cochair;
  • Meet at least four times each year; and
  • Submit to the school board an annual written report that includes certain information regarding the SHAC's recommendations, modifications, and activities.

To get a sense of school districts' compliance with the new requirements under SB 283, TEA conducts an annual school health survey. One person from each school district responds to the survey on behalf of all the district's campuses. The survey asks how many times a SHAC met in the past year and requires submission of the name and contact information of the chair, as well as a list of all SHAC members.

In 2009, Ms. Rathbone says TEA received 1,058 responses to the survey out of a total 1,235 districts. She says TEA examines the data from the surveys to determine whether a school district or particular region of the state needs additional help implementing its SHAC.

"If an area needs more help, TEA works with a district's school health specialists so they know where to provide more focus," she said.

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