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observed from 2000 to 2006 between HE staff and school 1). States with the lowest reported collaboration included
health services staff (-7 states) as well as school mental Georgia (3 organization types), South Dakota (3
health or social services staff (-4 states). During this same organization types), and Massachusetts (4 organization
time period, the number of HE staff reporting types). In 2006, 14 states reported collaborating with all
collaboration with businesses increased (+8 states) while listed organizations, however, no state reported
smaller increases were seen for state-level health collaborating with all 13 organizations in 2012.
departments (+1 state), mental health or social services
agency (+1 state), and academic institutions (+1 state).
This period also saw a decrease in collaboration among DISCUSSION
states and state-level ASHA (-7 states).
This study sought to quantify the extent of cross-
sector collaboration among organization types and state-
Figure 1. Distribution of organizations working with state level HE staff responsible for school health education
agency staff on school health education activities in 2012 activities. Few data sources exist that enable examination
of collaboration over time. By providing a national
representative analysis of state-level, cross-sector
collaboration in school HE, this study provides a
foundation in which current strengths and missed
opportunities for partnerships can be identified. As state-
level staff are often tasked with coordinating health
education implementation activities which may include
training and technical assistance (Cradock. Et al, 2013),
greater collaboration among staff consistent with the
WSCC framework can facilitate increased integration of
student wellness in schools (Durlak et al., 2011; Cohen,
McCabe, Michelli, & Pickeral, 2009).
Increasing evidence supports the effectiveness of the
WSCC model through cross-section collaboration at the
school level (Chiang, Meagher, & Slade, 2015), yet
whether increased collaboration across state-level
From 2006 to 2012, the number of states in which HE departments has resulted in facilitation of federal and state
staff reported collaborating increased for PE (+2 states) policies at the school-level should be addressed in future
and school health services (+9 states) while decreasing for research. An increase in collaboration was observed in
school nutrition and food services (-3 states) and school states where the HE staff indicated collaboration with PE,
mental health or social services (-1 state). There was an nutrition or food services, as well as school health
overall decrease in reported collaboration between HE services.
staff and external associations and nonprofit
organizations. The largest decreases were observed for Alternatively, there was a decrease in the number of
school nurses’ association (-7 states), health organizations states indicating HE staff collaborate with school mental
(-4 states), and ASHA (-4 states). Also during this period, health or social services. This is concerning as mental
collaboration with state-level health departments disorders and distress in children are prevalent public
increased resulting in all 50 states reporting some form of health issues with considerable associated costs to youth,
collaboration. There was no change in the number of families, and the community (National Research Council,
states indicating collaboration with academic institutions 2009). Given the finding that school mental health
and businesses. The most common collaborators services are often neglected or marginalized, Evans,
throughout this period were state-level health departments Weist, and Serpell (2007) discuss strategies to improve
(49–50 states), academic institutions (47 states), school school mental health services made available to students.
health staff services (38-47 states), school nutrition and The authors contend that collaboration is imperative,
food services (45-48 states), and PE staff (42-44 states). given that the most effective programs have a shared
The sharpest declines in collaboration were reported for agenda in which stakeholders collectively pursue mental
state-level ASHA (-11 states), school nurses’ association health promotion and school climate enhancement. As the
(-7 states), school mental health or social services (-5 WSCC model asserts, diverse sectors working together
states), and physicians’ organizations (- 2 states). (including mental health staff) can ensure all students
within schools and communities are healthy, safe,
engaged, and challenged.
In 2012, the number of organization types working
with HE staff on health education activities (collaboration This study also helps to elucidate common external
breadth) per state ranged from 3 to 12 of the 13 organization types that engaged in state-level HE activity
organization types measured, with a median of 10 (Figure collaboration over the past decade. Health departments,

10 THE HEALTH EDUCATION MONOGRAPH SERIES, Volume 34, Number 1, 2017