During spring 2013, ASCD and CDC convened a group of experts from education, public health, and academia to discuss lessons learned from implementation of both approaches and to explore the revision and development of a model that would incorporate the knowledge gained through implementation to date. A series of meetings were held and outcomes from the discussions were vetted with a review group made up of additional experts and stakeholders (Box 1).

Formal, structured health education consists of any combination of planned learning experiences that provide the opportunity to acquire information and the skills students need to make quality health decisions. When provided by qualified, trained teachers, health education helps students acquire the knowledge, attitudes, and skills they need for making health-promoting decisions, achieving health literacy, adopting health-enhancing behaviors, and promoting the health of others. Comprehensive school health education includes curricula and instruction for students in pre-K to grade 12 that address a variety of topics such as alcohol and other drug use and abuse, healthy eating/nutrition, mental and emotional health, personal health and wellness, physical activity, safety and injury prevention, sexual health, tobacco use, and violence prevention. Health education curricula and instruction should address the National Health Education Standards and incorporate the characteristics of an effective health education curriculum. Health education, based on an assessment of student health needs and planned in collaboration with the community, ensures reinforcement of health messages that are relevant for students and meet community needs. Students might also acquire health information through education that occurs as part of a patient visit with a school nurse, through posters or public service announcements, or through conversations with family and peers.

The school nutrition environment provides students with opportunities to learn about and practice healthy eating through available foods and beverages, nutrition education, and messages about food in the cafeteria and throughout the school campus. Students may have access to foods and beverages in a variety of venues at school including the cafeteria, vending machines, grab ‘n’ go kiosks, schools stores, concession stands, classroom rewards, classroom parties, school celebrations, and fundraisers.

School nutrition services provide meals that meet federal nutrition standards for the National School Lunch and Breakfast Programs, accommodate the health and nutrition needs of all students, and help ensure that foods and beverages sold outside of the school meal programs (competitive foods) meet Smart Snacks in School nutrition standards. School nutrition professionals should meet minimum education requirements and receive annual professional development and training to ensure that they have the knowledge and skills to provide these services. All individuals in the school community support a healthy school nutrition environment by marketing and promoting healthier foods and beverages, encouraging participation in the school meal programs, role-modeling healthy eating behaviors, and ensuring that students have access to free drinking water throughout the school day. Healthy eating has been linked in studies to improved learning outcomes and helps ensure that students are able to reach their potential.

Schools are not only places of learning, but they are also worksites. Fostering school employees' physical and mental health protects school staff, and by doing so, helps to support students' health and academic success. Healthy school employees—including teachers, administrators, bus drivers, cafeteria and custodial staff, and contractors—are more productive and less likely to be absent. They serve as powerful role models for students and may increase their attention to students' health. Schools can create work environments that support healthy eating, adopt active lifestyles, be tobacco free, manage stress, and avoid injury and exposure to hazards (such as mold or asbestos). A comprehensive school employee wellness approach is a coordinated set of programs, policies, benefits, and environmental supports designed to address multiple risk factors (including lack of physical activity and tobacco use) and health conditions (such as diabetes or depression) to meet the health and safety needs of all employees. Partnerships between school districts and their health insurance providers can help offer resources, including personalized health assessments and flu vaccinations. Employee wellness programs and healthy work environments can improve a district's bottom line by decreasing employee health insurance premiums, reducing employee turnover, and cutting costs of substitutes.

Social and emotional school climate refers to the psychosocial aspects of students' educational experience that influence their social and emotional development. The social and emotional climate of a school can impact student engagement in school activities; relationships with other students, staff, family, and community; and academic performance. A positive social and emotional school climate is conducive to effective teaching and learning. Such climates promote health, growth, and development by providing a safe and supportive learning environment.

A healthy and safe physical school environment promotes learning by ensuring the health and safety of students and staff. The physical school environment encompasses the school building and its contents, the land on which the school is located, and the area surrounding it. A healthy school environment will address a school's physical condition during normal operation as well as during renovation (including ventilation, moisture, temperature, noise, or natural and artificial lighting), and protect occupants from physical threats (such as crime, violence, traffic, or injuries) and biological and chemical agents in the air, water, or soil as well as those purposefully brought into the school (including pollution, mold, hazardous materials, pesticides, or cleaning agents).

School health services intervene with actual and potential health problems, including providing first aid, emergency care and assessment, and planning for the management of chronic conditions (such as asthma or diabetes). In addition, wellness promotion, preventive services and staff, and student and parent education complement the provision of care coordination services. These services are also designed to ensure access and/or referrals to the medical home or private healthcare provider. Health services connect school staff, students, families, community, and healthcare providers to promote the health care of students and a healthy and safe school environment. School health services actively collaborate with school and community support services to increase the ability of students and families to adapt to health and social stressors, such as chronic health conditions or social and economic barriers to health, and to be able to manage these stressors and advocate for their own health and learning needs. Qualified professionals such as school nurses, nurse practitioners, dentists, health educators, physicians, physician assistants, and allied health personnel provide these services.

These prevention and intervention services support the mental, behavioral, and social-emotional health of students and promote success in the learning process. Services include psychological, psychoeducational, and psychosocial assessments; direct and indirect interventions to address psychological, academic, and social barriers to learning, such as individual or group counseling and consultation; and referrals to school and community support services as needed. Additionally, systems-level assessment, prevention, intervention, and program design by school-employed mental health professionals contribute to the mental and behavioral health of students as well as to the health of the school environment. These services can be accomplished through resource identification and needs assessments, school-community-family collaboration, and ongoing participation in school safety and crisis response efforts. Additionally, school-employed professionals can provide skilled consultation with other school staff and community resources and community providers. School-employed mental health professionals ensure that services provided in school reinforce learning and help to align interventions provided by community providers with the school environment. Professionals such as certified school counselors, school psychologists, and school social workers provide these services.

Community groups, organizations, and local businesses create partnerships with schools, share resources, and volunteer to support student learning, development, and health-related activities. The school, its students, and their families benefit when leaders and staff at the district or school solicits and coordinates information, resources, and services available from community-based organizations, businesses, cultural and civic organizations, social service agencies, faith-based organizations, health clinics, colleges and universities, and other community groups. Schools, students, and their families can contribute to the community through service-learning opportunities and by sharing school facilities with community members such as school-based community health centers or fitness facilities.

Families and school staff work together to support and improve the learning, development, and health of students. Family engagement with schools is a shared responsibility of both school staff and families. School staff members are committed to making families feel welcomed, engaging families in a variety of meaningful ways, and sustaining family engagement. Families are committed to actively supporting their child's learning and development. This relationship between school staff and families cuts across and reinforces student health and learning in multiple settings—at home, in school, in out-of-school programs, and in the community. Family engagement should be continuous across a child's life and requires an ongoing commitment as children mature into young adulthood.

Schools can create an environment that offers many opportunities for students to be physically active throughout the school day. A comprehensive school physical activity program (CSPAP) is the national framework for physical education and youth physical activity. A CSPAP reflects strong coordination across 5 components: physical education, physical activity during school, physical activity before and after school, staff involvement, and family and community engagement. Physical education serves as the foundation of a CSPAP and is an academic subject characterized by a planned, sequential K-12 curriculum (course of study) that is based on the national standards for physical education. Physical education provides cognitive content and instruction designed to develop motor skills, knowledge, and behaviors for healthy active living, physical fitness, sportsmanship, self-efficacy, and emotional intelligence. A well-designed physical education program provides the opportunity for students to learn key concepts and practice critical skills needed to establish and maintain physically active lifestyles throughout childhood, adolescence, and into adulthood. Teachers should be certified or licensed, and endorsed by the state to teach physical education.

Inherent in the WSCC model is a holistic view of students, schools, and communities. The model builds on other socioecological models used in health and education, including Bronfenbrenner's “Ecological Framework for Human Development,”6 public health and health promotion models,7 and Lohrmann's “Ecological Model of the Coordinated School Health Program.”8 Each segment and layer of the WSCC model is interdependent on the others; the model is designed to emphasize the whole to support the development of each child and youth most effectively. The focus of the WSCC model is a socioecological approach that is directed at the whole school, with the school, in turn, drawing its resources and influences from the whole community and serving to address the needs of the whole child. ASCD and the CDC encourage use of the model as a framework for improving students' learning and health.3

The model is based on health and education research, including research that addresses the need to engage students as active participants in their learning and health. The figure of the child represents children and youth who should be at the center of decisions made by policymakers and practitioners from the education and health sectors. In addition, the child is a reminder of the powerful outcomes that can be achieved by giving voice to children and youth about their education, their health and their communities. To be successful adults, students must be provided a variety of opportunities to learn, including in the community, and to put into practice their learning through peer leadership and educational choices, as well as their involvement in peer education and youth development.

After years of observing the CSH approach in action in local schools and districts, the consultation team noted that without coordination, policies, practices, and processes in place, the model would not be effective in achieving its intended outcomes. Administrator support, particularly the support of principals, has been shown to be a key factor in the success of the integration of learning and health in schools.9 District and school policies that promote health and learning, practices that reinforce the policies and desired behaviors of staff and students, and processes that ensure that coordination, planning, use of data, and continuous improvement all must work in concert with the other pieces of the model.

The WSCC model represents an evolution of organizational thinking in schools. In the marriage of the two leading models addressing healthy schools, the Whole Child Initiative and the CSH approach, the WSCC approach provides a comprehensive framework for school districts and schools. The important changes within components and emphases on critical facilitative factors including community engagement, policies, processes, and practices build upon the assets of both approaches and effectively address the needs of modern schools.

By focusing on children and youth as students, addressing critical education and health outcomes, organizing collaborative actions and initiatives that support students, and strongly engaging community resources, the WSCC approach offers important opportunities for school improvements that will advance educational attainment and healthy development for students.