Student Health Service Professionals: Selected Competencies
The Council for the Advancement of Standards (CAS) in Higher Education provides a framework and guidance for 28 functional areas in student affairs (Miller et al, 2003). Each functional area has a list of competencies which guide student affairs professionals in all aspects of student life. One area of student life is the college health program. Typically this program has included both clinical and preventative health services. According to Komives, Woodard, and Associates, “The primary purpose of student health services is to provide immediate medical assistance to students who are ill or injured; student health services also encourage individual good health and provide leadership in promoting the concept of a healthy campus” (2003, p. 349). The importance of health to college students has been cited in several publications (as cited in Benjamin and Robinson, 1998).
For the sake of brevity, I will focus this paper around three student health professional competencies: budgeting, assessment/evaluation, and teaching/learning. The clinical aspects of college health are too broad for a paper of this nature. In order to conserve space, health education and health educators will be the primary focus. A historical context will be provided to showcase similarities of yesterday’s professional with the modern practitioner.
Dr. Edward Hitchcock, director of physical education at Amerherst College, is credited as being the first person to establish a formal college health program (The American College Health Association: A Brief History, 2001). In 1861, Hitchcock “created a health and physical education program that attempted to fill what he saw as the college’s role in combating the failing health of nineteenth century students” (Sloane and Sloane, 1986, p. 271). According to Sloane and Sloane, Hitchcock was the creator of health education and the role of the health educator (1986). Hitchcock’s programs focused on educating students “of the need for a nutritious diet and against the dangers of drinking and smoking” and “offered information on reproductive health…” (Sloane and Sloane, 1986, p. 271) Hitchcock offered a new, holistic approach which focused on a student’s well being (Christmas and Dorman, 1996). 40 years after Hitchcock’s initiation of college health, the University of California developed the first “comprehensive student health program (as it might be defined today), providing both medical care and infirmary care…” (Turner and Hurley, 2002, p. 4).
In 1932, William Hughes wrote a guide for student health professionals, entitled, “The Administration of Health and Physical Education for Men in Colleges and Universities.” Hughes developed a model for a student health service and included information on the financial aspects of student health (1932). According to Hughes, student health services should be funded by general university funds and from student fees (1932). The budgetary needs of a student health program were simple in that the funding primarily provided for staff salaries and supply costs. However, early administrators had to be fiscally responsible with their budgets. According to Weaver and Frederick, if student fees monies were not able to cover the costs of student health programming, it was “usually advisable for the college to make suitable appropriations from general college funds to maintain the health service program” (1947, p. 38). Insurance provided some students with health care but historically, “well recognized values are associated with health serviced practice and teaching which are impossible to duplicate through the usual insurance programs” (Weaver and Frederick, 1947, p. 38).
Assessment and Evaluation
Assessment and evaluation have been part of health education since the inception of the field. According to Stewart and Tipple, “A student-centered…program of health education for every student is a vital part…” of the college level experience (1954, p. 106). It is further stated that health education “assists materially in the development of the potential capacities of each student” (Stewart and Tipple, 1954, p. 106). These statements require validation and thus assessment and evaluation. Stewart and Tipple speak of using scientific methods of evaluation to justify health education programming (1954). One of the main goals for assessing student health programs is to see if student knowledge of health has increased. There were a variety of ways which student health professionals could assess student success including: “questionnaires, health interest inventories, student health autobiographies, and summaries of student health records” (Stewart and Tipple, 1954, p. 110). In 1937, assessment evolved from a process which considered the “adequacy of personnel, facilities, equipment and administrative provisions…” to a process which gave “primary consideration to the effects of health teaching and health service programs in terms of their adequacy in meeting the needs of the student body” (National Conference on College Hygiene, 1937, p. 45).
Teaching and Learning
In the early 1900’s, student health education programs were focused on student learning (National Conference on College Hygiene, 1937). Health education sought to develop the mind and body of the student and this form of education was considered as “one of the most difficult teaching assignments in the college curriculum” (National Conference on College Hygiene, 1937, p. 36). Constantly changing information, a lack of interest from students, and resistance to change provided health educators with a challenging teaching assignment (National Conference on College Hygiene, 1937).
College health programs have evolved considerably since 1861. Accreditation plays an important part in this area. Health educators are increasingly becoming Certified Health Education Specialists (CHES). 80% of all colleges and universities in the United States have “some organized arrangement for advancing [student] health” (Miller et al, 2003, p. 83). The principal associations for college health are the American College Health Association and the American Public Health Association. Budgeting, assessment/evaluation, and teaching/learning continue to be areas in which college health practitioners need to have proficiency.
The economic climate in which college health programs exist is one that is filled with uncertainty and opportunity. Funding sources are no longer limited to university general funds and student fee revenues. Grant funded programs can now supplement or increase overall service offerings (Turner and Hurley, 2002). College health programs can have multi-million dollar budgets especially when health education services are incorporated into “multi-specialty clinics” which offer services to “students, faculty, staff, spouses, dependents, and in some cases, the general public” (Turner and Hurley, 2002, p. 43).
Assessment and Evaluation
Assessment and evaluation are extremely important to a practitioner in a college health program. Turner and Hurley state that the evaluation of student health services should include the following questions: “How many students are utilizing the services? Are students satisfied with the services received? Are the program objectives being accomplished? Are the objectives being accomplished in the most cost-efficient manner?” (2002, p. 65). According to Hayden, college health programs should “plan on assessment”, “carry out evaluation of plans”, “interpret results of program evaluation”, and “infer implications from findings for future program planning” (2000, p. 7).
Teaching and Learning
College health educators are by default, teachers. They teach a specialized topic which can have a major impact on student success (Damush, Hays, and DiMatteo, 1997). According to Miller et al, a college health program “must provide evidence of its impact on the achievement of student learning and development outcomes” (2003, p. 86). Furthermore, a college health program and its practitioners “must be based on theories and knowledge of learning and human development” (Miller et al, 2003, p. 87). According to the International Association of Student Affairs and Services Professionals (IASAS), college health programs should provide “information on health issues specifically involving the college age student, e.g., sexually transmitted diseases, stress, diet, depression” (2001, p.41).
In 1998 the college health education Competency Update Project (CUP) was started by the National Commission for Health Education Credentialing. The project will have an impact on the “professional preparation, certification, and professional development” of college health practitioners (NCHEC – About NCHEC – CUP, 2002). The competencies for the college health program practitioner are constantly evolving and changing with the needs and requirements of the students that they serve.
American College Health Association, (2001). The american college health association: a brief history. retrieved Nov. 21, 2004, from ACHA: History Web site: http://www.acha.org/about_acha/history_extended.cfm.
Benjamin, M., & Robinson, J. (1998). Service quality, encounter satisfaction, and the delivery of student health services. Journal of College Student Development, 39(5), 427-437.
Christmas, W. A., & Dorman, J. M. (1996). The “storey” of college health hygiene. Journal of American College Health, 45(1), 27-35.
Damush, T. M., Hays, R. D., & DiMatteo M. R. (1997). Stressful life events and health-related quality of life in college students. Journal of College Student Development, 38(2), 181-190.
Hayden, J. (2000). The health education specialist: a study guide for professional competence. 4th ed. Allentown, PA: NCHEC.
Hughes, W. (1932). The administration of health and physical education for men in colleges and universities. New York City, NY: Bureau of Publications: Teachers College, Columbia University.
International Association of Student Affairs and Services Professionals. (2001). The role of student affairs and services in higher education: a practical manual for developing, implementing, and assessing student affairs programmes and services. R. Ludeman (Ed.).
Komives, S., Woodard, Jr., D., & associates. (2003). Student services: a handbook for the profession. 4th ed. San Francisco: Jossey-Bass.
Miller, T. (Ed.). (2003). The book of professional standards for higher education. 3rd ed. Washington, DC: Council for the Advancement of Standards in Higher Education.
National Commission for Health Education Credentialing, (2002). Nchec – about nchec — cup. retrieved Nov. 21, 2004, from http://www.nchec.org/aboutnchec/cup/cuphistory.htm.
National Conference on College Hygiene. (1937). Health in colleges. Proceedings of the second national conference on college hygiene. New York, NY: National Tuberculosis Association.
Sloane, D. C., & Sloane, B. C. (1986). Changing opportunities: an overview of the history of college health education. Journal of American College Health, 34, 271-273.
Stewart, E., & Tipple, D. (1954). How student health can be influenced through health education. Proceedings from the fourth national conference on health in colleges (pp. 106-116). American College Health Association.
Turner, H., & Hurley, J. (2002). The history and practice of college health. Lexington, KY: The University Press of Kentucky.
Weaver, M., & Marty F. (1947). Objectives, finances, housing, and equipment, staff, services, and records. A health program for colleges (pp. 27-39). National Tuberculosis Association.