Maricopa County in Arizona is big. Encompassing the Phoenix metropolitan area, the area has 4 million people making it the fourth most populous county in the country. With 58 school districts, the county’s education system is fragmented.
For the county’s public health department, this decentralization in education has made it difficult to implement public health initiatives targeting kids. Superintendents are busy, and getting 58 of them to attend one meeting was impossible.
"We were getting tired of focusing on a top-down approach in our schools, especially since there wasn't an efficient way to reach all 58 of our superintendents," said Jeanene Fowler, program operations administrator at Maricopa County’s Department of Public Health.
So the staff in the department decided to get creative.
“One day in 2011, we just asked: ‘What if we made parents public health ambassadors?'”
In 2012, the county was awarded a Native American tribal grant through revenue from area casinos, then teamed up with University of Arizona’s School of Public Health to create what is now the Parent Ambassadors program. Parents or guardians who currently volunteer in their child’s school or are interested in volunteering are invited to take a 12-hour, two-day training program.
"At first we incentived parents to take part in the program because we didn't know how many parents were going to have the time," said Fowler. "Now we no longer have to; we've found there are a lot of people who want to be active in their child's school."
It was important to be inclusive with the large Hispanic population, so some programs are offered just in Spanish for the roughly 40 percent of Spanish-speaking parent ambassadors, according to Anna David, the program manager for the Office of Public Health Policy at Maricopa County.
The program teaches parents about the ins and outs of Maricopa County bureaucracy, what public health is and the public health issues facing schools, such as obesity, the importance of hand washing and STDs. But public health employees leave it up to the parents to decide what the most pressing health issues are in their child's school.
“Learning the structure of bureaucracy was the most helpful aspect for me," said Jeff Spellman, a volunteer in the first wave of parent ambassadors. "So many parents want to speak up about issues they’re concerned about but have no idea who to talk to."
The issues ambassadors decided to target weren't necessarily conventional public health problems. One school district’s parent ambassadors identified bullying as the most important issue and pledged to commit more volunteers to oversee recess. Since this is Arizona, heat was another issue. One school had recently eliminated recess because of high temperatures, and parents teamed up to find resources for a structured indoor recess.
The program has resulted in important changes in several schools. One school was able to completely reorganize its lunch schedule to combat overcrowded cafeterias, and another has implemented 'morning stretches' to increase physical activity.
There isn't any specific evidence that points to an overall healthier school system since the program was implemented but, "our school staff often don't have time to address these issues. So having parent volunteers identify problems has become instrumental in improving the school environment," said David.
“In my particular school district, we were concerned about the amount of food that was being wasted on a daily basis -- especially since there are some kids who only receive square meals during the school day,” said Spellman. So the schools implemented ‘sharing tables’ where kids were able to give away unwanted food.
The county using its parents as its best public health resource is novel, but Fowler admits the program is limited. After all, there are about 500 parent ambassadors for a county with 700,000 children.
“We’ve been thinking a lot about how we can keep parents engaged even after they’ve come up with an action plan. We’re also eager to expand beyond schools, but unsure the best way to do that -- there’s been some discussion of implementing similar initiatives in faith-based settings,” she said.
Fowler also believes this program could show other places with fragmented school districts what to do -- as long as they create programs to address the specific needs of their own counties
“It’s refreshing seeing such a huge county make these sorts of efforts for the health of its children. It would be hard to believe that the groundwork that’s been laid couldn’t be implemented elsewhere,” Spellman said.
“Sometimes all it takes is seeing success somewhere else, and realizing it can be implemented where you are,” he said.