A complementary ecological model of the coordinated school health program.

A complementary ecological model of the coordinated school health program (CSHP) reflecting 20 years of evolved changes is proposed. Ecology refers to the complex interrelationship among intrapersonal factors, interpersonal processes and primary groups, institutional factors, community factors, and public policy. Public health and child development theories that incorporate the influence of personal and social environments on health behavior, along with models that incorporate the influence of ecology, were consulted. Concepts from several models were combined with the eight components of CSHP to formulate an ecological model involving six program and services components in an inner circle surrounded by four concentric rings representing the healthy school environment, essential structures of CSHP, local school district governance, and family and community involvement. This complementary ecological model is intended to serve as an additional conceptual approach to CSHP practice, evaluation, and research, and should prove especially useful to practitioners and researchers who already have a fundamental understanding of CSHP.