Healthy People 2020: Educational and Community-Based Programs

Taylor Mills and Lara Nasser

PTH 825

Objectives: Community-Based Programs

ECBP-2.9: Increase the proportion of elementary, middle, and senior high schools that provide
comprehensive school health education to prevent health problems in inadequate physical
activity
ECBP-19: Increase the proportion of academic institutions with health professions education
programs whose prevention curricula include interprofessional educational experiences

Search Engine Strategies Used:

ERIC because this is a database involving health education and may have information on our
population of elementary, middle, and senior students.
CINAHL and PubMed are databases with information about physical education, sports,
interprofessional collaboration/education and multiple allied health professions.
We also used government and national association journal articles such as the Centers for
Disease Control, American Physical Therapy Association, the State of Obesity and the World
Health Organization for background information on community-based programs, physical
activity and statistical information for both objectives.
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There has been a dramatic increase in the use of electronics and a decrease in physical

activity for recreation within the past 20 years.1 In 2017, 43% of high school students in the

United States spent three or more hours using a computer for video games or social media.1

There has also been a reduction in high school student participation in physical and health

education classes with only 51.7% of students attending these classes at least once per week in

2017.1 These two factors, reduced physical education and increased technology use, have likely

contributed to only 26.1% of six to nineteen-year-old students meeting the recommendation of at

least sixty minutes of physical activity at least five days per week.1,2

Physical inactivity within the United States is leading to more health comorbidities, such

as cardiovascular disease, type II diabetes, cancers, and low bone density.2 Physical inactivity in

children and adolescents can specifically contribute to health complications involving energy

imbalance, early obesity, and developing risk factors for diseases later in life.2 There is a need

for physical inactivity to be addressed within schools and communities.1-3 Health and wellness

promotion for youths and adolescents may be a great starting point and physical therapists can

play a role in addressing physical inactivity.

In states with direct access, physical therapists (PTs) are considered primary healthcare

providers and focus on patient education, prescribing exercise, and promoting health and

wellness.4,5 All of these actions are within a physical therapist’s scope of practice and it is their

active duty to help their patients. Physical therapists have the potential to address some of the

objectives discussed in the Healthy People 2020,3 such as increasing health education to

elementary, middle, and high school students to promote physical activity and prevent healthcare

problems associated with inactivity.

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Physical therapists can promote many health topics to their patients, but physical activity

has been found to be the “most important and effective intervention.”6 (p.4) Dr. Janet Bezner,

DPT,6 discussed seven evidence-based steps on how physical therapists could address physical

inactivity with their patients to promote a more active lifestyle.6 Some of the steps included

educating patients on the benefits of exercise, informing patients on the current

recommendations for physical activity based on their age, promoting self-efficacy and goal

setting with physical activity, identifying individual barriers and finding strategies to prevent

exercise discontinuation, and helping patients build a support system.6 These steps could be used

by physical therapists in all settings to promote health and wellness to their patients and may

help to address the Healthy People 2020 objective involving promotion of health and prevention

of diseases involved with physical inactivity for youth and adolescent students.3,6

Other studies have looked directly into perceptions of physical therapists who work in the

school setting and their strategies on addressing childhood obesity while at school, such as

Kendall's7 longitudinal study. Surveys were completed in 2005 and then again in 2015. Attitudes

supporting PT intervention to fight childhood obesity increased as physical therapists had more

exposure to obesity-related work and many physical therapists believed they could intervene to

help prevent obesity.7

There are multiple existing strategies that PTs can use to address physical inactivity in

elementary, middle, and high school students while promoting health education in school. As

movement experts, physical therapists can partner with physical educators and health instructors

in schools to help students develop skills and habits to stay physically active.8 Physical therapists

could develop fitness programs for students, help administer fitness tests in schools, and teach in

classes to educate and promote health to youth and adolescent students.8 Along with educating
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the students, PTs can also educate teachers, administrators, and parents on ways to increase

physical activity during school hours and at home. They could hold conferences, hand-out

brochures, and be available for consultation with students, faculty, and parents.8 As healthcare

professionals, PTs can provide recommendations for physical activity in all age groups, try to

link activity to the learning environment, inform others of the long-term benefits of exercise, and

discuss ways to incorporate more active breaks into the classroom setting.8

PTs can also offer health education through outside school activities by becoming

involved with community-based afterschool programs, such as clubs, student groups, and sports

programs.8 This is an option for PTs who may not directly have contact with a school but do

want to get involved with the community and help promote health education to the youth.

Overall, PTs should aim to promote health and wellness by involving physical activity and

encouraging individuals to be less sedentary6 and hopefully, this information can carry over from

school and be implemented in students’ homes and in the community.

The suggested strategies listed above do comply with various documents that are set forth

by the American Physical Therapy Association (APTA). The APTA’s Code of Ethics for the

Physical Therapist discusses how PTs should empower their patients to make decisions about

their health care and provide the necessary information to make these informed decisions.4 The

Code of Ethics also states that PTs have a social responsibility to educate community members

on the benefits of physical therapy, advocate to reduce health disparities, and address patient

concerns involving health, wellness, and prevention.4

The APTA also has a policy document called, Physical Therapists’ Role in Prevention,

Wellness, Fitness, Health Promotion, and Management of Disease and Disability, which states

that it is within a PTs scope of practice to provide health education and promotion to their
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patients, including elementary, middle, and high school students.5 Within this document,

strategies are discussed to work in communities, conduct screening programs, and try to prevent

diseases for “individuals and populations of all ages.”5 (p.1) Specifically, it states that physical

therapists should “advocate for physical education, physical conditioning, and wellness

instruction at all levels of education, from preschool through higher education.”5 (p.2) There is

also a statement about promoting physical activity to improve the health of individuals and

prevent diseases, thus this APTA document clearly shows that PTs have an important role to

bring awareness to community-based programs in order to promote health to students.5

Lastly, the Academy of Pediatric Physical Therapy has a fact sheet that discusses reasons

why PTs should use health promotion strategies with pediatric patients both in and out of a

school setting.9 It also discusses health promotion strategies and interventions that PTs can use

with young individuals who may or may not have disabilities. Interventions can help to improve

students’ strength, reduce obesity, incorporate aerobic exercise, or offer additional resources to

the child and their family.9 Some of these interventions can include healthcare professionals

within an interdisciplinary team.

The World Health Organization conducted an international environmental scan to

determine the current status of interprofessional education in 42 countries.10 Results indicated

that only 10.1% of physiotherapy institutions incorporated interprofessional education. Healthy

People 20203 stated that 33.3% of academic institutions with health profession programs

included interprofessional education. Currently, there is limited exposure to interprofessional

education within academic institutions although research has shown that collaborative practice

can improve health outcomes for individuals who have chronic diseases, increase patient care

and safety, and decrease the length of hospital stay. Implementing interprofessional education
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and collaborative practice can help to change the interactions of healthcare professionals to

deliver better quality care.10

The American Physical Therapy Association encourages interprofessional education and

collaborative practice by encouraging the integration of core competencies into practice and

education initiatives.11 The core competencies are values/ethics for interprofessional practice,

roles/responsibilities, interprofessional communication, and teamwork.11 The core competencies

originated from the Interprofessional Educational Collaborative (IPEC) and was formed to

promote and encourage interprofessional learning in order to help prepare future health

professionals for enhanced team-based care.12 The American Council of Academic Physical

Therapy (ACAPT) is an IPEC national member and the core competencies can be widely

applicable towards the field of physical therapy.12

It is valuable to determine the effectiveness of interprofessional education in order to

have implementation in academic institutions. Kim et al13 conducted a study regarding the

effectiveness of interprofessional education (IPE) between physical therapy, occupational

therapy, and physician assistant graduate students on a fall risk prevention. The IPE objectives

involved the four core competencies by the IPEC. The graduate students were asked to discuss

their programs curriculum and then to discuss the best assessment tools to administer to

individuals who are at risk of falls. The study found significant improvements in

interprofessional attitudes regarding teamwork, shared learning, and responsibilities from all

three disciplines. The students also reported gaining more knowledge about other professions.

Researchers concluded that incorporating an IPE with a common objective, such fall risk

prevention, can improve teamwork, achieve a common goal, and should be implemented in

institutions that do not have a formal interprofessional curriculum.13

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In 2015, Wise et al14 conducted a study to determine the amount of IPE that was

implemented in the curriculum of physical therapy institutions in the United States. 106

institutions responded to a survey created by the researchers regarding the use of IPE, and it was

reported that 58.5% of the institutions identified IPE as a focus of physical therapy curriculum.

Researchers asked the institutions to explain what plan was used to address the interprofessional

education and 63.2% identified classroom courses that encompassed teamwork and

responsibilities as the method of educating students. A follow-up survey was distributed, and

researchers learned that 50% of institutions stated that interprofessional competencies were not

addressed during the PT students’ clinical experiences. The researchers concluded that to

advance and sustain IPE within higher education a strong institutional support is required.

Reported challenges of implementing IPE included faculty resources, schedules across

disciplines, awareness and importance of IPE, and funding. Additional effort needs to be directed

toward developing strong partnerships with higher education institutions to advance

collaborative practice.14

In accordance with the APTA's Code of Ethics, a physical therapist has moral

responsibilities and ethical obligations to maintain within the profession.4 A unique role of a PT

is the amount of time that is spent with patients. PTs have the ability to dedicate time to answer

questions regarding the patient’s care and provide education on the different roles that healthcare

providers can play in the individual’s continuum of care. With the enactment of direct access,

PTs have the ability to treat patients at the primary level, which means a greater push for patient

education as PTs can be the patient’s first healthcare resource.15 Consequently, this would lead to

a greater collaborative effort between healthcare providers. A PTs scope of practice encompasses

rehabilitation, performance enhancement, and prevention and risk-reduction services.16 All of

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which could be enhanced through interprofessional education and collaborative efforts. A

fundamental core value of the APTA is excellence, which encompasses integrative and

collaborative practice to promote high quality health and educational outcomes.17 PTs can assist

other healthcare professionals to bridge the gap between healthcare providers and patients

through education and knowledge.

Educational and community-based programs have been proven to increase the

effectiveness and quality of care to prevent disease and injury, improve health, and enhance the

patient’s quality of life.3 Physical therapists can play an active role in addressing these objectives

by promoting health and wellness to individuals and by participating within an interdisciplinary

team through involvement in community-based programs. Community-based programs are a

vital component to improving overall healthcare and should be implemented more within the PT

profession.
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References

1.The State of Obesity. Physical activity among U.S. high school students (1991-2017).
https://www.stateofobesity.org/high-school-physical-activity/. Published 2018. Accessed July 5,
2019.

2. Centers for Disease Control and Prevention. Physical activity facts.

https://www.cdc.gov/healthyschools/physicalactivity/facts.htm. Published April 9, 2018.
Accessed July 5, 2019.

3. Healthy People 2020. Educational and Community-Based Programs.

https://www.healthypeople.gov/2020/data-search/Search-the-Data#objid=4230.Updated July 6,
2019. Accessed on July 7, 2019.

4. American Physical Therapy Association. Code of Ethics for the Physical Therapist. APTA.
https://www.apta.org/uploadedFiles/APTAorg/About_Us/Policies/Ethics/CodeofEthics.pdf.
Updated on June 6, 2019. Accessed on July 1, 2019.

5. American Physical Therapy Association. Physical Therapists’ Role in Prevention, Wellness,

Fitness, Health Promotion, and Management of Disease and Disability.
http://www.apta.org/uploadedFiles/APTAorg/About_Us/Policies/Practice/PTRoleAdvocacy.pdf.
Updated September 2, 2016. Accessed July 6, 2019.

6. Bezner JR. Promoting health and wellness: implications for physical therapist practice. Phys
Ther. 2015;95(10):1433-1444. doi: 10.2522/ptj.20140271.

7. Kendall E. Trends in attitudes and practice patterns of physical therapists in addressing

childhood obesity in schools. Pediatr Phys Ther. 2018;30(1):40-48.
doi:10.1097/PEP.0000000000000466.

8. McClary King K, CHES, Terson de Paleville D. Partnering with schools to implement

physical activity interventions. ACSM’s Health & Fitness Journal. 2018;22(2):38-41.
https://www.researchgate.net/publication/323476376_Partnering_with_Schools_to_Implement_P
hysical_Activity_Interventions. Accessed July 5, 2019.

9. Academy of Pediatric Physical Therapy. Fact sheet: The role and scope of pediatric physical
therapy in fitness, wellness, health promotion, and prevention.
https://pediatricapta.org/includes/fact-
sheets/pdfs/12%20Role%20and%20Scope%20in%20Fitness%20Health%20Promo.pdf.
Published 2012. Accessed July 6, 2019.

10. The World Health Organization. Framework for Action on Interprofessional Education and
Collaborative Practice. WHO. 2010;10-20.
https://www.who.int/hrh/resources/framework_action/en/. Accessed on July 1, 2019.
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11. American Physical Therapy Association. Interprofessional Education and Collaborative

Practice Resources. APTA. https://www.apta.org/Educators/Curriculum/Interprofessional/.
Updated on April 24, 2019. Accessed on July 5, 2019.

12. Interprofessional Education Collaborative. What is Interprofessional Education (IPE).

IPEC. https://www.ipecollaborative.org/about-ipec.html Updated in 2019. Accessed on July 7,
2019.

13. Kim Y, Radloff J, Stokes K, Lysaght C. Interprofessional education for health science
students’ attitudes and readiness to work interprofessionally: a prospective cohort study. Braz J
Phys Ther. 2018;1-9. doi:10.1016/j.bjpt.2018.09.003

14. Wise H, Frost J, Resnick C, Davis B, Iglarsh A. Interprofessional education: an exploration

in physical therapists education. J Phys Ther Educ. 2015;29:72–83.
https://www.pacific.edu/Documents/school-
pharmacy/Interprofessional%20Education_An%20Exploration%20in%20Physical%20Therapist
%20Education.pdf. Accessed on July 3, 2019

15. American Physical Therapy Association. Direct Access: How It Can Change Your Practice.
APTA. http://www.apta.org/DirectAccess/HowItCanChangeYourPractice/. Updated on June 25,
2015. Accessed on July 6, 2019.

16. American Physical Therapy Association. Professionalism in Physical Therapy: Core Values.
APTA.http://www.apta.org/uploadedFiles/APTAorg/About_Us/Policies/BOD/Judicial/Profession
alisminPT.pdf. Updated on December 14, 2009. Accessed on July 6, 2019.

17. American Physical Therapy Association. The Physical Therapist Scope of Practice. APTA.
http://www.apta.org/ScopeOfPractice/. Updated on April 5, 2019. Accessed on July 2, 2019.

18. Cox M, Cuff P, Brandt B, Reeves S, Zierler B. Measuring the impact of interprofessional
education on collaborative practice and patient outcomes. J Interprof Care. 2016;30:1-3.
doi:10.3109/13561820.2015.1111052

Individual Roles of Authors: Taylor Mills & Lara Nasser

•Both chose a topic on Healthy People 2020 and decided on 2 objectives we were both
interested in.
•Taylor wrote about Objective 1 and Lara wrote about Objective 2. Then we came
together to reread both parts and make edits and discuss main topics. After this revision,
we worked together to make a conclusion.
•We both worked on our AMA reference page and made necessary edits.
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Individual Assignment
a. Write a thoughtful statement regarding why a physical therapist would be an appropriate
person to include on the consulting team/committee.
Healthy People 2030’s mission statement is “to promote, strengthen and evaluate
the Nation’s efforts to improve the health and well-being of all people.”1 (p.1) A physical therapist
(PT) would be a valuable addition to this committee because they are movement experts with an
overall goal to promote patient education on health and wellness. In most states, physical
therapists have direct access and are considered primary healthcare providers. They are
knowledgeable on multiple body systems and have the background to educate community
members on ways to improve their health. PTs can assist the Healthy People 2030 committee in
developing strategies and resources to provide to the community on ways to optimize their health
and prevent diseases.
b. Indicate a NEW area related to health in which physical therapists could be
involved/consult/give expert opinion (provide one piece of evidence from the literature regarding
this need.)
PTs can perform wound evaluation, treatment, and help with the prevention and
management of multiple types of wounds in various healthcare settings. Healthy People 2020 has
a topic on Diabetes, which discusses diabetic ulcers, but they do not have a specific topic on
wound care or management. Physical therapists could be consulted to provide information on the
topic of wound management stemming from an array of health comorbidities, such as diabetes,
cardiovascular disease, or immobility-related ulcers. The committee would heavily benefit from
having PT clinical wound care specialists on their team to provide expert opinions. Turan,
Ertugrul, Lipsky, and Bayraktar2 reviewed randomized control trials and cohort studies and
found multiple physical therapy interventions that may help with the treatment of diabetic foot
ulcers, including thermal modality use, electrotherapy interventions, shoe modifications, and
therapeutic exercise. This article concluded that although diabetic foot ulcers are a
multidisciplinary approach, it is beneficial to have physical therapists help with the intervention
and management of diabetic wounds.2
References
1.) Healthy People 2030. Healthy People 2030 Framework.
https://www.healthypeople.gov/2020/About-Healthy-People/Development-Healthy-
People-2030/Framework.Updated July 6, 2019. Accessed on July 8, 2019.

2.) Turan Y, Ertugrul BM, Lipsky BA, Bayraktar K. Does physical therapy and rehabilitation
improve outcomes for diabetic foot ulcers? World J Exp Med. 2005 May 20;5(2):130-
139. Doi: 10.5493/wjem.v5.i2.130.