Abstract
The health education profession is committed to maintaining the highest standards of quality assurance, including accreditation of professional preparation programs in both school and community/public health education. Since 2001, the Society for Public Health Education (SOPHE) has increased attention to strengthening accreditation processes for preservice programs. This article focuses on the preparation of school health educators and the evolving philosophies and approaches concerning quality assurance, with particular attention to recent changes in teacher education and national professional accreditation entities. The unification of the National Council for Accreditation of Teacher Education (NCATE) and the Teacher Education Accreditation Council (TEAC) to form the Council for the Accreditation of Educator Preparation (CAEP) as the single voice for teacher accreditation presents an opportunity to create a model unified accreditation system. Such a system can improve and enhance the stature of the teaching profession, raise expectations and the performance standards for teacher education candidates, and strengthen the standards for the evidence used to support claims of quality. During this transition period from NCATE and TEAC to CAEP, a School Health Education Accreditation Working Group convened by SOPHE recommended to the SOPHE Board of Trustees that SOPHE urge health education professionals to monitor and provide input into the emerging standards and processes for school health educator program accreditation. The Working Group also recommended that both health education professionals and the stakeholder professional organizations advocate for strong quality assurance standards for school health educator professional preparation programs. The Working Group anticipates future changes in quality assurance processes and curricula to keep pace with new accreditation requirements and the results from the latest role delineation research for health education specialists.
University programs to prepare health educators for work in schools first emerged in the late 19th century (Allegrante et al., 2004). Since then, the health education profession has evolved and in the past 40 years has made significant progress in promoting quality assurance and program accreditation (Allegrante et al., 2004; Bernhardt et al., 2003; Cottrell, Auld, et al., 2012; Cottrell, Lysoby, et al., 2009; Taub, Allegrante, Barry, & Sakagami, 2009; Taub, Birch, Auld, Lysoby, & King, 2009). The Council for Higher Education Accreditation (CHEA, 2010) defines accreditation as both a process and a status. It is the process of reviewing colleges, universities, institutions and programs to judge their educational quality—how well they serve students and society. The result of the process, if successful, is the award of “accredited status.” (p. 1)
The benefits of accreditation are presented in Table 1. An overview of credentialing for school health educators and professional preparation programs in school health education is presented in Figure 1.
Benefits of Accreditation.
Note. CHES = certified health education specialist.

Overview of health education credentialing in the United States
Recent developments in teacher education and accreditation are altering accreditation standards and processes of professional preparation programs for school health educators. In this article, we provide a brief history of quality assurance in the preparation of school health educators, describe accreditors of professional preparation programs in school health education, discuss the role of professional associations such as the Society for Public Health Education (SOPHE) and state governments in the accreditation process, and conclude with recommendations for the future made by the SOPHE School Health Education Accreditation Working Group.
The Changing Landscape
National changes over the past decade are shaping the preparation of school health educators. In particular, new developments in teacher education, new accreditation standards, and the expanded reliance on data (Rogers, Vossoughi, & Fanelli, 2011; Sawchuk, 2013c) reflect the changing educator preparation system and a renewed commitment to quality assurance in educator preparation. Attention now focuses on understanding and assessing the impact of educator preparation and professional development of teachers on P-12 student learning and development, particularly focusing on greater accountability (American Council on Education [ACE], 2012; Brabeck & Koch, 2013; Council for the Accreditation of Educator Preparation [CAEP], 2013b). Educator preparation providers (EPPs) and accreditors are striving to improve EPP quality and the performance of teacher education graduates through new standards that address how programs select, prepare, and measure the success of their graduates (CAEP, 2013b; Ginsberg & Levine, 2013; Sawchuk, 2013a).
Historically, critics claimed that accreditation focused too much on educational outcomes that intruded on institutional autonomy and academic freedom (ACE, 2012). Thus, accreditors modified their approach to recognize the educational distinctiveness of EPPs (ACE, 2012) and increased their reliance on faculty to define what teacher education candidates should learn in order to teach in their specific discipline (ACE, 2012). Accreditors are moving toward institutionally specific assessment of student achievement to assure quality (ACE, 2012). The result is more emphasis on evidence from a variety of sources to support accreditation decision-making (ACE, 2012; Brabeck & Koch, 2013; Sawchuk, 2013b).
CAEP proposes that a shift in emphasis of accreditation standards from process to outcomes and performance will help ensure quality, rather than relying solely on the capacity or reputation of the institution or program (CAEP, 2013b; LaCelle-Peterson & Rigden, 2012). By focusing on outcome measures to assess the quality of educator preparation, CAEP expects a positive impact on P-12 student learning and development (Brabeck & Koch, 2013; CAEP, 2013b). The changes in educator preparation, accreditation standards, and reliance on data are all expected to strengthen quality assurance in educator preparation.
Quality Assurance in Health Education
Quality assurance in the health education profession occurs through credentialing at both the individual practice level (e.g., certification) and the professional preparation level (e.g., program accreditation), as shown in Figure 1. Certification of health education specialists is the responsibility of the National Commission for Health Education Credentialing, Inc. (NCHEC), which administers the Certified Health Education Specialist (CHES) and Master Certified Health Education Specialist (MCHES) credentials. School health educators can also seek national certification through the National Board of Professional Teaching Standards. To be employed in schools, school health educators, in most instances, must possess state certification from their state education agencies.
Historically, three different bodies have accredited health education professional preparation programs. The Council on Education for Public Health accredits schools of public health and public health programs outside schools of public health. The National Council for Accreditation of Teacher Education (NCATE) and the Teacher Education Accreditation Council (TEAC) both accredit teacher education programs. Each state grants certification to health education teachers and approves professional preparation programs in its own state. Requirements vary from state to state (some areas of difference include what certification covers in content and grade levels, required coursework, and required continuing education), which supports the need for national efforts to set standards.
A National Task Force on Accreditation in Health Education, convened by SOPHE and the American Association for Health Education (AAHE) between 2001 and 2003, concluded that the profession needed a coordinated system of quality assurance for both community/public health education and school health education (Allegrante et al., 2004). Two successive task forces, the National Transition Task Force on Accreditation in Health Education (2004-2006) and the National Implementation Task Force for Accreditation in Health Education (2007-present), continued to pursue this goal (Allegrante et al., 2004; Cottrell, Auld, et al., 2012; Taub, Birch, et al., 2009), engaging discourse across the health education profession (Clark, 2009; Taub, 1994; Taub, Birch, Auld, & Cottrell, 2011).
Some institutions of higher education offer combined teacher preparation programs for both health educators and physical educators. However, neither the health education nor the physical education disciplines recommend combined programs (Cobb, 1981; Hillman et al., 2010; National Association for Sport and Physical Education [NASPE], 2004, 2008; Pigg, 1978). The National Task Force on Accreditation in Health Education recommended the following: “If a dual teacher [health education and physical education] certification program is in place, health education is to be reviewed as a separate program” (Allegrante et al., 2004, p. 677). The content knowledge and pedagogical skills for teaching physical education and classroom-based health education are distinct. Also, the current health education and physical education P-12 student standards defining what students should know and be able to do have few similarities (Joint Committee on National Health Education Standards, 2007; NASPE, 2004). Providing prospective teachers with adequate opportunities to become proficient in both physical education and health education requires more than the traditional 4-year undergraduate teaching course of study. Having different standards for both P-12 student outcomes and teacher preparation in health education and physical education, thus, dictates the need for discipline-specific experts as reviewers of program reports.
With the formal dissolution of AAHE in 2013, SOPHE President Kelli McCormack Brown requested that SOPHE’s National Implementation Task Force for Accreditation in Health Education organize a special Working Group on School Health Education Accreditation with the following charge:
To develop short- and long-term recommendations for SOPHE’s role in strengthening the field of accreditation of professional preparation programs in school health education.
The individuals serving on the Working Group possess extensive knowledge of and track record of publication in quality assurance for health education, plus a history of involvement with SOPHE and AAHE. Cochairs of the Working Group were John P. Allegrante, PhD, Columbia University; and David A. Birch, PhD, MCHES, The University of Alabama. Other work group members included Alyson Taub, EdD, MCHES, New York University; Susan Goekler, PhD, MCHES, Directors of Health Promotion and Education; Susan Muller, PhD, MCHES, Murray State University; Deitra Wengert, PhD, MCHES, Towson University; and M. Elaine Auld, MPH, MCHES, SOPHE. The Working Group members authored this article to disseminate the group’s findings and recommendations.
Accreditors of Teacher Preparation Programs
The U.S. Department of Education and the CHEA recognize two organizations as professional accrediting bodies for teacher preparation, NCATE and TEAC (CHEA, 2013). Founded in 1954, NCATE replaced the American Association of Colleges for Teacher Education as the agency responsible for accreditation in teacher education (NCATE, 2013a). In 1997, TEAC became a second accrediting agency for educator preparation programs. Since then, both NCATE and TEAC accredited teacher preparation programs, including those training school health educators. In 2010, NCATE and TEAC unified to become CAEP (CAEP, 2010, 2013a). This transition from NCATE or TEAC accreditation to CAEP accreditation will take several years. During the transition, NCATE and TEAC are subsidiaries of CAEP for the purpose of maintaining the accreditation of EPPs until the EPPs are due for reaccreditation under CAEP.
NCATE
NCATE accredits educator preparation units within institutions of higher education and recognizes discipline-specific programs (e.g., health education, science education, language arts). NCATE’s performance-based system of accreditation requires institutions involved in educator preparation, including institutions of higher education as well as alternative certification pathways, to meet six unit standards. These standards include the following: (a) Candidate Knowledge, Skills, and Professional Dispositions; (b) Assessment System and Unit Evaluation; (c) Field Experiences and Clinical Practice; (d) Diversity; (e) Faculty Qualifications, Performance, and Development; and (f) Unit Governance and Resources (NCATE, 2013b). NCATE has formal relationships with professional associations to serve as Specialized Professional Associations (SPAs). The SPAs establish the professional standards that guide curricula in discipline-specific teacher preparation programs. The American Alliance for Health, Physical Education, Recreation and Dance (AAHPERD) was recognized as the SPA for both Health Education and Physical Education; two different associations within AAHPERD, the AAHE and the NASPE, were responsible for each discipline. After a reorganization of AAHPERD in April 2013, AAHE and NASPE were disbanded. AAHPERD moved forward as a new organization, without discipline-specific associations. The dissolution of a health education specific entity within AAHPERD raises concerns within the Coalition of National Health Education Organizations and SOPHE about quality assurance in school health education professional preparation.
TEAC
TEAC accredits undergraduate and graduate programs that prepare professional educators for pre-K through Grade 12 “based on (a) the evidence they prepare competent, caring, and qualified professional educators and (b) their capacity to monitor and improve the program’s quality” (TEAC, 2012, p. 1). TEAC recognizes that programs approach the preparation of professional educators in different ways: “. . . in the TEAC system, a single program may include several license areas, options, and levels if they share a common logic, structure, quality control system, and similar and comparable categories of evidence” (TEAC, 2012, p. 7). If an EPP offers different curricula to prepare teachers, the EPP may bundle the curricula into a single program for TEAC accreditation. To receive TEAC program accreditation, an EPP must satisfy three Quality Principles: I: Evidence of candidate learning, II: Evidence of faculty learning and inquiry, and III: Evidence of institutional commitment and program capacity for quality (TEAC, 2012, p. 2). When analyzing a given discipline’s curriculum and requirements, TEAC relies on the standards developed by professional societies in the various teacher education specialties. Faculties specify which standards guide their course of study in presenting their case for meeting Quality Principle I.
CAEP
As of July 1, 2013, NCATE and TEAC officially consolidated so that CAEP is now the new, sole specialized accreditor for educator preparation. The creation of CAEP provides an opportunity to create a unified accreditation system that raises the performance standards of teacher education candidates, the stature of the teaching profession, and the standards for the evidence that supports claims of quality. “CAEP accreditation is specific to educator preparation and is different from regional accreditation. It is the educator preparation provider, specifically, that receives CAEP accreditation—not the larger organization or institution of higher education that may house the provider” (CAEP, 2013c, p. 1). In August 2013, the CAEP Board of Directors approved new Accreditation Standards (CAEP, 2013b). These standards
will move providers from a process-oriented system of accountability to one that measures improvement against desired student outcomes, from inclusive to highly selective admissions, and from theoretical, academic preparation to an emphasis on pedagogy and clinical practice learned from hands-on experience in schools. (Brabeck & Koch, 2013, p. 1)
A broad cross section of stakeholders developed these new expectations for educator preparation.
The CAEP accreditation process includes a self-study, site visit, and peer review. EPPs have a choice of three accreditation pathways (Continuous Improvement, Inquiry Brief, Transformation Initiative) for the self-study and report (see Table 2 for a description of each accreditation pathway). All pathways require EPPs to meet CAEP’s Standards for Accreditation of Educator Preparation (CAEP, 2013b). Thus,
the CAEP review includes all specialty areas that prepare candidates to work in preschool through grade 12 settings and lead to a professional license, certificate, or endorsement; it also includes graduate and non-certification programs for licensed educators who are extending their knowledge and skills for working in school settings. Programs that lead to endorsements, add-ons, or their equivalent for which its state or country requires national or state program review must be included in the CAEP self-study report. (CAEP, 2013d, p. 2)
CAEP Accreditation Pathways.
Note. CAEP = Council for the Accreditation of Educator Preparation; EPP = educator preparation provider.
Source. CAEP (2013d, p. 3).
During the transition, EPPs in the review process through NCATE or TEAC will have the option of using the new CAEP standards and procedures or the NCATE or TEAC standards currently in existence. The CAEP website states,
Educator Preparation Providers (EPPs) with accreditation visits scheduled for January 2014 through Spring 2016 may choose to write the self study and host the visit with a) NCATE Standards or TEAC Quality Principles
State Governments
Each state decides how it will regulate educator preparation in the state. Some states have only a state program approval process, whereas others have a state program approval process plus a partnership agreement with a national accreditor, such as CAEP. CAEP is negotiating new agreements with states that will replace previous agreements with NCATE and TEAC. Under these agreements, states may offer EPPs three review options:
CAEP Program Review with SPA Standards
CAEP Program Review with Feedback
State Review by State Authority (CAEP, 2013d)
These options combine features of prior arrangements with either NCATE or TEAC.
Role of Professional Organizations
In the field of health education, professional organizations (including associations and other entities) have collectively supported role delineation research; developed professional standards; recruited, trained, and assigned reviewers for accrediting groups; and/or established working groups to monitor and support accreditation. Thus, these organizations have a vested interest in the accreditation process and provide a vital interface between accreditation organizations and the health education discipline.
Role Delineation Research
Because of its role delineation efforts beginning in the late 1970s, the health education profession was the first profession concerned with population-based health to identify specific roles, responsibilities, and competencies (Livingood & Auld, 2001). Health education leaders decided early in the process to define generic roles and responsibilities of health educators, regardless of work setting (Cleary, 1995). These roles and responsibilities form the basis for the certification system for individuals administered by NCHEC, in addition to guiding accreditation standards for undergraduate and graduate professional preparation programs in health education (including school health education) and workforce development.
Since publication of the first research findings to define the role of the health educator (NCHEC, 1985), the health education profession (led by SOPHE, AAHE, and NCHEC) has undertaken two comprehensive, psychometrically validated studies to update the health education model of professional practice to meet requirements of the National Commission of Certifying Agencies, the agency that accredits NCHEC and other programs/organizations that assess professional competence. Using landmark data collected and analyzed from 1998 through 2004, including 4,030 respondents, the findings from the National Health Educator Competencies Update Project (CUP) supported a three-tiered hierarchical model of professional practice for credentialing, preparation, and professional development in health education (Gilmore, Olsen, Taub, & Connell, 2005). Building on CUP study approaches and analyses, in 2008 SOPHE, AAHE, and NCHEC conducted the National Health Educator Job Analysis, which surveyed 1,022 respondents from 49 states, the District of Columbia, and Puerto Rico. The result of the online survey was an updated model of responsibilities, competencies, and subcompetencies for health education specialists and the addition of 133 knowledge items (Doyle et al., 2012).
In 2013, NCHEC and SOPHE launched another study to update and validate the description of entry- and advanced-level health education specialists’ practice and shape the blueprint for credentialing. To ensure that the research reflects current health education practice, the Health Education Specialist Practice Analysis (HESPA) survey assesses the frequency and importance of specific health education skills. Key steps in the HESPA process include the following: (a) interviews of subject matter experts (SMEs), including those in school health, about the current state of professional practice; (b) independent reviews via e-mail of draft updated descriptions of practice by additional SMEs; (c) pilot testing of a questionnaire by health educators from a variety of work settings; (d) refining the questionnaire; (e) disseminating the questionnaire to a large sample of health educators; and (f) analyzing data and reporting results. HESPA will be completed in 2014, with the results formally released in early 2015. The Working Group authors recommend that any revision of health education teacher preparation standards reflect the results of the HESPA.
Professional Standards for Health Education Teacher Preparation 1
In 1985, the document Framework for the Development of Competency Based Curricula for Entry-Level Health Educators (NCHEC, 1985) described the first profession-wide consensus on the responsibilities, competencies, and subcompetencies for entry-level health educators. In establishing professional standards for health education teacher preparation, the Areas of Responsibility and Competencies from the Framework that defined the role of all health educators, regardless of work setting were foundational. An AAHE working group of experienced health education faculty and school health practitioners adapted those responsibilities and competencies to meet NCATE’s requirements for the assessment of teacher candidates in order to demonstrate discipline-specific content and pedagogical and professional knowledge and skills, as well as for application in the school environment. As the NCATE-designated SPA for health education teacher preparation, AAHE sent draft standards to health education professionals as well as to relevant professional associations for input before finalizing the health education teacher professional preparation standards and key elements as found in editions of Guidelines for AAHE/NCATE Review of Health Education Teacher Preparation Programs (AAHE, 2001; Hillman et al., 2010). Table 3 illustrates the similarities between the Health Educator Job Analysis 2010 Areas of Responsibility for the Health Education Specialist and the 2008 Health Education Standards for health teachers. Other than the addition of a content standard for health teachers (Standard I), the two sets of standards align well, assuring that school health educators meet the same quality assurance standards as professionally prepared health educators working in other settings.
HEJA Areas of Responsibility and AAHE/NCATE Health Education Standards.
Note. HEJA = Health Educator Job Analysis; AAHE = American Association for Health Education; NCATE = National Council for Accreditation of Teacher Education; NCHEC = National Commission for Health Education Credentialing; SOPHE = Society for Public Health Education.
SPA Reviews for Health Education
Institutions seeking NCATE approval use the program review process for unit standards, and programs in some states also use the processes for recognition from national SPAs. In applying for national recognition as a school health educator preparation program, faculty prepare a report, including six to eight assessments that provide evidence of teacher candidates’ mastery of these standards. NCATE sends those reports to SPA-selected trained reviewers. In 2013, a total of 56 colleges and universities had nationally recognized school health education professional preparation programs (NCATE, 2013c).
It is unknown whether AAHPERD will maintain AAHE’s requirements for being a reviewer, which included meeting one of the following three specific qualification categories and receiving training on the review process.
Doctoral Health Education Specialist with at least 5 years experience in the preparation of specialists for teacher certification in health education
Certified Health Education Specialist (CHES) with a master’s degree in health education, at least 5 years’ experience teaching health education in a school system, and currently employed as a school health educator or supervisor in a school setting
Certified Health Education Specialist with expertise in curriculum development, a master’s degree in health education, and at least 5 years of experience in a school health education program (AAHE, 2001; Hillman et al., 2010)
Before its dissolution, AAHE had an AAHE/NCATE Review Committee whose members served as auditors. Currently, AAHPERD is relying on experienced AAHE auditors, but the future responsibility is undefined.
School Health Education Accreditation Working Group
The SOPHE School Health Education Accreditation Working Group reaffirmed the original principles of the National Task Force on Accreditation in Health Education, with the following update:
Health education is a single profession, with common roles and responsibilities across various practice settings, including schools.
School health education and physical education are separate and unique disciplines and require distinct quality assurance standards and processes.
All those assigned to teach health education in schools should be professionally prepared in health education.
Teacher education in health education incorporates the knowledge and skills that form a foundation that is common to all health education specialists as well as those competencies specific to schools (pre-K to 12).
CAEP is the national body for quality assurance of teacher education in school health education and works in partnership with the states to achieve that goal.
The health education profession is responsible for assuring quality in professional preparation and practice, including teacher education in school health education.
SOPHE is the sole independent professional association representing health educators in all settings.
Given SOPHE’s prominence as the sole independent voice for the health education profession and its long history of commitment to quality assurance in the preparation and practice of all health educators, the Working Group concluded that SOPHE should assume a preeminent role in promoting quality assurance in the professional preparation of school health educators. After an extensive review of the current status of teacher education accreditation and related developments in health education, the Working Group offered short- and long-term recommendations to SOPHE with a rationale and potential action steps for each recommendation. The SOPHE Board of Trustees received and accepted the report in September 2013 and appointed a follow-up group to prioritize the Working Groups’ recommendations.
Recommendations for the Future
To move the accreditation agenda forward in health education teacher preparation, the SOPHE School Health Education Accreditation Working Group offers the following recommendations to the profession:
All professional organizations that are members of the Coalition of National Health Education Organizations that have a direct interest in school health education should monitor changes in teacher education accreditation, promote accreditation, and communicate periodic updates to their members, the overall health education profession, and academic leaders, including deans and department chairs. This monitoring and communication should also be a responsibility of SOPHE’s National Implementation Task Force for Accreditation in Health Education.
All departments with teacher education programs in health education should monitor what is happening in teacher education broadly, providing regular updates to deans and holding discussions among department chairs and health education faculty members.
All stakeholders in the profession should advocate that quality assurance standards for professional preparation programs for school health educators must (a) have an evidence-based foundation, (b) use the most up-to-date Competency-Based Framework for Health Education Specialists, and (c) be developed with input from broad internal and external stakeholders. They should also advocate for program reviewers who have health education academic preparation and experience and have training as accreditation reviewers of school health education professional preparation programs.
The SOPHE, as an organization with the professional capacity and expertise and the sole independent professional association of health educators in all settings, should have the lead role with accrediting bodies in the accreditation of teacher education programs in health education.
Conclusion
The health education profession has a history of commitment to quality assurance, including accreditation of professional preparation programs in both school and community/public health education, and SOPHE has provided leadership in quality assurance. Recent changes in teacher education, national professional organizations, and philosophies and approaches concerning quality assurance are reinvigorating discussions about accreditation for professional preparation programs for school health educators. Emphasis on outcome and performance indicators is gaining new ground over the traditional focus on institutional or program capacity or reputation in the accreditation philosophy dialogue (LaCelle-Peterson & Rigden, 2012).
The next few years will be both transformational and exciting for professional preparation in school health education. The health education profession must ensure that future school health educators have the contemporary skills and abilities needed in the 21st-century classroom, consistent with changes to the competencies and subcompetencies that health education specialists require in all settings. Assuring that future school health educators have the preparation needed for the changing landscape will require stakeholders to monitor the evolving accreditation standards and requirements for school health education professional preparation programs; advocate for strong, quality assurance standards for school health educator professional preparation programs, including review by individuals who have professional preparation in school health education; and modify professional preparation quality assurance processes as well as curricula. SOPHE stands ready to lead and engage the health education profession in this effort.
Footnotes
Declaration of Conflicting Interests
The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: As the Chief Executive Officer of the Society for Public Health Education (SOPHE), M. Elaine Auld participated in discussions conducted by the School Health Education Working Group. However, she is a non-voting member of SOPHE’s Board of Trustees, which accepted the Working Group’s final report and recommendations.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
