Building Healthy School Communities: A Collaborative Strategy to Improve Health in Oklahoma

Tara M. Jackson DrPH; Oklahoma State University
Melenda M. Knight MEd; Oklahoma State University
Edward L. Harris; PhD; Oklahoma State University

Corresponding Author: Ed Harris, (405.780.0099)
Funding Sources: TSET and Oklahoma State University


Oklahoma has recently introduced important health improvement initiatives, including the State Health Improvement Plan (SHIP),1 the State Obesity Plan,2 and the Oklahoma Health Education Act.3 While these and other health improvement efforts are significant, Oklahoma continues to rank 47th among all states in health.4 Moreover, in relation to the other 49 states, Oklahoma is 49th in nutrition, 48th in physical activity, 48th in obesity, and has the highest death rate from heart disease and the fourth highest related to diabetes.4-6

Oklahoma State University’s (OSU) land grant system is addressing these staggering statistics through a transdisciplinary, multisector strategy. The plan includes a state-of-the-art professional learning platform, a research-based institute to promote optimal health practices, and a statewide project to advance healthy behaviors through reinforcing efficacious partnerships.

Telementoring Platform: Project ECHO

An important feature of OSU’s plan is the dissemination of real-time expertise and knowledge through the Extension for Community Healthcare Outcomes (Project ECHO), which is housed in OSU’s Center of Health Sciences (OSU-CHS). Project ECHO, founded by Dr. Sanjeev Arora at the University of Mexico, is a hub-and-spoke, telementoring model that addresses health and educational needs of rural and underserved communities. ECHO equips health providers and educators with the right knowledge and expertise at the right place and the right time by leveraging technology to facilitate professional learning. Experts and participants collaborate to solve problems and integrate best practices. By moving knowledge instead of people, ECHO creates a global system that supports equitable opportunities for professional growth.7

In 2016, OSU-CHS established a Project ECHO office to serve Oklahoma and subsequently launched ECHO lines in Psychiatry, Pediatric Obesity Medicine, and Addiction Medicine. OSU-CHS was soon designated as a “Superhub,” an ECHO partner authorized to provide training and technical assistance to those who wish to start ECHO programs. In 2018, the services expanded to provide professional development for Oklahoma’s educators. During the COVID pandemic, every county in Oklahoma was served through ECHO Health and ECHO Education programs.8

Currently, OSU-CHS offers over 20 diverse education and health related ECHO programs to meet the learning needs of educators and health care professionals across the state. ECHO Health programs connect health care providers in rural and underserved areas to specialists at academic medical centers. Providers receive training and mentorship on complex and chronic conditions, empowering them to improve care to people in their communities. ECHO Education programs improve student learning by establishing statewide networks to enhance teacher effectiveness, providing a platform for sharing multifaceted resources, and help school systems build leadership capacity.9

Project ECHO’s Principles and Protocol

Four principles guide ECHO processes: maximize available technologies to leverage scarce resources, disseminate best practices to democratize knowledge, use case-based learning to master complexity, and develop a web-based database to monitor outcomes and curate digital archives and resource materials.10

The ECHO protocol, initially founded on the notion of clinical rounds, is a process where professionals review existing problems, access best practice procedures, and collaboratively determine optimal solutions.10 Building on this protocol, the ECHO model uses a virtual hub-and-spoke knowledge sharing approach through Zoom technology. In these virtual settings, teams of subject matter experts (“hub teams”) lead telementoring sessions for health care and/or education professionals in their local contexts (“spoke sites”).10 These sessions provide real-time knowledge and expertise and thereby, amplify the capacity of these individuals to deliver optimum services to their local communities.

Typically, ECHO sessions are offered weekly, biweekly, or monthly. Each one-to two-hour session incorporates a three-part format: (1) a ten-to-fifteen-minute presentation stressing best theory-to-practice applications, (2) a case or problem of practice focusing on context-based issues, and (3) hub/spoke interaction leading to recommendations to systemically improve plans and practices. In both health and education, application of ECHO principles and processes help cultivate a dynamic, professional learning community in which “all teach; all learn.”

Human Performance and Nutrition Research Institute and Building Healthy School Communities ECHO

In 2022, OSU established the Human Performance and Nutrition Research Institute (HPNRI), a research-based institute that focuses on strategic areas of human performance and nutrition science to improve lives in Oklahoma. Operating under the umbrella of The Innovation Foundation at Oklahoma State University, HPNRI unites researchers and resources to translate applied research into practical solutions and leverage advanced knowledge gained from OSU’s sports performance, sports medicine, collaborative research programs, and leading industry partner relationships.11

The transmission and diffusion of knowledge represents an integral component of OSU’s land grant mission. Consequently, OSU has an established widespread presence across all Oklahoma counties facilitated by extension and clinical care programs. OSU’s utilization of Project ECHO telementoring network has effectively established a virtual framework for the rapid dissemination of best practices throughout the State. Leveraging these resources, HPNRI is positioned to employ this existing infrastructure to advance therapeutic solutions aimed at enhancing the health and well-being of the people of Oklahoma.

HPNRI’s transdisciplinary approach combines scientific discovery, partnership opportunities, OSU Extension services, and the OSU-CHS ECHO platform to help mitigate systemic health issues in the broader Oklahoma population. Through a generous grant from the Tobacco Settlement Endowment Trust (TSET), Project ECHO and HPNRI collaboratively administer three ECHO programs targeting Pediatric Obesity, Athletic Training and Sports Medicine, and Building Healthy School Communities (BHSC).

The Centrality of Schools in Building Healthy Communities

To help fulfill HPNRI’s mission, the institute recently created the Building Healthy School Communities (BHSC) ECHO program, a unique ECHO line that provides Oklahoma public school leaders with vital knowledge, expertise, and resources to improve physical activity, healthy nutritional behaviors, and health literacy in their school communities. BHSC ECHO collaborates with OSU Extension, the Oklahoma State Department of Education (OSDE), the Oklahoma State Department of Health (OSDH), the Oklahoma Association for Health, Physical Education, Recreation, and Dance (OAHPERD), and Oklahoma public school systems.

A central strategy of BHSC ECHO is to strengthen healthy communities through their school systems. Schools play a critical role in promoting students’ lifelong healthy behaviors and are cultural hubs that promote social cohesion and preserve community identity. In rural communities especially, schools are often largest employer and depend on established partnerships with local businesses, organizations, and health providers to provide well-rounded, equitable opportunities for students and families.12


Spoke Site Selection

Qualitative methods were used to select the first BHSC ECHO cohort, which was initiated during the 2023-24 academic year, and to determine program curricula. Participant selection involved purposive sampling strategies. Triangulating data from sources such as OSDH, the State of the State’s Health Report, the County Health Rankings & Roadmaps (CHR&R), and the Public Health Institute of Oklahoma provided a means to identify county health rankings in Oklahoma. Based on these rankings, the authors targeted counties representing diverse geographic regions of the State.

The authors then utilized the HPNRI established networks and consulted with academic departments in OSU’s College of Education and Human Sciences (CEHS) to determine schools and educators within those targeted counties to contact. Criteria for the first cohort schools included willingness to be a part of the program, identifiable needs that could be addressed through the program, and identifiable strengths that partner schools could bring to the sessions.

Six schools were identified: Muskogee Public Schools (Muskogee County), Clinton Public Schools (Custer County), Poteau Public Schools (Le Flore County), Cimarron Public Schools (Major and Garfield Counites), Adair Public Schools (Mayes County), and New Castle Public Schools (McClain County). The authors then met with the schools’ leaders to determine key representatives from their schools that would be part of the Spoke Sites.

A needs assessment was conducted with selected focus groups from each school and qualitative interviews were conducted with each focus group. Questions that allowed for rich discussion and follow-up queries centered on health and wellness goals of the schools, strengths and weaknesses of current health programs, and current partnerships.

Data were analyzed using the constant comparative method, a procedure for evaluating qualitative data in which the information is coded and compared across categories, patterns and themes were identified and refined.13,14 In the findings, prominent themes included the improvement of health literacy, mental and physical health, nutrition programs, and community engagement. These findings provided the foundation for the program curriculum development and hub team selection. The curriculum is focused on the following topics: Physical and Health Literacy, Nutrition and Performance, Physical Education, Mental Health for Students and Educators, Partnerships, Resources, and Community Engagement.

Hub Team Selection

A competent hub team plays a vital role in the success of any ECHO program. The hub team provides specialty expertise, facilitates coordination of each ECHO session, and builds trust among all involved in the process. Hub responsibilities include creating a beneficial curriculum and schedule, understanding the theory and practice relationship in the specific ECHO program, ensuring that all involved are working synergistically towards common goals, promoting efficient communication, and streamlining resource allocation. Per those responsibilities and the findings of the needs assessment, a seven-member hub team was selected representing the following knowledge fields and expertise.

• Professor of Educational Leadership and Policy
• Professor and Associate Department Head of Nutritional Sciences
• National Board-Certified Teacher (NBCT) in Health/Physical Education
• OSDE Director of Health and Physical Education
• Executive Director Youth Medical Mentorship
• Assistant Professor, School Psychology, Director, School Psychology Center
• OSU Associate Extension Specialist Community Nutrition Education Programs

Evaluation Component

The BHSC ECHO program is being assessed through formative and summative evaluation strategies and both qualitative and quantitative methods. Wenger-Trayner and Wenger-Trayner’s15 value creation model is serving as a primary framework for evaluation. The framework provides criteria to assess the efficacy and applied value of a program and language to describe outcomes in the professional learning process. The framework is useful because it encompasses both individual benefits and broader, collective impacts that learning can have on systems and contexts. Formative evaluations include implementation readiness surveys at the end of each session, and summative evaluation will include qualitative and quantitative procedures to assess such factors as content and resource implementation, health literacy awareness and application, inter-group networking, and levels of community engagement and partnerships.


BHSC is the first ECHO program to emphasize the centrality of school systems to improve health in entire communities. The methods used in launching this program allowed for prominent themes that provided the foundation for program curricula and hub team selection and focused on improving health and nutrition literacy, mental/physical health, and community partnerships. Further research and evaluation results will be published as the program expands across Oklahoma.


This paper lays the foundation for exploration that will result in more tangible conclusions. However, the paper does have implications for research theory and practice. Regarding implications for practice, OSU has a presence in each of Oklahoma’s seventy-seven counties through its Extension offices and has clinical care programs in major rural areas. Through Project ECHO, the OSU land grant system has an established virtual infrastructure to push out best practices quickly across Oklahoma. HPNRI will be able to tap into these assets to promote therapeutics that will help Oklahomans lead healthier and more productive lives.

Moreover, the BHSC ECHO model is extremely transferable and can be adapted to multiple sectors and emerging needs. Consequently, replicating new programs in strategic counties each year will form a ripple effect across the state. These programs will allow for a consistent channel of clear and timely communication between educational leaders and practitioners, physicians, state officials, and experts in multiple health fields to enrich the school community and improve the lives of thousands of Oklahoma citizens.

Teams of experts, including medical professionals, educational specialists, and state officials, can be recruited to provide pertinent, real-time information. The “all teach; all learn” ECHO mentality provides a foundation for rich dialogue and promotes sustainable professional development and networking.

Oklahoma’s disparities have brought the educational and health communities together, yet the effectiveness of these initial relationships for professional learning over time is still to be determined and merits further exploration and evaluation. Professional Learning Communities (PLCs), Communities of Practice (CoPs), Project Based Learning, and Adult Learning Theory provide frameworks for qualitative and quantitative research, program evaluation, and a means to move the combined fields of health and education forward.


Networks established through BHSC ECHO lines are designed to enhance efficacy for remote learning and networking as well as provide a platform for sharing multifaceted health and education resources to communities across Oklahoma. As Oklahoma continues to address its health disparities and move up in national health rankings, implications for practice, research, evaluation, and theory will continue to abound.

In summary, implementing effective programs that systemically advance health and modify behaviors can be challenging. However, OSU’s land-grant systems’ transdisciplinary, telementoring approach provides a model for sustainable, collaborative training and successful health improvement. When networked professional learning and strategic partnerships are combined, the potential for capacity building and improvement expands exponentially and genuine change can occur.


1. Oklahoma State Department of Health. 2023-2028 Oklahoma State Health Improvement Plan. Issued 2023. Accessed February 22, 2024.

2. Oklahoma State Department of Health. Health for a Lifetime: State of Oklahoma Obesity Prevention Plan. Issued 2022. Accessed February 22, 2024.

3. Senate Bill 89: Health Education Act 2021. 70 O.S. § 11-103.12, 11-103.13. Accessed February 22, 2024.

4. United Health Foundation. 2023 Annual Report: Oklahoma. America’s Health Rankings. Published 2024. Accessed February 22, 2024.

5. United Health Foundation. Obesity in United States. America’s Health Rankings. Published 2024. Accessed February 22, 2024.

6. National Center for Health Statistics: Stats for the State of Oklahoma. Centers for Disease Control and Prevention. Updated April 9, 2018. Accessed February 22, 2024.

7. UNM. Two Decades of Positive Impact in New Mexico: Read the Stories. University of New Mexico, Project ECHO. Accessed February 22, 2024.

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9. OSU. Extension for Community Healthcare Outcomes. Project ECHO, Oklahoma State University. Accessed February 22, 2024.

10. UNM. About the ECHO Model. University of New Mexico, Project ECHO. Accessed February 22, 2024.

11. OSU. Human Performance and Nutrition Research Institute. The Innovation Foundation at OSU. Accessed February 26, 2024.

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