The contributions of credentialing and the code of Ethics to quality assurance in the health education/promotion profession.
Abstract: Quality assurance in health education/promotion profession has taken significant strides over recent decades to enhance the delivery of health education/promotion services to consumers. Over the past 35+ years the profession has helped to provide quality assurance by working to credential both the academic professional preparation programs and the individuals who will deliver health education/promotion services. In addition, quality assurance has been enhanced by the creation and revision of a profession-wide code of ethics. This paper presents an overview of the major components of quality assurance of the health education/promotion profession--academic program approval/accreditation, individual credentialing of professionals, and the Code of Ethics for the health education/promotion profession.
Subject: Medical personnel (Training)
Consumer education
Health education
Quality control
Ethics
Authors: Baldwin, Sue
McKenzie, James F.
Capwell, Ellen
Hanson, Carl L.
Pub Date: 09/22/2011
Publication: Name: American Journal of Health Studies Publisher: American Journal of Health Studies Audience: Professional Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2011 American Journal of Health Studies ISSN: 1090-0500
Issue: Date: Fall, 2011 Source Volume: 26 Source Issue: 4
Topic: Computer Subject: Quality control
Product: Product Code: 9914206 Consumer Education; 9913300 Quality Control Management
Accession Number: 308741494
Full Text: The health education/promotion profession has taken significant strides in quality assurance in recent decades to enhance the delivery of health education/ promotion services to consumers. Maybe the single most important event in history to enhance quality assurance was the delineation of the role of the health education specialist (National Task Force on the Preparation and Practice of Health Educators [NTPPPHE], 1985). With the delineation of the role, a framework was created on which: 1) curricula for professional preparation programs could be built, 2) the criteria for credentialing health education/ promotion professional preparation were organized, and 3) the foundation for credentialing health education/promotion professionals was based. In addition to these practices that are tied to the role delineation, the health education/promotion profession has also created (as cited in Cottrell, Girvan, & McKenzie, 2012) and revised (CNHEO, 2011b) a code of ethics that contributes to the quality of the health education/promotion services. These four milestones are not the only contributions to ensuring quality in the profession, but they have laid a solid foundation on which quality assurance has been and continues to be built. The purpose of this paper is provide an overview of the credentialing processes in the health education/promotion profession and the Code of Ethics of the profession and how they contribute to quality assurance.

"Credentialing is an umbrella term referring to the various means employed to designate that individuals or organizations have met or exceeded established standards. These may include certification, registration or licensure of individuals or accreditation of organizations" (NCHEC, 2011c, para. 1). There are distinct differences in program approval/accreditation and credentialing of professionals but quality assurance efforts typically share the same common goals: 1) "to protect the public by establishing and ensuring a minimum acceptable standard of quality and performance for professionals working in population health, 2) to improve or strengthen institutions and programs of professional preparation through systems of external peer review and increased public accountability, and 3) to promote continued professional development of the workforce in an effort to strengthen public health capacity" (Allegrante, Barry, Auld, Lamarre & Taub, 2009, p. 428). We begin our discussion of quality assurance processes with a review of the credentialing processes available to health education/ promotion professional preparation programs.

CREDENTIALING PROFESSIONAL PREPARATION PROGRAMS

One of the recommendations of the National Task Force on Accreditation in Health Education, was "[T]hat there be a unified accreditation system, comprising two parallel, coordinated accreditation mechanisms for community and school health education preparation institutions" (Allegrante et al., 2004, p. 677). This recommendation has not been met yet, but the profession is making progress towards it. Currently, there are several different approval/accreditation processes by which health education professional preparation programs can be credentialed. They include: 1) The Society for Public Health Education (SOPHE) - American Association for Health Education (AAHE) Baccalaureate Program Approval Committee (SABPAC) for undergraduate community health education programs, 2) the National Council for the Accreditation of Teacher Education (NCATE) for teacher education programs, and 3) the Council on Education in Public Health (CEPH) for graduate programs in public health and limited undergraduate programs. The approval/ accreditation process that is most appropriate for a professional preparation program is dependent on the academic degree level at which the program is offered. However, each approval/accreditation process is based upon the six accrediting procedures: 1) standards or criteria that describe an acceptable program, 2) a self-study which compares a program's performance against the standards, 3) an on-site evaluation of the program by outside reviewers, 4) publication of the names of the programs that hold the approval/accreditation, 5) monitoring of the program through the period of approval/ accreditation to verify that the program continues to meet the standards, and 6) periodic reevaluation of the program (Department of Education [USDE], 2011).

SABPAC

The Society for Public Health Education (SOPHE)--American Association for Health Education (AAHE) Baccalaureate Program Approval Committee (SABPAC) is a conjoint committee of SOPHE and AAHE with the purpose of reviewing and approving baccalaureate programs in community health. It was created in 1987 as the successor to SOPHE's Approval Committee when the then presidents of SOPHE and AAHE felt the benefits of collaboration could enhance the approval process (Cissell, 1997). Today, SABPAC is still a conjoint committee and oversees the SABPAC approval process. As such, the Committee is comprised of health education professionals who volunteer their service to the two professional organizations. SABPAC approval is recognized by the profession as the standard for programs preparing baccalaureate entry-level community health education specialists that are not associated with CEPH accredited master of public health programs. It is an approval process not accreditation process because SABPAC is not recognized by the Secretary of the U.S. Department of Education as an accrediting agency (U.S. Department of Education, [USDE], 2011).

A SABPAC review is a voluntary process designed to promote excellence in education relating to undergraduate community health education practice in order to prepare competent entry-level health education specialists. The SABPAC process is based upon a program self-study and an external site team review. The review process should enable institutions of higher education, AAHE, and SOPHE to make a qualitative assessment of the programs. SABPAC recommends program approval status based on the degree to which a program's self-study reflects alignment to 15 criteria (see Table 1) (SABPAC, 2007). Programs that meet the established criteria are recognized as SABPAC approved.

SABPAC PROCESS AND PROCEDURES

The process for new applicants to obtain SABPAC program approval begins when the faculty of a professional preparation program submits a written application. Once the application is approved by SABPAC, the faculty of the applying program must complete a program self-study based on the 15 SABPAC criteria (see Table 1). The self-study should explain how the professional preparation program meets the SABPAC criteria. The complete written self-study document is then submitted to SABPAC. After the co-chairs of SABPAC receive the self-study document and deem it acceptable, a pre-assigned Site Visit Review (SVR) Team analyzes the self-study and schedules an on-site visit. SVR Team members are selected for their competence, knowledge, experience, and training in health education/promotion. Each SVR includes: one nonacademic practitioner in the field of health education/ promotion, one faculty member from a baccalaureate health education/promotion program, and a team chairperson with significant SABPAC experience. Also, one of the three-person SVR Team members should have expertise in health education/promotion curriculum development at the baccalaureate level. In addition, it is mandated that at least two of the three team members be Certified Health Education Specialists (CHES)/Master Certified Health Education Specialist (MCHES) or at the discretion of SABPAC, possess other appropriate qualifications. Programs that do not meet established criteria are provided recommendations that can lead to program improvement and possible later approval. A complete listing of the SABPAC criteria and guidelines can be found in the SABPAC Manual: Criteria, Process, & Procedures for Quality Assurance in Community Health Education (SABPAC, 2007). Additional information regarding SABPAC criteria, processes and procedures can be found at the Web site of the National Implementation Task Force on Accreditation in Health Education (SOPHE & AAHE, 2011).

SABPAC APPROVAL REQUIREMENTS

To be eligible for SABPAC approval an institution must have current regional accreditation, must not discriminate, must conduct a self-study and prepare a written document, must be a baccalaureate major that prepares students for the Certified Health Education Specialist (CHES) exam, must provide students with at least a 320 hour field experience with a qualified health professional and must have at least two full-time faculty members eligible for CHES or MCHES certification (see Table 2). The SABPAC application fee is $1000.00. Programs can be granted several approval designations--approval for five years, provisional approval for one year or denial of approval. Programs are able to appeal designations. Currently, 20 community health education programs are SABPAC approved.

NCATE, TEAC & CAEP HISTORY AND BACKGROUND

A second program credential that professional preparation programs in health education have sought is granted by the National Council for the Accreditation of Teacher Education (NCATE). NCATE was founded in 1954 as a non-profit, nongovernmental organization and is recognized by the U.S. Department of Education that accredits colleges/universities that prepare teachers that work in elementary and secondary schools (NCATE, 2010, para. 3). For many years this accreditation, with program recognition was the only one available specific for school health education programs. One of the recommendations of the National Task Force on Accreditation in Health Education, in 2004, was "[T]hat the National Council for the Accreditation of Teacher Education (NCATE) is the preferred accrediting entity to provide a single coordinated accreditation mechanism for school health education programs at the undergraduate and graduate levels ..." (Allegrante et al., 2004, p. 677). NCATE was identified as the preferred accrediting entity because, since 1978, NCATE has worked with AAHE as the Specialty Professional Association (SPA) for health education. NCATE accepted the original generic health education areas of responsibilities as the standards for preparing health education teacher candidates in 1986. The NCATE Folio Review Committee was established by AAHE in 1988 to review health education teacher preparation programs for approval and recognition. In 2007, the AAHE Teacher Education Standards Task Force began work to align the 2006 Competency Update Project (CUP) competencies with the 2000 NCATE Professional Standards (Hillman et al., 2010, p.6-7).

The resulting 2008 Guidelines for AAHE/NCATE Health Education Teacher Preparation Standards reflects the health education competencies as well as the unique knowledge and skills necessary for teacher education candidates in the school setting. Greater emphasis is also placed on performance-based assessments, with rubrics provided to guide assessment. The standards integrate concepts of educational psychology and behavior change, related to health, as well as the eight National Health Education Standards, reflective of health literacy (Hillman et al., 2010).

While the National Commission for Health Education Credentialing, Inc. (NCHEC) seven Areas of Responsibility defined by the Competency Update Project (CUP) are the basis for the AAHE/NCATE standards, there is not a complete correlation. NCHEC responsibilities and competencies were grouped or reconfigured to be reflected within the NCATE standards. The NCHEC responsibilities are referenced as AAHE/NCATE standards and the NCHEC competencies are referenced as AAHE/ NCATE key elements. NCHEC sub-competencies are reflected in the AAHE/NCATE standards as performance-based skills for the school setting, measured by the three level rubric provided (Hillman et al., 2010; NCHEC, SOPHE, & AAHE, 2006).

The 2008 Guidelines for AAHE/NCATE Health Education Teacher Preparation Standards (Hillman, et al., 2010) are to be used by all programs beginning in the spring of 2011. Since these guidelines were approved, NCHEC completed its required 5-year review of the health education competencies to determine if they still reflect the role of a practicing health education specialist. That review titled, Health Educator Job Analysis (HEJA) 2010, yielded additions and modifications to the NCHEC responsibilities and competencies that are not yet reflected in the AAHE/NCATE Guidelines. Among the NCATE accredited institutions throughout the U.S. there are 53 institutions with nationally recognized school health education programs (NCATE, 2011d).

Meanwhile, NCATE has begun organizational changes that will also affect the process and standards used to accredit teacher education preparation programs. Over the last decade, a new accrediting body, Teacher Education Accreditation Council (TEAC), emerged as an alternative to NCATE.

Yet another development occurred which will increase the complexity of the school health education accreditation process. On October 22, 2010, NCATE and TEAC agreed to consolidate the two accrediting bodies into the Council for Accreditation for Educator Preparation (CAEP) within the next two years. A plan for consolidation and unification was developed following input from the field (NCATE, 2011a, para.1; NCATE & TEAC, 2010). The plan calls for providing a choice to institutions regarding the processes by which accreditation occurs. Four options for the accreditation process that are currently being planned are: 1) TEAC's Academic Quality Audit, 2) NCATE's Continuous Improvement, 3) TEAC's Inquiry Brief, and 4) NCATE's Transformation Initiative. Institutions will choose which one of the four accreditation process options to use (CAEP, 2011). Two Commissions of CAEP will oversee a review; one to oversee options currently offered by NCATE and the other to oversee options offered by TEAC (CAEP, 2011; NCATE & TEAC, 2010, p. 4).

Three options are also proposed for review of specialty preparations, such as Health Education. Only one option will need to be applied by programs, based on whether or not there is a desire for national recognition. States will determine which options are available to be chosen by institutions. The first option is a process similar to that used by NCATE SPAs where the institution program would have to meet standards set by the SPA (e.g., AAHE). This option would lead to national recognition. A second option would involve a CAEP review of clusters of program areas, which could be used for state approval, but not national recognition. The third option would involve review, by a state, of applicant program areas. Results of the reviews would inform review teams, institutions, states and CAEP regarding accreditation decision (CAEP, 2011).

As the CAEP plan is being refined, the implications for health education need to be carefully considered to ensure that the most current NCHEC Health Education Areas of Responsibility are linked to the CAEP review process for all school health education preparation programs. As refinements are being made to the process over the next two years, monitoring and input by the health education profession will help to assure quality of our health education preparation programs.

NCATE PROCESS AND PROCEDURES

The three options that CAEP has proposed for program review will be pilot tested and modified in 2012 in preparation for full implementation in 2013 (CAEP, 2011). Meanwhile, for those institutions undergoing the NCATE program review process, all reports are to be submitted and reviewed online (NCATE, 2011b). Of the program review options currently approved by NCATE Specialty Areas Studies Board, there are two report form options for Health Education. Option A, continuation of the previous process, requires six to eight key assessments for all candidates, with the first five prescribed by NCATE. Option B provides greater flexibility to institutions to select up to eight assessments. Specific elements of each option are delineated on the NCATE Website (NCATE, 2011b). Program reports must be submitted at least one year prior to the institution's scheduled onsite accreditation visit. AAHPERD-AAHE serves as the Specialized Professional Association (SPA) for Health Education, and is responsible for development/revision of program standards and review of programs. The AAHE Standards approved in 2008, are the current standards to be used for Health Education. As described earlier, these relate to the 2006 NCHEC responsibilities and competencies (NCATE, 2011c). Program review materials submitted to NCATE are forwarded to AAHE reviewers to judge alignment of assessments and candidate data with AAHE/NCATE standards (Hillman et al., 2010; NCATE, 2011c). The process for program approval will be evolving as the transition is made to CAEP.

NCATE PROGRAM APPROVAL REQUIREMENTS

Generally, institutions seeking NCATE accreditation must prepare program reports for any of the 21 professional preparation programs for which NCATE has approved program standards, including Health Education (NCATE, 2011d). Program reviewers determine whether program reports adequately address the required elements for the review option used by a program. Program reports are required as part of the institution's efforts to seek NCATE accreditation (see Table 2). Programs can be granted several approval designations--Nationally recognized for six years; Recognized with Conditions; or National Recognition with Probation (S. Muller, personal communication, August 25, 2011). Programs are able to appeal

designations. Process and approval requirements may differ depending on NCATE state partnership agreements, or whether institutions are accredited by TEAC or other accrediting organizations.

COUNCIL ON EDUCATION IN PUBLIC HEALTH (CEPH)

The third program approval/accreditation process available to health education professional preparation programs is the one offered by the Council on Education in Public Health (CEPH). Accreditation of public health programs has a rich history and dates back to the 1940s with the organization of the first 10 schools of public health. From the mid-1940s to 1974, the American Public Health Association (APHA) accredited schools of public health (CEPH, 2011a, para. 1). In 1974, the APHA partnered with the Association of Schools of Public Health (ASPH) to create the Council on Education for Public Health (CEPH), a private, nonprofit corporation with the goal "to enhance health in human populations through organized community effort" (CEPH, 2011a, para. 2; CEPH, 2011b, para. 2). While SABPAC and NCATE provide the quality assurance mechanism for undergraduate programs in health education, CEPH provides quality assurance for graduate programs--primarily those offering the Master of Public Health (or MPH) degree. The purposes of the Council, as outlined in the accreditation procedures, are to:

1. promote quality in education for public health through a continuing process of self-evaluation by the schools and programs that seek accreditation;

2. assure the public that institutions offering accredited instruction in public health have been evaluated and judged to meet standards essential to conduct such educational programs; and

3. encourage through periodic review, consultation, research, publication and other means improvements in the quality of education for the field of public health (CEPH, 2011a, para. 2).

As a result of the ASPH and APHA partnership forged in 1974, the Council has become the sole accrediting body for public health programs and an independent accrediting agency recognized by the Secretary of the U.S. Department of Education (USDE). It establishes its own accreditation policies and procedures through the work of 10-member CEPH Board of Councilors. The CEPH Board is primarily responsible for adopting the criteria for evaluating schools and programs, making accreditation decisions, and managing the corporation (CEPH, 2011a, para. 3).

Historically CEPH required schools of public health to present all public health degree programs for accreditation review--both graduate and undergraduate. In 2005, however, CEPH revised its criteria to allow public health and community health education degrees to be accredited in programs outside of schools of public health as long as a master's degree in public/community health education is offered (Taub, Birch, Auld, Lysoby & King, 2009). The principal degree is a Master of Public Health (MPH) with training provided in the areas of epidemiology, biostatisitics, behavioral science, environmental health and management. Many programs of public health offer the MPH in community health or health education (Novick, Morrow & Mays, 2008). To date, eligibility for CEPH accreditation requires that a master's degree in public health be offered. Bachelors and doctoral degrees may be offered by institutions and accredited by CEPH, but only if a master's degree in public health is offered.

As noted above, CEPH only reviews undergraduate programs if a master's degree in public/community health education is also offered, while the SABPAC approval process was instituted to fill the accreditation void for undergraduate health education programs. The National Task Forces on Accreditation in Health Education recognized that SABPAC approval alone was not the ideal and encouraged CEPH to accredit stand-alone undergraduate public/community health education programs (Cottrell et al., 2009). The SABPAC approval system could be integrated into the CEPH processes to accommodate the many stand-alone programs that exist in academic settings where no master's level public health degree exists. Despite the perceived value for undergraduate health education programs and years of SABPAC approval experience, the proposal for stand-alone accreditation is still under consideration by CEPH. Concerns about lack of infrastructure, capacity and specific accreditation requirements to initiate the request are cited by CEPH as reasons for delay (Cottrell et al., 2009). The Council continues to explore the feasibility of accrediting stand-alone programs. For example, in February 2011 CEPH consulted with a group of education and public health leaders regarding quality assurance in undergraduate public education. The group agreed on the following consensus statements (CEPH, 2011d, para. 3):

1. "Given the rapid growth in undergraduate public health in all types of higher education institutions, accreditation might be necessary to assure quality in baccalaureate-level public health majors."

2. "Accreditation is an iterative, collaborative process that takes time and must involve key stakeholder groups."

3. "Principles of quality should apply to all baccalaureate-level public health majors, whether in schools or public health, affiliated with graduate public health programs, or in colleges or universities without graduate-level public health training."

CEPH PROCESS AND PROCEDURES

The process for new applicants to obtain CEPH accreditation begins when a school or program submits a written application outlining qualifications. Qualifications include, but are not limited to, institutional commitment and support; regional accreditation; a solid organizational structure to support curriculum development; admission standards; faculty selection and retention and a curriculum consonant with CEPH criteria (CEPH, 2011c, p.6-7, para. 1). Similar to other approval (SABPAC) and accreditation processes, CEPH requires a detailed self-analysis through the preparation of a self-study (see Table 2). The written self-study documents the extent to which the school or program is in compliance with the accreditation criteria. Initiation of the accreditation process includes a preliminary review of the self-study five months prior to an on-site visit. If the preliminary review team views the document as acceptable, a team of reviewers will make an on-site visit.

CEPH APPROVAL REQUIREMENTS

The criteria for CEPH accreditation are divided into four areas: 1) the public health program (e.g., institutional environment, governance, evaluation and planning, fiscal resources), 2) instructional programs (e.g., degree offerings, culminating experience, program length, assessment procedures), 3) creation, application and advancement of knowledge (e.g., research, service), and 4) faculty, staff, and students (e.g., faculty qualifications, student recruitment) (CEPH, 2011c).

The Council adapted revised accreditation criteria in June of 2011 revising the 2005 criteria. Programs and schools that have site visits after January 2013 will be expected to comply with these new criteria. Changes included but are not limited to: (1) condensing the student diversity and faculty/ staff criteria into one, (2) establishing benchmark graduation rates bachelors, masters, and doctoral degrees, (3) simplification of reporting categories for graduates' employment and further education, and (4) development of a separate criterion for undergraduate degrees that establishes curricular expectations (CEPH, 2011e).

The CEPH application for a program of public health include the initial application fee of $2500, an accreditation review fee, annual fees also apply as well as possible consultation visit fees plus all site reviewer travel expenses (CEPH, 2011f, para. 1-3, 5-6). Once accredited, the annual support fee for programs of public health is $3108. Following the self-study and review process, new programs can be granted several accreditation decisions - approval, denial or deferral so the Council can gather more information for an appropriate decision (CEPH, 2011c). Programs are able to appeal decisions. Currently, CEPH has accredited 48 schools of public health and 82 programs of public health. Additional information regarding CEPH processes and procedures can be found at the CEPH Website (CEPH, 2011a).

SHORT OF APPROVAL/ACCREDITATION

Although program approval or accreditation are the desired routes to insure that professional preparation programs meet the high standards to produce quality professionals, not all programs have the necessary resources to seek approval or accreditation. Would mandating approval or accreditation of all programs be realistic or viable? There are many more small professional preparation health education programs in the United States than large programs. Many of these smaller programs do an excellent job preparing future health education specialists but may lack the resources (i.e., funding, faculty members, staff members, facilities) to meet certain approval/accreditation criteria.

Another question that must be answered is would a program that offers three tracks in school health, community health and public health be mandated to seek NCATE, SABPAC and CEPH accreditation/approval? If so, going through all three accreditations/approvals can be very costly and time consuming. Would mandating that all programs, small or large, be accredited affect quality assurance? Should the profession insist that all professional preparation programs be approved or accredited?

Short of having a program that is approved or accredited, a faculty can take upon itself to create program-specific policies that can contribute to quality assurance of a profession. For example, programs can build a curriculum based on the competency-based framework outlined in the responsibilities, competencies, and sub-competencies of health education specialists (NCHEC, SOPHE, & AAHE, 2010). They could also put into place policies that require rigorous standards for 1) entry into the program (e.g., minimum grade point average entrance interview, or previous practical experience), 2) retention in the program (e.g., minimum grade in key courses or minimum point average needed to enroll in a required internship or student teaching), 3) the curriculum (e.g., internships or student teaching experience that are equivalent in length to a full-time work experience for an academic term), and 4) exiting the program (e.g., minimum grade point average, exit interview, public presentation of a professional portfolio, or passing a certification exam [i.e., CHES/MCHES]).

INDIVIDUAL CREDENTIALING

Another means to enhance the quality of a profession is by credentialing those who practice within it. Individual credentialing can take the form of certification, licensure, and registration. Currently, health education specialists can become certified or licensed. Certification "is the process by which a professional organization grants recognition to an individual who, upon completion of a competency-based curriculum, can demonstrate a predetermined standard of performance" (Cleary, 1995, p. 39), while licensure is "the process by which an agency or government [usually a state] grants permission to individuals to practice a given profession by certifying that those licensed have attained specific standards of competence" (Cleary, 1995, p. 39). State licensure is required to teach health education/ promotion in K-12 schools, while certification (i.e., CHES or MCHES) is a voluntary certification that health education specialists can obtain regardless of the setting in which they work. Because the licensure standards for health education specialists who teach in K-12 schools are state-specific, our discussion here will be limited CHES and MCHES certifications. Not only does certification contribute to quality assurance of the profession, it also provides benefits to the individual practitioners who hold the credential. Some of those benefits include:

* "Establishes a national standard of practice for all health education specialists

* Attests to the individual health education specialists' knowledge and skills

* Assists employers in identifying qualified health education practitioners

* Develops a sense of pride and accomplishment among certified health education specialists

* Promotes continued professional development for health education specialists" (NCHEC, 2011b, para. 4)

Since 1989, health education specialists meeting education eligibility requirements (see Table 3) have had the opportunity to become Certified Health Education Specialists (CHES), a credential offered by the National Commission on Health Education Credentialing, Inc. (NCHEC). The first group of individuals to become certified did so in December 1989 at the close of the charter certification period. Charter certification allowed qualified individuals to be certified based upon academic training, work experience and references, without taking an exam (Cottrell et al., 2012, p. 178). After the chartering period, health education specialists have been able to obtain certification by passing an examination that covers the seven Areas of Responsibility for Health Education Specialists (NCHEC, SOPHE, & AAHE, 2010). The first CHES examination was offered in 1990 (see Table 3 for a list of the current eligibility criteria to take the exam).

The Master Certified Health Education Specialist (MCHES) credential has been available since 2011. The first group of individuals to receive the MCHES credential did so through the Experience Documentation Opportunity (EDO). The EDO was a six-month window from late 2010 to early 2011 in which those CHES who had held active status for the previous five consecutive years had the opportunity to elect an assessment mechanism to apply for the MCHES credential. If successful, these individuals were not required to take the exam to obtain the MCHES designation. During the EDO window 812 health education specialists received the MCHES credential (NCHEC, 2011c). After the EDO, health education specialists are able to obtain certification by passing an examination that covers the seven Areas of Responsibility and Competencies for Health Education Specialists, including the advanced level competencies (NCHEC, SOPHE, & AAHE, 2010) (see Table 3 for a list of the eligibility criteria to take the exam). The first MCHES examination was offered on October 15, 2011. Between 1989 and 2010 over 18,000 individuals earned either the CHES or MCHES credential and currently there are approximately 10,000 professional who hold one of these credentials (L. Lysoby, personal communication, August 29, 2011).

Once professionals earn the CHES or MCHES credential they are required to complete a minimum of 75 Continuing Education Contact Hours (CHECs) over the 5-year certification period in all of the Areas of Responsibility and Competencies for Health Education Specialists (NCHEC, 2011a).

Health Education Code of Ethics

The Code of Ethics for the Health Education Profession (Coalition of National Health Education Organizations [CHNEO], 2011b) is another means by which the health education/promotion profession has worked toward quality assurance. The importance of developing a guide for professional behavior was first realized in 1976 with the SOPHE Code of Ethics (Taub, Kreuter, Parcel & Vitello, 1987). Refinements were made in 1978 and 1983. Although a SOPHE-AAHE Joint Committee, established in 1984, recommended that the 1983 Code of Ethics be adopted profession-wide (Taub et al., 1987), this did not become a reality until much later. In the early 1990s AAHE adopted its own Code of Ethics. Later, CNHEO assumed the task of developing a profession-wide code of ethics, based on the work of both SOPHE and AAHE (Bloom, 1999). A National Ethics Task Force, which included representatives from each of the CNHEO organizations (see Figure 1) coordinated the work. Between 1995 and 1999, a code was drafted and multiple revisions were made following input from the field at numerous national professional organization meetings. The resulting Code of Ethics for the Health Education Profession (CNHEO, 2011b) was approved by all member organizations of the CNHEO in 1999 (CNHEO, 2011a). It was considered a living document, to be continually revised and updated. In 2005, a task force of CNHEO was charged with making recommendations regarding the Code of Ethics. Two recommendations were approved by CNHEO: 1) to revise the Code of Ethics, and 2) to develop ethics audits for each work setting, to be used by professional preparation programs (CNHEO, 2011a). In 2008, a Task Force was charged with revising the Code of Ethics, which was completed and approved by the CNHEO in February 2011 (CNHEO, 2011a).

[FIGURE 1 OMITTED]

The updated Code of Ethics for the Health Education Profession contains the same six articles, which address responsibility to the public, the profession, and employers, in delivery of health education, in research and evaluation and in professional preparation. New sections relate to communicating suspected unethical practice and to exercising fiduciary responsibility. Other new sections help to clarify or enhance existing sections. Wording changes, throughout, reflect a positive tone, current terminology in the field, as well as compatibility with the NCHEC Responsibilities and Competencies. The Code of Ethics, as an element of quality assurance, continues to be an important characteristic of the maturing profession.

CONCLUSIONS

The profession of Health Education dates back only about 80 years, but the progress in development has accelerated most rapidly in the past 30 years (Glanz & Rimer, 2008). It is also during this most recent 30 years that progress has been made in the quality assurance. During this period of time, the profession has made great strides towards quality assurance by establishing approval and accreditation processes, individual credentialing, and creating a code of ethics. However, there is still more than can be done. Fewer than half of all health education/ promotion professional preparation programs in the United States are approved/accredited and there is currently no mechanism in place to enforce the Code of Ethics. In addition, even though more people now hold either the CHES or MCHES credential than anytime in the past, these credentials are still not well understood by consumers of health education services. And, even though more employers who hire health education specials are requiring candidates for their positions to either hold a CHES/MCHES credential or be eligible to earn one, they do not represent the majority of employers. What are the next steps needed for the health education/promotion profession to move forward?

We have several recommendations for continuing the profession's movement toward greater quality assurance. The profession needs to:

1. Continue to work toward a unified and coordinated standardized accreditation process made up of two parallel coordinated systems for community and school health education preparation institutions.

2. Aggressively market the CHES and MCHES credentials to both the consumers of health education/promotion services and to the employers who hire health education specialists.

3. Monitor the ethical behavior described in the Code of Ethics for Health Educators and sanction those who do not behave in an ethical manner.

REFERENCES

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Allegrante, J. P., Barry, M. M., Auld, M. E., Lamarre, M. C., & Taub, A. (2009). Toward international collaboration on credentialing in health promotion and health education: The Gallway Consensus Conference. Health Education and Behavior, 36(27), 427-438.

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Sue Baldwin, PhD, MCHES

James F. McKenzie, PhD, MPH, MCHES

Ellen Capwell, PhD, MCHES

Carl L. Hanson, PhD, MCHES

Sue Baldwin, PhD, MCHES Assistant Professor, Department of Health and Wellness, SUNY--Buffalo State College; James F. McKenzie, PhD, MPH, MCHES, Professor, Department of Public Health Sciences, Penn State Hershey and Professor Emeritus, Department of Physiology and Health Science--Ball State University; Ellen Capwell, PhD, MCHES, Retired, Department of Health and Sport Sciences--Otterbein University; Carl L. Hanson, PhD, MCHES, Associate Professor, Department of Health Sciences--Brigham Young University. Correspondence concerning this article should be addressed to Sue Baldwin, Department of Health and Wellness, 1300 Elmwood Avenue, Houston Gym, Room 220, Buffalo, NY 14222. Phone: (716) 878-6503. E-mail: baldwism@buffalostate.edu
Table 1. Fifteen SABPAC Criteria For Program Alignment.

SABPAC CRITERIA

program history and mission
program outcomes and educational objectives
program organization and faculty
physical facilities
qualifications and number of faculty
interrelationships
financing
educational program
admission and retention requirements
curriculum
continuing education
scholarship, research and grantsmanship
service
student services
evaluation

Table 2. Types of Approval/Accreditation and Eligibility Requirements

Type of Approval/   Eligibility Requirements
Accreditation

SABPAC (SOPHE/      The department or unit must:
AAHE, 2007)
                    1) be associated with an institution that
                    is regional accredited
                    2) be a part of an institution that do
                    not discriminate with regard to age, gender,
                    race, religion, disability, or national origin
                    3) be prepared to conduct a self-study
                    program evaluation according to guidelines
                    outlined in the "Criteria and Guidelines for
                    Baccalaureate Degree Programs in
                    Community Health Education."
                    4) offer a baccalaureate degree in
                    communication health education
                    5) offer a capstone or culminating
                    experience for academic credit
                    6) have a program direction or administrator
                    and at least one faculty member with
                    educational qualifications and
                    experience in health education

NCATE (NCATE,
2009)               The institution must:

                    1) recognize a professional education unit
                    that has responsibility and authority for
                    preparation of teachers
                    2) have written policies and procedures
                    guiding the operation of the unit
                    3) be committed to submitting program
                    reports for each program at least one year
                    prior to a site visit
                    4) have a unit with a well developed
                    conceptual framework for preparing educators
                    5) have a unit with program approved by
                    the appropriate state agency or agencies
                    and where required, the unit's summary of
                    licensing examination pass rates meet or
                    exceed required state pass rate
                    6) have institutional or regional
                    accreditation without probation

CEPH (CEPH,         Programs or schools of public health must:
2010)
                    1) be located in a regionally
                    accredited institution
                    2) have a planned or established organizational
                    structure for a school or program
                    3) have a mission with supporting
                    goals and objective
                    4) have a curriculum that meets CEPH criteria
                    5) have evidence of institutional
                    commitment and fiscal support
                    6) have policies and procedures for
                    recruitment and selection of faculty and
                    students

                    Programs of public health must:
                    1) have at least three full-time faculty
                    who dedicate at least .5 FTE to the program
                    2) has or will have graduated at least one
                    class from a curriculum that meets CEPH
                    criteria prior to a site visit or
                    within two years of application

                    Schools of public health must:
                    1) have at least five full-time faculty with
                    training and expertise in concentration
                    areas if offering a doctorate degree and at
                    least three full-time faculty plus two FTE
                    faculty in concentration areas
                    offering the MPH or equivalent
                    2) offer the MPH or equivalent in at
                    least five basic areas of public health
                    3) offer doctoral degrees in at least three
                    of the five basic areas of public health
                    4) have an independent structure and
                    reporting mechanism equivalent to other
                    schools or colleges within the university

Table 3: Eligibility Requirements for Certification Examinations

Certification   Eligibility Requirements

CHES            "A bachelor's, master's or doctoral degree
(NCHEC, 2011)   from an accredited institution of higher
                education; AND one of the following:

                * An official transcript (including course titles)
                that clearly shows a major in health
                education, e.g., Health Education,
                Community Health Education, Public Health
                Education, School Health Education, etc.
                Degree/major must explicitly be in a
                discipline of 'Health Education'
                -or-
                * An official transcript that reflects
                at least 25 semester hours or 37 quarter hours of
                course work (with a grade "c" or better) with
                specific preparation addressing the
                Seven Areas of Responsibility and
                Competency for Health Educators"

MCHES           The MCHES exam eligibility includes both academic
(NCHEC, 2011)   and experience requirements.

                Exam Eligibility
                For CHES: A minimum of the past five (5)
                continuous years in active status as a
                Certified Health Education Specialist.
                For Non-CHES or CHES with fewer than five
                years active status AND five years
                experience:
                * A Master's degree or higher in Health Education,
                Public Health Education, School
                Health Education, Community Health Education, etc.
                -or-
                * A Master's degree or higher with an academic
                transcript reflecting at least 25 semester
                hours (37 quarter hours) of course work in which
                the Seven Areas of Responsibility of
                Health Educators were addressed.
                * Five (5) years of documented experience
                as a health education specialist
                To verify applicants must submit:
                * Two verification forms from a current or
                 past manager/supervisor, and/or a leader in a
                health education professional organization.
                * A current curriculum vitae/ resume--in the
                verification form it must be indicated,
                and in the curriculum vitae/resume it must
                clearly be shown, that the applicant has
                been engaged in the Areas of Responsibility
                for at least the past five years (experience
                may be prior to completion of graduate degree)
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