Comprehensive School Health Promotion Evolution In Canada & Other Countries
Comprehensive Approaches, Coordinated Programs, Health-promoting Schools Progress in Canada towards effective approaches to promoting health, social development and learning in middle childhood Douglas S McCall Learning Summit on Middle Childhood Ottawa, April 23, 2007
Purposes of Presentation <ul><li>School role in middle childhood </li></ul><ul><li>CSH History – diverse strands and approaches, different & competing, emerging systems approach </li></ul><ul><li>SH in Canada today – promising strategies and lingering problems </li></ul><ul><li>Some potential CSH futures – challenges & opportunities </li></ul><ul><li>Through the lens of the Canadian CSH Consensus Statement 1990-2007 </li></ul>
The 1990 Statement - From CSHE to CSH <ul><li>CSH in Canada: shared responsibility of several agencies, professionals, tri-level implementation, whole child not just one disease) </li></ul><ul><li>HPS in Europe: values, culture, democracy, empowerment, coordinators, accountability </li></ul><ul><li>CSHP in United States : focus, programs not projects, coordination, evaluation, surveillance, research </li></ul><ul><li>HPS in Australia: education mission of school, practicality, mental health </li></ul><ul><li>HPS in Latin America : Context of low income communities, role of corporate sector </li></ul><ul><li>C&S in Aboriginal communities (need to develop) </li></ul><ul><li>Things in common: (1) instruction, services, social support, physical environment (2) started in basements & university offices (3) Focus on context, complexity, coordination, capacity & characteristics </li></ul>
School & Other Roles: Measure & Monitor Outputs <ul><li>Learn about : web safety, child abuse, meal prep. relationships, puberty, fire, accidents, basic HL </li></ul><ul><li>At school : school meals, transport, playgrounds, connect with teacher, </li></ul><ul><li>- schools </li></ul><ul><li>libraries, museums </li></ul><ul><li>private/remedial tutoring </li></ul><ul><li>recreation programs </li></ul><ul><li>web-based learning? </li></ul>Learning <ul><li>meals at home, lunches to school, expectations, attitudes </li></ul><ul><li>TV/games/web practices </li></ul><ul><li>honesty, character, outlook, friends, spirituality </li></ul><ul><li>participation in supervised after school </li></ul><ul><li>- parents </li></ul><ul><li>media </li></ul><ul><li>Internet </li></ul><ul><li>other adults </li></ul><ul><li>faith Organizations </li></ul><ul><li>youth centres/programs </li></ul>Social Development <ul><li>injuries </li></ul><ul><li>allergies </li></ul><ul><li>vaccinations </li></ul><ul><li>child neglect/alone </li></ul><ul><li>sexual abuse </li></ul><ul><li>weight, body image </li></ul><ul><li>physical activity levels </li></ul><ul><li>divorce/separation rates </li></ul><ul><li>- family physician </li></ul><ul><li>immunization </li></ul><ul><li>early id/ screening </li></ul><ul><li>day care services </li></ul><ul><li>taxes/subsidies for poor families </li></ul>Health & Welfare
What we Know <ul><li>Recent reviews, CCL SH Research Seminar, IUHPE & UN Agencies Ctte. </li></ul><ul><li>Good instruction works, but not enough, but Health Literacy possibly a prerequisite </li></ul><ul><li>Multiple, coordinated programs and services have greater impact </li></ul><ul><li>On some issues, on specific aspects or behaviours, in certain situations, for a certain time, can save dollars, but let’s measure outputs not life-long outcomes </li></ul><ul><li>Investing in SH capacity (critical mass) affects several issues </li></ul><ul><li>CSH improves health and achievement </li></ul>
Mistakes (school abuse) in the past and present <ul><li>Captive audience vs shared responsibility </li></ul><ul><li>Primary role is….to educate! </li></ul><ul><li>Projects & packages vs principles and programs </li></ul><ul><li>Collect data on kids health at school but not schools do not have primary accountability for health, </li></ul><ul><li>Push for more school accountability for learning about health and exploring health jobs </li></ul>
Lots of approaches HS, AS SS, DS, TS, NS Choices still being made, challenges associated in those choices <ul><li>Lots of approaches to SH today. They are similar but also different. </li></ul><ul><li>Differing philosophies – individual responsibility or cultural/ determinants approach </li></ul><ul><li>Pre-select priority issues at the top or empower local agencies & schools to make choices based on data </li></ul><ul><li>Competition among diseases </li></ul><ul><li>Recent evidence that investing in climate and overall capacity can reduce several health and social problems. </li></ul>
2007 CSH Statement: From One “C” to Five “C’s” <ul><li>From Comprehensiveness to: </li></ul><ul><li>Context – will shape most efforts </li></ul><ul><li>Complexity - systems approach to policy, programs and research </li></ul><ul><li>Capacity – system s , agencie s , schools/neighbourhoods </li></ul><ul><li>Characteristics – multiple, open, loosely coupled, bureaucratic </li></ul>
Building System Capacities <ul><li>Coordinated policy / policy on coordination </li></ul><ul><li>Assigned staff and infrastructure </li></ul><ul><li>Formal and informal mechanisms for cooperation </li></ul><ul><li>Knowledge transfer , translation, promising practices </li></ul><ul><li>On-going work force development (pre and in-service) </li></ul><ul><li>Strategic, coordinated issue management </li></ul><ul><li>Ongoing surveys of kids health , periodic surveys of policies & programs, reports on health literacy </li></ul><ul><li>Explicit plan for sustainability. </li></ul>
System Characteristics <ul><li>System Characteristics that Affect SH Program Effectiveness </li></ul><ul><li>Multiple Systems </li></ul><ul><li>Openess </li></ul><ul><li>Loose Coupling </li></ul><ul><li>Bureaucracies of Professionals </li></ul>
SH: A Pathway Forward <ul><li>From diverse beginnings, approaches – </li></ul><ul><li>A Clear and Shared Vision, at all levels, among all stakeholders </li></ul><ul><li>Better understanding of the school </li></ul><ul><li>More realistic but better monitored comparative results available to the public </li></ul><ul><li>No more disease competition, but still a focus on selected issues - sequential, managed selection without denial to any </li></ul><ul><li>No more projects without a plan and a commitment </li></ul><ul><li>Agreement at all levels in the systems – systematic sustained approach </li></ul>
Some Potential Futures <ul><li>Public health infrastructure is abandoned just when education ready to listen </li></ul><ul><li>Governments fund awards & projects </li></ul><ul><li>Governments continue with disease of the month or clumps of diseases and ignore all others </li></ul><ul><li>Safe schools is married with healthy schools and effective schools and democratic schools </li></ul><ul><li>Pandemic washes away all but health protection within PH </li></ul><ul><li>Basic life and family skills continue to be ignored and we wonder why school shootings are increasing </li></ul>
Some Opportunities <ul><li>New, impatient government – no more HL strategies that go nowhere, willingness to work with groups outside government, looking for results </li></ul><ul><li>New government unwilling to take leadership role on issues in PT jurisdiction, willing to achieve fiscal balance without accountability from PT’s </li></ul><ul><li>Youth and schools are a public concern – more than ever </li></ul><ul><li>International events hosted in Canada – UN Agencies, IUHPE, CCL settings symposium </li></ul><ul><li>Research on ecology of school, systems approach showing a new pathway </li></ul><ul><li>Four legs of the SH chair now in place in Canada albeit wobbly– now the seat, the padding, perfect the design, create chairs in each PT and more </li></ul>
Hinweis der Redaktion
I hope that I can offer some thoughts and observations based on 20 years of involvement in school health promotion. It is an evolutionary rather than a revolutionary concept. School health is kind of like golf…you are always learning. For me, that began in BC where I was working with the School Boards Association, when I was asked to chair a Task Force on sexual abuse. That led to HIV/AIDS crisis and then we did some work on substance abuse. By then, I had noticed some similarities and started using the word comprehensive.
Not a revolutionary idea. In the jargon of school reform, most things we try to do in SH are innovations rather then reform or transformative. Most SH bits do not shift the balance between the five functions of schooling (academic, socialization, vocational, custody, and the one that we don’t talk about sorting and selection. Each particular piece will not change the slope of participation in schools. However, by the time we implement all of the pieces on all of the issues, we will have achieved a revolution.
The school is likely the first setting in which children who are becoming youth interact with the world outside their family, relatives and neighbourhood friends. As part of this summit’s attempt to look at middle childhood, we should be defining what we can reasonably expect to have as outputs at the end of middle childhood. This chart is an attempt to illustrate what those outputs might look like. Later in this presentation we will tlak about the future, but this slide reminds me of both the future and the past. In the future, our Asocciation will be preparing a position paper for the Health Learning KC on Indicators for school-age children and one aspect of this position paper will focus on elementary school ouputs Please note that schools resp for learning, not health and social developmnt Please note limited list of priority issues for this age group. Also, note that certan school factors outside classroo. I n the past did a paper for HC. They chose not to act on that paper for school age kids and focused only on young children. Now, ten years later, picking up on the fact that kids get older.
New understanding of school that underpins new consensus statement Developed by SHN irv rootman,maryanne doherty, donna murgnahan, michel janosz, martin shaine, paul cappon Reflect settings, system approach Interaction between child, home, school and community Not static environment, changes each day for each kid
In the past 15 years we have learned some things, here are a few examples
Australians have said this best…. Remember Don Nutbeam and Emery Dosdall a time when a few of us were forming the joint inter-governmental consortium on healthy schools
a) The approach can focus on specific health or social issues one at a time , or on three our four issues at a time as they arise. This single-issue can use a coordinated approach by delivering multiple interventions simultaneously and coordinating them, Examples of this approach have been evaluated and found to be effective. b) The approach can be based a sub-population approach (high-risk kids, kids in poverty, early childhood, gender, culture, aboriginal etc). c) The approach can be based on a type of intervention (focus on improving instruction or type of instruction such as skills-based instruction or active learning, development of health services, strengthening of youth participation, development of staff skills etc.. d) The approach can be values driven , promoting universal principles such as equity, human rights, youth participation, parent involvement, democracy, community development and social cohesion. e) The approach can be driven by learning and educational objectives and seek improvements in health and social development so that schools become more effective and are continuously seeking their own improvement . f) The approach can combine specific health issues in an ad-hoc way , based on resources, expediency. g) The approach can combine health issues under two categories, chronic and communicable diseases. h) The health issues can be grouped under a youth risks/behaviours approach to focus on topics such as smoking, drinking, using drugs, taking sexual risks and risking injury. i) The approach can focus on selected positive physical health behaviours such as physical activity, healthy eating, not smoking or grouped under an active, healthy living approach emphasizing personal responsibility and basic physical health as the cornerstone. j) The approach can focus on life or social skills, social influences and social/emotional development, mental health to support positive behaviours and prevent negative health and social behaviours. k) The approach to healthy child and adolescent development as well as health risks and behaviours can seek to modify the key social and physical environments (homes, schools, communities) that influence these behaviours and development. l) A comprehensive approach that combines changes in individual behaviors, skills, knowledge and attitudes as well as modifications to the environments, conditions and services. m) The comprehensive approach can be pursued through a systems-based approach that develops certain capacities within the systems, including coordinated policy/leadership, staffing dedicated to school health coordination, formal and informal mechanisms for cooperation, knowledge exchange, sustained work force development, early identification of emerging issues, surveillance of health/monitoring of system capacity. n) Other (including combinations of the above).
Now turn to 2007 version of the statement NGO network still signing up, over 25 and counting
Explicit, coordinated policy and managerial support for inter-ministry, interagency and inter-disciplinary coordination and cooperation. This should include establishing procedures in policy-making, program planning and budget preparation so that responses to health and social issues undertaken through and with the school systems are aligned. As well, there should be an overarching policy that such inter-sectorial approaches are to be favoured and followed to the extent that is possible and effective. This overarching policy would be reflected in guidance and directives to school, public health, police, social service and other local authorities and agencies. Use of formal and informal mechanisms for coordination and cooperation such as joint committees, job descriptions, written policy statements, joint in-service programs, joint planning, shared budget allocations, joint vision development and consensus building Assigned staff and infrastructure at the national, provincial/territorial and local agency level specifically to facilitate and support coordination and cooperation. These staff assignments should include time for actively supporting voluntary cooperation and alignment of activities, programs, polices and practices, should be based on explicit intergovernmental, inter-ministry, inter-agency and inter-disciplinary agreements and should ensure that the voices of youth, parents, professionals and volunteers are heard in the decision-making about policies and programs. Mechanisms and processes to transfer, translate, exchange and disseminate knowledge to decision-makers and practitioners and to promote promising practices and describe lessons learned from experience, reviews, evaluations and studies. This would included evidence-based knowledge summaries published by a variety of sources, guidelines for policy, programs and practice from provincial, territorial and professional sources and tools and models that enable decision-makers and practitioners to reflect on their situation and their practice and to locate materials and models that can be adapted to their circumstance. Explicit and sustained programs and processes to develop ministry and local agency workforce , including studies of current professional practices, guidance and support for the development of university and college pre-service preparation programs and development of guidelines, models and materials for sustained staff development programs. Explicit and agreed upon procedures and processes to identify emerging issues and plan responses accordingly. This would include a regular scan of health, social, educational and other trends with suggested actions for policymakers and agencies. Regular, reliable and timely collection and communication of data on the health outcomes, social behaviours and related learning of children and youth , and their connectedness to parents, schools and the community for use in appropriate decision-making and Indicators systems as well as periodic surveys of local agency policies, programs and capacities to ascertain their capacity without implying a supervisory role or identifying survey participants Explicit plans for sustainability in the school health policies and programs undertaken. This will need to include regular evaluations and assessments of progress as well as a willingness to allow the school health programs to evolve to meet emerging needs and circumstances.
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