(An item from the ISHN Member information service)  University-school district partnerships in the implementation of comprehensive school health programs proved to be effective in Taiwan. An article in Issue #4, 2015 of Health Education Research examined whether expanding the support for this initiative was effective in advancing HPS implementation, perceived HPS impact and perceived HPS efficacy. "In 2011, the Taiwan government expanded its support of school–district/university partnership programs that promote the implementation of the evidenced-based Health Promoting Schools (HPS) program. In 2011 and 2013, a total of 647 and 1195 schools, respectively, complemented the questionnaire. Univariate analysis results indicated that the HPS implementation levels for six components were significantly increased from 2011 to 2013. These components included school health policies, physical environment, social environment, teaching activities and school–community relationships. Participant teachers also reported significantly greater levels of perceived HPS impact and HPS efficacy after the expansion of support for school–district/university partnership programs. Multivariate analysis results indicated that after controlling for school level, HPS funding and HPS action research approach variables, the expansion had a positive impact on increasing the levels of HPS implementation, perceived HPS impact and perceived HPS efficacy." Read more>>

(An item from the ISHN Member information service)  Several of the articles in Issue #7, 2015 of Psychology in the Schools examine the role that school nurses play with other school personnel. The introduction to the speacial issue notes the lack of cooperation between nurses and mental health personnel. "The impetus for this special issue was the lack of research focused on the collaboration of school personnel (i.e., school psychologists and special education teachers) and school nurses. It is surprising that highly recognized professions working within schools, and who often work with same children, rarely collaborate with the goal of enhancing student learning. Although it is common for school psychologists to request vision and hearing examinations or to consult with school nurses regarding medication, active involvement of school nurses during the evaluation and classification process appears limited. In addition, school nurses appear to have limited input during the development and implementation of interventions. The primary aim of this special issue is to demonstrate how school personnel and school nurses can collaborate when developing prevention programs, addressing chronic health needs, and addressing the health needs of children with special needs. Another unique aspect of this special issue is that several of the articles were co-authored by a school nurse or nurse and a school psychologist." The articles in the special issue deal with topics such as continuum of care, identification and evaluation of autistic students, bullying prevention and response, students with disabilities, diabetes and other chronic diseases, responding to crises and roles within comprehensive school mental health promotion programs. Read more>>

(An item from the ISHN Member information service)  Several studies have shown that LGBT senior high school students experience higher rates of homelessness than their heterosexual peers. Moreover, LGBQ high school students are more likely to stay in riskier locations (eg, with a stranger) and less likely to stay in a shelter. Some studies show that 40% of homeless youth are LGBT (http://usich.gov/issue/lgbt_youth/lgbtq_youth_homelessness_in_focus/). This is likely to occur when the young person discloses their orientation and family members are not supportive, or even hostile. An article in the August 2015 Issue of Journal of School Health tested whether these trends also apply to middle school students. "Using representative data, we examined sexual identity and homelessness among Los Angeles Unified School District middle school students. Nearly 10% of middle school students identified as LGBQ and 23.5% experienced at least 1 night of homelessness during the previous year. Contrary to high school data, LGBQ students did not experience higher rates of homelessness overall. However, when limiting the sample to students who had experienced homelessness, LGBQ students were more than 5 times as likely as heterosexual students to have stayed in a public place and 63% as likely to have stayed in a shelter." the authors conclude that "Lesbian, gay, bisexual, or questioning students are more likely to experience public homelessness. Schools must implement homelessness surveillance systems to assist in identifying early episodes of homelessness, thereby reducing the likelihood of poor physical and mental health outcomes associated with chronic homelessness. Read more>>

(An item from the ISHN Member information service)  An article in Issue #7, 2015 of The Lancet Global Health, written by the Assistant Director of PAHO, the regional office for WHO in the Americas agrees witb the assertion made in the May 2015 issue of that Journal. (ISHN highlighted that earlier article in our weekly report for May 25-31, 2015. We have reposted that item into this blog here) The earlier article " reports on an interdisciplinary analytical review of the SDG process, in which experts in different SDG areas identified potential interactions through a series of interdisciplinary workshops. This process generated a framework that reveals potential conflicts and synergies between goals, and how their interactions might be governed. We noted that this call for integrated system-based responses underlines the need for the global dialogue that ASCD, Education International and ISHN have stimulated in regards to integrating health and social programs within the education systems. The PAHO article notes that "Greater synergies between health and other sectors could be achieved by framing the SDGs in such a way that their attainment requires policy coherence and shared solutions across multiple sectors; that is a Health-in-All-Policies approach" In essence, the educator led dialogue on school health promotion might be summarized with this slogan; a Health in All Policies approach will require that Health is in (actively, with personnel and funding) in all sectors (HiAS). Read more>>

(An item from the ISHN Member information service)  An article in May 2015 Issue of The Lancet Global Health underlines the need and huge challenges in aligning the work on the 17 SD Goals recently adopted by the UN. The article also underlines the need for the global dialogue that ASCD, Education International and ISHN have stimulated in regards to integrating health and social programs within the education systems. The article " reports on an interdisciplinary analytical review of the SDG process, in which experts in different SDG areas identified potential interactions through a series of interdisciplinary workshops. This process generated a framework that reveals potential conflicts and synergies between goals, and how their interactions might be governed. The 17 SDGs are represented in three concentric layers. In the inner layer we find the people-centred goals that aim to deliver individual and collective wellbeing. The wellbeing goals are supported by second-level goals that relate to the production, distribution, and delivery of goods and services including food, energy, clean water, and waste and sanitation services in cities and human settlements (ISHN suggests that equitable and inclusive education systems is better placed here). We call these infrastructure goals to deliver the wellbeing goals and provide a platform for delivering the wellbeing goals. The figure's outer layer contains three natural environment goals; natural resources and public goods in land, ocean, and air, including biodiversity and climate change.In our framework, the middle layer, infrastructure goals, represent a domain for global development goal setting with particularly strong effects on inner-level and outer-level goals. A crucial lack of potential synergies at the level of infrastructure goals is compounded by governance issues at this level. Here decisions are typically taken by powerful elites and technical experts. Read more>>

(An item from the ISHN Member information service)  The implementation, scaling up, maintenance and sustainability of individual programs as well as multi-intervention approaches such as comprehensive school health promotion requires new frameworks and better ways to understand the complex interactions at multiple levels in several systems. An article in Issue #5, 2015 of Prevention Science helps us toward that goal, as it describes the implementation and sustainability of a Social-Emotional Learning program in four schools in Wales. "his paper draws upon Rogers (2003) Diffusion of Innovations Theory to explain the adoption, implementation and discontinuance of a SEL intervention. A pragmatic, formative process evaluation was conducted in alignment with phase 1 of the UK Medical Research Council’s framework for Developing and Evaluating Complex Interventions. Employing case-study methodology, qualitative data were generated with four socio-economically and academically contrasting secondary schools in Wales implementing the Student Assistance Programme. Semi-structured interviews were conducted with 15 programme stakeholders. Data suggested that variation in implementation activity could be largely attributed to four key intervention reinvention points, which contributed to the transformation of the programme as it interacted with contextual features and individual needs. These reinvention points comprise the following: intervention training, which captures the process through which adopters acquire knowledge about a programme and delivery expertise; intervention assessment, which reflects adopters’ evaluation of an intervention in relation to contextual needs; intervention clarification, which comprises the cascading of knowledge through an organisation in order to secure support in delivery; and intervention responsibility, which refers to the process of assigning accountability for sustainable delivery." Read more>>

(An item from the ISHN Member information service)  An editorial and accompanying article on the impact of a program to prevent school violence in Uganda is both starling and controversial. It is so because the problem being addressed includes violence perpetrated by teachers. The editorial states" Still, despite its impressive findings (Of the Good School Toolkit) —a significantly lower rate of violence was reported in intervention schools relative to controls after 18 months, with no apparent adverse effects of the intervention—an astute reader will observe that the total efficacy of the intervention is modest. Even after this rigorous school-based intervention, almost a third of primary school children in the intervention group of the trial still reported one or more episodes of physical violence in the past week. This is violence perpetrated by school staff—acts that in other jurisdictions and countries could lead to severe reprimands, dismissal, or even incarceration. 434 children were referred to child protective services over the course of the trial, representing one in nine trial participants.". The study examined 42 randomly selected primary schools (clusters) from 151 schools in Luwero District, Uganda. The researchers report "We randomly assigned 21 schools to receive the Good School Toolkit and 21 to a waitlisted control group in September, 2012. The intervention was implemented from September, 2012, to April, 2014. Owing to the nature of the intervention, it was not possible to mask assignment. The primary outcome, assessed in 2014, was past week physical violence from school staff, measured by students' self-reports using the International Society for the Prevention of Child Abuse and Neglect Child Abuse Screening Tool—Child Institutional." Read more>>

(An item from the ISHN Member information service)  "The weekly epidemiological record of the World Health Organisation 15th May 20151 states that ‘the cases of Middle East Respiratory Syndrome (MERS) recently exported to other countries have not resulted in sustained onward transmission to persons in close contact with these cases on aircraft or in the respective countries outside the Middle East.’ This situation has changed rapidly and remarkably. Five days after the publication of this report, the first case of a MERS-coronavirus (MERS-CoV) infection in Seoul, South Korea was reported...". This first sentence in an article in the July 2015 Issue of International Journal of Infectious Diseases got our attention. It is noteworthy that South Korea closed 2700 schools quickly during the outbreak. In discussions with Toronto public health and school officials after the SARS outbreak, we learned that closure of schools was difficult due to poor communications and unclear definitions of decision-making roles. The authors of the MERS article conclude that " Moving forward, it is critical that global efforts are focussed urgently on the basic science and on clinical and public health research so that the exact mode of transmission to and between humans, and new drugs and other therapeutic interventions and vaccines can be developed6, 7. Two coronaviruses, SARS-CoV and now MERS-CoV, which cause severe respiratory disease with high mortality rates emerged within the past two decades10, reinforcing the need for clinically efficacious antivirals targeting coronaviruses. Lessons learnt from the recent Ebola Virus Disease could also be applied to MERS11. Whilst MERS does not yet constitute an International Public Health Emergency the Korean outbreak is an extraordinary event." Read more>>

(An item from the ISHN Member information service)  An article in July 2015 Issue of Frontiers in Public Health: Child Health & Human Development describes how such school meal programs can positively affect student friendships and reduce bullying. "The aim of the current paper is to investigate whether attendance at BCs and ASCs has an impact on children’s friendship quality and experiences of peer victimization. BC attendees, ASC attendees, and non-attendees completed the Friendship Qualities Scale and the Multidimensional Peer Victimization Scale (MPVS) at two time points. Time-1 data were collected 2 months after the introduction of school clubs. Time-2 data were then collected on the same measures again 6 months later. Results of the analyses of Time-1 data showed no significant differences between groups on any of the measures at Time-1. However, at Time-2, BC attendees showed improved levels of friendship quality compared to the other two groups. Moreover, analysis of the MPVS data at Time-2 showed that children who attended BC or ASC experienced a decline in victimization across time. The current findings suggest that BC attendance facilitates the quality of children’s relationships with their best friend over time. Additionally, attendance at a breakfast or ASC was associated with a reduction in victimization over time. Read more>>

(An item from the ISHN Member information service)  A blog post this week from Sean Slade of ASCD reminds us why we,proponents of health/personal/social education need to be more engaged in the global debate about the purposes of education now underway around the world. We have noted the current legislative debates now underway in England and the USA in this blog before. Thanks to ASCD, we can now add Australia to the list. In the review done for the Australian government, there are five purposes of education posited: (1) to help students develop practical skills and focus on work-related outcomes, (2) to prepare students to deal with current issues affecting the well-being of society, (3) to help students develop by focusing on their individual needs, interests and learning styles, (4) to teach students about inequality and justice and (5) to introduce students to the accumulated knowledge of their society. These Australian goals are quite similar to a more traditional view of the intellectual (academic), social, vocational, custodial and accreditation functions of schooling. As Slade points out, they are also similar to the utilitarian, future-focused, personalized learning, core basics and classical views of education. His point, is that we need to debate these goals before we settle on the curricula, structures and other aspects of schooling. Proponents of health and social development will note that these concepts are missing or at best, implicit, in all of these goal statements. We need to be better engaged. Indeed, the UN agencies are close to closing the debates about educational goals as they clarify the meaning of a high quality education in Target 4.7 of the Framework for Action, a document that will go for UN approval this September. If you want to comment on the indicators being proposed for the final FFA document go this web page and scroll down to Target 4.7. (PS We suggest that you comment on the wording of the summary statement, where the word "sustainable" lifestyles was inserted to replace an earlier version of "healthy" lifestyles. Read more>>

(An item from the ISHN Member information service)  We do not often pay attention to the various companies that supply goods and services to educational systems but one item caught our eye this week. Education Week reported that Pearson, a multi-national education company, had sold the business newspaper Financial Times to a Japanese company so that it could focus solely on its global education strategy. The story noted that "To many in the world of K-12, it might seem that Pearson is already just that focused on education. The Wall Street Journal reported that Pearson generates about 60 percent of its sales in North America, and three-quarters of its revenue from education". ISHN has been hearing more and more about the influence that Pearson has been exerting on the UN discussions on education targets in the revised millennium development goals. We obviously need to listen even more. Read more>>

(An item from the ISHN Member information service)  The news stories we identified this week included a story about an American forum organized by the White House to "rethink school discipline". The news release stated "The U.S. Departments of Education and Justice are hosting teams of superintendents, principals, and teachers from across the country today for "Rethink Discipline," a day-long conference at the White House on creating positive school climates and implementing effective discipline practices. The conference seeks to advance the national conversation about reducing the overuse of unnecessary out of school suspensions and expulsions and replacing these practices with positive alternatives that keep students in school and engaged in learning, but also ensure accountability." According to data released at the Forum , the number of US students losing critical learning time due to out of school suspensions and expulsions is staggering. Over 3 million students are suspended or expelled every year. A number of excellent actions were also announced, including policy, planning and profession al guides, a clearinghouse/web site and a public awareness campaign. The initiative was also linked to other US initiatives on racism, gender equity and similar policy directions. The search for meaningful alternatives to suspension are real and laudable. But do these various actions address the core dilemma for teachers; namely, if one or a few students continually disrupt the order and learning of other students, or if they break defined rules in a significant manner, what is the disciplinary pathway to follow. Particularly if the pathway is made more difficult and complicated by various administrative needs, family and neighbourhood factors and more? Read more>>

(An item from the ISHN Member information service)  An article in Volume 197, 2015 of Procedia - Social and Behavioral Sciences reports on a small qualitative study of teacher beliefs about school and classroom discipline. Although the study is small, the implications are significant, particularly, if, as we suspect, the views and beliefs of the teachers in this study do not differ greatly from teachers around the world. In the study, 20 teachers from primary and secondary schools were interviewed. Numerous concepts that teachers used to define the meaning of discipline were weighted according to the interviews. Among these concepts, the notions of "order" and "rules" were believed to be far more important to these teachers than other concepts such as ethics, compassion, determination, ability and an interactive process. In the middle ranking, but still far below the importance of order and rules, the concepts of volunteering, self-control, respect and adaptation to life were found. In other words, the traditional teacher beliefs and professional norms about student discipline appear to be well-reflected in this Turkish sample. Order and rules are paramount, the rest is much less important. Our only question is whether these views are consistemt with other teachers around the world. Read more>>

(An item from the ISHN Member information service)  With the adoption of the education targets in the 2015-30 UN Social Development Goals, there is increased interest in how health, personal and citizenship education can be delivered. An article in Volume 197, 2015 of Procedia - Social and Behavioral Sciences describes how citizenship education is delivered in several western European countries as an independent subject that can be mandatory or optional, or integrated in one or more subjects. In 2002 the Council of Europe suggested that CE be included in every level and must have, be linked to knowledge but also to the development of attitudes and abilities, which will provide to the students the possibility to actively participate within the society. The authors describe several countries in depth, but here is a quick summary: Spain offers CE as an optional subject at the primary and secondary level, with parents choosing between a religion course or a course on social/civic and ethical values. France defines CE as "civic and moral education" that is mandatory that is delivered in a cross-curricular format with extensive detailed guidelines in the primary school. In secondary school, "Civic, Legal and Social Education" is mandatory for one hour per week. In the UK, CE is an optional topic in primary schools and is mandatory at the secondary levels. Finland requires CE at the junior secondary levels and is optional at the senior grade levels. A participatory, empowering approach is used at all levels. In the Netherlands, CE is delivered as an explicit part of environmental education and is also delivered in a cross-curricular format. Italy delivers CE as a cross-curricular topic in primary schools and as separate subject in secondary schools. Read more>>

(An item from the ISHN Member information service)  A July 15, 2015 news release from the Office for Standards in Education (Ofsted) in England has announced that it will monitor the joint delivery of support services to children and youth. "Joint Targeted Area Inspections (JTAI) are to be introduced from autumn this year by Ofsted, the Care Quality Commission, Her Majesty’s Inspectorate of Constabulary and Her Majesty’s Inspectorate of Probation. They will specifically examine how well local authorities, health, police and probation services work together in a particular area to safeguard children. The new inspections aim to shine a light on both good and poor practice, identifying examples from which others can learn and helping local agencies to improve. The proposals, set out in a consultation launched today (Wednesday 15 July), will give inspectorates more flexibility and the ability to be responsive to certain areas of interest or concern. Each inspection is to include a ‘deep dive’ element, with the first 6 set to focus on children at risk of sexual exploitation and those missing from home, school or care. Further inspections will look at other issues by theme. The experiences of children and young people are at the heart of the proposed model. Inspectors from across all 4 inspectorates will work in small multi-disciplinary teams jointly tracking and sampling cases to assess the progress and outcomes for children and young people at risk of harm. This will complement the single agency inspections and provide a joined up evaluation of how well the agencies work together to protect children. Under the proposals the final report will include a narrative judgement that clearly sets out how the local partnership and the agencies who are part of it are performing and what they need to do to improve.". Read more>>

(An item from the ISHN Member information service)  The world’s leading NGOs demand action on education in emergencies at Oslo Education Summit on July 7th. Here are some excerpts from the NGO call to action released subsequent to the conference. "The education of an estimated 65 million children age 3-15 is disrupted as a result of wars, natural disasters and other emergencies. These children are out-of-school, at risk of dropping out or suffer from poor quality education and learning. Over 20 million are out-of-school primary school-age children. But last year, only 1% of humanitarian aid went to education..... We, the undersigned organisations, call upon world leaders at the Oslo Summit to publicly commit to the creation of a Global Humanitarian Fund for Education in Emergencies to protect the most vulnerable children and get them back in school. The fund must strengthen existing mechanisms, rapidly coordinate and deliver education in emergencies, and leverage new finance. World leaders must create this fund in 2015 if we are to keep our promise to children and the right to education. We hope this call to action leads to a process of robust technical analysis and wide consultation to determine how best to secure more and better funding for education in emergencies. World leaders have said “Education Cannot Wait,” and must now take action to keep the promise to the most marginalised and vulnerable children. Read more>>

(An item from the ISHN Member information service)  Readers of this blog will know that we have been tracking the relationship (or lack thereof) between physical activity and overweight/obesity. Two Articles in July 2015 Issue of International Journal of Obesity continue the discussion. One article suggests that self-reporting of eating and activity behaviours are not sufficiently accurate and objective measurement is required. Another article reports on a study that "identified an unhealthy cluster of TV viewing with ED food/drink consumption, which predicted overweight/obesity in a small longitudinal sample of Australian children. Cluster stability was fair to moderate over 3 years and is a novel finding. A third behaviour examined in the study, physical activity was apparently not as significant as the eating/TV watching behaviours. This finding continues our growing realization that eating and activity may be independent factors/behaviours rather than linked and that it may be wiser to focus on eating, especially when combined with television viewing. Read more>>

(An item from the ISHN Member information service)  Public health nutritionists were asked to describe the elements of system and organizational capacity in an article in Issue #10, 2015 of Public Health Nutrition. " A Delphi study involving three iterations of email-delivered questionnaires testing a range of capacity determinants derived from the literature. Consensus was set at >50 % of panellists ranking items as ‘very important’ on a five-point Likert scale across three survey rounds. A total of thirty expert panellists (68 % of an initial panel of forty-four participants) completed all three rounds of Delphi questionnaires. Consensus identified determinants of capacity building in practice including partnerships, resourcing, community development, leadership, workforce development, intelligence and quality of project management." Note: This article reflects the definition of capacity and capacity building developed and used by ISHN as part of its Wikipedia style web site. Read more>>

(An item from the ISHN Member information service)  A blog post from Live Science suggests that a better understanding is needed of the practical or real life reasons why teens use marijuana is required. Based on a study done in the USA, the author suggests that boredom, experimentation and pleasure (to get high) are among the strongest reasons for use. Mixing marijuana with other drugs to increase the effect was another. The study then examined which reasons were associated with the use of other drugs, exploring the often discussed notion that marijuana is a gateway to other drugs. Experimentation was not tied to other drug use but boredom was. Read more>>

(An item from the ISHN Member information service)  With debates about the purposes of schooling now underway in several countries such as England, the US and others, we note that several blogs are adding useful commentaries suggesting that a holistic education, aimed at developing the whole child, are also adding to those debates. Watch these pages for ongoing reporting of the education reform paper in England and the renewal of the Education Act in the US. Both countries are deciding whether health education will be part of their core subjects. Read more>>

(An item from the ISHN Member information service)  Among the news stories this week were several items reporting on the intrusion of video cameras into schools to record student and staff behaviours. In Iowa, a school district has required school principals to wear video cameras much like the police are now doing in several cities. In Abu Dhabi and other countries, video cameras are now being used to record student behaviours on school buses. Ironically, this weeks news items included a national report from the education ministry in the US that student violence and fear of violence are declining. Read more>>

(An item from the ISHN Member information service)  An analysis of coordination the Dutch Healthy School Approach (HSA) is reported in the July 2015 Issue of BMC Public Health. "HSA targets demand-driven practices based on the epidemiological data, a prioritization of needs, an assessment of important/modifiable determinants, the drafting and implementation of a multi-year plan, and its evaluation. All this is done jointly with multiple stakeholders. At school level, implementation is assisted by a ‘HPS advisor’, who represents various public services and providers in individual contacts with schools. At local and regional levels, the public health services (PHSs) function as a coordinator between the education, health and other services stakeholders. Their coordinating role derives from a legal responsibility for the implementation of local public health policy and youth health care financed by the municipality". The study "reports on the longitudinal quantitative and qualitative data resulting from a two-year trajectory (2008–2011) based on the DIagnosis of Sustainable Collaboration (DISC) model. This trajectory aimed to support regional coordinators of comprehensive school health promotion (CSHP) in systematically developing change management and project management to establish intersectoral collaboration. Multilevel analyses of quantitative data on the determinants of collaborations according to the DISC model were done, with 90 respondents (response 57 %) at pretest and 69 respondents (52 %) at posttest. Quantitative data showed major improvements in change management and project management. There were also improvements in consensus development, commitment formation, formalization of the CSHP, and alignment of policies, although organizational problems within the collaboration increased. Content analyses of qualitative data identified five main management styles. Read more>>

(An item from the ISHN Member information service)  An article in Volume 76, 2015 of Preventive Medicine reports on a review of studies using the Reach, Efficacy/Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to evaluate physical activity interventions aimed at youth. "A systematic search for controlled interventions conducted within the last ten years identified 50 studies that met the selection criteria. Based on Reach, Efficacy/Effectiveness, Adoption, Implementation and Maintenance criteria, most of these studies focused on statistically significant findings and internal validity rather than on issues of external validity. Due to this lack of information, it is difficult to determine whether or not reportedly successful interventions are feasible and sustainable in an uncontrolled, real-world setting. Areas requiring further research include costs associated with recruitment and implementation, adoption rate, and representativeness of participants and settings. This review adds data to support recommendations that interventions promoting physical activity in youth should include assessment of adoption and implementation issues". Read more>>

(An item from the ISHN Member information service)  A traditional approach to evaluating the effectiveness of school health promotion programs was used in a small scale study reported in Issue #4, 2015 of Health Promotion Practice. The authors report that "SH interventions are evidence based and integrated into the curriculum, while embedded in complementary healthy school policies and environment. This study evaluates the effects of such an intervention on Dutch high schools. Methods. Two Dutch high schools and two controls were followed to evaluate the intervention’s effects on health behaviors, body mass index, and psychosocial problems after 1 year (N = 969) and 2 years (N = 605). Outcomes were measured via self-report surveys and analyzed with mixed methods regression analyses. To complement information on intervention effects, structured interviews were held with a representative sample of teachers per intervention school to map their respective whole school approach implementation success. Results. After 2 years, one intervention school showed significant improvements: Body mass index and excessive screen time use were reduced. In the other intervention school, priority targets did not improve. These findings reflected their respective success in intervention implementation, for example, differences in intervention integration and tailoring." The challenges associated with this type of study, beyond the short term measurement of behavioural effects, is that we are no informed about why implementation worked in one school but not the other. Read more>>