(From the ISHN Member information service)  There is a well-established pattern in the research about the effects and nature of effective parenting. Many studies have told us about parent-child communications, parental supervision, parent expectations, role modeling, parenting styles and other general attributes and how they affect their children's behaviours and health status. However, several articles in Issue #3, 2014 of Social Development take us towards a deeper and more detailed understanding. The first article reports on how parenting, when combined with certain genetic traits, can increase "ego-resiliency". Another article discusses how "maternal social coaching" can affect relational aggression among children. Yet another article describes how parents can provide "support for autonomy" within their children. Another article uses values socialization theories to explain how "values emphasized in families" affects behaviour. The final article in this issue discusses how parenting can overcome economic deprivation and cumulative risk to children by building "effortful control" in their children through "warmth, limit setting, and responsiveness. Read more>>

(From Drug & Alcohol Findings UK)  A cogent analysis of the limitations of school-based drug education is discussed in a blog post from this multi-partner knowledge exchange organization in the UK. The article suggests that school-based instruction is, almost by definition, constrained by the social forces surrounding and enshrined in schools. When adults, whose normative beliefs and practices encourage alcohol use, try to impose a delay in access to this popular pastime in the adult world on adolescents, the results are predictably limited. The article suggests a possible divorce of the "educational" aspects (empowering youth to make decisions) from the preventive aspects. Or, at least, the article suggests, that the goals of drug education should be modified to more limited objectives (harm reduction) or different objectives more compatible with schooling (character building, preventing school dropouts etc). Here is a brief except: 
"School-based drug education was and for many remains the great hope for preventing unhealthy or illegal substance use. Across almost an entire age group it offers a way to divert the development of these forms of substance use before they or their precursors have taken root. Though promise is clear, the fulfilment is less so. Most disappointing for Europe and for the UK were results from the seven-nation EU-Dap European drug education trial and the English Blueprint trial. The former was the largest European drug education trial ever conducted and tested a sophisticated US-style social influence programme, yet the results were patchy – generally positive but modest and usually not statistically significant benefits relative to control schools. The multi-million pound Blueprint trial was the largest in Britain and featured advanced interactive teaching methods reinforced by parental and community-wide components. Its government funders expected the results to “trigger a fundamental assessment of the place of drug education” in UK drug policy. If it did, it would be to confirm that drug education in secondary schools makes little contribution to the prevention of problems related to drinking and illegal drug use, though the evidence in respect of smoking is stronger. By the end of the follow-up period, on none of the most relevant measures was there was any sign that Blueprint had retarded growth in substance use any more effectively than usual lessons in the non-Blueprint schools. What might lie behind such disappointments can be divided in to at least two possibly interrelated domains: contradictions in principle, shortfalls in practice. Among the first is the contradiction between the objectives of education and those of prevention: the former seeks to empower children to think for themselves and open up new horizons, the latter to channel thoughts, attitudes and actions in ways intended by programme developers and teachers. Then there are potential contradictions within prevention programmes themselves. Some aim to limit young people’s autonomy in their choice of friends and substances by extending autonomy in decision-making, to encourage conformity to non-drug use values by discouraging conformity to other young people, to develop team work and social solidarity without accepting that youngsters may express this by going along with their peers as well as deciding not to". Read more>>

(From the ISHN Member information service)  A Chicago-based organization, the Healthy Schools Campaign, has emerged on the national scene in the United States and is working hard to influence national policy decisions. Working from a background paper/initiative, Health in Mind, HSC has formed an  influential group of organizational and government leaders called the National Collaborative on Education and Health, with an impressive list of members  The NCEH has gained access to the US Surgeon General's Advisory Group on Prevention, Health Promotion, and Integrative and Public Health (Prevention Advisory Group), which was created by the Affordable Care Act to bring a non-Federal perspective to the Strategy’s policy and program recommendations and to its implementation. 

On August 24, 2014, the NCEH hosted the first meeting of its Health Systems Working Group, an important step towards identifying strategies for redesigning health delivery systems to meet the health needs of students. The Health Systems Working Group members bring together over 25 health and education leaders who will work together over the next four months to identify strategies to increase collaboration between the health and education sectors to support the delivery of school health services and programs. Some of the key questions this group will address include:
• How can schools be incorporated into delivery system reforms; other new models of care emerging from the Affordable Care Act; and other innovations being tested for the delivery of physical and mental health services, health promotion and prevention?
• How can the health care system better support schools in creating the conditions of health for students?
• What new models of practice are needed in both the health sector and schools to support an integrated delivery of care model?
• What type of guidance needs to be shared with the health and education sectors to promote collaboration?

At the first meeting of the working group, participants discussed a brief discussion paper describing the opportunities presented by the Affordable Care Act that can be used to promote collaboration between the health and education sectors. The paper also discussed the need for a model that leverages these opportunities. These examples illustrated how preventive and primary care examples where hospitals/health care organizations from Portland, St. Paul, Madison, Grand Rapids, Deleware, Austin, Cincinnati and Kentucky are working closely with schools.

Commentary:
This is an exciting development within the United States. Coinciding with the release of the updated US school health promotion model from the Centers for Disease Control and Prevention and the educational leaders organization, ASCD, these policy level discussions could be connected to the renewed program and practitioner led efforts. They could also be built upon previous substantive work done on school health care services and centres in the US. Hopefully, these high level policy/advocate discussions will be connected firmly to the extensive history of programmic excellence.

Secondly, we hope that the discussions of this NCEH Working Group can be linked to broader discussions of how the health systems can support promotion and prevention policies and programs as well as preventive care through schools. As we know from the many different successful models of school health promotion in the US and elsewhere in the world, several aspects the public health functions of coordination, promotion, prevention, protection and surveillance can all be accomplished by working with and within school systems.  

As well, we hope that these policy/advocacy discussions on US health care-school programs can address the barriers and facilitators that health systems face when maintaining and sustaining long-term health promotion approaches such as school health. There is constant pressure on the health promotion sectors of health systems to respond to the latest health/social problem of the day. With scarce resources often drawn to treatment and emergency health, the health promotion sector is often forced to fund activities on a selected list of issues rather than on health overall. While this underlying problem of scarce resources will never disappear, there are systemic changes that can be made to structures, staffing and decision-making to ensure continuity and ongoing relationships/commitments to non-health sectors such as schools. A research agenda on such barriers and facilitators has already been proposed by a recent North American symposium of education and health leaders.  Another practical suggestion coming out of that symposium was greater and sustained investments in school nursing. If school nurses can be mandated to the full scope of their professional roles, then they can be be essential glue that keeps school health care connected to school health promotion and to the many specific prevention activities. 

A third hope for these high powered US discussions is that they take the time to truly understand the core mandates, concerns and constraints of school systems so that they can truly motivate and engage school systems in health promotion. Educators will happily accommodate health services in their schools. Indeed, this is often the first thing that school administrators ask for. Educators can provide all sorts of other health promoting support in their teaching, caring for children, working with parents and community leaders and more. But, as recent research is showing, they are reluctant to do that unless the health systems modify their approach to ensure that is it based on systemic, long-term strategies. ISHN and ASCD have gathered this recent research into a global discussion of how health (and other systems) need to integrate their programs within education systems. Insights and evidence-based and experience-tested ideas from the global discussion, including a consensus statement, a background paper and International Discussion Group are all sources that we hope American and other national leaders will not ignore.  

(From the ISHN Member information service) A constant refrain in practitioner and policy-maker commentary on random control trial based research (usually leading to systematic reviews and other conclusions that favour artificially "controlled" conditions over the real world). An article in Issue #3, 2014 of Child Development explains how the statistical methodology used in these studies (Frequentist methods) often dictates the nature of the investigation. Although the "gentle introduction" to Bayesian methods provided in the article is hardly such, the different methodology may help us all to get out of the RCT box. The authors note that "Conventional approaches to developmental research derive from the frequentist paradigm of statistics. This paradigm associates probability with long-run frequency. The canonical example of long-run frequency is the notion of an infinite coin toss. A sample space of possible outcomes (heads and tails) is enumerated, and probability is the proportion of the outcome (say heads) over the number of coin tosses. The Bayesian paradigm, in contrast, interprets probability as the subjective experience of uncertainty (De Finetti, 1974b). Bayes’ theorem is a model for learning from data. In this paradigm, the classic example of the subjective experience of uncertainty is the notion of placing a bet. Here, unlike with the frequentist paradigm, there is no notion of infinitely repeating an event of interest. Rather, placing a bet—for example, on a baseball game or horse race—involves using as much prior information as possible as well as personal judgment. Once the outcome is revealed, then prior information is updated. This is the model of learning from experience (data) that is the essence of the Bayersian method." The authors go on to explain that " the Bayesian paradigm offers a very different view of hypothesis testing (e.g., Kaplan & Depaoli, 2012, 2013; Walker, Gustafson, & Frimer, 2007; Zhang, Hamagami, Wang, Grimm, & Nesselroade, 2007). Specifically, Bayesian approaches allow researchers to incorporate background knowledge into their analyses instead of testing essentially the same null hypothesis over and over again, ignoring the lessons of previous studies. In contrast, statistical methods based on the frequentist (classical) paradigm (i.e., the default approach in most software) often involve testing the null hypothesis. In plain terms, the null hypothesis states that “nothing is going on.” This hypothesis might be a bad starting point because, based on previous research, it is almost always expected that “something is going on." It is this faulty assumption of "nothing going on" that may force RCT type studies to compare a new program/intervention to a controlled one (which is assumed to be the null hypothesis (nothing going on) but which actually may have a lot going on. The researchers using "frequentist" statistics then conclude that the new program works (or not) when in fact, they are really comparing the new program to others in which very similar programs, or similar but disorganized activities, are actually taking place. We leave it to others more schooled in statistics to respond, but from our vantage point, the increased use of Bayersian statistical methods deserves our consideration.   (Full text of the article can be accessed) Read more>>

(From the ISHN Member information service)  A background paper on metrics (monitoring, reporting, indicators and data sources) has been prepared for the US National Collaborative on Education and Health (NCEH) Published in August 2014 which describes current US state and federal efforts to include health data in school monitoring and reporting systems.  This ISHN commentary includes several excerpts from the paper followed by some brief comments on how the analysis can be extended to delve deeper into the relationship between health and education systems.

Selected Excerpts: 
'With the passage of the Elementary and Secondary Education Act (ESEA) as reauthorized by No Child Left Behind of 2001, states are now required to provide report cards for all public schools, which must include information about students’ performance on standardized tests, as well as whether schools have been identified as needing improvement, corrective action, or restructuring. Student data must be dis-aggregated by student subgroups according to race, ethnicity,gender, English language proficiency, migrant status, disability status and low
-income status. These report cards must be made public online and through other mechanisms. Some Local Education Agencies use this opportunity to share comprehensive data about schools in the district, particularly contextual data on issues that are strongly correlated with academic achievement, including teacher qualifications, school climate and safety, and commitment to health and wellness. States also have laws requiring that schools report other data, such as school safety (e.g., Virginia and Oklahoma) or the condition of school facilities (e.g.,
Pennsylvania). Finally, Illinois and Colorado have state laws that require the schools to report on health and wellness data, including access to recess, physical education and access to school health services.  

For the past two decades, states have been creating and refining longitudinal data systems to track, store, analyze, and apply a range of data to improve academic achievement and student outcomes. These State Longitudinal Data Systems (SLDS) allow states to track and monitor a student’s data from one grade to the next. In addition, most of the data reported in state school report cards comes from SLDS. While states generally do collect individual student data on health conditions that are correlated with academic achievement, such as a
ctive asthma, vision problems, or dental caries via school health services or required state school health forms, these data are not commonly tracked longitudinally or linked with a student’s academic data. California represents one example of a state that is using a longitudinal data system, the California School Climate, Health and Learning System, to collect information about both education and health." (Note: Later in the report, brief summaries of other states doing similar reporting are provided. These include Oregon, Texas, Colorado and Illinois,)

Although health has not traditionally been collected in SLDS, there is a precedent for collecting non-academic student data in SLDS to inform and develop educationally relevant interventions. Examples such as these can provide a framework for how health can inform and enrich SLDS
to create more robust student interventions. For example , some states have used their SLDS to establish an Early Warning System that can be used to identify students at risk of dropping out by tracking attendance, behavior and course success. According to
the Data Quality Campaign, in 2013, 26 states had an Early Warning System that they were using to identify students who might be at risk of dropping out. "

The report also examines recent efforts by the US Department of Education to monitor student health and wellness. "The National Center on Safe Supportive Learning Environments (NCSSLE) is funded by the U.S. Department of Education’s Office of Safe and Healthy Students and seeks to improve schools’ conditions for learning through measurement and program implementation, so that all students have the opportunity to realize academic success in safe and supportive environments.A key activity of the NCSSLE is to provide support to 11 grantees
that are working to address factors that affect conditions for learning and impede the building and maintenance of safe and supportive learning environments (e.g.,bullying, harassment, violence, substance abuse). Specifically, these grantees are in the process of implementing programs
or developing initiatives to collect and use data to assess the extent to which schools are safe and supportive. NCSSLE also maintains a compendium of valid and reliable surveys, assessments and scales of school climate. 

Commentary: 

This NCEH background paper provides a good overview of the efforts of some states and the recent federal work to include health data in education monitoring and reporting systems. It provides a description of current education state education department activities in monitoring their system results and how some health data can be included. 

However, the paper does not mention the well-developed system for reporting on student health and on system capacity that has been developed by the Centers for Disease Control and Prevention, including the Youth Risk Behavior Survey, the School Health Policies and Practices Survey and the various other "profile" reports that CDC publishes. The activities from the education system could be combined with the existing monitoring and reporting systems  that have been well developed by CDC. The YRBS data is available by state. The SHPPS data would provide much of the policy/program data required to complete the picture. 

As well, the US is one of 43 countries participating in the Health Behaviors of School-aged Children (HBSC) survey, a long-standing international survey done regularly by countries in western Europe and Canada that tracks student health behaviors as well as the social support provided by parents, peers and schools. In particular, the HBSC survey offers excellent data on the "connectedness" between students and their teachers and schools, a key factor in school success. 

Further, the discussions and initial framework for Monitoring & Reporting Systems developed by the International Discussion Group on MRE led by the International School health Network suggests that in addition to tracking health status/behaviours and system policies/programs, an effective M&R system needs to include data on the learning outcomes achieved by students in health, family studies, personal/social development and physical education. although a couple of US states have considered the development of such additions to their tracking of the learning occurring in other core subjects such as language arts, math and science, there is no system in the US (or any other country) for reporting on student learning in these areas. )Note: The report does discuss student learning somewhat noting that " Most states, for example, have standards for physical and health education. Some states assess student progress on meeting these standards using statewide tests, allowing a statewide comparison and analysis of scores." However, the examples cited in this section in the report such as the Fitnessgram used in California and Texas actually measure health status (fitness levels) rather than what has been learned in PE classes.)   

This initial NCEH report could be extended or elaborated upon so that the development of metrics (indicators, data sources and monitoring/reporting systems) is based on a truer, more appropriate relationship between health and education systems. Rather than starting with the concerns of health systems (or by using the readily available data sources), the process could begin with identifying the health and social issues/factors that are most relevant to student learning and school success. Charles Basch, in his work on health equity and schooling in the US, has identified several health problems that have a significantly more impact on educational success. These include eating breakfast, hungry children/school meal programs, teen pregnancies causing school dropouts, homophobic and other forms of bullying, dental health, head lice, asthma and others that cause prolonged absences from school. By starting with these health and social issues, the process becomes more of a support to educators and their primary mission, rather than adding more items for which schools become implicitly accountable (since they are often the only ones reporting on the health and well-being of children on a regular basis). This new premise is part of a US/Canada and global dialogue on how health (and other systems) can fit better within the core mandates, concerns and constraints of school systems. Using this integration within" premise, rather than "adding to" or even "aligning" the metrics of the two systems offers the promise of more engagement and more sustainable support from educators and the systems in which they work.      

(From the ISHN Member information service)   Using odds ratio calculations from data from the Canadian HBSC survey, a researcher shows (Vol 66, 2014, Preventive Medicine) that both the perception of safety in a neighbourhood, as well as the actual crime rate, will affect the levels of physical activity among adolescents. However, the article suggests that these are independent variables (with actual crime rates having more impact than perceived safety). Consequently, the author suggests that the reach of PA programs can be improved if we address the perceptions of safety alone. "After controlling for crime and relevant confounders, the relative odds of being physically active outside of school was 0.52 (95% CI: 0.44–0.62) in youth whose perceptions of neighborhood safety were in the lowest quintile. After controlling for perceptions of safety and relevant confounders, the relative odds of being physically active outside of school was 0.75 (0.60–0.95) in youth from neighborhoods with crimes against persons scores in the highest quintile. Within this large sample of 11–15 year olds, perceptions and objective measures of neighborhood safety and crime were independently associated with physical activity in free-time outside of school. Read more>>

(From the ISHN Member information service) A blog post noted this week reports an another trend in education, another one that should catch the attention of advocates of health and personal/social development education because of the ongoing competition for time in over-crowded curricula. ASCD, a leading educational organizations notes the trend "Lessons involving STEAM -- science, technology, engineering, arts and math -- are catching on nationwide, including in schools in Florida, Ohio and Texas. The concept also has drawn support from businesses and government. Still, some say the effects of STEAM on student achievement remains unclear. " STEM education–that’s science, technology, engineering, and math–has gotten an increasing amount of buzz over the past few years. And now, there’s a twist on STEM: the addition of the arts, making it STEAM. Supporters say a more focused inclusion of the arts helps kids become creative, hands-on learners by sparking innovation. This fits with the calls for "21st Century Learning from business and other leaders, where innovation and creativity are increasingly valued as a business, enterprenurial skill. Read more>>

(From the ISHN Member information service)  A survey of 900 officials in all US states in the August 2014 issue pf Preventing Chronic Disease reports that "On average, 45.7% of staff per state health department use journals. Common barriers to use included lack of time, lack of access, and expense. The 904 respondents were from each of the 50 state health departments and DC. There were 6 to 45 participants per state health department (mean = 31; median = 30). Response rates from state health departments varied from 58.6% to 96.0%. Participants self-identified as program managers or coordinators (57.3%), health educators (12.1%), epidemiologists (8.6%), bureau or division chiefs or directors of chronic disease units (4.5%), and 17.5% other (eg, program evaluators). An average of 45.7% of staff per state health department reported using journals as a top method for finding evidence. State health departments where at least 50% of staff identified journals as a top source participated in more research activities compared with state health departments where fewer than 50% of staff used journals (6.5 activities vs 5.0). There were no other notable differences in journal use for staffing levels, mean employee age, mean years of service, number of people served, or revenue." In the discussion section, the authors note that "Relevance of journal content for state health department practice may also influence use, although relevance was not a top barrier selected. Previous studies of public health agencies found staff wanted access to journals and gray literature for evidence directly related to public health practice (12). Unfortunately, there is limited literature focused on practice; instead, scientific evidence in journals focuses heavily on discovery research (3), which identifies existence of and relationships between health risks and health conditions (eg, smoking and lung cancer) (6,10)." Read more>>

(From the ISHN Member information service)  As we learn more about the sustainability of multi-intervention approaches and programs, we are seeing the development of various techniques to measure and monitor such sustainability. An article in Issue #2, 2014 of School Psychology Quarterly reports o the development of "the School-Wide Universal Behavior Sustainability Index: School Teams (SUBSIST; McIntosh, Doolittle, Vincent, Horner, & Ervin, 2009) a measure of school and district contextual factors that promote the sustainability of school practices, demonstrated measurement invariance across groups of schools that differed in length of time implementing school-wide Positive Behavioral Interventions and Supports (PBIS; Sugai & Horner, 2009), student ethnic composition, and student socioeconomic status (SES). School PBIS team members and district coaches representing 860 schools in 14 U.S. states completed the SUBSIST. Findings supported strong measurement invariance, for all items except 1, of a model with two school-level factors (School Priority and Team Use of Data) and 2 district-level factors (District Priority and Capacity Building) across groups of schools at initial implementation, institutionalization, and sustainability phases of PBIS implementation. Schools in the sustainability phase were rated significantly higher on School Priority and Team Use of Data than schools in initial implementation." Read more>>

(From the ISHN Member information service) Three articles in the August 2014 issue of the American Journal of Clinical Nutrition question the value of eating breakfast. The first, an RCT, suggests that eating or skipping breakfast had no effect on weight loss. The second, an RCT, reported no difference in resting metabolism rates. The third, a systematic review, found only equivocal evidence that eating breakfast had a positive impact on student academic performance. Another systematic review reported that consuming fruits and vegetables without cutting back on total caloric intake will not result in weight loss and another RCT study found little impact from switching to whole grains. Read more>>

(From the ISHN Member information service)  Two research reviews reported in Issue #4, 2014 of Aggression & Violent Behavior add to the evidence-based supporting school-based and school-linked prevention and promotion. The first review, reporting on a meta-analysis of school-based cognitive-behavioral interventions in the treatment of aggression in the US found small effect sizes. "mean effect size (ES) of − 0.14, (SD = 0.48) and a mean weighted ES score of − 0.23. Results showed that the universal intervention delivery method had a significant influence on the magnitude of the effect size (F(1, 61) = 4.84, p = .032). In light of these results we discuss study limitations and suggest future research on potential CBI moderators and the role of CBI in the current school environment." The second article, a systematic review of sexual violence prevention programs, found that none of the "brief, psycho-educational programs focused on increasing knowledge or changing attitudes have shown evidence of effectiveness" but there are effective school-based instructional programs such as "Safe Dates". Read more>>

(From the ISHN Member information service)   An August 19, 2014 posting to the Teachers Blog from Education Week discusses the "the Unwritten Job Descriptions of Teachers in High-Needs Schools" and thereby underlines one of the challenges and dilemmas of their daily work and professional careers. The author, a woman, discusses her "worst class" and how the pre-dominantly male students in a class in a high needs, ubran school in a poor neighbourhood challenged her, her female co-teacher an dmost other authority figures in the school. She adds "  A couple of the guys had terrible tempers, and managing their angry and unpredictable outbursts made me feel like I was walking on eggshells in my own classroom. When the principal and other higher-ups from the Board of Education would come in, instead of feigning interest in the class-work (as most groups of students would have, under those circumstances), they'd ask, "Why are these people here? Tell them to leave," as though we all spoke some other language that our visitors would not understand."  She then describes the dramatic changes to their behaviours when a male teacher replaced her female colleague in the team teaching assignment. " In some way, we had become "mom and dad" (albeit, extremely hetero-normatively) for these guys. It was not only evident in their antics of trying to play one of us off the other; the young men in our class could sometimes be calmed down by "man-to-man" talks in the hallway with my team teacher, after which they'd come to me for hugs, band-aids, snacks, what-have-you."Years later, reflecting on that year, the female teacher realized that the students in that class had needed them as surrogate parents and that the real needs of those students were based on the need for secure social attachments with adults. She then briefly cites some of the recent research on this and criticizes the current efforts in the US to see education as a business, as a competition and as a workplace for students rather than a home away from home. Read the blog article here. 
All this is not very new, any teacher can tell you about the kids in their class with the same needs. What was significant to me in reading the blog commentary was how the writer argues that " For teachers, this represents an added layer of responsibility, one for which we can't expect recognition within our formal evaluations, but which is nonetheless a vital component of doing our jobs well...particularly in high-needs schools in poor areas, where children are often coming from unsteady home lives.'  While respecting and even agreeing that view as a former teacher, I am struck by the constant barrage of attacks on teachers these days. More testing, more accountability for students progress regardless of their effort or their families contribution, introduction of term-limited teacher licenses, unilateral legislative attacks on their bargaining agents, reductions in their pensions and so on. In what other profession, in what other industry, in what other corporation would the authorities really expect their employees to stay faithful to their altruistic, additional, uncompensated roles and additional unrecognized responsibilities, especially when assigned to the worst assignments?. Really. And then we have the well-meant, checklists, teacher-proof instructional programs and the fix-the-teacher "professional" development programs from the health and social program advocates constantly knocking on the school door.... This article and our additional comments here present one of the aspects of our global discussion of why the health and social sectors need to step back from their current appeals to schools and seek a new path that can lead to a systematic and teacher aware approach to the integration of these programs within the constraints, concerns and core mandates of education systems. Join us in our on-going, International Discussion Group and series of global symposiums.