This blog has been identifying the limits of RCT's & systematic reviews. RCT's are problematic when seeking to assess complex, multiple interventions that develop over several years across several systems, agencies and professionals. An editorial in the October 2015 Issue of Journal of Epidemiology & Community Health continues this discussion by arguing for more use of "pragmatic, formative evaluations" when implementing a complex intervention. The editorial begins: "Recently published guidance on process evaluations by the Medical Research Council's (MRC's) Population Health Sciences Research Network (PHSRN) marks a significant advance in the evaluation of complex public health interventions. In presenting programmes as not just a set of mechanisms of change across multiple socioecological domains, but as an interaction of theory, context and implementation, the guidance extends the remit of evaluation. Process evaluations have emerged as vital instruments in these changing needs through modelling causal mechanisms; identification of contextual influences and monitoring fidelity & adaptations." They go on to say: "One particular conceptual space that needs to be carved out is pragmatic formative process evaluation, defined as the application of formative process evaluation criteria to interventions that have ostensibly been formulated, and are likely in routine practice, but have not been subjected to rigorous evaluation. Moreover, even where some understanding of the theory of change is present, it is unlikely that the unintended consequence of interventions will have been sufficiently explored. For example, our recent evaluation of a school-based social & emotional learning intervention, which had been recommended by the Welsh school inspectorate indicated a number of potential iatrogenic effects due to a stigmatising process". Read more>> (An item from the ISHN Member information service)
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A book review on school Social Work practice and research around the world, published in Issue #4, 2015 of Children & Schools, reflects the growth and development of this professional practice. The reviewers note that "There is a general consensus that key functions of social workers in schools are to promote positive well-being among students, foster children’s rights, and create better academic and socioemotional outcomes for children and young people. However, the scope of school social work services among the seven selected countries or places varies considerably." Several themes emerge from this edited volume. First, though school social work is a commonly used avenue to deal with at-risk youths such as school dropouts, drug abusers, and school bullies, there is still a lack of a clear definition of the exact purpose and role of the school social worker around the world. There is an urgent need for international comparative studies in the field of school social work (Huxtable & Blyth, 2002) to initiate further discussions on the mission and standards of its services for children and young people. Second, it is pleasing to see that individual researchers around the world have started to look for empirical evidence to demonstrate the effectiveness and outcomes of social work interventions. There are numerous examples of “best practices” presented to meet the changing personal, psychological, emotional, and social needs of young students. The move toward more evidence-based practice is commendable, but whether or not the outcomes of successful programs can be achieved across different locational contexts remains to be seen.". Read more>> (An item from the ISHN Member information service)
Israeli schools expressly forbid a student to hit back after being attacked. In a context in which violence and retaliation are magnified, this rule is likely consistent with the local circumstances.An article in Issue #4, 2015 of Journal of School Violence explores Israeli teacher attitudes towards this task of enforcing fair rules & punishment, a task which is challenging enough in all circumstances. "In semistructured interviews,71 Israeli educators were asked for their views on the hitting-back tactic. The interviews compared their attitude toward hitting back as teachers with their take on the matter as parents. The results, analyzed using grounded theory, show that most educators would not object if their children hit back in self-defense when attacked but would discipline students who hit back unless they can prove their claim of self-defense. Interviewees are much less inclined to discipline retaliators who do manage to prove self-defense but feel that investigations to verify self-defense under school conditions are impractical. To deter bullies, they say, teachers must declare their readiness to discipline everyone involved; otherwise, bullies will falsely claim self-defense. The discussion explores the implications of role theory on teachers’ attitudes." Read more>> (An item from the ISHN Member information service)
An article in Issue #4, 2015 of Journal of School Violence reports on teacher ability and willingness to implement the many different components of the Olweus Bullying Prevention Program . As with many other such multi-component approaches and programs, the evaluation shows that "among 2,022 teachers, 88.5% female, from 88 elementary schools located in Pennsylvania, results indicated that the majority of respondents had attended the school kick-off event, posted the rules in the classroom, and explained the rules to students. Receiving booster sessions and activities involving parental involvement were the least likely elements to have been performed. Logistic regression analyses revealed that teachers with confidence in their ability to implement the OBPP had completed all of the OBPP programmatic activities. Similarly, multiple regression analysis results revealed that teachers with self-efficacy to implement the OBPP implemented more components than respondents without self-efficacy. In addition, teachers with more OBPP experience were more likely to have completed individual-level activities. Our findings reveal that certain OBPP components are easier to perform than others and that implementer characteristics matter." This study examined the eight activities within the program that teachers are expected to implement. We would expect the same or even more challenges in implementing and especially maintaining the community, school and other components. Read more>> (An item from the ISHN Member information service)
In our quest to influence behaviour through multiple interventions in the school setting and to overcome the systemic, complex barriers to maintaining such multi-component programs, we sometimes forget that simple activities can also help students. A small scale study from the United Arab Emirates, published in Issue #6, 2015 of the British Journal of School Nursing, reminds us of this fact, as the authors report on the impact of a large group educational activity for 150 students delivered by the school nurse. "A quasi-experimental control group, and post-test only design was used. A school-based healthy nutrition educational programme was implemented to improve the nutritional knowledge of adolescents, and to promote a healthy life style among them. The ‘Let's Eat Healthy’ programme was delivered to 150 students in the intervention group, who were compared to another 150 students in the control group where the programme was not delivered. Students that participated in the intervention group were significantly more knowledgeable about healthy nutrition compared to students that didn't participate (P<0.01). They also scored significantly higher in the dietary behaviours survey, which reflects the adoption of more healthy eating behaviours. Read more>> (An item from the ISHN Member information service)
A study on the relationship between a schools’ health and teachers’ organizational commitment reported in Issue #4, 2015 of the International Journal of School Health confirms our intuitive guess, a healthy school means more committed teachers. The purpose of this study is to examine the relationship between schools’ organizational health and teachers’ organizational commitment in Shiraz high schools in Iran. "The findings indicated that schools’ organizational health and its dimensions including institutional integrity, consideration, resource support, morale and academic emphasis were at moderate level, but the initiating structure and principal influence were at low level. Also, teacher’s commitment and its dimensions (emotional commitment and continuance commitment) were at moderate level and normative commitment was at high level. The results showed that the correlation between schools’ organizational health and teachers’ commitment was 0.64, and the correlation coefficients between teachers’ commitment and institutional integrity, initiating structure, consideration, principal influence, resource support, morale and academic emphasis were 0.56, 0.44, 0.42, 0.22, 0.26, 0.16 and 0.65, respectively. The results indicated that the correlation between schools’ organizational health and emotional commitment, continuance commitment, and normative commitment were 0.62, 0.32, and 0.66, respectively. Finally, five dimensions of school health- institutional integrity, initiating structure, resource support, morale and academic emphasis positively predicted teacher commitment.". Read more>> (An item from the ISHN Member information service)
A locally developed instructional program that was started by a teacher, helped by crowd-sourced funding and then evaluated by the Johnson Foundation and North Carolina has reported reductions in BMI after one year in a small scale quasi-experimental study published in the October 2015 issue of the Journal of School Health. "Motivating Adolescents with Technology to CHOOSE Health™ (MATCH) is an educational and behavioral intervention in seventh grade. Teachers in 2 schools delivered the MATCH curriculum, with 1 control school. Using a quasi-experimental design, outcome measures included lessons completed, body mass index (BMI), BMI z-score (zBMI), BMI percentile, weight category, and self-reported lifestyle behaviors. We used multiple regression models to compare group results. For the MATCH group (N = 189), teachers provided lessons over 14 weeks; the control group (N = 173) received usual curriculum. Post-intervention, the MATCH group had significant decreases in BMI measures compared with the control. In combined overweight and obese participants, the mean (95% confidence interval) zBMI change was −0.05 (−0.07, −0.03) in MATCH and −0.01 (−0.04, 0.02) in control, p = .034 between groups. After 1 year, improvements are sustained: for the overweight subgroup, the mean zBMI decreased from 1.34 to 1.26 post-MATCH, then to 1.26 after 1 year; for the obese subgroup, mean zBMI = 2.16, to 2.13 post-MATCH to 2.08 after 1 year. Self-reported lifestyle behaviors showed no differences." Read more>> (An item from the ISHN Member information service)
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