(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)  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)  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 education ministry funded evaluation of the effectiveness of the Taiwan Health Promoting Schools Network, the mechanism used to implement school health in that country since 2001 was summarized in the July 2015 issue of the Journal of School Health. The survey of 800 randomly selected schools found that "Respondents were most satisfied with consultants and schools' recognition of responsibilities and rules and their interactions with HPSSN administrators. They were least satisfied with the extent of their HPSSN consultant interaction and believed HPSSN provided insufficient resources to establish HPS. Respondents' consultant partnerships and satisfaction with HPSSN administration significantly predicted HPS implementation. Additionally, the predictive values of healthy policies and school-community relationships were greater than the other 6 HPS components." In other words, capacity and relationships were critical. Read more>>

(An item from the ISHN Member information service)  A special issue (Issue 2-3, 2015) of Journal of Educational and Psychological Consultation examines the use of school psychologists as systems-level consultants as a strategy to deal with the complexities of the multi-level changes required to introduce and sustain comprehensive approaches to school mental health promotion. An interdisciplinary perspective is used to select the articles which cover topics such as Interdisciplinary Collaboration Supporting Social-Emotional Learning, Ecologically Based Organizational Consultations, the Competencies for Systems-Level Consultants, Multi-Tiered Systems of Support, Collaboration Between School Psychologists and Administrators and Critical Features and Lessons Learned for Implementation. Read more>> Readers may also be interested in a similar ISHN description of a systems-based approach to SMH that is based on capacity and capacity-building at this web page.

(An item from the ISHN Member information service)  An article in Volume 36 of the Annual Review of Public Health describes some of the lessons we have collectively learned about complex interventions to improve health, especiually the ways that complex systems thinking is being used in clinical settings. "Complexity—resulting from interactions among many component parts—is a property of both the intervention and the context (or system) into which it is placed. Complexity increases the unpredictability of effects. Complexity invites new approaches to logic modeling, definitions of integrity and means of standardization, and evaluation. New metaphors and terminology are needed to capture the recognition that knowledge generation comes from the hands of practitioners/ implementers as much as it comes from those usually playing the role of intervention researcher. Failure to acknowledge this may blind us to the very mechanisms we seek to understand. Researchers in clinical settings are documenting health improvement gains made as a consequence of complex systems thinking. Improvement science in clinical settings has much to offer researchers in population health." This succinct summary, presented in the abstract, captures many of the lessons that need to be applied. Since ISHN sponsors a Wikipedia style web site that uses the slogan "where (research) evidence meets (professional) experience, and since many of the summaries in that web site attempt to explain these new ideas based on ecological, systems-based thinking, we highly recommend this article. Read more>>

(From the ISHN Member information service)  An article in Issue #2, 2015 of Psychological Bulletin describes how any multiple intervention program such as school health promotion will need to determine how many health issues need to be addressed in their context, how many interventions will likely achieve an optimal affect and which issues being addressed are more relevant/proximal to the population being served. The " meta-analysis of 150 research reports summarizing the results of multiple behavior domain interventions examined theoretical predictions about the effects of the included number of recommendations on behavioral and clinical change in the domains of smoking, diet, and physical activity. The meta-analysis yielded 3 main conclusions. First, there is a curvilinear relation between the number of behavioral recommendations and improvements in behavioral and clinical measures, with a moderate number of recommendations producing the highest level of change. A moderate number of recommendations is likely to be associated with stronger effects because the intervention ensures the necessary level of motivation to implement the recommended changes, thereby increasing compliance with the goals set by the intervention, without making the intervention excessively demanding. Second, this curve was more pronounced when samples were likely to have low motivation to change, such as when interventions were delivered to nonpatient (vs. patient) populations, were implemented in nonclinic (vs. clinic) settings, used lay community (vs. expert) facilitators, and involved group (vs. individual) delivery formats. Finally, change in behavioral outcomes mediated the effects of number of recommended behaviors on clinical change. These findings provide important insights that can help guide the design of effective multiple behavior domain interventions". Read More>>

(From the ISHN Member information service)   The eight-part ISHN model for the system/organizational capacity in sustaining comprehensive, multi-intervention approaches includes the concept of "explicit planning for sustainability". An article in the January 2015 issue of Prevention Science reports on sustainability of evidence-based programs in a variety of settings, including schools. Explicit sustainability planning was among the list of features that helped to sustain programs at least two years after the external funding or support is removed. The authors note that " Despite its obvious importance, sustainability has received relatively little attention in prevention science until recently. Moreover, there have been few opportunities to study the correlates of sustainability in large-scale, multi-year initiatives involving multiple programs. The present study examined rates of sustainment of a wide range of proven-effective prevention and intervention programs; identified factors related to organizational support and readiness, program and implementer characteristics, and sustainability planning that distinguished sustained programs; and examined variability in these associations across classroom-based, community/mentoring, family-focused prevention, and family treatment program types within the context of a state-wide EBP dissemination initiative in Pennsylvania over 4 years. The majority of EBPs sustained functioning 2 years or more beyond their initial funding. In general, sustained programs reported greater community coalition functioning, communication to key stakeholders, knowledge of the program's logical model, communication with the trainer or program developer, and sustainability planning. In addition to these universal correlates, important program-specific correlates emerged as well." 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 National Collaborating Centre on HP Methods and Tools)  A planning tool developed in Alberta Canada for health care organizations could be adapted for use in school health and development promotion. A 2009 journal article presents the development and initial psychometric validation of the Alberta Context Tool (ACT), an eight dimension measure of organizational context for healthcare settings. Three principles guided the development of the ACT: substantive theory, brevity, and modifiability. The Promoting Action on Research Implementation in Health Services (PARiHS) framework and related literature were used to guide selection of items in the ACT. The ACT was required to be brief enough to be tolerated in busy and resource stretched work settings and to assess concepts of organizational context that were potentially modifiable. The English version of the ACT was completed by 764 nurses (752 valid responses) working in seven Canadian pediatric care hospitals as part of its initial validation. Cronbach's alpha, exploratory factor analysis, analysis of variance, and tests of association were used to assess instrument reliability and validity. The concepts that underlie the tool are very relevant to school health promotion and development. These concepts were converted to several definitions that were generally confirmed in the research study. These definitions were developed into research questions for the study and include: 

• Leadership: The actions of formal leaders in an organization (unit) to influence change and excellence in practice, items generally reflect emotionally intelligent leadership
• Culture: The way that 'we do things' in our organizations and work units, items generally reflect a supportive work culture
• Evaluation: The process of using data to assess group/team performance and to achieve outcomes in organizations or units
• Social Capital: The stock of active connections among people. These connections are of three types: bonding, bridging, and linking
• Formal Interactions: Formal exchanges that occur between individuals working within an organization (unit) through scheduled activities that can promote the transfer of knowledge
• Informal Interactions: Informal exchanges that occur between individuals working within an organization (unit) that can promote the transfer of knowledge
• Structure/Electronic Resources: The structural and electronic elements of an organization (unit) that facilitate the ability to assess and use knowledge
• Organizational Slack: The cushion of actual or potential resources which allows an organization (unit) to adapt successfully to internal pressures for adjustments or to external pressures for changes         
• Human Resources (staffing): Perceived and actual levels of staffing are sufficient 
• Time: There is sufficient time available for staff to complete knowledge related work
• Space: There is sufficient work space in the organization for staff to complete knowledge related work.  

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(From the ISHN Member information service) Our pioneering work with simple, cheap and accessible technologies such as multiple Twitter accounts (instead of email), webinars and web meetings complementing expensive face-to-face events, a Wikipedia style web site to accumulate knowledge, Skype calls to eliminate long distance charges, blogs with high quality content and other tools has persuaded us that we are at the cusp of a dramatically different world of knowledge exchange that is no longer controlled and dominated by academic journals or governments/large organizations with the resources to purchase or maintain expensive web-based resources. While front-line workers in all sectors will continue to face the limitations of time/busy schedules and we can expect the 90-9-1 rule (90% following web resources passively, nine per cent occasionally contributing and one per cent actively participating, we also note that huge proportions of the population are now publishing personal content on family/individual Facebook pages, sharing interesting videos and photographs and looking for information on the web every day with tablets now sitting in living rooms and kitchens. We also see books, newspapers, television and radio converging into web-based combinations that are now charging small subscription fees or lower web-based prices. 
It is this environment that we note the start of a new journal, The Canadian Journal for Teacher Research, which is enabling classroom teachers to articulate their views based on their practice-based expertise and professional experience. The inaugural articles in this new journal indicate some of the content and media uses in our immediate future. An April 2014 article in this new journal highlights the fact that most of us have learned that simple, easy to use technologies such as inexpensive tablets rather than expensive computers, or simple presentation and editing tools in the classroom can transform learning and communications. Other articles in this new journal are presented in video format. Rather than asking teachers or other front-line workers to write complex articles with complex academic rules designed to favour those with extensive time in front of computers, the videos can simply record presentations or interviews or even simple class events or discussions. A good example can be found with this video article on the importance of teachers as leaders of innovation, research and collaboration that featured a teacher, principal and academic in a recorded discussion. 
ISHN is going into its first experience with recorded Skype interviews with practitioners in the coming months. We hope that the three minute format, which will seek to present one or two key ideas/insights from the practitioners based on their "practice story' (rather than asking them to prepare a "case study" (often controlled by academic concerns) or be constricted to the positives in a "success story" (often controlled by the interests of the sponsor or government funders). We are also trying to accumulate and "roll-up" several small scale webinars, recorded inerviews, slide presentations, inforgraphucs and accompanying Wikipedia style summaries into lengthier thematic collections and, eventually, into web-based handbooks of better practices. 
Obviously, there will always be an important place for disciplined, research-based discourse in knowledge development and exchange. There is also a need for large organizations and governments to select and present the knowledge that they view as more important in their own reports, guides, policy documents and web sites. But we think the simple, convenient and cheap technologies will add a new set of voices to the mix, one that can come more easily from those in the front-lines of professional work and knowledge based on professional experience.       
       

(An item from the ISHN Member information service) "Going beyond training and hoping" is a colourful way to describe the paradigm shift now underway in research, practice and policy-making in school health promotion and social development. The words in the titles of the articles the October 2013 Issue of implementation Science are indicative of the new concepts that must be among the new, fundamentally different way that we approach our work and careers in the future. Although these concepts are applied to non-school settings and practices, their resonance should be self-evident. They include: transfer and implementation, scale-up, spread, and sustainability, making change last, leadership in complex networks, multifaceted, multilevel continuous quality improvement programs, dynamic sustainability frameworks and Social network diagnostics. Read more>>

(From the Education Commission of the US) Do state education agencies (SEAs) have the capacity to deepen their work improving outcomes for students? The answer from a long list of policy advocates and observers is “no”—or at least not without significant changes to the way they currently function. This project sought to more systematically examine SEAs’ existing capacities to understand the seriousness of the problem and the strategies state chiefs are using to confront it. The 10 states we analyzed represent a variety of approaches and political contexts for the work of reform, as well as varied records on student achievement. For each of these states, we asked: • What are the primary obstacles that inhibit SEAs from supporting school and district improvement? and • What levers can chiefs utilize to transform their agencies into more effective drivers of reform?  Read More>>

(An item from the ISHN Member information service) The school health movement has focused on transforming schools through "whole school" strategies. As proponents, we would learn much from reading Issue #2, 2013 of Improving Schools, where the concept of "schoolwide pedagogies" is discussed in a special issue. There are several articles but this quote from the concluding article is quite revealing. "The term schoolwide pedagogy was once rarely heard and yet has now become a part of most discussions around school improvement. But what does it really mean and why is the presence of a schoolwide pedagogical framework important? Some would say that in their school the adoption of an authoritative approach such as Habits of Mind, Bloom’s Taxonomies or the Productive Pedagogies is a schoolwide pedagogical framework. To some extent they are, but what is often lacking is the intellectual and social capacity that is built through collective professional sharing and articulation of strongly held beliefs about contextually relevant teaching and learning practices. Without this sense of ownership, teacher adoption ends up being sporadic at best with some teachers paying only lip service to imposed quality frameworks". If this is the case for matters at the heart of the school (ie how to teach), then what can we expect for matters such as health, which are often seen as secondary? (unless we truly understand and commit to working within schools in a sustained manner) Read more>>

(An item from the ISHN Member information service) An article in Issue #6, 2013 of Preventive Medicine reports on the success of a three year capacity-building approach to school physical activity promotion. According to the authors " The objective was to determine changes in capacity over a 3 year intervention (2005–2008) in schools and whether greater increases in capacity were associated with greater decreases in overweight/obesity. “It's your Move!” (IYM) was an obesity prevention project, in 12 Australian secondary schools (5 intervention; 7 comparison), that aimed to increase community capacity to promote healthy eating and physical activity. Capacity was assessed pre/post intervention using the ‘Community Readiness to Change (RTC)’ tool. Comparisons from baseline to follow-up were tested using Wilcoxon Signed-Ranks and results plotted against changes (Newcombe's paired differences) in prevalence of overweight/obesity (WHO standards). RTC increased in intervention schools (p = 0.04) over time but not for comparison schools (p = 0.50). The intervention group improved on 5 of 6 dimensions and the three intervention schools that increased three levels on the RTC scale each had significant reductions in overweight/obesity prevalence. Read more>>

(An item from the ISHN Member information service) An article in Issue #6, 2013 of the American Journal of Public Health reports on the growing use of the RE-AIM Framework, a planning/assessment tool that measures changes in the system implementing innovations.Almost all of the 45 studies reviewed used all five elements of the assessment tool, namely Reach, Effectiveness, Adoption, Implementation, and Maintenance. It is the latter two elements that offer greater insights into capacity and sustainability issues. Read more>>

(An item from the ISHN Member information service) A review of the research on multi-intervention approaches to school health promotion reported in the July 2013 issue of the Journal of School Health suggests that effective approaches included stronger consideration of integration within the school system. the local context, building capacity for sustained implementation and ensuring coordination. The authors report that "Findings indicated that, for adequate implementation, an intervention should be integrated in pre-existent school settings, fine-tuned to its target population or environment, involve family and the community, and be led by the school itself, with there being a “healthy school coordinator” to coordinate the program." Read more>>

(An item from ISHN Member information service) A national survey of school psychologists in the USA reported on their current practices and preferences regarding continuing professional devlopment in an article in Issue #4, 2013 of Psychology in the Schools. The researchers report that: "Respondents expressed opinions about CPD that were positive, optimistic, and consistent with their high levels of engagement and investments of both time and financial resources. Most respondents reported engaging in 25 or more hours of CPD during the previous year. CPD topics in which they engaged most frequently were response to intervention and academic, behavioral, and social–emotional interventions, and academic screening and progress monitoring. Respondents reported a high level of need for more CPD in those same topic areas, but a low level of need for offerings in standardized assessment. Older school psychologists were less likely to have engaged in CPD relating to contemporary assessment practices and interventions and more likely to have engaged in activities related to standardized assessment. Almost half of the respondents had engaged in CPD through an online activity and reported a desire for more online opportunities. No relationship was found between age and usage of, or positive opinions about, online CPD."  Read more>>

(An item from ISHN Member information service) An article in the February 2013 issue of the International Journal of Behavioral Nutrition & Physical Activity reported on a correlational assessment of school level capacity and the implementation of school nutrition policies and programs as well as the food offered to students. The authors report that "Our measurement framework integrated constructs from the Theories of Organizational Change and elements from Stillman’s Tobacco Policy Framework adapted for obesity prevention. Our measurement framework included assessment of policy institutionalization of nutritional guidelines at the district and school levels, climate, nutritional capacity and resources (nutritional resources and participation in nutritional programs), nutritional practices, and school community support for enacting stricter nutritional guidelines. We used hierarchical mixed-effects logistic regression analyses to examine associations with the availability of fruit, vegetables, pizza/hamburgers/hot dogs, chocolate candy, sugar-sweetened beverages, and french fried potatoes." They also found that "In elementary schools, fruit and vegetable availability was more likely among schools that have more nutritional resources (OR = 6.74 and 5.23, respectively). In addition, fruit availability in elementary schools was highest in schools that participated in the BC School Fruit and Vegetable Nutritional Program and the BC Milk program (OR = 4.54 and OR = 3.05, respectively). In middle/high schools, having more nutritional resources was associated with vegetable availability only (OR = 5.78). Finally, middle/high schools that have healthier nutritional practices (i.e., which align with upcoming provincial/state guidelines) were less likely to have the following food/beverage items available at school: chocolate candy (OR = .80) and sugar-sweetened beverages (OR = .76).Read More. 

(An item from ISHN Member information service) An article in the October 2012 issue of Social Science & Medicine that links specific government capacity at the sub-national level with the prevention and incidence of malaria. The authors report that: "Government capacity is more successful in predicting malaria incidence than potentially more direct indicators such as state public health expenditures and economic development levels. We find that high government capacity can moderate the deleterious health effects of malaria in rice producing regions. Our research also suggests that government capacity may have exacerbated the effectiveness of the World Bank Malaria Control Project in India over the period studied. We conclude by proposing the integration of government capacity measures into existing planning efforts, including vulnerability mapping tools and disease surveillance efforts. Read more.