(An item from the ISHN Member information service) We often refer to the need to have an evidence-based framework for planning and implementing health/development approaches and programs. One of these frameworks is the Concerns-based Adoption Model model that was published several years ago. An article published in Issue 33, 2013 of the Journal of Educational Administration by one of the authors of this model examines the implementation processes through this lens. "this paper introduces the three diagnostic dimensions of the CBAM) along with illustrations of how each can be used to assess extent of implementation. Highlights from the four decades of development and use of each of these constructs are presented. Each of the constructs, Stages of Concern, Levels of Use and Innovation Configurations, is described along with review of the four decade story of its measurement development. Reference is made to selected studies. Implications of each construct for research, program evaluation and facilitating change processes are highlighted."  Read more>>

(An item from the ISHN Member information service) An article in Issue #2, 2013 of the Asia-Pacific Journal on Teacher Education reports on a survey of 1397 teachers in Australia, followed by interviews with 37 teachers. the authors report that one-half to two-thirds of teachers were knowledgeable and confident about selected components of mental health promotion. The authors report that "Independent judgments by staff about students’ mental health status concurred with students’ scores on the Strengths and Difficulties Questionnaire in about 75% of cases, indicating a good level of staff awareness about students’ mental health status. Exposure to the KidsMatter Primary mental health promotion initiative was associated with improvements in teachers’ efficacy, knowledge and pedagogy, with small to medium effect sizes. Qualitative analysis indicated that teachers’ subject-matter and pedagogical knowledge were heavily reliant on curriculum resources." Implications of these findings are discussed. 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) An article in Issue #2, 2013 of School Psychology Quarterly presents the results of an APA Working Group studying the application of implementation science to school psychology. The authors report that "ncreasing attention to implementation will lead to the improvement of school psychological services and school learning environments. Key elements of implementation and implementation science are described. Four critical issues for implementation science in school psychology are presented: barriers to implementation, improving intervention fidelity and identifying core intervention components, implementation with diverse client populations, and implementation in diverse settings. What is known and what researchers need to investigate for each set of issues is addressed. A discussion of implementation science methods and measures is included. Finally, implications for research, training and practice are presented". Read more>>

(An item from ISHN Member information service) A theory about teacher behaviours in implementing programs, the Planning Realistic Intervention Implementation and Maintenance by Educators, is used to explain a teacher's use of a behaviour support program for students. The case study is reported in an article in Issue #1, 2013 of School Psychology Quarterly. The authors report that "We propose that to transform student outcomes through evidence-based practice, conceptualization of mediators' intervention implementation must move beyond quantification of discrete intervention steps implemented. Intervention implementation requires behavior change and thus can be conceptualized as an adult behavior change process. The purpose of this article is to illustrate how adult behavior change theory may inform how intervention implementation is conceptualized, facilitated, and supported. An empirically supported theory of adult behavior change from health psychology, the Health Action Process Approach, and how it has informed development of PRIME (Planning Realistic Intervention Implementation and Maintenance by Educators), a system of supports to facilitate mediators' implementation of school-based interventions, are introduced". Read More>>

(An item from ISHN Member information service) In this web site, we often refer to "non-rational decision-making" as a concept that helps to explain decision-making in large systems such as schools or health systems. The concepts helps to broaden our understanding of the processes that influence systems, organizations and individuals in maintaining or modifying theior practices. This week, we came across a similar concept being developed by the National collaborating Centre on Public Policy in health promotion in Canada. Their video presentation on "deliberative processes" is an excellent overview of this deeper understanding that goes beyond simplistic expectations that research evidence alone can persuade us to make changes. Read more. 

(An item from ISHN Member information service) n article in Issue #6, 2012 of Environmental Education Research discusses how teacher reflections in a small case study on implementing a curriculum on education for sustainable development can help to understand the implementation process and ongoing teacher concerns. The author notes that It examines what the teachers learned about effective pedagogy from undertaking a systematic study of their own practice in ESD/GCE-based topics, and it highlights the development of their own understanding of, and values about the place of ESD/GCE in the curriculum. Findings emerging from the study were that critical reflection on their work gave the teachers the confidence to adopt the more learner-centred pedagogy of ESD/GCE, and that teachers, too, were able to learn/benefit from the participation in ESD/GCE activities. Read more. 

(An item from ISHN Member information service) An article from Issue #6, 2012 of the Journal of Child & Family Development presents and applies a fidelity implementation model that nudges out of the traditional rigid box of implementation science by actually including a major component on participant responses to the intervention as well as program differentiation. The authors note that " Fidelity, or the degree to which interventions are implemented as originally designed, is generally conceptualized as a system of unique and interrelated components including adherence, dosage and quality of delivery". To accept the notions that practitioners will inevitably modify the program and that different types of program participants may react differently to the intervention is a step forward. Read more.  

(An item from ISHN Member information service) An article in the December 2012 Issue of Social Science & Medicine suggests that realist perspectives should be integrated within random controlled trials in order to better understand the complexity of interventions and how their components and their characteristics interact with the local context. The authors suggest that `Randomized trials of complex public health interventions generally aim to identify what works, accrediting specific intervention ‘products’ as effective. This approach often fails to give sufficient consideration to how intervention components interact with each other and with local context. ‘Realists’ argue that trials misunderstand the scientific method, offer only a ‘successionist’ approach to causation, which brackets out the complexity of social causation, and fail to ask which interventions work, for whom and under what circumstances. We counter-argue that trials are useful in evaluating social interventions because randomized control groups actually take proper account of rather than bracket out the complexity of social causation. Nonetheless, realists are right to stress understanding of ‘what works, for whom and under what circumstances’ and to argue for the importance of theorizing and empirically examining underlying mechanisms.`The authors also propose that ‘realist’ trials should aim to: examine the effects of intervention components separately and in combination, explore mechanisms of change, analysing how pathway variables mediate intervention effects; use multiple trials across contexts; draw on qualitative & quantitative data; and be oriented towards building theories setting out how interventions interact with context. This last suggestion resonates with recent suggestions that, in delivering truly ‘complex’ interventions, fidelity is important not so much in terms of precise activities but, rather, key intervention ‘processes’ and ‘functions’. Read more

An item from ISHN Member information service) Our acquired knowledge about the need to address adopter concerns directly if we expect them to implement a suggested practice is illustrated again in an article in Issue #4, 2012 of School Mental Health. Researchers interviewed 124 school psychologists to determine why the implementation of cognitive-behavioural interventions is so low. According to the authors, "This preliminary investigation examined the relative contributions of personal beliefs about an intervention, attitudes toward client problems, social factors, and organizational factors in school psychologists’ willingness to implement cognitive–behavioral interventions. In addition to the particular client problem, beliefs about acceptability/efficacy of an intervention and organizational resources for it were most important in predicting school psychologists’ implementation commitment. Read more. 

(An item from ISHN Member information service)   Action learning is an educational process whereby people work and learn together by tackling real issues and reflecting on their actions. Learners acquire knowledge through actual actions and practice rather than through traditional instruction. Action learning is done in conjunction with others, in small groups called action learning sets. It is proposed as particularly suitable for adults, as it enables each person to reflect on and review the action they have taken and the learning points arising. This should then guide future action and improve performance (Wikipedia). This AL concept is discussed in several ways a special issue #3, 2012 of Action Learning, Research & Practice. Concepts discussed in the issue include the connection between AL and critical thinking, systems and organizational change, power, the development of personal insights and more.  Read more 

(An item from ISHN Member information service) An article in the October 2012 issue of Health Education research reports on four years of implementing a sun safety accreditation program for elementary schools in New Zealand. After four years (2005-09) the authors report that "Compared with 2005, increase in the percentages of schools meeting each of the 12 accreditation criteria were observed in 2009, except role modeling which dropped slightly to become the second most frequently attained criterion, marginally below play in the shade (Table I). The greatest increase was found for play in the shade, sunscreen and hats, followed by other clothing and environmental shade. The smallest increase was found for planning, followed by rescheduling and curriculum. The clothing component remained the least frequently attained SSAP criterion, followed by shade, then curriculum". In 2009, although most of the 189 participating schools followed up still only partially addressed sun protection, many had increased the number of ways in which they did this since baseline. However, relatively low levels of attainment were observed for some SSAP components, in particular, clothing (43.3%), shade (51.5%) and curriculum (54.4%). The study noted that advocates of the accreditation program included Cancer Society volunteers, the NZ Health Promoting Schools program, nurses and a Fruit in the Schools program. The authors conclude with the statement that " it seems anomalous that it should remain largely the responsibility of NGO health promoters and a charity to not only develop, implement and evaluate the SSAP, but also to continue to resource it in the absence of appropriate commitment at public service level. The Ministries of Health and Education could make collaborative efforts to help ensure the universal implementation and sustainability of this established and positively evaluated program through its integration into broader health and safety practice. Read more. 

(An item from ISHN Member information service) Local drivers of change and continuity in each community and organization will affect the processes of adoption, implementation, operation and sustainability of school programs and multi-intervention approaches. The local history, existing inter-personal relationships, incidents, external directives and demands and many other circumstances, which are often ignored in controlled trial studies, all eventually become significant in one way or another. A case study in Issue #5, 2012 of Education and Urban Society gives us an idea of how these local drivers play out in on-going narratives. This study investigated the recent histories of the urban public school districts of St. Louis, Missouri and Cincinnati, Ohio in the United States of America. The purpose was to identify the similar challenges that each had recently faced in regard to the maintenance and development of its public school systems, as well to gauge the level of community support for the numerous reforms proposed by local education officials in each city over the past decade. Each city was also examined in its particular historical context, with the accompanying educational, political, and social issues which have manifested themselves to the present state of affairs. After a critical review of the research and applicable theory, the authors offer suggestions for solidifying the future success of each system with examples of positive experimentation occurring in these cities and others. Read more..

(An item taken from the daily/weekly/monthly ISHN Member information service) Five articles in Issue #3, 2012 of Evaluation & Program Planning use adopter concerns or perceptions as a lens in delving more deeply into implementation and program sustainability issues. One article examined how field based Extension educators (i.e. program staff) in four Extension services use the results of evaluations of programs that they have conducted themselves (rather than externally-based evaluations) and found that "there are few programmatic changes as a result of evaluation findings among the non-formal educators surveyed in this study. Extension educators tend to use evaluation results to persuade others about the value of their programs and learn from the evaluation process. Evaluation use is driven by accountability measures with very little program improvement use". The second article reports on site vists to research centers and found that" Decisions about how to structure site visits appear to depend on the research context, practical considerations, the level at which the review is being conducted and the intended impact of the report. Future research pertaining to the selection of site visitors, the autonomy of the visitors in data collection and report writing, and the amount and type of information provided would be particularly valuable. A third article reported that "Perceived usefulness and motivation to use were the primary reasons for junior high school teachers to use web-based e-learning systems for in-service training. The fourth article reports on public health professionals use of environmental/systems change approaches and found that (1) many partners did not feel their “regular” jobs afforded them sufficient time to do community work., (2) many partners did not feel they had the personal political power to work on broader environmental, policy, or system change issues, (3) facilitating and policy change and reaching out to non-traditional partners, like businesses, required developing a new set of public health skills and (4) the long-time frame of environmental and policy work meant that many efforts would exceed the grant period. The fifth article conducted a qualitative assessment of school staff perspectives in implementing an after-school intervention that to promote physical activity in underserved adolescents. The authors identified adopter concerns such as "(1) Logistics; (2) Essential Elements; (3) Staff and Child Challenges; (4) Staff Comprehension, Value, and Enjoyment; (5) Spill-Over Effects.  Read More..

(An item taken from the daily/weekly/monthly ISHN Member information service) Farm to school nutrition programs are emerging in many countries as the next innovative approach to healthy eating. Three articles in Issue #4, 2012 of Childhood Obesity provide excellent analyses, along with others on school salad bars, school gardens and the elimination of processed foods by cooking from scratch in schools. All of these are good but in this commentary, we want to illustrate how narrow our focus can become, even when we use evidence-based logic models and behaviour theory. One article in this journal issue presents an excellent linear logic model that correctly depicts the multiple inputs, processes, outputs and outcomes associated with FtoS programs. As well, the model correctly seeks to take local context and feedback loops within the social system of the school and community into account. In summary, the paper presents one of the better linear logic models that we have seen. But here is the rub: what about the complexity of the school-neighbourhood-family setting and the competition from the many, many other school programs also entering that same context? If we do consider these things, then program innovations like this can become pretty academic pretty quickly. Read more

(An item taken from the daily/weekly/monthly ISHN Member information service) An article in Issue #3, 2012 of Educational Administration Quarterly provides advice that many of us should take to heart before we re-invent yet another model or framework on school health promotion. Using meta-analytic review techniques, this study synthesized the results of 79 unpublished studies about the nature of transformational school leadership (TSL) and its impact on the school organization, teachers, and students. This corpus of research associates TSL with 11 specific leadership practices. These practices, as a whole, have moderate positive effects on a wide range of consequential school conditions. They also have moderately strong and positive effects on individual teachers’ internal states, followed by their influence on teacher behaviors and collective teachers’ internal states. TSL has small but significant positive effects on student achievement. Now here is the kicker...The authors also state that: "Among the conclusions arising from the study is that several of the most widely advocated models of effective educational leadership actually include many of the same practices. Conclusions: More attention by researchers, practitioners, and researchers needs to be devoted to the impact of specific leadership practices and less to leadership models"  Read More..

(An item taken from the daily/weekly/monthly ISHN Member information service) Another example of the use of an evidenced-based implementation plan appears in Issue #4, 2012 of Preventing School Failute, where it is used to assess implementation quality in the application of the Positive Behavior Support approach and multi-intervention program. This article describes the procedures and utility of the Benchmarks of Quality as part of a comprehensive evaluation plan to assess the universal level of implementation fidelity of behavior support for a school. However, results can also be examined to determine the level of implementation fidelity across a district or state for ongoing behavioral training and technical assistance planning. A recent factor analysis and validation of various administration techniques has changed the content of the instrument and are discussed. The purpose of this article is to describe how practitioners can use the Benchmarks of Quality from administration to analysis and eventually to corrective action planning in addressing behavior successfully across individual schools and districts.  Read more..

(An item taken from the daily/weekly/monthly ISHN Member information service)  An article in Issue #5, 2012 of the Journal of Community Psychology reports on a framework to guide and monitor the development of sustainable school-based prevention programs and approaches. School-based prevention and promotion interventions (SBPPI) improve desirable outcomes (e.g., commitment to school and attendance) and reduce undesirable outcomes (e.g., suspensions and violence). Unfortunately, our understanding of how to effectively implement and sustain SBPPI outside of well-controlled conditions is lacking. To bridge this science/“real world” practice gap, a system of sustainable implementation, which merges implementation strategies and sustainability strategies, is proposed in this article. Ecological levels and phases are part of this new concept. This conceptualization is supported by analyses from a diverse sample of 157 schools implementing Social-Emotional Character Development. The authors used the system of sustainable implementation that was measured using the Schools Implementing Towards Sustainability (SITS) scale, which was designed to be “user-friendly” in field settings by being viable and scalable. The SITS demonstrated strong reliability as well as promising concurrent and construct validity. Read more..

(An item taken from the daily/weekly/monthly ISHN Member information service)  Most of the discussion about organizational change in school mental health promotion focuses on school systems, so it is refreshing to read an article in Issue #8, 2012 of the Journal of the American Academy of Child and Adolescent Psychiatry that reports on an intervention or strategy to improve the Availability, Responsiveness and Continuity of child/youth mental health services. Evidence-based Practice (EBP) implementation is likely to be most efficient and effective in organizations with positive social contexts (i.e., organizational culture, climate, and work attitudes of clinicians). The study objective was to test whether an organizational intervention labeled Availability, Responsiveness and Continuity (ARC) could improve the organizational social contexts of community-based mental health programs for youth. The study randomly assigned 26 community-based mental health programs for youth to ARC or control conditions. Hierarchical linear models (HLM) analyses indicated that organizational culture, climate, and work attitudes were significantly improved in the ARC condition after 18 months. Clinicians in programs assigned to ARC reported less rigid, less centralized and less apathetic organizational cultures, more engaged and functional organizational climates with less role conflict, and work attitudes with improved morale, job satisfaction, and organizational commitment. Read more..

(An item taken from the daily/weekly/monthly ISHN Member information service) An article in the June 2012 Issue of the International Journal of  Behavioral Nutrition and Physical Activity shows the value of using an evidence-based and experience-tested implementation model to improve both the effectiveness and sustainability of a school nutrition program in a tough, low income environment. .Read More 

(An item taken from the daily/weekly/monthly ISHN Member information service)  With one of the highest participation rates of schools in an extensive school accreditation program, a dedicated team at the national level and a range of highly focused and evidenced-based programs, Singapore is among the leaders of national school health programs. This summer, they have extended the SH approach to pre-schools and universities in the most extensive set of programs found around the world. News Story (Jul 26-12) Singapore School Health CHERISH Award extended to pre-schools & universities Read more

(Posted from the ISHN members information service monitoring over 225 journals) An article in Issue #2, of the NASSP Bulletin describes four systems change theories widely used in education today. The article provides an opportunity for practicing leaders to review four major theories of organizational change—continuous improvement, two approaches to organizational learning, and appreciative inquiry. These four theories were selected because of their emergence within the field of education, possible adaptability to school systems, and potential to support organizational change. Such theories can provide clear guidelines for successful organizational transformation, promote effective change management, and facilitate operative decision making. Since they are widely used by educators, it might be worthwhile for advocates of heakth and socila programs to consider their use in theor approaches to educators. Read more...

(Posted by ISHN from its members information service) An article in Issue #3, 2012 of Health Education Research examined which components of a whole school physical activity (PA) strategy were most likely to be implemented successfully. These components included sports after school and during lunch break, active schoolyards, active school commuting) and organizational principles (e.g. safe bike racks, pupil involvement). Key representatives of 111 elementary and 125 secondary schools filled out an online survey. Less than half of the elementary schools organized sports during lunch-break or after school. In secondary schools the least implemented strategies were the promotion of active school commuting and after-school sports. In general pupil, parental and community involvement scored low. Better knowledge of community schools and having attended in-service training were associated with higher implementation scores in elementary and secondary schools. Better implementation of the strategies was found in larger schools. Participation in activities from the School Sports Association and more perceived interest from parents and the school board were also associated with higher implementation scores. In conclusion, knowledge of community schools and in-service training next to sufficient human resources are potential key factors to promote PA. Read more. 

The Health Council of Canada is mandated to report on progress being made as a result of the 2004 Federal-Provincial Health Care Accord. Its recent 2012 progress report fails to mention anything on the commitments of Canadian governments: "  governments commit to accelerate work on a pan-Canadian Public Health Strategy. For the first time, governments will set goals and targets for improving the health status of Canadians through a collaborative process with experts. The Strategy will include efforts to address common risk factors, such as physical inactivity, and integrated disease strategies. First Ministers commit to working across sectors through initiatives such as Healthy Schools".