(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 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)   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. 

(From the ISHN Member information service)  As we learn more about how health and social programs can be better integrated within education systems, one of the new areas for discussion is how educator understandings, beliefs and professional identities will have an impact on their willingness to address such issues in their practice. Three articles in the July 2014 issue of Environmental Education Research provide insights on teacher, administrator/school leader and education faculty understanding of the concept of sustainable development plays out in their respective work assignments. One article shows that Swedish teachers differ in their understanding of the concept mostly according to their subject traditions. generally do not have a holistic understanding which is prescribed in the formal curriculum documents. The second article examines how a holistic, whole school approach and vision to ESD can be developed by school leaders in different ways. The third article examined how teacher educators were constrained from addressing ESD in their work due to pressing and competing priorities, even when they understood the concept. Read more>>

(From the ISHN Member information service) The National Association of Chronic Disease Directors (NACDD) has just released an easy-to-read summary of a research article (Bradley & Greene, 2013) published in the May 2013 issue of the Journal of Adolescent Health.  the relationship between health risk behaviors and academic achievement. This article, along with a recent Cochrane Review (Langford et al, 2014) of the effectiveness of multi-intervention approaches in school health promotion, has raised questions about what we know (and don't know) about such comprehensive approaches, their impact on on health and educational achievement and how new understandings based on ecological and systems-based thinking need to be taken into account as we move forward. This blog post provides a brief introduction to a discussion which ISHN will undertake this fall in cooperation with its International Discussion Group addressing healthy school models and frameworks.   

As we noted in our ISHN members weekly report on news/research in May 2013,  the connections between health status, risk/protective behaviours, health inequities and health promoting conditions and learning have been well-established by many studies and reviews. This 2013 review correlated risk behaviours such as violence, tobacco use, alcohol and other drug use, sexual behaviors contributing to unintended pregnancy and sexually transmitted diseases, inadequate physical activity and unhealthy dietary behaviors to various measures of academic achievement and found that for "all six health-risk behaviors, 96.6% of the studies reported statistically significant inverse relationships between health-risk behaviors and academic achievement.". In our view, the direct connection between health and learning is not really the issue for us to consider again today. The current question, already being discussed in several recent reviews and reports is whether multi-intervention approaches such as healthy schools affect educational achievement. The  recent Cochrane Review (Langford et al, 2014) did not find sufficient evidence to support this claim but there have been several sources who suggest otherwise, at least in part, for health and social problems that have a direct impact on school attendance and participation. These sources include a review sponsored by WHO-Europe (Suhcrke $ de Paz Nieves, 2011), our ISHN analysis (McCall, 2010), a health inequities analysis (Basch, 2010), the Centers for Disease Control and Prevention (Web page summary, nd) and many others focused on specific health/social behaviours or conditions.  A recent discussion paper from the intergovernmental consortium on school health in Canada (Hussain & Freeman, 2013) offers an interesting elaboration of the concept of "educational achievement" and starts a conversation about some indicators depicting some student and school outputs that can be jointly pursued by health and education systems. We need to sort out these claims and counter claims about whether and which types of multi-intervention approaches are most effective in promoting student achievement, student success, school and health, education and other system effectiveness.

The Langford et al, 2014 review has also caused some decision-makers to question the value of school health promotion in general. Coming at a time when public health systems and authorities around the world are withdrawing from long-term commitments to school health promotion as their resources are reduced from the economic downturn, this is an alarming coincidence. Advocates for comprehensive school health approaches need to point out that the 2014 review essentially echos the findings of a similar review done for WHO in 2006 (Stewart-Brown, 2006) insofar as concluding that the evidence supporting the use of multi-intervention programs is limited to specific health issues and behaviours,  and that  there are several other systematic reviews with findings that contradict or clarify the Langford et al review. But we also develop and argue for a new paradigm for evaluating the impact of multi-intervention approaches that is truly based on ecological and systems-based evidence. Comprehensive school health programs in which school efforts are supported by school board and other agencies as well as by several ministries of government working together take several years to develop. They require holistic understandings of health rather than measures based on the absence of disease or specific health/social behaviours. We need to be measuring realistic outputs (basic health knowledge, generic and applied life skills, mindful self-understanding and realistic behavioural plans) that can be observed as students graduate from schools. The limitations of random controlled trials that often compare specific, artificially supported programs to existing programs without much clarity or understanding of the complexity of systems needs to be challenged. We need more multi-level models and analysis and systematic reviews that use mixed method studies as their basis.     

Our ISHN May 2013 weekly report also questioned the wishful thinking in the JAH article when it suggested that a "unified (health & education) system that addresses both health behavior and academic achievement would have reciprocal and synergistic effects on the health and academic achievement". In our view, establishing such a "unified system" runs counter to the reality of government structures. Instead, ISHN and other organizations have initiated an international discussion that suggests that health and other systems need to revise their approach so that health and social programs are integrated within the core mandates, constraints and concerns of education systems. ISHN, ASCD and other organizations have initiated an international discussion group that suggests that health and other systems need to revise their approach so that health and social programs are integrated within the core mandates, constraints and concerns of education systems. A global consensus statement has prompted and international dialogue in several regions of the world leading up to a forum with UN agencies in May, 2015. International school health symposiums have already been Asia and North America on the many aspects of this integration challenge. 

Watch for the announcements of our discussions in webinars and web meetings on the evidence and experience in multi-intervention approaches to school health promotion and development in the fall of 2014 on the ISHN webinars and conference schedules foubnd at the Wikipedia style web site at www.schools-for-all.org .   

(From the ISHN Member information service)  The US Department of Education announced the winners of their research granting program on educational innovations this week. The focus of these large grants (1.5 million + for each) was on mental health issues, including resilience, social emotional learning, integrated mental health services and many more topics. The extent to which these grants are coordinated with the efforts of non-educational sectors will help to determine their ultimate impact on education and other systems. Read more>>

(From the UCLA Center on Mental Health in Schools) In the ASCD-ISHN sponsored discussions about integrating health and social programs more effectively within schools, we have identified a set of challenges associated with the contradictory or competing demands and constraints placed in teachers and schools by society. The UCLA Center on Mental Health in Schools has discussed one of these challenges in a recent paper on Helping and Socialization. The paper notes that a significant concern or dilemma arises when the teacher and the school are asked to both help the child displaying deviant behaviour while also serving the school's mandate to socialize children and to exercise the social controls necessary to ensure that other children can continue to learn. An example is presented in the paper as follows: 
"  One major reason for compulsory education is that society wants schools to act as socializing agencies. When a child misbehaves at school, the teacher's job is to bring the deviant and devious behavior under control. Interventions are designed to convince the child he should conform to the proscribed limits of the social setting. The child's parents valued the school's socializing agenda, but also wanted him to receive special help at school for what they saw as an emotionally based problem. The child, like most children did not appreciate the increasing efforts to control his behavior, especially since many of his actions were intended to enable him to escape such control. Under the circumstances , not only was there conflict among the involved parties, it is likely that the teacher's intervention efforts actually caused the child displaying deviant behaviour to experience negative emotional and behavior reactions (e.g., psychological reactance). It is commonplace for policy makers, practitioners, family members to be confronted with situations where socialization and helping agenda are in conflict. Some resolve the conflict by clearly defining themselves as socializing agents and in that role pursue socialization goals. In such a context, it is understood that helping is not the primary concern. Others resolve the conflict by viewing individuals as "clients" and pursuing interventions that can be defined as helping. In such cases, the goal is to work withthe consenting individual to resolve learning and behavior problems, including efforts designed to make environments more accommodative of individual differences. Some practitioners are unclear about their agenda or are forced by circumstances to try to pursue helping and socialization simultaneously, and this adds confusion to an already difficult situation."
This role conflict or dilemma is not limited to children who are misbehaving. If teachers are asked to spend inordinately more time helping other children with special medical needs or to help children with social isolation or family stress issues, their time is taken away from the other students. In the "helping professions" such as nursing or social work, there is no conflict, because their priority is clearly with the more vulnerable child. However, educators are mandated to enable every child to reach their full potential, so the maxim is often to try to spend an equivalent amount of time and energy with each and every child, even if they have fewer health, social or even learning needs. To access the UCLA paper Read More>>


 

(From the ISHN Member information service)   An article in the April 2014 issue of BMC Public Health discusses a longitudinal study and knowledge development project in Canada (The COMPASS Study) that will enable researchers to assess the cumulative impact of several school health policies and programs on multiple issues over time. The authors describe the study as "COMPASS is a prospective cohort study designed to annually collect hierarchical longitudinal data from a sample of 90 secondary schools and the 50,000+ grade 9 to 12 students attending those schools. COMPASS uses a rigorous quasi-experimental design to evaluate how changes in school programs, policies, and/or built environment (BE) characteristics are related to changes in multiple youth health behaviours and outcomes over time. It is the first study with the infrastructure to robustly evaluate the impact that changes in multiple school-level programs, policies, and BE characteristics within or surrounding a school might have on multiple youth health behaviours " The researchers note that "In Year 1 (2012–13), data were collected from 43 Ontario schools and over 24,000 grade 9 to 12 students. In Year 2 (2013–14), the cohort was increased by 47 additional schools to reach our target of 90 schools (79 in Ontario and 11 in Alberta), with more than 50,000 grade 9 to 12 students participating. Given the hierarchical longitudinal nature of the data, the cohort of 90 secondary schools are being followed over time through annual school data collection of the program and policy environment within each school, the built environment characteristics within each school, and the built environment characteristics in the community immediately surrounding each school. At the student-level, the cohort of grade 9 to 12 students within the 90 schools are followed over time using annual surveys that assess obesity, healthy eating, physical activity, sedentary behaviour, tobacco use, alcohol and marijuana use, school connectedness, bullying, and academic achievement using scientifically supported measures.COMPASS can evaluate the ‘real-world’ effectiveness of evidence-based interventions that are implemented in COMPASS schools throughout the course of the study. Considering that schools also often implement innovative and unique programs or policies that are not yet evidence-based, 
COMPASS can start to generate practice-based evidence by evaluating those natural experiments throughout the course of the study." In order to help foster health promoting schools to develop stronger links and engagement with participating schools, and track knowledge use as it unfolds from inception through decision-making, adoption, adaption and implementation in participating schools, the COMPASS study developed the COMPASS School Health Profile (SHP) and connects participating schools with a COMPASS knowledge broker.The hierarchical longitudinal nature of the COMPASS data allows for a number of different analytical strategies for examining each of the outcomes in COMPASS. For instance, both cross-sectional and longitudinal core analytical approaches to examining the data will be used. Cross-sectional analyses include, but are not limited to: 1. Identification of high-risk individuals or high-risk school environments; 2. Examination of between-school variability in the different student-level outcomes among students; 
3. Examination of the co-occurrence of different outcomes; and,4. Hierarchical analyses examining the student- and school-level characteristics associated with each outcome. Longitudinal analyses include, but are not limited to: 1. Examination of the temporal sequence for the development of individual outcomes or the co-occurrence of outcomes; 2. Hierarchical examination of how changes in school-level characteristics (programs, policies, or built environment resources) are related to changes in school-level prevalence or individual student-level outcomes over time; 3. Evaluation of how the different knowledge exchange strategies impact the provision of school-level prevention activities or resources; and, 4. Examining how the trajectories of different outcomes are predicted by other outcomes (e.g. declines in physical activity over time impact obesity) and the available sociodemographic characteristics of students and/or schools.
The authors conclude that "In conclusion, the COMPASS study is among the first of its kind internationally to create the infrastructure to robustly evaluate the impact that changes in school-level programs, policies, and built environment resources might have on multiple youth health behaviours and outcomes over time. Determining the school-level characteristics that are related to the development of multiple modifiable youth health behaviours and outcomes will provide valuable insight for informing the future development, tailoring, and targeting of school-based prevention initiatives to where they are most likely to have an impact [46], and will provide the opportunity to understand how the school environment can either promote or inhibit health inequities among subpopulations of at-risk youth. Such insight could save valuable and limited prevention/promotion resources. Developing the ability to evaluate natural experiments that occur within schools will substantially add to the breadth of our understanding of what interventions work, for which students, and in which context." Read more>>

(From the ISHN Member information service) An article in the June 21, 2014 issue of The Lancet calls for systems thinking from governments and Un agencies when they decide on the set of goals to replace the existing MDG goals. The authors assert that "Global priorities have progressed from the Millennium Development Goals (MDG) that will expire in 2015 to global sustainable development. Although there is not yet a consensus on the specific goals for the post-MDG era, the post-2015 investment agenda for health will probably emphasise social determinants of health, sustainable development, non-communicable diseases, health systems strengthening, universal health coverage, the health of women and children, and ageing."  They then go on to make the case for "systems thinking". " The MDGs were undoubtedly successful in focusing international donor financing and domestic investments to achieve the targets set in these goals. Yet, undue emphasis on financing narrow disease programmes used to achieve disease-specific targets in the MDGs often missed opportunities to effectively strengthen health systems.1 Consequently, several low-income countries with weak health systems have struggled to reach the targets set in health-related MDGs and will not achieve them by 2015.2 An important lesson from the MDGs is that current and emerging global health challenges require action that embraces interdisciplinary and intersectoral approaches to development,3 which acknowledge the path-dependence and context-dependence of implementation." 
A table in the article underlines the differences between "selective approaches" (linear thinking) focused on preventing specific problems and "systems thinking" In linear thinking, the program is developed from a blueprint, developed by trials in controlled circumstances, that are top-down in nature, often without considering local contexts or potential unintended consequences. In systems-based approaches, learning and context drive the action and selection of issues to be addressed as well as the programs. In linear thinking, the programs target disease-specific, quick-wins. Planners develop a specific program for a specific population and assess its ability to produce specific short-term outcomes. In systems-based approaches, the action is across various sectors, with key stakeholders involved from the beginning to develop and implement approaches across the relevant sectors. In selective thinking, there is a reliance on isolated, quantitative measures. Single snap shot data points are used by specialized experts to assess if the programs are meeting their objectives. In systems thinking, multiple interative measurements and synthesis as well as relationships are used to assess progress. Longitudinal, real-world data from multiple qualitative and quantitative sources are used to monitor relevant effects.  Read more>>      

(From the ISHN Member information service) The Healthy Schools program in British Columbia, Canada is among the Canadian and international leaders in school-based and school-linked prevention of specific health problems and in promoting overall health.  A visit to their content rich web site will reveal that the schools program is part of an overall settings-based approach and a "whole of government" strategy called Act Now BC. The province provides funding for a number of excellent initiatives and activities, all of which have used a long-term, systems-based strategy.  Multi-intervention approaches are used regularly as the basis for strategies on physical activity, healthy eating, addictions and mental health. The province has mandatory health/personal planning as well as physical education curricula from kindergarten to senior high school grades. The province funds a network of over 150 schools per year as innovators and leaders in school prevention and promotion. Regular conferences bring the school health community together. Excellent learning resources are identified and promoted. The Healthy Schools program has funded the development of a number of generic school health resources that encourage good planning school self-assessments, the use of multiple interventions, effective teaching and student assessment practices and more. Indeed, the province has been both a pioneer and a leader.
However, like all other jurisdictions, British Columbia struggles to truly maintain a focus on improving the overall health of the school environment (policies, practices, social interactions, physical conditions, family problems and strengths, relationship with the community etc) rather than being fixated on a selected set of health or social behaviours or conditions. The list of priority topics on the BC education ministry web page for its healthy schools program is typical of most jurisdictions; healthy eating, physical activity, tobacco/drugs. If one reads the list of "generic" school health planning guides and tools from BC (and most other jurisdictions) one will find that the generic principles and practices are almost entirely focused on or applied to only these health problems or behaviours. We will struggle to find references to to child abuse, sexual health, poverty, indigenous students, LGBT students, violence, crime and many other issues confronting youth and families today in those planning documents. The BC Healthy Schools web site does maintain a list of educational and other resources addressing a broader list of issues. And it does list its 150+ school success stories according to this broader list of topics. But, again, if we examine these stories, we find almost no examples of schools trying to build their overall capacity to implement and maintain school health promotion programs (3/159) but we do find an overwhelming number of stories on healthy eating and physical activity. We also find very few stories from schools addressing topics like substance abuse, child abuse and other more difficult social issues.   
If we turn our attention to the current dominant thinking in the health sector these days, we will find out why so many of the "healthy schools" programs have actually become "school prevention" programs rather than "school health promotion" programs. As funding has been leeched from the health sector overall, we find that health authorities have retreated back to their protection and prevention functions and away from their health promotion function. The work done by health professionals in schools simply reflects this larger trend. Indeed, if one were to examine health ministries around the world and even the WHO, we would find that they are structured, staffed and funded more favourably around "non-communicable diseases" than around "health promotion".   
The danger in this trend to reduce the focus and fixate on a selected number of health issues means that the healthy schools programs become vulnerable when a new issue such as cyber-bullying emerges to capture the attention of the public, parents and decision-makers. Resources are quickly devoted to this new problem and if the healthy schools movement is not ready to address it, they will be by=passed. Or, if other multi-intervention approaches/programs such as safe schools or community schools are available and compete with each other for such new resources, then we will soon see new infrastructure, new documents, new research, new leaders emerge, often repeating or over-lapping with work that has already been done. We will also see educators and school systems having to yet again adjust to a new set of requests and demands from a new set of stakeholders, often without aligning with existing initiatives. This is what happened in BC and several other Canadian and western countries. New laws, new coordinators, new professional development  activities and much more, all focused on bullying, cyber-bullying and to a lesser extent on LGBT students have been brought into BC (and other jurisdictions) in separate strategies
If the healthy schools movement and its related government, agency and school level programs do not move towards a school health promotion rather than prevention approach, it may very well find itself bypassed by new initiatives focused on the topt topic of the day rather than a long term developmental, systems-based approach. This is not to say that the HS movement should try to compete with such specific emerging concerns. Indeed, that is the way the health system has always been funded, by disease, rather than health. But the proponents of healthy schools need to always include all of the many aspects of health, wellness, development and its connection to learning in its mandate, maintaining links with the advocates, experts and practitioners focused on these 25+ issues and concerns and being ready to work with them as attention is turned to their issue. 
This is also not to say that the healthy schools movement should try to be the primary or over-arching paradigm for addressing many of these issues. Instead, the healthy schools movement, linked most effectively to the health sector,  and programs should be ready and willing to work with the many other multi-intervention approaches that work with other systems and sectors. These include the safe schools movement working with law enforcement, community schools working with social services and community development sectors, social/emotional learning and PBS models grounded in the school systems, the relief aid/emergencies in education movement working in countries facing disasters/conflict, school health & nutrition programs working in low income countries and many others. 
But if the healthy schools movement focuses too much on prevention and too little on promotion, it will not be able to either meet its mandate in addressing all aspects of health nor will it be able work effectively to work with other movements/sectoes in addressing the needs of the whole child.                      

(From the ISHN Member information service)  In the ASCD-ISHN global discussion of the need to better integrate health and social programs within education systems, it has been strongly suggested that authorities take a holisitc, whole child approach to education rather than trying to carve up children into specific health/social behaviours or conditions to to compete with the academic purposes of schooling. With the October 2013 release of its Education Renewal and Innovation Framework: Directions for Change, the Government of the Northwest Territories in Canada illustrates how this can be done from the ground up, while using a distinctly indigenous and rural set of values and principles. The news release announcing the framework identifies several challenges that require changes in the schools, the nature of which illustrate how the new directions see school as part of their respective social and economic contexts and communities. "The framework is one of several initiatives developed by the Government of the Northwest Territories to address challenges like poverty, mental health, addictions, early childhood development, safety, the legacy of residential schools and school attendance.  Other challenges within the school system, like authentic learning, staff recruitment, training and retention and transitions to work or learning after high school will be met primarily through school programming and policies themselves, preparing children for a prosperous and healthy future." The foundations of the reforms are equally holistic in their approach to education. The executive summary of the document says it this way: "Thinking around teaching and learning is undergoing a major shift world-wide. The current education system is a model off a system similar to the factories of the Industrial Age. Subject areas are separated, students are sorted by age, and the end goal is a very specific set of skills and knowledge. Research now points to a more ecological understanding of the needs of learners and the factors that benefit learning."  These foundational statements are intended to guide the initiative. These statements, especially the first few, are born of indigenous worldviews and experiences where relationships with the land, ecology, and identity are very powerful.     

1. Relationships: Meaningful relationships with self, others, ideas, and the land are the foundation for all learning. 
   
2. Ecological Understanding: Education in the NWT is a living system of connections, each affecting an individual’s relationships and well-being. 
   
3. Identity: A positive sense of identity is actively supported. 
   
4. Development of Self: Each person has multiple needs that must be met in order to grow and become a capable, contributing person. 
   
5. Learning Together: People construct knowledge and learn individually and together. 
   
6. Diversity: Diversity is recognized and valued in the education system. 
   
7. Strengths and Growth: The ongoing growth of learners is nurtured. 
   
8. Competencies: The development of competencies is supported in all learners
   

The proposed directions for change reflect the holistic understanding and the set of coherent values. They include commitments on the part of government to  (1) "ensure that the school and community work together to build and renew positive 
relationships", (2) "e that student wellness and the development of a positive sense of identity are promoted and embedded in school experiences, programming, and environments", (3)  "ensure that educators have access to experiences and resources that enhance their wellness in order for them to focus on excellence in teaching" (5) "that the strengths and realities of small communities are recognized and built upon in order to ensure equitable, quality education in all NWT communities" and (9) "work with Aboriginal governments to be successful as they draw down jurisdiction over the education of their people".
The document does include other directions that will be more familiar to those working in school systems based on competition, traditional rote style learning and even narrow, behavioural modification approaches to promote health. These include research-based curriculum, better data and use of those data in decision-making, and more monitoring/reporting to provide better accountability. However, these traditional, more industrial approaches to education are firmly based and and linked within this indigenous, holistic, whole child approach, that in turn, is rooted in a deep understanding the indigenous and rural, northern communities served by the schools in this system.  To read more about the NWT education renewal, start at this web page.   

(From the ISHN Member information service)  One of the major challenges in sustaining and integrating health and social programs within education systems is the tendency in government to create and maintain "silos" of programs, often delivered in isolation or even competition with each other. Most governments create committees to encourage coordination but they often fail, or they focus on only one problem at a time. The Manitoba Healthy Child Agency, a strategy established in law in 2007, is an exception to this rule. The slogan on Manitoba license plates tells the world about "Friendly Manitoba". More than just words, this slogan actually reflects a culture and customs in the province, one which was born in Canada's harshest winters and bred by generations of immigrants who had to rely on each other. So, perhaps, it is this culture of cooperation that enables Healthy Child Manitoba (HCM) to be as effective as an inter-ministry agency, coordinating several ministers and ministries, in a "whole of government" strategy.  Other factors could include their requirement to report results every five years, its research, innovation and knowledge development capacity, and its combination of programs (as opposed to framework documents) that are delivered hands-on and delegated ways. As well, the Healthy Child inter-ministry program has its own legislation, entitled the Healthy Child Manitoba Act, thereby giving its coordination work legal authority and requirements to report every five years on progress.     

The HCM web site describes its work as follows: " in 2000, the provincial government implemented the Healthy Child Manitoba (HCM) Strategy – a network of programs and supports for children, youth and families. This nationally recognized strategy was set in legislation under The Healthy Child Manitoba Act in 2007.Led by the Healthy Child Committee of Cabinet, Healthy Child Manitoba bridges departments and governments and, together with the community, works to improve the well-being of Manitoba's children and youth. HCM focuses on child-centred public policy through the integration of financial and community-based family supports.In addition to these cross-sectoral government structures, The HCM Act also continues the work of cross-sectoral community structures, including Parent-Child Coalitions and the Provincial Healthy Child Advisory Committee (PHCAC). HCM researches best practices and models and adapts these to Manitoba's unique situation. It strengthens provincial policies and programs for healthy child and adolescent development, from the prenatal period to adulthood. HCM then evaluates programs and services to find the most effective ways to achieve the best possible outcomes for Manitoba children, families, and communities."

(From the ISHN Member information service)  A recent article describing a growing trend in the United states to voluntarily delay entry into high school in order to strengthen students academically and socially reflects increased attention to various transition periods in a child's schooling. A report on grade retention done by UNESCO is primarily focused on involuntary cases but does include some students who have volunteered to wait a year. That UNESCO report concludes that    “Grade repetition represents inefficiency and wastage of resources for society, but its voluntary forms may be beneficial to students in certain circumstances,”. In Ireland, a voluntary "transition" year has become so popular that the vast majority of students now make the choice to wait a year before proceeding. See our previous blof post on the Irish program here. In both of these cases and others, it may very well come down to the supports that are available to students as they make the transition. this is where effective, comprehensive health and social programs that are linked effectively within the school systems can be of the greatest service. Read more from the American news story.    

(Identified by ASCD SmartBrief)  A blog post identified by the ASCD Smart Brief service and published by Edutopia suggests that students should be taught to prepare their curricula vitae (which include personal and professional goals) rather then a simple resume (which simply lists assignments and accomplishments). This strategy for Career Education and Student Planning, one which the author calls preparing a "course for life", fits very well with health/personal/social development education, where effective teachers often use student journals and other reflection activities to help students learn more about themselves and their surroundings. As well, linking CV preparation with health journals and reflections is another way to achieve a better integration of health concerns within the core concerns of education systems. The author of the blog post discuses how difficult it can be for students to learn self-reflection techniques. But we all know that this process is essential if students are to develop personal behavioural and life plans. The article then outlines a five phases of preparing a CV, all of which are applicable to HPSD education as well as career education. Read more>> 

(From the ISHN Member information service) The news release describing the new Ontario Government vision for education, Achieving Excellence includes well-being as one of the three sub-headings for the release. The release itself includes these two points among the four used to provide examples of how the new educational policy will be implemented:

• Working with education and health partners to improve and expand health services for students and families
  
• Working with partners inside and outside of school to encourage students to be physically active and practise healthy lifestyles
  

The web page introducing the Ontario policy document states that Ontario's renewed and inter-connected goals for education are:

• Achieving Excellence: Children and students of all ages will achieve high levels of academic performance, acquire valuable skills and demonstrate good citizenship. Educators will be supported in learning continuously and will be recognized as among the best in the world.
  
• Ensuring Equity: All children and students will be inspired to reach their full potential, with access to rich learning experiences that begin at birth and continue into adulthood.
  
• Promoting Well-Being: All children and students will develop enhanced mental and physical health, a positive sense of self and belonging, and the skills to make positive choices.
  
• Enhancing Public Confidence: Ontarians will continue to have confidence in a publicly funded education system that helps develop new generations of confident, capable and caring citizens.
  

The political party that governed Ontario at the time this policy paper was published (April 2014) has recently been elected, so this emphasis on equity and wellness as part of the planned education goals would appear to have a good chance at implementation. the education ministry also released documents linking this policy paper Achieving Excellence to various health issues and directions being taken in the Ontario Healthy Schools Program. Read more from the news release

(From the UCLA School Mental Health Project)  A part of the ASCD-ISHN global dialogue on integrating health & social programs more effectively within education systems has focused on the need for better coordinated among the various student support services. A recent UCLA planning guide takes this coordination a major step forward and connects it to student learning and success. The guide suggests that "New directions for student and learning supports are key to systemically addressing barriers to learning and teaching. The aim is to unify and then develop a comprehensive and equitable system of student/learning supports at every school.This guide incorporates years of research and prototype development and a variety of examples from trailblazing efforts at local, district, regional, and state levels. The prototypes and examples can be adopted/adapted to design and plan ways to transform the role schools play." 

The UCLA analysis of the causes of this fragmentation is revealing. They suggest that "  While the range of student and learning supports at schools varies; some have few, some have many. In some instances, community services (e.g.,health and social services, after-school programs) are connected to a school. However, given their sparsity, agencies endeavoring to bring community services to schools usually must limit their activities to enhancing supports at a couple of school campuses in a neighborhood. Moreover, there often is not a good connection between community services and the work of the many school and district-based student support staff whose roles include preventing, intervening early, and treating students with learning, behavior, and emotional problems. Such school employed personnel include psychologists, counselors, social workers, nurses, dropout/graduation support staff, special educators, and others. When school and community efforts are poorly connected, community and school personnel tend to work
with the same students and families with little shared planning or ongoing communication. Ironically, some education policy makers have developed the false impression that community resources are ready and able to meet all the support needs of students and their families. This impression already has contributed to serious cuts related to student supports (e.g ., districts laying off student support personnel) in the struggle to balance tight school budgets.An outgrowth of all this has been increased fragmentation, as well ascounterproductive competition for sparse resources related to student and learning supports. Underlying the fragmentation is a fundamental policy problem. That problem is the long-standing and continuing marginalization in school improvement policy and practice of most efforts to directly use student and learning supports to address barriers to learning and teaching and re-engage disconnected students. "

The UCLA research and planning guide calls for a transformative change student support services that is based on these four principles:
1) Expand the policy framework for school improvement to fully integrate, as primary and essential, a component that brings together the supports for addressing barriers to learning and teaching and re-engaging disconnected students.
(2) Reframe student and learning support interventions to create a unified and comprehensive system of learning supports in classrooms and school-wide.
(3) Rework the operational infrastructure to ensure effective daily implementation and ongoing development of a unified and comprehensive system for addressing barriers to learning and teaching.
(4) Enhance approaches for systemic change in ways that ensure effective implementation, replication toscale, and sustainability

Read more>>

(From the ISHN Member information service) ISHN and ASCD have been sponsoring an international dialogue on how health 7 social programs can be integrated within education systems. One aspect of that suggests that H&S advocates should support a broad, liberal and student-centered approach to learning as outlined in the ASCD Whole Child approach. However, should we also be asking H&S advocates if they are actually doing that in their various instructional programs that seek to teach specific knowledge and skills about particular health or social topics? A recent blog underlines this question when it describes the difference between education and training (or education based on outdated factory models).  

The blog article, appearing in the Smart Blog on Education (Jun 9, 2014) suggests that " Our traditional approach to schools was based on a factory model where workers had to be “trained” to perform actions and repeat them in the same way and at the same time. Anything that distracted them from performing the way the factory prescribed was just a distraction to be extinguished as quickly as possible. A person’s natural interests, including the desire to socially connect to others, needed to be put aside in favor of the required work. Workers needed to be “trained” in a way of acting that was foreign to how they were naturally wired to learn. Since the work they did was arbitrary, relatively meaningless and tedious, they needed to be rewarded for performing in a certain way and penalized for performing in a different way." "In this factory model of schools, character and social/emotional skills are not integrated into the interactions between teachers and students. There is one main social skill: Do what you are told. Policymakers recognizing that schools are missing this social/character element decided to have character education and social emotional skill training inserted into the traditional structure of schools." "The environment and structure of a school sends a message to students that very often contradicts the content of many social emotional and character education programs. In addition, when the basic structure of schools does not change, neither do the attitudes of many teachers. It’s not surprising that many of them view these programs just as add-ons or distractions from teaching academic content. ".Instead of training students, schools should be educating them. Education comes from the Latin words e and ducere–meaning to lead out of. Education therefore is not about creating skills and abilities in people who are blank slates waiting to be shaped and molded. Education assumes that people come ready to learn with special abilities, capacities, interests and affinities, and need guidance and support from human relationships for their unique human qualities to come out." 

Based on this analysis, can we truly say that we are guiding students to learn about their health and social development based on their interests, needs and abilities, OR, are we designing instructional programs to teach specific, predetermined content to all students based on a factory style approach?  

From the ISHN Member information service) An article in Issue #1, 2014 of Physical and Health Education Academic journal review the socialization of PE teachers. The authors note that "Teacher socialization is a term used to describe the socializing processes that influence a teacher’s beliefs, assumptions, and values regarding teaching. The nature, quality and effectiveness of teaching is greatly influenced by a teacher’s early socializing experiences. Using Lortie’s (1975) theoretical framework, Lawson (1983a) identified three main kinds of socialization that teachers face: (a) Acculturation: this includes actions, beliefs, and value systems that are learned from birth and foster ideologies about, in this case, professional conduct. (b) Professional socialization: this is the process through which prospective and practicing teachers learn and maintain the values deemed ideal for teaching physical education. Professional socialization is strongly influenced by recruits’ experiences as a K-12 school student (the period of time described by Lortie 
(1975) as the apprenticeship of observation). These experiences inform recruits’ subjective warrant, which consists of their beliefs about the requirements for being a physical education teacher. (c) Organizational socialization: this process serves to maintain the “traditional skills” valued by institutions and organizations. Organizational socialization may work against change in order to uphold traditions and routines." 

The review (full text available free) concludes that "there have been several patterns to emerge in socialization research since 2000, most notably in the increasingly progressive, “teaching-oriented” views that many physical education recruits now hold. In particular, the findings suggest that teaching orientations are now more prevalent in recruits than they were prior to 2000. Attached to this finding is a general pattern that physical education teachers today are more likely now than in the past to develop a student-centered holistic approach to teaching physical education that develops the “whole-student”, one who is socially responsible and aware. While there appears to be less evidence supporting the presence of coaching orientations in recruits which is likely due to a change in the modern recruit’s acculturation, we feel that this finding should be treated with caution, as it does not suggest that coaching orientations are “things of the past” or are no longer present in physical education. There are still many recruits who do come to physical education with the aim of becoming coaches and the sport-centred philosophies to physical education content and pedagogy that tend to come with this mindset. Read more>>

A team of Quebec researchers and government officials has been working to develop a new model for school health promotion that results in better integration with the goals and mandates of school systems and effective interventions based on sound theoretical foundations and essential knowledge gleaned from many years of experience. An interim report and synthesis, published in French, is titled " For integrated and effective promotion and prevention interventions in the school context: theoretical foundations, model and essential knowledge". In order to improve the compatibility of health promoting and prevention interventions with the mission of the school, its policies and operations, the National Institute of Public Health (INSPQ ) was given the following mandate .
Working from the synthesis of expert recommendations in the report Success , health and well -being: to act effectively in the school context produced by the INSPQ in 2010 ( Palluy et al , 2010. ), the INSPQ is to: 

• Identify the essential elements common to all health topics youth from a model that incorporates the determinants of health and educational success according to the phases of development of young people - from preschool to grade 5 secondary - and intervention (youth, school, family, community) levels; 
• Identify best practices in relation to these common essential elements; 
• Confirm with experts and key players of the two networks (health and social services , and education) model, essential to all health topics common elements among youth and best practices related thereto .

This interim report and synthesis presents the results of the first part of the work or the development of a model for integrated and effective interventions for promotion and prevention in the school context and the identification of essential common elements of the Youth section of the primary and Youth secondary synthesis of expert recommendations ( Palluy et al. , 2010). The first chapter focuses on the background and objectives of the work . The second chapter presents the theoretical foundations underlying the development of a model for integrated and effective interventions for the promotion and prevention in schools as well as the dimensions of the model context. The third chapter presents the methodology used to analyze, from the model , the recommendations of the Youth and Young primary school section . Must more than one health topic emerging from this analysis are described common elements . A fourth chapter discusses the implications of a competency-based approach to educational interventions to deploy youth .
A second report will include a distribution of objectives of educational interventions depending on the stage of development of young people and their reality, identification and prioritization of essential elements common to all the themes in the recommendations section school, family, community ( objects of environmental interventions).
A process of co-construction is underway to improve the model , identify ways of achieving promotion interventions and prevention better integrated in the school context and produce tools tailored to the needs of managers and players on both networks (health and education ) . This process is being conducted jointly with the Ministry of Health and Social Services and the Ministry of Education, Recreation and Sport. This process will take place from September 2012 to June 2014 , in collaboration with actors in the health and education at three levels of intervention ( national, regional and local). With the coming of the process, the enhanced model will become a common reference for effective interventions for promotion and prevention in school context for managers and stakeholders on both networks. Planning tools and intervention will be made available to stakeholders .
Read the interim report (Published in French) 

(From the UCLA School Mental Health Center) One of the themes being developed in our discussions is how to integrate health and social programs within education systems. A recent report from the US-based Child Trends organization has described how an integrated set of student services is how the health, social services, mental health and other sectors can and should contribute to student success. If these various services can cooperate and deliver such support in a concerted manner, it would assure educators of their ongoing commitment to working with and within schools. A summary of the Child Trend report and the full research review are available from Child trends. These documents define ISS “representing an emerging field of practice that aims to address persistent disparities in educational achievement and attainment. ISS is a school-based approach to promoting students’ academic achievement and educational attainment by coordinating a seamless system of wraparound supports for the child, the family, and schools, to target student’s academic and non-academic barriers to learning." That report focuses on nine programs:Beacon Initiative, Children’s Aid Society Community Schools, City Connects, Comer School Development Program, Communities In Schools, CoZi Initiative, Say Yes to Education, School of the 21st Century and University‑Assisted Community Schools.. However, the UCLA Center on School Mental Health, a long-time advocate for comprehensive approaches to removing barriers to learning, strongly suggests that integrated student supports (ISS) alone "do not effectively address the fundamental policy and practice concerns about the consequences of pursuing the limited approach that the concept of integrated student supports engenders with respect to enhancing equity of opportunity for students to succeed at school and beyond". The UCLA analysis suggests that "the Child Trends report "doesn’t consider the implications of the fact that in most schools student support is primarily provided by school and district-based student support personnel (e.g., school psychologists, school counselors, school social workers, school nurses, school dropout/graduation support, special educators, and many more school personnel who play a role in prevention, early intervention, and treatment of students with severe and chronic problems. The UCLA "emphasis continues to be on moving toward policy and practice for addressing a wide range barriers to student development and learning and to teachers teaching. Making this a reality involves much more than integrating already over-committed community services into schools. It requires transforming the role schools play and weaving together the broadest range of school and community resources for enhancing student and learning supports. In other words, the support services that must be provided by other agencies, which are vital as a long term commitment from those sectors, must be fully integrated within the goals and priorities of the school systems. Further, school systems must be committed to ensuring that all children are well-served by their schooling.

(An item from the ISHN Member information service) In a thorough and provocative article in the Winter 2014 issue of the AASA Journal of Scholarship and Practice, the author begins with these words: " In this article I argue, with evidence, that the scores and rankings from PISA are not important and that they cannot give policy makers or educators meaningful insights into student preparedness for the global economy." He then goes on later in the article to say that "The Organisation for Economic Co-operation and Development (OECD, 2013, p. 265), the private entity that develops and vends the PISA, explains that policy makers should not use results either to indict or commend education systems. Furthermore, they should not use the results to make important policy decisions. In fact, the OECD authors explain that PISA results are due to a combination of variables, including but not limited to schooling, life experiences/home environment, poverty, access to early childhood programs, and health."   After further analysis and quoting of the PISA authors about their own report, the analysis concludes that " So, if the vendors of PISA repeatedly warn that (a) PISA is not aligned to school curricula, (b) the scores and ranks are influenced strongly by poverty and selection bias, (c) the skills are left over from the 19th and early 20th centuries, and (d) one test of a 15- year-old child cannot possibly represent the future success of that child or of a country, then what does PISA really tell us about the quality of a school system? Not much." Yet, for those who advocate for health and social development through schools, the recent report is already putting pressure on the school systems to do more about math in schools. Read more>>

(An item from the ISHN Member information service) The research supporting multi-intervention approaches and programs in school health promotion is abundant and long standing. Recent research is underlining the need for long-term, systemic planning and investments in capacity-building in areas such as coordination, work force development, inter-agency agreements, coordinated policy development and joint issue management. However, experience in the real world suggests that local health authorities (LHA) do not follow that research and instead, constantly try to implement short-term, project-style interventions based on a "training, then hoping" strategy. Four articles in Issue #6, 2013 of American Journal of Preventive Medicine examine evidence-based decision-making in LHA's and provide clues for this cognitive dissonance.  One article examines the factors that affect evidence-based decision-making (EBDM) and found that "Although most people understood the concept, a relatively small number had substantial expertise and experience with its practice. Many indicated that they applied EBDM unevenly. Factors associated with use of EBDM included strong leadership; workforce capacity (number and skills); resources; funding and program mandates; political support; and access to data and program models suitable to community conditions." A second article found that "Local decision-making authority was perceived as greatly restricted by what public health activities were legally mandated and the categoric nature of funding sources, even as some leaders exercised deliberate strategic approaches. One’s workforce and board of health were also influential in making decisions regarding resource allocations. Programmatic mandates, funding restrictions, local stakeholders, and workforce capacity appear to trump factors such as research evidence and perceived community need in public health resource allocation." A third article suggested that LHA participation in a "Practice-based Research Network" will help in the implementation of research. A fourth article introduced the idea that LHA's could make use of local taxation revenue.  Read More>>