(An item from ISHN Member information service) An article in Issue #4, 2012 of Critical Public Health opens the door to a discussion of how public health systems need to divest themselves of terms, practices, structures and underlying assumptions imported from the health care system. The authiors note that "Public Health specialists have increasingly deployed the concept of ‘dose–response’ in areas such as diet (‘five-a-day’), alcohol (‘21 weekly units’) and physical activity (‘150 minutes of weekly activity’). Using these examples and a case study that sought to establish an optimal dose of physical activity for mental health gain, this article offers a critical assessment of the nature, robustness and function of ‘dose’ in public health. Drawing on a ‘sociology of knowledge’, the article argues that dose–response can best be considered an analogy that does not necessarily translate favourably from its original expression in toxicology to some public health domains – an over-extended analogy. Rather than having technical robustness, its attractiveness and utility is seen to lie in it possessing ‘cultural capital’ (ie sounding medical). Here, the ability to link behavioural concerns to clinical practice, to simplify complex ideas and to act as a regulatory form of behavioural governance. The article is skeptical of further empirical pursuits in identifying optimal doses and offers an alternative course for public health framing. Read more..

(An item from ISHN Member information service) One of the characteristics of large "professional bureaucracies" such as education, health and social service is that knowledge is a source of power and influence within those layered and loosely-coupled structures. Consequently, it makes sense that knowledge management (KM) strategies can be helpful in coordinating these systems and enabling the local agencies and professionals to work together. An article in Issue #5, 2012 of Health & Social Care in the Community reports on the use of KM strategies to integrate the efforts of two systems. The authors completed a critical review of the literature to identify theoretical insights and models in this field. The findings were then used to explore the approach to KM. This case study involved an interrogation of relevant documentary material, together with 25 in-depth interviews with managers and professionals. The authors no planned KM strategies for learning and KM, but rather, interventions and mechanisms at different levels to support integration processes. These included formal activities, training and appraisal, but also informal ones within communities of practice and networking. Although structural enablers such as a co-location of facilities and joint appointments were important, the value of trust and inter-personal relationships was highlighted especially for tacit knowledge exchange. The conclusion to the article uses Nonaka’s knowledge conversation model to reflect on the research findings, to comment on the absence of an explicit approach to learning and KM, and to develop a template to assist policy-makers with the design of planned strategies" Read more..

(An item from ISHN Member information service)  Earlier this month, we noted a debate about the usefulness of RCT's in real world conditions that was initiated by a leading authors of systematic reviews, Sarah Stewart-Brown. Two articles in Issue #6, 2012 of the American Psychologist continue these revolutionary thoughts. One article questions the wisdom of basing scholarship and knowledge development on an ever-increasing number of research reviews, that examine different interventions in different contexts and often clumped together in inappropriate ways. The second article suggests that rather than trying to reframe systems in the light of accumulated evidence from research, we seek to identify "disruptive innovations" such as micro-clinics in retail chain drug stores, $2 generic eyeglasses and automatic teller machines that fit into real world situations and offer practical convenience to the intended users. Read more..

(An item from ISHN Member information service)  An article in the September 2012 Issue of Educational Policy discusses how school systems both respond to new small demands while resisting large scale reforms. The article is actually a review of the 2010 book, Someone Has to Fail, which examines while many efforts to reform school systems have failed. The authors note that: "Someone Has to Fail offers a reinterpretation of the complexities of education reform, one that is full of useful counterpoints to many of the most common claims made by today’s business-minded reformers. Thus, the work is well worth reading. However, we still wish that Labaree had more deeply explored the contexts within which his education “consumers” were making their system-shaping decisions. Such an effort would have offered a more compellingly critical assessment of the importance of curriculum and the struggles over knowledge and culture. It would have brought the experiences and movements of the marginalized closer to the center of its account. And in the process, it might have engendered a somewhat less gloomy perspective regarding the roles that schools might still play in efforts to create a more just society." Read more..

(An item from ISHN Member information service)  An article in the September 2012 Issue of the Journal of School Health analyzes the submissions made to a 2009 Parliamentary Inquiry into "the opportunities for schools to become a focus for promoting healthy community living. Submissions to the Inquiry varied widely in their positions about school health promotion. The aim of this review is to analyze the submissions to identify core themes in the debates about school health promotion and how stakeholders saw schools becoming a focus for promoting healthy communities. The submissions (N = 159) were downloaded from the Inquiry website. Open coding was used to code the data. The codes were then refined into conceptual categories to create themes. The Inquiry's terms of reference were used as an organizing framework. RESULTS: Emergent themes included barriers and enablers to school health promotion including the need for stronger leadership from the Departments of Health (DoH) and Education and Early Childhood Development (DEECD). CONCLUSION: Rather than supporting the idea that schools could have a wider role in communities, submissions pointed to the acute need for increased resource allocation to support health promotion in schools, and for coordinated approaches with stronger leadership from the health and education sectors. Without these structures, schools can only address health in an ad hoc manner with limited resources, capacity, and outcomes" Read more..

(An item taken from the daily/weekly/monthly ISHN Member information service)  Several articles in Issue #3, 2012 of Policy Studies Journal examine how informal social networks within and across government ministries as well as among organizations and sectors can affect policy development. Five of the articles discuss how to track the influence of these networks within systems using various statistical analysis tools. One article examines how such networks can be used in rebuilding communities after disasters and another examines inter-organizational cooperation via networks or competition during economic development programs. These informal social networks are one of the characteristics that need to be considered when pursuing systems change and sustainability.  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)  Most of the discussion in school-based and school-linked human development is focused on the implementation of specific programs. When researchers, officials and policy-makers eventually realize that system capacity building is required, they too often focus solely on the school system and usually on teacher knowledge. So it is refreshing to read several articles in Issue 1-2, 2012 of Journal of Evidence-based Social Work which form part of a special Issue: Building Knowledge-Sharing Systems to Support Evidence-Informed Practice: Case Studies of “Works-in-Progress” in Public Sector Human Service Organizations. Several case studies of capacity-building in local social services agencies are presented. the topics examined include data-based decision-making, assigning senior staff to knowledge management, the development of key system performance indicators, and building organizational support for research-minded practitioners. 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) The Transforming Public Health project, funded by the Robert Wood Johnson Foundation (RWJF) and convened by RESOLVE, tasked a small group of public health thought leaders with developing guidance for public health officials and policy-makers in prioritizing vital public health functions in a shifting political and fiscal landscape. The resulting document stresses the need for health departments to develop policy goals; use integrated data sets; communicate with the public and other audiences to disseminate and receive information; mobilize the community and forge partnerships; cultivate leadership along with organization, management, and business skills; and protect the public in the event of an emergency. These emerging concepts are intended for consideration by governmental health practitioners to help guide difficult resource allocation decisions while also trying to adapt to ever changing challenges, demands, and opportunities. There is much to agree with in this paper but I want to isolate and debate a key contradiction or competition within the report that dramatically affects how public health systems work with schools. 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) The ISHN information service provided to its members monitors over 200 journals, over 100 media outlets and over 100 social media accounts and posts the titles, with links, into the School Health Insider, a members only web site as well as selected Twitter accounts. In the first week of May, 2012, we identified three journal articles that provide examples of why system, organizational and professional capacity matter in implementing/operating and sustaining programs and approaches.  

• State/Provincial Leadership Matters
  
• Three articles in the May, 2012 Issue of Journal of School Health report on the effect of state level leadership in regulating school food sales, in farm to school programs and in monitoring BMI. Not surprisingly, those states that had passed laws and shown active leadership had more school districts and schools implementing those poicies and programs.
  
• Assistance, Coordination, Training Matter
  
• Two articles in Issue #3, 2012 of Preventing Chronic Disease report on the Healthy Schools program, a support to the US federal law requiring funded schools to implement nutrition and activity programs. The article on the role of the Technical Assistance component of the HSP shows that training, assistance and coordination matter in the implementation and operation of the program.
  
• Coordinators Matter
  
• An article in Issue #3, 2012 of the Health Education Journal describes the factors that facilitate and barriers towards the implementation of health education programmes in primary education schools of the prefecture of Achaia, Greece.Findings indicated that the most significant factor that facilitates the implementation of innovative health education programmes is ‘Knowledge and skills of the Health Education Officer and the teachers’. The Health Education Officer plays an important role in programme coordination by supporting, counselling, giving feedback and providing training/educational materials to teachers.

Several articles in Issue #1, 2012 of Policy Studies Journal discuss "punctuated equilibrium", a theory of policy-making that fits very well with current ecological, complex, adaptive systems thinking about school health and social development. In previous decades, the “incrementalist” model dominated theories of policymaking. However, the “punctuated equilibrium” model, borrowed from evolutionary biology, has supplanted the incrementalist model. Punctuated Equilibrium Theory (PET) was born of unhappiness with models that emphasized stability, rules, incremental adjustment,whereas change as oftentimes disjoint, episodic, and unpredictable. The incremental model seemed to be a beneficial approach because policymakers were operating within the reasonable range of experience, and incremental adjustments could always be reversed. PET rests solidly on a microfoundation: a model of decision makers based on bounded rationality. Bounded rationality rejects the premise of comprehensive rationality that humans tally up costs and benefits and choose the best course of action. Rather, decisions are channeled by their cognitive and emotional architectures. In particular, decision makers are prisoners to their limited attention spans, and the key governor of the allocation of attention: emotion. Media attention is fundamental to the policy process and policy change in punctuated equilibrium theory. In this literature, media attention is usually conceptualized as fomenting or contributing to shifts in attention, positive feedback, and large-scale policy change. Read more...