Knowledge Matters April 2010This is a featured page

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Canada's monthly school health report from the Canadian Association for School Health
Volume 4 Issue 8 (April 2010)
___________________________________________________________________________________________________
Featuring Canadian Research in School Health Promotion, Safety, Social and Sustainable Development

This month’s feature article is a listing of Canadian research reports and studies that have been published in peer reviewed journals and other places over the past year. If you have been following our monthly SH Reports, Knowledge Matters, or, if you have been visiting our monthly blog page, you will have seen these items before.

The article below starts with an overview of SH research starting with a summary of a CIHR research project that our informal network of researchers undertook in 2005. That project included the3 development of a framework based on an ecological and systems-based approach to SH promotion, a national consultation and international seminar setting out a SH research agenda and the creation of a web site at: www.schoolhealthresearch.org That web site was the home for our loose network of researchers that have met occasionally and corresponded over the past few years. As part of the consolidation of the entire Canadian SH community onto our wiki-based web site, the pages and the email list for the School Health Research Network are now being transferred to the www.canadianschoolhealth.ca web site (Select SH Research Network from the left hand menu)

We conclude this introduction with a call for suggestions for key Canadian research projects in school-based or school-linked health promotion, safety and social development. These suggestions will be considered in the writing of a book chapter on Canadian health promotion over the past decade, a project that is underway across Canada. Send a brief description of 250 words to dmccall@cash-aces.ca if your work or that of a colleague should be on that list. We will edit and post all of the submissions and post them on the web site in the research network section noted above.

We conclude this brief introduction noting that these Canadian research studies, reports and stories have been identified by the international SH information service being developed by the International School Health Network. The School Health Insider tracks over 60 peer reviewed journals, over 50 media outlets and an ever-increasing number of social media outlets and then posts them in a daily news-clipping style Twitter account, a weekly blog page and a monthly report. The Canadian items are posted free of charge in the blog page maintained in the www.canadianschoolhealth.ca web site.

Canadian School Health Knowledge Network NewsCanadian Media Reports for March 2010

  • Schools for All. A National Conference on Alleviating Disadvantage. April 21-23, Halifax, NS
    The sixth annual national school health conference was held on April 21-23, in Dartmouth, NS. The format was a little different this year, with a about 200 participants attending an event that did not include symposia organized by our Communities of Practice. (We will return to this CoP format next year.) The Final Program had numerous sessions on different programs that can help to address social determinants, reduce disparities and alleviate disadvantages caused by Registration was $325 for SH Knowledge Network Members, $475 for non members. The registration fee includes access to five webinars to be held jointly with an international SH Symposium in Geneva in July.

  • National Consultation on School Mental Health. CASH will be looking for your feedback to guide our input into several national initiatives relating to schools and mental health. These include a national consortium project, consultation with the Canadian Population Health Initiative, the Mental Health Commission of Canada and a series of webinars on implementation strategies.

  • How Tweet! Do you have SH news you want to share with 2500 other Canadian SH practitioners. Then feel free to post your news on the shared "CSH Tweets" account on Twitter. Simply go to www.twitter.com/cshtweets, sign in as user "cshtweets`, password `cash-aces and post your news. Those tweets and other items posted on this web site through posting updates directly onto our School Health Blog will be included in this mailout to 2500 people. This process is starting to work, with three recent postings coming directly from other organizations into the School Health Blog.

  • CSH Community
    The CSH Knowledge Network list of SH contacts has grown to over 2500 people. We are continuing to transfer the email contacts lists over to the professional networking web site at www.canadianschoolhealth.ca. Agencies, organizations and individuals will be able to control the email they receive from this wiki-based web site through their own profiles. (This occurs by "watching" or "unwatching" selected pages). As well, they will be able to use the tools on the web site to interact with others and receive RSS feeds from the daily blog of SH news.

  • Call for Suggestions about Canadian SH Research
    Marthe Deschenes (Public Health Institute of Quebec) and Doug McCall have been asked to prepare a book chapter on Canadian developments in SH promotion. See their call for suggestions on this page and then send your suggestions to dmccall@cash-aces.ca

  • CASH Invited to CIHR Injury Prevention Project
    The Association will be represented on the Steering Committee of a multi-year CIHR project on injury prevention being led by the Children’s Hospital of BC. This is the first major project on injury prevention in Canada in a long time and we look forward to building a comprehensive, school-based and school-linked approach to this problem using this project as a starting point.


News Story (Mar 17-10) Pepsi out of schools by 2012 http://is.gd/br2fs

News Story (Mar 16-10) Internet access funds not cut: Clement http://is.gd/br2bL

News Story (Mar 19-10) Residential school survivors fear network end http://is.gd/br23r

News Story (Mar 22-10) COPD found in 1 in 10 adults http://is.gd/br1Vq

News Story (Mar 31-10) Oshawa teen charged with murder in stabbing http://is.gd/br1zH

Policy Doc Millenium Development Goals and Canada (Canadian Teachers Federation 2010) http://is.gd/bm0Lb

News Release (Mar 31-10) CCL Calls for Ed Plan with School as a Hub http://is.gd/bknRr

News Story (Mar 18-10) Canadian Government Backs Down. Contraception 'option' in maternal health plan http://is.gd/aPnQX
News Story (Mar 11-10) TB rate more than 30 times higher for aboriginal Canadians: Report http://is.gd/aPnsw

News Story (Mar 19-10) Kraft pledges salt reduction http://is.gd/aPnmK

News Story (Mar 19-10) experts agreed it's not clear that the vaccine did anything to stop H1N1 http://is.gd/aPngZ

News Story (Mar 19-10) Caffeine in sodas OK: Health Canada http://is.gd/aPn7z
News Story (Mar 15-10) Ottawa Board revises suspension figures http://is.gd/aPkZI

News Story (Mar 15-10) Tories cut funding for community Internet access http://is.gd/aKSab

News Story (Mar 16-10) Pepsi to stop selling sugary drinks in schools http://is.gd/aKS2k

News Story (Mar 9-10) Bullying may have caused school stabbing in Windsor http://is.gd/adC7F

News Story (Mar 10-10) Government of Canada Supports Major Renovation and Expansion of Innu School in Natashquan, Quebec http://is.gd/ady5Y

News Story (Mar 10-10) Peterborough Board defends costly legal battle over suspension http://is.gd/adxuM

News Story (Mar 10-10) Battling bullying on the schoolyard and the computer in London http://is.gd/adw75

Announcement: CPHA is seeking feedback on virtual communities of practice from public health professionals in Canada. To provide your input, please click here.

News Story (Mar 11-10) Beyond the blow to self-esteem, bullying can hurt the brain, too http://is.gd/adkfo

News Story (Mar 10-10) Battling bullying on the schoolyard and the computer in London http://is.gd/adw75

News Story (Mar 10-10) Government of Canada Supports Major Renovation and Expansion of Innu School in Natashquan, Quebec http://is.gd/ady5Y

News Story (Mar 10-10) Aboriginals in Canada face ‘Third World'-level risk of tuberculosis http://is.gd/adjTJ

News Story (Mar 9-10) Bullying may have caused school stabbing in Windsor http://is.gd/adC7F

News Release (Mar 9-10) Health Canada Launches the Translated Eating Well with Canada's Food Guide in Aboriginal Languageshttp://is.gd/a425B

News Story (Mar 3-10) CHILD POVERTY: Burnaby Schools the front line for needy kidshttp://is.gd/9ZZb2

News Story (Federal Civil Service Gets its Own Wiki http://is.gd/9ZThH

News Story (Mar 4-10) Hostage-taking ends at Calgary school http://is.gd/br2Vu

News Story (Mar 5-10) Low number of flu cases stymie experts http://is.gd/9ZRV3

News Story (Mar 8-10) Add diabetes to Ont. school policy: parents http://is.gd/9ZRxz

News Story (Mar 4-10) Hostage-taking ends at Calgary school http://is.gd/9ZOP0

News Story (Mar 1-10) B.C. teen reports U.S. school shooting plot http://is.gd/br3dw

Canadian Research, Reports and Resources from the April School Health Blog Postings

Our blog also tracks Canadian research studies, reports and new planning/educational resources announcements. Here are the ones posted for April 2010:
  • Policy Doc Millennium Development Goals and Canada (Canadian Teachers Federation 2010)
    Canada is a country that has tremendous financial and human resources, some of which are dedicated to the promise of meeting the Millennium Development Goals (MDGs). However, we find a paradox in Canada when it comes to the MDGs, where fragments of these can be found in our own society, particularly within Aboriginal communities. The following statements are intended to generate thought and discussion; they are not meant to be exhaustive in content. We’ve tied the statements to the MDGs to demonstrate how every nation has inequities related to the Millennium Development Goals.
  • Policy Doc Interprovincial Paper on Education for Sustainable Development (Council of Ministers of Education, Canada, 2010) The purpose of this background paper is two-fold: to provide the international context for work on ESD in Canada and to lay out CMEC’s commitment to ESD, in order to provide a rationale for the development of the Pan-Canadian ESF Framework for Collaboration and Action.

  • Report Physical Activity Levels Canadian Children (Active Kids Canada, 2010)
    The Active Healthy Kids Canada Report Card offers the most comprehensive annual assessment of child and youth physical activity in Canada

  • Reflections on H1N1
    The CANWEST newspapers have run an excellent series of articles reflecting on the H1N1 experience. For these latest articles and a complete tracking of that issue around the world, go to the Influenza page on the School Health Insider
  • Montreal Inter-agency Agreement on Healthy Schools and Communities (2008-2013)
    Since 2003, a provincial agreement for the complementarity of services has marked the collaboration between the education and the health and social services networks. This regional agreement to support the implementation of HSC was signed to put into practice the promotion of health and well-being as well as prevention strategies. The signatories are:
    ■ The 5 school boards
    ■ The 12 CSSS
    ■ Direction régionale du ministère de l’Éducation, du Loisir et du Sport
    ■ L’Agence de la santé et des services sociaux de Montréal

    By 2013, the parties have agreed that: 75% of elementary and secondary schools will be involved in HSC collaborative
    efforts (young people-schools-families-communities) to carry out the program; Three-quarters of these collaborations—in which schools participate—will have developed and implemented health promotion-prevention action plans. As a result, over 50% of targeted youth will be reached.
  • Report Early Childhood Investment (United Way of Lower Mainland, BC, Canada, 2010)
    United Way of the Lower Mainland invests in research to identify what children need for their healthy development during middle childhood. We’re helping kids by funding out-of-school programs and educational programs for parents


Feature Article: Recent Canadian contributions to an international SH research agenda

 This article presents and discusses a list of published Canadian research studies (ie those discussing Canadian studies or published by Canadian researchers) that have been identified by scanning the contents of over 50 journals published on health promotion, safety, social development and education. Articles were identified only through their titles, so we extend our apologies if we missed any studies. We would be pleased to add them to the updated list found on the www.canadianschoolhealth.ca web site.

These articles were selected from a database maintained by the International School Health Network which publishes the School Health Insider, a multi-source information service tracking research, news, web sites, presentations and professional uses of social media such as Facebook, Twitter, GoogleDocs and YouTube.

We begin by summarizing a report on a 2004-05 CIHR project (McCall & Doherty, 2004) that developed an international research agenda for school health promotion. This agenda is based on a national email survey, literature reviews, two Canadian workshops and an international seminar. It presents an ecological and systems-based approach to the promotion of health, safety, social development and sustainable development through schools. It also presents a list of concerns and major research/knowledge development issues that should be addressed in future research.

Readers can review the list of Canadian studies and reports published in 2009-10 and determine if the list of broad topics is being addressed in the recent Canadian work. A more thorough analysis of the school-based research will be done by the International School Health Network at the conclusion of 2010. If you are interested in being part of that analysis, which will result in the submission of articles to various journals and an international report, contact dmccall@internationalschoolhealth.org

A Research Agenda in School Health Promotion: Canadian Consultations and International Validation

In 2004-05 a group of researchers chaired by Dr. Irving Rootman and Douglas McCall were awarded an CIHR Development grant to develop an agenda of major research issues in school health promotion. The national project concluded that an ecological and systems-based approach was more appropriate as a frame of reference than the traditional focus on specific or multiple programs addressing a single or related set of health concerns. The report noted that we now commonly understand that it is better to develop a coordinated set of selected, multiple interventions that will improve the overall health and social conditions within a setting. It also noted that, given the complexity of the school setting, researchers, practitioners, officials and policy-makers needed to pay much more attention to implementation, capacity-building, systems change and sustainability.

An ecological and systems-based understanding of social and physical environments leads to these kinds of insights:
  • it shows the interactions between individual, environment and interventions/programs.
  • more recent evidence that we need to integrate our approaches to individual health and social problems to address clusters (eg chronic diseases and risk/protective factors, eg clusters of negative and positive social behaviours).
  • some evidence is emerging that the influences of home, school and community are inseparable.
The report also identified the need for more and better research on interventions rather than simply describing risk and protective factors. The report also noted that cost-benefit and cost-effectiveness research was also urgently needed. The team of researchers noted these challenges for policy-makers are:
  • how to pick the better interventions based on effectiveness and cost,
  • how negotiate the roles of several agencies/systems in order to deliver the interventions,
  • how align/coordinate the systems at all levels
  • and sustain them through ongoing knowledge, skills development and other resources.
The report also noted that evidence is now emerging and being examined that describes how to use systems theory to explain how coordinate and sustain interventions. The characteristics of open, loosely-coupled, professional bureaucracies where sharing vision, transferring knowledge, addressing concerns, recognizing system values/differences and persuading middle managers are all important. And, the challenge is to do this long-term work while responding to urgent issues in a visible way. Systems theory tells us to:
  1. Recognize the layers in various systems that deliver school health programs (e.g. There are 24 steps from national level to the school level in Canada)
  2. Note the openness of school systems to other competing influences
  3. Understand that loosely coupled systems are not managed well by directives, they require persuasion through ongoing knowledge exchange
  4. Be aware that “professional bureaucracies” such as schools and public health systems have middle managers protecting system boundaries and that such bureaucracies also have professionals who will not adopt the change or innovation until it addresses their practical and personal concerns and until they truly share the vision gained that specific knowledge and skills
A diagram depicting the various elements in the school was developed and presented in a survey and interviews for validation. Although the consultation called this a “conceptual framework” it is really only a diagram showing the elements in the “ecology and open systems that influence schools. There is no “logic model” or research paradigm presented in this diagram that begins to show the more important factors or causal relationships within the elements depicted. That diagram is reproduced on the next page. The respondents in the national consultation felt that the diagram was useful in showing the complexity and messiness of the situation but rightfully noted that it did not really explain what was happening and why.

Knowledge Matters April 2010 - Canadian School Health

Themes and Topics in a School Health Research Agenda

The following list of themes and topics was developed through interviews with key informants, an email survey of about 100 school board and public health officials and a workshop with researchers, ministry officials and non-governmental organizations. The initial list of themes and topics was drawn up from a review of several landmark reports and studies from several countries and then further developed by the members of the School Health Research network. It should be noted that this list of themes and topics is related to overall health and school health promotion. It is possible, indeed desirable, to develop more specific research agendas on single or combined health topics or on aspects of school health such as health literacy, youth involvement, preventive school health services and others.

Six broad themes emerged from the international research review and Canadian consultations. Several topics related to those themes were also identified.
Themes Topics Needing Better Research and Practice-based Reflection
A – The Relationship between Health and Learning - Clarify the relationship between school affiliation (the child’s feeling of being connected to and welcome in the school) and health status. We know that school affiliation is correlated to health, but what are the determinants that can be influenced by school-based or school-linked interventions?
- Better understand the connection between basic literacy/basic school achievement and health status. Is there a minimum literacy and social competency level that is critical to health?
- Clarify what learning about health (knowledge, skills, attitudes, beliefs, values, personal goal-setting, problem solving/decision-making, media literacy, awareness of health services, career and life aspirations, etc.) is essential and exactly how curricula and teaching practice can be organized and delivered to achieve those essential outputs. Describe a minimum and optimum set of health-related learning outcomes that can be achieved by schools.
- Develop a clearer understanding of the potential and the realistic sustainable limits of school-based and school-linked interventions to prevent specific health problems. In other words, knowing what is achievable for the school in relation to several health issues including which issues, if any, are more easily influenced by school health programs, and which issues are essential for the school to address for which age groups of youth, and at what stages of their development. These issues can include injury prevention, sexual health, safety/violence, physical activity, healthy eating, mental health, alcohol/ drugs/addiction, tobacco use, environmental health, health maintenance and sanitary precautions, home economics and family studies, as well as the general development of skills such as life skills, social skills, social responsibility, media literacy, human growth and development, decision-making, goal setting, personal planning, and awareness of careers in health.
B – The Nature and Influence of the Social and Physical
Environment of the School 		- Develop a more sophisticated and meaningful understanding of the school environment by examining the social and physical dynamics of different micro-environments within the school including recess and lunch hours, clubs and extra-curricular activities, sports and intramurals, the cafeteria, the school grounds, behaviours in the hallways, school rituals, etc.
- Understand the interaction between selected microenvironments within the school environment and student variables such as gender, culture, language, socio-economic status, school variables such as school rules, teacher practices, physical plant and facilities, and mediating variables such as parental attitudes/practices, and resources or community variables such as transportation, community services, social norms, community customs and resources, and how all of these factors create an overall school culture or ethos.
- Understand the relationship between the culture/ethos of the school and local community norms and wider societal influences that restrict the potential of the school to influence health behaviours
- Examine the non-school factors (personal, home, community) that influence or determine the experience the child has in schools
C – The Effect, Cost Effect and Cost Benefit of Various School-based or School-Linked Strategies and
Interventions 		- Evaluate new school health strategies such as ecological and systems-based approaches. Also return to “old” strategies (eg Community Schools) to learn what happened in their experience
- Seek greater clarity on the concepts of school health promotion and develop more evidence-based logic models and explanations of different aspects of the diagram used to depict the reality of the school environment.
- Evaluate ways in which schools can engage youth in preventing health problems and modifying their school and neighbourhood environments, advocating for youth-friendly policies and practices (community service learning, student leadership programs, peer helper programs, etc.), etc.
- Evaluate ways in which schools can involve, inform, and support parents in health-promoting interactions with their children
- Evaluate ways in which schools that are working with other agencies can reach and support families who are at risk
- Evaluate ways to maximize the benefits and extend the involvement of youth in supervised after-school programs
- Examine new questions relating to individual interventions within a comprehensive approach.
- List, describe and validate the things that schools cannot successfully accomplish or sustain in promoting health and social development. Describe the limits in evidence-based terms.
Instructional strategies:
- Under what circumstances are teachers, schools and education systems prepared and able to make sustained investments?
- To what extent can formal instruction influence coping skills, attitudes/beliefs, self-esteem, and behavioural interactions (rather than simply knowledge)?
- Are there efficiencies possible in curriculum design so that all relevant health topics are covered with a coherent scope and sequence to affect skills, beliefs, key knowledge, behavioural intentions, etc.?
- To what extent can health be integrated into other subjects?
- What is the status of current health teaching practice, competence, coverage, and comfort?
- What is the most effective and efficient scope and sequence for health curricula based on research evidence? What are the minimal learning outcomes that absolutely must be taught? What are the minimum intensity, duration, and learning outcomes required for each health issue? For example, research tells us that 11 sessions for tobacco on selected skills, attitudes, and beliefs –but what about other issues?
- What is the most effective way of teaching generic health skills and attitudes such as decision-making, problem-solving, resistance skills, risk avoidance, health beliefs, self-esteem, and resilience?
- To what extent are Canadian-based publishers able to supply our schools with appropriate, up-to-date materials? To what extent can the Internet and other technology-based tools be used in health education?
School Policies and Procedures:
- What is the impact of gender equity policies and programs? Have they been implemented?
- What are the impact and potential unintended consequences of zero tolerance policies in schools related to drugs, weapons, and other anti-social behaviours?
- To what extent are all school health policies implemented (not just whether the school has a policy)?
Physical Environment:
- What are the effects of aesthetics and environmental design?
- To what extent can changes to the school’s physical environment and resources (cafeteria food, gymnasium, school grounds, etc.) affect behaviour?
School Health Services:
- To what extent is there systemic collaboration across sectors to deliver primary care to children and adolescents?
- To what extent are services truly accessible and actually used by youth?
- What is the potential impact, suitability, and effect of innovative delivery methods of adolescent and children health services via the school as a hub or place for delivery (i.e. school-based clinics, parent resource centres, community resource centres, placement of nurses, police officers and social workers in schools, etc.)?
- What is the current status of children and adolescent preventive health services in Canada? How many youth use them? For which services? Can schools increase the use of such preventive services by young people?
Parental Involvement:
- To what extent are individual parents informed about school health programs? What are their perceptions and perspectives on school health programs? Are there unintended consequences of students bringing home health messages and materials from programs?
- To what extent can schools be used to involve and support parents in health issues (take home student assignments, parent education nights, parent outreach, parent resource centres, referral and crisis intervention procedures, training and procedures for early identification of potential problems, etc.)?
- How can schools involve their obligatory parent advisory committees in improving the quality of health programs and services in their school and community?
- To what extent can school-based or school-links efforts encourage parents to take more interest or be more effective with their child’s health
- Examine effective school-parent partnerships in other non-health areas to learn more about doing it for health
Community Involvement:
- Why do teachers and schools have such difficulty in working with community agencies?
- How can obligatory community service learning be used to engage students in health issues and learning?
- Examine how schools can be involved and supportive of community development strategies as well as how community action and advocacy can support the school’s role in health promotion and social development.
- Examine the role that schools can play as community and parent resource centres.
- Examine how the school can reach out to disenfranchised groups such as non-parents, disadvantaged families etc,
Youth Engagement, Peer Helper, Community Service Learning, Extracurricular, Co-curricular:
- To what extent does engaging youth in school-related health promoting activities affect their behaviour and their environments?
- How many young people participate regularly in after-school programs that are supervised by adults? Those delivered in schools? Those delivered by other agencies?
- How can we overcome transportation, safety, and other barriers to ensure that all youth have a safe, healthy, supervised place to go after school?
- To what extent do we take knowledge about adolescent development and youth sub-cultures into account when we plan programs and develop policies?
- What are the perceptions held by students about school and health agency programs for youth? Conduct appropriate surveys and use other methods to enable broader more diverse samples of youth than those traditionally involved in health promoting and school activities.
Staff Involvement/Wellness
- Examine perceptions of educators, public health staff of their school’s health promotion efforts
- Examine correlations between staff health/wellness and status of school and student health
School Ethos, Social Climate:
- Are children and staff in healthy schools more likely to intervene to help others?
- What is the role of the school principal? How is it changing and how will this shift away from education leadership affect the ethos of the school?
- What are the interventions that schools can use to create social support? (policies, programs, friendship clubs, extracurricular, student buddy systems, etc.)
- How can we measure and monitor school culture, climate and ethos in a meaningful, reliable, and regular way?
D – Sustained, Multiple, Coordinated Interventions and
the Process of School-Agency, School-Home, School-Community
Cooperation and Coordination 		- Develop, validate, test and determine ways to measure the key system capacities being used for basis of school health plan for Canada (coordinated policy, staffing infrastructure, coordination mechanisms, knowledge transfer, work force development, issue management and child/youth health/local programs surveys)
- Develop a better understanding of the linkages between the school systems and other youth and family-serving agencies and systems
- Understand the limits and contradictory pressures on school systems to promote health (i.e. the recognition of competing demands, reality of the school's mission to sort and select students, etc.)
- Develop a better understanding of the roles that public health, recreation, sports, social services, employment, justice, and law enforcement systems play in school-based and school-linked programs and services
- Use systems and organizational change theory and knowledge to understand implementation and sustainability issues
- For single health issues, a multi-faceted approach is superior to a single strategy but there have been relatively few intervention studies on comprehensive school health (health promoting schools) as an intervention itself. (Is it feasible to study something that covers all issues at all levels or does it need to be delineated – i.e. coordinated vs. Uncoordinated interventions? Is there a diminishing return to trying to cover too many issues or too many interventions?)
- How can school and local agencies be encouraged to work together? What is the best locus of control? How can such coordination be sustained? What are the incentives, directives, structural changes, training, assignments, and other steps needed to overcome the tendency to create vertical “silos” for program delivery?
- What is the role of public health agencies and professionals in school-community coordination? Are public health systems adequately trained and resourced to play this role?
- There are several examples of Comprehensive School Health but we have not studied them. How did they start? How do they work? How did they fail? How can they be sustained?
- How can school health coordinating committees be sustained over time?
- Seek to determine the “critical mass” of policies, programs, activities and issues as well as the reach, duration, intensity of interventions being developed by schools to become “healthy enough” to make a difference.
E – Policies, Program Implementation and Monitoring - Develop more meaningful indicators to measure factors such as the resiliency within children and the capacity of systems to respond to rather than simply list deficits and negative incidents or treatment statistics. The tendency in health promotion and education is to focus on the concepts that are most easily operationalized and measured.
- There is an urgent need for more meaningful indicators that report on a comprehensive set of indicators that cover context, inputs, and processes at all levels as well as immediate outputs and long-term outcomes.
- Develop a better understanding of how to initiate, promote, and sustain school-agency-community cooperation. What are the policy levers, financial incentives, and training required (not structure)?
- How can innovations in health education (more than materials and programs) be implemented and diffused effectively?
- Specifically ask school and public health administrators (middle managers in professional bureaucracies) about their research needs.
- Identify and describe ways where the “prevention” side of health can overcome the imbalance created in the “treatment” side of health. Also examine the role of school health services more than currently is done in research

F – Development of New Research Methods and Practices - Randomized, controlled trials can measure the impact of a particular intervention under particular circumstances. However, this method is too narrow to help us understand the complexities of individual schools and students. Case studies are a detailed examination of a single case but cannot be generalized for other situations. Consequently, experimental or qualitative designed studies are not adequate to describe the meaning and complexity of school health situations and programs. Thus, school health research should seek to measure and monitor a “hierarchical set of causal relationships in which school factors interact with home and personal characteristics to determine school or heath outcomes.
- We need more cost-benefit and cost effectiveness studies to demonstrate the value of school health programs and services. Currently, we have only a few studies on economic and cost-benefits of school-based interventions on topics such as immunization, tobacco education, and comprehensive approaches to single issues such as pregnancy prevention.
- Develop criteria for evaluating the effect and success of school health research programs and agendas in areas such as knowledge transfer, uptake in the systems as well as in the published works and funded studies.
- Be realistic about and measure how research evidence is used by decision-makers. Research does not necessarily guide decisions. Develop and apply theories and knowledge about system and professional decision-making practices to improve the use of research evidence. How can we use research to create change, rather then just describe change?
- Identify ways that research and survey results can be returned, understood and used by respondents and schools.
- Develop and test school-related channels and formats to translate and disseminate knowledge and promising practices. Develop and test user-friendly formats and describe what different categories of personnel in the systems are looking for and how they currently receive or seek such information
- Set a general criteria that research about school-based and school-linked interventions should be looking at least three years after the intervention for continuing effect.
- Develop logic models that explain cause and effect rather then simply describe correlations. Note that researchers have already identified “clusters’ of negative and positive actors and behaviours. use multi-level models but also recognize that schools and agencies have little means and blunt policy and program instruments to identify kids, or to develop specific programs adapted to combinations of factors, characteristics and individual experiences.

Canadian Studies and Articles Published Between July 2009 and August 2010

The following list of Canadian studies and articles written by Canadian researchers has been prepared from the ongoing monitoring of over 50 research journals done every month by the International School Health Network. Each month, the Canadian studies are extracted and posted in the monthly news blog page with the www.canadianschoolhealth.ca web site. If we missed any articles, please go to this page and use the “easy edit tool to add the web-linked reference.



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