School Health in Canada - Recently Updated Pages

8. Findings by health or social topic

dmccall — Thu, 04 Sep 2008 17:22:15 CDT

Since much of the work done in school health promotion is within the context of preventing specific health problems or promoting specific health behaviours, this section of the report summarizes the findings of selected health topics.

Note: To emphasize the potential extent of what topics could be covered in this section, we have listed the various health and social problems that can and should be addressed in school health promotion here. However, we are able to report on only a few of these issues.

General Health/Growth & Development/Puberty
Infectious Disease/ Personal Hygiene
First Aid
Home Economics/Family Studies
Child Abuse-Neglect/Sexual Abuse of Children
Vision, Hearing, Genetic Defects § Parasites
Physical Activity/Sports/Active Living-Recreation
Healthy Eating/Nutrition/Obesity/Eating Disorders/Food Security
Injury Prevention
Addictions/Alcohol/Drugs
Mental Health/Mental Illness/Suicide/School Psychologists/MH workers § Sexual Health/HIV-AIDS/STI
Tobacco
Bullying/Violence/Crime/Students with Behaviour Disorders-ADHD/Security/role of police
Social Development-Responsibility/Civics/Service Learning/Relationships/Social-Emotional Learning
Gender Equity
Racism/Multicultural Awareness/Human rights/Diversity
Ethics/Character/Personal Development/Decision-making/Critical Thinking
Life Planning/Career Planning/Self Esteem-Awareness
Environmental Health/Allergies/Asthma/Lung Health
Environmental Citizenship/Stewardship

The findings from these scans, selected articles and other sources is organized as shown below.

Health/Social Development Topic:

Data Sources
Synthesis of Findings
Comprehensiveness
Evidence-basis of Interventions
Systems Capacities/ Strategic Nature of the Activities

Health/Social Development Topic: Physical Activity

Data Sources	CAHPERD Scan of National Activities (2006) CFLRI Baseline Survey of School Practices (2001) Active, Healthy Kids Survey (2007) Globe & Mail Survey of School Boards
Synthesis of Findings	The CAHPERD scan notes that Physical education is taught as a separate subject in most jurisdictions and combined with health education in three jurisdictions. Recently three provinces have increased the time required to instruct students in PE. The CAHPERD report contains a summary of the recommended or required time for PE instruction. The CAHPERD scan notes that three jurisdictions have recently required that students engage in daily physical activity outside of formal instruction time. Non-mandatory physical activity is promoted in almost all jurisdictions through a variety of games and special school-wide activities. Many of these school activities include national or PT “challenges” and competitions for students or schools. At the national level, there are large-scale initiatives to promote the Physical Activity Guide, summer and winter activity promotion programs, active school transportation. CAHPERD and the Heart & Stroke Foundation offer several such activity programs.
Comprehensiveness	Physical activity is linked with preventing over-eating (obesity) in many recent PE and PA programs.
Coordination Strategies	The CAHPERD scan reports that there are several models of “whole school” approaches to promoting PA, including the Ontario Active School model, EverActive schools in Alberta and Action Schools in BC. Several provinces have also supported “community-school” approaches to PA, such as the In-Motion program that was developed in SK. As well, several PTs support active transportation programs where students walk to school, “active recess programs and other specific elements to influence the school day. The CAHPERD report also describes several national and PT initiatives related to sports participation through and with schools. A listing of PT school sports organizations is provided.
Evidence Basis of Activities
System Capacities/Strategic Nature of the Activities	Monitoring & Reporting: The CAHPERD scan did not locate many examples of monitoring and reporting on the levels of physical activity among children, nor the status of PE/PA programs nor the learned skills/attitudes/knowledge being acquired by students. The CFLRI reported on PE and PA program status as of 2001. Most parents reported that their child received PE in school about 1-2 times per week. Two thirds of parents reported that their child was offered PA after school. The annual report from Active Healthy Kids Canada reports on the levels of physical activity among children. The report is based on data from several sources including international and Canadian health surveys and school-based self-assessment tools.

Health/Social Development Topic: Safety, Crime Prevention, Bullying

Data Sources	CASH Scan of current programs (2007)
Synthesis of Findings	The CASH scan found that there were several well-accepted and widely used terms describing “safe & caring schools”. There is a national consensus statement and several PT’s have initiatives with staff and program funds assigned under the name.
Comprehensiveness	The National Crime Prevention Centre and several other organizations have published reports advocating for comprehensive and coordinated approaches. There is a strong linkage made between safety, crime and bullying and a positive, respectful or caring environment and programs in the schools. In a related way, mental health (developed from the health sector) and social and academic learning (developed from the education sector) emphasize positive social environments in schools. Instructional strategies have tended to focus on specific aspects such as bullying or conflict resolution or character education. All jurisdictions cover such topics as part of their mandatory personal and social development education curricula. Comprehensive guidance counselling services are cited as part of the school response to bullying and other anti-social behaviours. Family support programs are also used often in the jurisdictions. Most of these programs seem to be geared to families in distress due to violence and delinquency. A continuing major policy issue is the dilemma of not having “zero tolerance” of anti-social behaviours but also having the supports and services needed for alternatives to suspension and expulsion.
Coordination Strategies	Coordination issues seem to be addressed most often in providing services such as Behaviour Support (Special education) or Restorative Justice (Courts/detention centres) or in responding to crises (police departments) The notion of a “safe school coordinator is also used in all education ministries as well as several school boards.
Evidence Basis of Activities	There are a number of proven instructional, support services and whole school programs available in Canada that have been evaluated to be effective.
System Capacities/Strategic Nature of the Activities	There appears to be an opportunity for stronger linkages between concerns about bullying and work in other sectors on mental health and social/emotional learning. The challenge may be to maintain a positive youth development approach in the face of growing public concern over school shootings and highly publicized youth violence in Toronto.

Health/Social Development Topic: Sexual Health

Data Sources	CASH Scan on School Sexual Health Promotion (2007) Health Canada Review of Curricula Adolescent Sexual and Reproductive Health in Canada: A Report Card in 2004 (Canadian Journal of Human Sexuality) Status report on Sexual Health & SH (CMEC, 1999) Sexual Health in Canada a comprehensive, national, statistical portrait of Canadians’ sexual and reproductive health (SRH). The report contains information related to government roles and responsibilities, youth SRH, sexually transmitted infections (STIs), contraception, pregnancy and outcomes, and sexual violence, as well as provincial and territorial profiles of SRH.
Synthesis of Findings
Comprehensiveness	There has been considerable attention given to sexual halth instruction in Canada, with federal guidelines, report cards and other reports but less attention paid to coordinated and comprehensive sexual health promotion in schools. The 1999 CMEC report on HIV/AIDS and Sexual Health includes an extensive multi-level analysis of how a comprehensive approach can, should and was not being implemented at that time.
Coordination Strategies
Evidence Basis of Activities
Systems capacities/Strategic Nature of the Activities

Health/Social Development Topic: Nutrition

Data Sources	HLKC Report on Nutrition & Schools (2006) Report: Canadian Centre for Science in the Public Interest (2007) SHRN Survey of PT Capacity on Nutrition & Schools (2005) Breakfast for Learning Report on School Meal Programs (2006) Globe & Mail Survey of School Boards (2006)
Synthesis of Findings
Comprehensiveness
Coordination Strategies
Evidence Basis of Activities
Systems Capacities/ Strategic Nature of the Activities

Health/Social Development Topic: Mental Health

Data Sources	Feature Article: Mental Health & Schools (CASH, 2007)
Synthesis of Findings
Comprehensiveness
Coordination Strategies
Evidence Basis of Activities
Systems Capacities/ Strategic Nature of the Activities

Health/Social Development Topic: Substance Abuse

Data Sources	CCSA Provincial/Territorial Scans (2007)
Synthesis of Findings
Comprehensiveness
Coordination Strategies
Evidence Basis for the Activities
Strategic Nature of the Activities

Health/Social Development Topic: Tobacco

Data Sources	Health & Learning Knowledge Centre Scan (2006)
Synthesis of Findings
Comprehensiveness
Coordination Strategies
Evidence Basis of Activities
Systems Capacities/ Strategic Nature of the Activities

Health/Social Development Topic: Aboriginal Students

Data Sources	Health & Learning Knowledge Centre Scan (2006)
Synthesis of Findings
Comprehensiveness
Coordination Strategies
Evidence Basis of Activities
Systems Capacities/ Strategic Nature of the Activities

Health/Social Development Topic: Air Quality/Environmental Health

Data Sources	Globe & Mail Survey of School Boards (2007)
Synthesis of Findings
Comprehensiveness
Coordination Strategies
Evidence Basis of Activities
Systems Capacities/ Strategic Nature of the Activities

Health/Social Development Topic:

Data Sources	HLKC Scan on French Language Students (2006)
Synthesis of Findings
Comprehensiveness
Coordination Strategies
Evidence Basis of Activities
Systems Capacities/ Strategic Nature of the Activities

Health/Social Development Topic:

Data Sources
Synthesis of Findings
Comprehensiveness
Coordination Strategies
Evidence Basis of Activities
Systems capacities/ Strategic Nature of the Activities

Health/Social Development Topic:

Data Sources
Synthesis of Findings
Comprehensiveness
Coordination Strategies
Evidence Basis of Activities
Systems Capacities/ Strategic Nature of the Activities

15. Future directions of SH in Canada

dmccall — Sun, 27 Apr 2008 13:53:56 CDT

This concluding section of this wiki will provide ongoing commentary from participants in this wiki as well asthe original authors of the wiki.

14. Synthesis of comments and additions to this wiki

dmccall — Sun, 27 Apr 2008 13:53:00 CDT

This page will reproduce or synthesize comments made on the contents of this wiki. This record of dialogue, amendments, additions and web links created will serve as an ongoing assessment of progress being made in school health in Canada.

13. Findings on the state of SH research in Canada

dmccall — Sun, 27 Apr 2008 10:20:25 CDT

This page has two sub-pages. The first lists current, recent and planned school health research initiaitves in Canada. The second sub-page presents the work of the members of the School Health Research Network, who in 2005-06 created a long-term research agenda for school health promotion that was validated through consultations with Canadian researchers, decision-makers and practitioners as well as international colleagues. The text of this page lists some of the trends in school health promotion research in Canada and around the world.

Current trends and major reports in school health research:

(to be added)

An international and Canadian SH research agenda

dmccall — Sun, 27 Apr 2008 10:13:43 CDT

Working with a research grant from the Canadian Institutes for Health Research, a number of researchers formed the School Health Research Network and developed a research agenda for school health promotion.

This research agenda was based on a literature review, national email consultation, presentations at two Canadian workshops, interviews with key informants and an international symposium.

The research agenda is based on an ecological approach that pays more attention to issues such as context, system capacity, organizational and professional norms and cultures and dissemination/diffusion research.

The major questions derived from this research agenda are listed below. The final report from that project is attached to this page.

The major research themes that were found to be relevant to SHRN members in 2005-06 are as follows:

(These broad questions were derived from SHRN Investigative Framework and later confirmed in an international symposium, Canadian workshop and survey/consultation with key informants)

What is the connection between health status/behaviours, social development and learning/educational achievement?
What is the impact of the physical and social environment of the school setting and how does it interact with the family and community settings?
How do different country and community contexts affect the development, implementation and outputs/outcomes of school health programs?
What is the effect of SH programs/interventions (eg education or peer program or health service or policy) on overall health? Note: The research on the effect of SH programs on specific health/social problems is covered above within the topics section.
What is the effect of improving different elements of a comprehensive and coordinated approach to healthy promoting schools in areas such as policies, health education, health services, physical environment and social environment?
What is the effect of using comprehensive approaches, coordinated programs to create health promoting schools? Are they more effective than single interventions? Is there a difference between "whole schoos" and "community, agency and school programs?
How can such multiple coordinated programs/services be coordinated effectively?
How can comprehensive and coordinated school health programs be sustained?
What is the cost-effectiveness of various SH programs and what is their cost-benefit?
Which research methods are most appropriate for different aspects of SH promotion?

Canadian SH research Initiatives

dmccall — Sun, 27 Apr 2008 09:57:11 CDT

This page contains a list of current, recent or planned research initiatives and programs in Canada. In order to be added to this list, a research initiaitve or program should be ongoing for more than one year or one study. Links are provided to web sites and published studies whenever possible. Researchers are encouraged to add to and edit this page.

Summary of Research Initiatives

A. Research Projects and Programs

1. School Health Research Network
The purpose of the developmental grant was to develop a program of research on school-based and school-linked health promotion that includes participation from researchers, practitioners and policy-makers. The program of the School Health Research Network (SHRN) is :

(1) developing an enhanced conceptual framework for understanding the school environment and school health promotion.. This framework has been reviewed in an electronic and workshop-based consultation and will be presented at a national Symposium with participants from governments, non-governmental groups and research agencies. This framework is also already guiding a key intergovernmental (FPT) consortium developing a Canadian school health strategy.

(2) enhancing capacity in Canada by creating a network of researchers and stimulating an international school health research network linked to WHO and other countries directly. The project has created an agenda of themes and topics for school health research generally as well as on the specific issues of nutrition and alcohol/drug abuse.

(3) stimulating intergovernmental discussions about developing more meaningful Indicators of child/youth health, social and school-related behaviours and relevant policies, programs and practices

(4) improving the dissemination and application of research findings in this area by publishing summaries and reports on a web site, by using an email lists, by working with relevant researcher and practitioner networks and associations and by creating a list of local school board/public health unit contacts interested in school health research;

(5) encouraging the training of future researchers in school health promotion by engaging them in project activities such as capacity assessments, focus groups and literature reviews and facilitating the development of several research proposals to different funding agencies;

(6) stimulating collaboration among researchers from different disciplines in direct consultations, a national think tank and a national/international symposium

The research program is exploring the interaction between the school environment and its linkages to the home and community as well as its interactions with the individual characteristics of the child/youth. The concomitant focus on the characteristics of open, loosely-coupled systems reveals significant gaps in our ability to coordinate and sustain various interventions, even in an environment/system that is easily accessed as schools.

In one SHRN project, this frame for analysis leads to blunt questions about how public systems such as schools, public health and addictions agencies have shifted resources to provide equity to disadvantaged groups, or adapted programs to meet specific needs based on gender, culture or other factors.

The school environment is a critical setting to promote positive health behaviours, not only through formal instruction but in peer, parent, mentoring, health services, extra-curricular and other programs.The conceptual framework developed by SHRN has revealed both the potential and the limits of using the school setting to promote health. Our findings indicate that the school is much more than just the classroom and other micro-environments within the school need to be considered and addressed. These include hallways, cafeterias, sports programs and other venues as well as the overall ethos of the school.

Our framework also shows how the school environment is inseparable from that of the home and the school, thereby underlining the need for school-agency-parent coordination. The framework also reveals the limits as well as the levers that are available to policy-makers in influencing open, loosely-coupled, professional bureaucracies in addressing gender, sex, social and sensitive health issues. The school setting addresses the health systems capacity and willingness to re-orient itself to prevention through programs such as school-linked preventive services, school-based clinics, consulting with youth on the friendliness of service delivery and the role of the public health nurse which varies from immunization to organizational development.

The project has used reviews of the research literature, consultations with key informants, workshops with representative organizations, email surveys, focus groups and other means for its initial goal of developing a program of research. The comprehensive approach to school health promotion, a major focus of our work, is both an application and predecessor of the population health approach The SHRN in becoming recognized by its members as well as by the Council of Ministers of Education, Canada and the Conference of Deputy Ministers of Health. Research organizations such as the Canadian Population Health Initiative have been involved in specific project activities of the SHRN.

Contacts SHRN Coordinator 16629 62A Avenue Surrey, BC, V3S 9L5 604 575 3199 dmccall@schoolfile.com
2. Petits cuistots - parents en réseaux
An implementation evaluation of context: The classroom climate, student school integration and their relationship with the elementary school program Petits cuistots - parents en réseaux

Overview of intervention In 1998, a school-based nutrition intervention Petits cuistots - parents en réseaux (PC-PR), was implemented in primary schools in disadvantaged Montreal neighbourhoods. Stepping beyond traditional intervention approaches, where nutrition abilities and knowledge represent the ends of the intervention, and which assume the acquisition of such knowledge and abilities will translate into improved nutritional status and/or behaviours, this project uses nutrition education as a means to touch upon elements which are not habitually addressed in such projects.

The PC-PR program activities aim to build culinary abilities, increase nutrition knowledge, and support parental networks, with the ultimate aim of increasing children’s motivations and enjoyment surrounding the school experience. The program consists of two components, an educative and socio-educative component and a social development component. Although they are connected, the former is principally directed at children and invites parental participation, the later is directed specifically at parents. The educative and socio-educative component is based upon a series of nutrition workshops with predetermined themes, recipes and objectives, which change from year to year. Each workshop is proceeded and preceded by a set of activities proposed to the teacher to complement and reinforce each workshop theme. The workshop is run by a nutritionist and consists of two activities; nutrition instruction and a hands-on cooking activity. The latter can be characterized as a cooperative learning activity, whereby children work in small groups to follow a recipe. Samples from the prepared dish are tasted and packaged to be taken home. The social development component of the program is run by community development agents whose aim is to create links between parents, the school, and existing community networks. This component takes the form of a series of community and school based activities, and might touch upon issues such as food security or food industry but are ultimately directed by the topics expressed by parents. The PC-PR program was formally initiated in 8 schools during the 1999/2000 school year targeting children in maternelle. Participating schools were selected based upon the high proportion of children from low income families, their location in low income neighborhoods along with the approval of the school commission and each school director. Expanding each year by grade, the program presently targets children from maternelle up to the 5th grade. The children currently in the 5th grade have thus been program recipients for 6 years, while the children currently in 6th grade have never participated in the program. Program financing is secured up until and including the 2006/07 school year. During the 2003/04 school year, the nutrition workshop was delivered to 117 classes, from kindergarten to the 4th grade, and included approximately 2000 students and their parents. The interventionists include 7 nutritionists and 3 community development workers.

Overview of Research

This evaluation research is situated within a larger evaluation of the PC-PR program. The overall aim of this evaluation research is to describe the implementation of the PC-PR program in a manner which widens its perceived field of action by bringing to light those aspects of the program which move it beyond a traditional nutrition intervention centered upon building knowledge and abilities, toward one which uses culinary activities to alter social regularities in the classroom. The implementation study seeks to describe one feature of classroom climate and how this might change in interaction with the program. More specifically it asks if the PC-PR program functions as a cooperative learning activity if such functioning varies with classroom climate, and if this variation is associated with positive school integration. In addition, this research will determine if students participating in the program have a relatively higher level of school integration compared to students not participating in the program. Data collection will begin during January 2005 and end February 2006. Four of the 8 schools will be selected to participate based upon 1) consent from direction and 2) perceptions of program as discussed by school direction for the 2002 evaluation report. Training and piloting will take place during the months of October, November and December of 2004. Three types of data collection will be used (1) interviews, (2) structured observations and (3) a questionnaire. Interviews will be conducted with approximately 18 teachers and the 6 nutrition interventionists with the objective of identifying perceptions and practices surrounding the nutrition workshop and a content analysis will permit determination of the degree to which the activity is perceived to function as a cooperative learning activity along with the influencing factors surrounding such perceptions and practices. Structured observations will involve those classrooms for which the teacher has agreed to an interview (approximately 18) and will take place during the nutrition workshop and a pre-identified classroom activity, with the purpose of describing the classroom climate. In particular these structured observations will utilize a pre-tested grid which identifies a pre-determined set of behaviors and classifies them under a construct related to cohesion, flexibility and communication. The use of this tool has been published in education research literature for the purposes of studying the classroom system. Lastly, a questionnaire, adapted from the WHO’s Health Behaviors for School-Aged Children, will survey approximately 900 grade 5 and grade 6 students in March 2005 and 450 grade 6 students in March 2006. A total of 39 questions on school environment and school adjustment will be used to represent the level of student school integration.

Responsible for research

The research will be completed by Sherri Bisset a doctorate student in Public Health under the option of Health Promotion. The scientific value of this research has been evaluated by the Département Médicine Social et Préventive in the form of a comprehensive exam. Supervisors for the project include Drs Louise Potvin and Mark Daniel. This evaluation research is located in a larger evaluation project, headed by Chaire Approches communautaires et inégalitiés de santé (CACIS) and for which Drs Joanne Bédard and Louise Potvin are the principal investigators. The evaluation of this program has been approved by the concerned partners namely; les ateliers cinq épices, commission scolaire de Montréal (CSDM), Fondation Lucie et André Chagnon, and Table de concertaion sur la faim et le développement social du Montréal métropolitian. Correspondence should be addressed to: Sherri Bisset, Groupe de recherché interdisciplinaire en santé (GRIS) Université de Montréal e-mail: Sherri.L.Bisset@umontreal.ca phone: 514-343-6185 fax: 514-343-2207

3. CANSPANN (Canadian School Physical Activity & Nutrition Network CANSPANN (Canadian School Physical Activity & Nutrition Network) is being developed as a sustainable, pan-Canadian network for enhancing the production and use of innovative, transdisciplinary, school-based youth physical activity and nutrition research that is related to the social and physical environment of the school. Our premise is that the school is a highly influential social-environment that affects children and youth who should be a major focus of both prevention and health promotion. Using a social-ecological approach, CANSPANN’s objective is to address social environmental research priorities that could not be addressed by individual groups or networks alone. Core CANSPANN investigators are pooling resources and multi-disciplinary expertise in mutual support. The plan is to extend and enhance their efforts via an integrated national network of affiliated decision-makers and researchers. Scientific evidence on promoting healthy eating and activity lags far behind tobacco control. McKinlay’s (1995) population model of disease prevention indicates a full spectrum of individual, community, and public policy level interventions will be needed to realize the goal of healthy weights. Although school and community-based trials of physical activity and nutrition interventions are informative, the most recent evidence suggests it is conflicting at best. We hope an integrated, pan-Canadian research network can take advantage of the full range of possible interventions including large-scale “natural experiments”. At present, there exists no integrated pan-provincial or pan-Canadian research network specifically focusing upon social-ecological research about physical activity and nutrition that would serve the needs of a healthy living strategy. While existing school health initiatives may examine many healthy behaviours in various Canadian institutions, none focus specifically on the underserved environmental knowledge area about physical activity and nutrition for healthy living. CANSPANN will initiate prioritized strategies for research and practice in this area aimed for immediate effect and those targeted for the next five years. To work toward action on these high priority strategies, we plan to achieve the following network deliverables in the next year. (1) Develop a logic model (i.e., a social-environmental or social ecological framework to guide development year decision-making). We have a draft logic model that will be vetted at the workshop (2) Develop specific research priorities for the next 5 years for physical activity and healthy weight that are based upon the logic model and an evidence-based rationale for their priority. These priorities will be the key outcome of the 2-day workshop to which you are invited. (3) Develop a feasible plan for sustaining the CANSPANN Network for the next 5 years using multiple funding sources. We have current funding from CIHR to support network development. (4) Two research proposals that outline priority programmatic investigations about the social and physical environment of the school and about the social context that immediately influences the school. (5) Prepare a knowledge exchange-based report on the evolution of the CANSPANN “community of practice” that led to the integration of decision makers and researcher perspectives To achieve these outcomes, we have identified several processes. (1) Utilize CANSPANN core members to create initial network working groups to develop an initial logic model. (2 a) The CANSPANN Coordinating Centre at University of Waterloo will host a consensus workshop to coordinate additional researchers, decision-makers, and practitioners to react to the logic model and distil the specific “fast-track” research priorities. (2 b) In parallel with the consensus workshop, we will discuss CANSPANN plans with other projects funded through this CIHR development grant. Independent of CIHR monies, the CANSPANN coordinating centre will host a Waterloo-funded teleconference to facilitate collaboration and identify research synergies. (3) The Coordinating Centre will integrate initial workshop outcomes to develop drafts of proposed priority research projects that use CANSPANN (4) Circulate proposal drafts for revision to interested network members who represent workshop attendees and CANSPANN working groups. (5) Circulate the revised proposal drafts and conduct a second smaller workshop using face to face and electronic means to finalize two CIHR programmatic research proposals (6) Move the emerging “community of practice” towards a common objective using electronic and other means. (7) Evaluate CANSPANN and contribute to the science of knowledge exchange, by designing an ongoing evaluation plan establishing the critical processes and outcomes of the network (see deliverable #5) during the development year as a basis on which to adjust network operation. We hope that you will join our group and help shape it to meet your needs and the needs of Canadian schools Steve Manske
Scientist/Assistant Professor
Centre for Behavioural Research and Program Evaluation
Lyle Hallman Institute, University of Waterloo
Waterloo, Ontario CANADA N2L 3G1
phone: 519-888-4518
fax: 519-886-6424
Email: manske@uwaterloo.ca

4. Collaboration école - famille - communauté

À titre d’information…

En collaboration avec le ministère de la Santé et des Services sociaux, l’Institut national de santé publique du Québec et l’Association des CLSC-CHSLD, le ministère de l’Éducation travaille actuellement à la conception d’un outil de travail portant sur une approche globale et concertée en promotion-prévention. Selon cette approche, intitulée École en santé, une équipe formée de membres du personnel de l’école ainsi que de partenaires de l’école (parents et autres partenaires de la communauté) s’assurent que le plan de réussite de l’école prend en compte six facteurs qui, selon les recherches, peuvent contribuer à prévenir plusieurs problématiques que risquent de vivre les jeunes d’aujourd’hui, comme la toxicomanie. Selon l’approche École en santé, des actions sont à prévoir avec et auprès de tous les partenaires de l’éducation (élèves, familles, écoles et autres partenaires de la communauté) pour assurer aux jeunes de meilleures chances de réussite.

Le ministère de l’Éducation réalise actuellement un projet-pilote dans 24 écoles primaires du Québec dont l’indice de défavorisation, selon la carte de population scolaire, est de 9 ou 10. Le projet-pilote a débuté au cours de l’année scolaire 2003-2004, à l’intérieur du programme intitulé Famille, école, communauté : Réussir ensemble, qui est un programme d’intervention axé sur la réussite scolaire dans les milieux défavorisés. Chacune des écoles identifiées a formé, avec l’aide de représentants de parents, de l’école et de la communauté, une équipe appelée équipe locale de projets. Cette équipe a pour mandat d’intégrer au plan de réussite de l’école une série de moyens d’action relativement à quinze facteurs de la réussite scolaire et de prévoir des interventions à différents niveaux (l’enfant ou l’élève, la famille, la classe, l’école, la communauté). Ce projet-pilote, qui s’échelonne sur cinq ans, est toujours en cours et le rapport final est attendu en juin 2007.

La stratégie d’intervention Agir autrement a été annoncée au printemps 2002 et mise en place dans les écoles secondaires en milieu défavorisé dans le but de contrer le phénomène du décrochage scolaire chez les jeunes. Cette stratégie, qui touche plus de 100 000 élèves, privilégie un travail concerté entre les partenaires de la communauté, dont les familles. Le ministère de l’Éducation, en collaboration avec l’Université du Québec à Trois-Rivières (UQTR), participe à une recherche-action qui s’échelonne sur trois ans et qui porte sur la collaboration école-famille-communauté. Cette recherche-action se déroule dans quatre écoles de la région de la Mauricie et du Centre-du-Québec. Le rapport final est attendu en février 2005.

Liens intéressants

Sur le site Internet du ministère de l'Éducation, la stratégie d'intervention Agir autrement, , qui est brièvement décrite ci-dessus, donne accès à différents documents concernant l'école, la famille et la communauté.

L’Observatoire international de la réussite scolaire du Centre de recherche et d’intervention sur la réussite scolaire (CRIRES) a lancé, au mois de juin 2004, la nouvelle thématique « Collaboration école-famille-communauté ». On y trouve notamment, en traduction libre de Mme Rollande Deslandes, Ph. D., de l’Université du Québec à Trois-Rivières (UQTR), le compte rendu d’une communication intitulée «Collaboration école-famille-communauté et réussite scolaire : défis et pratiques », donnée par Mme Joyce L. Epstein de l'Université Johns Hopkins, à Baltimore, dans le cadre d’une journée portant sur la collaboration école-famille-communauté et organisée par l’UQTR en collaboration avec le CRIRES.

Sur le site Internet du ministère de l’Éducation, une section porte sur une recension de littérature réalisée par Mme Rollande Deslandes et M. Richard Bertrand, Ph. D., de l'Université Laval. Cette recension, intitulée « La création d'une véritable communauté éducative autour de l'élève : une intervention plus cohérente des services mieux harmonisés » porte sur la communauté éducative et sur les conditions favorisant la création d'une communauté éducative autour de l'élève.

Le Programme de soutien à l’école montréalaise, par ses mesures 6 et 7, offre aux écoles montréalaises différentes possibilités de soutien dans des projets avec les familles ou les autres partenaires de la communauté. En plus d’offrir cette possibilité aux écoles montréalaises, il met à la disposition des autres écoles les résultats de ses recherches ou tout autre outil pertinent au regard de la thématique école-famille-communauté. À titre d’exemple, le Ministère (Direction des services aux communautés culturelles et Programme de soutien à l’école montréalaise) a publié, en février 2000, le document intitulé Consolider la collaboration entre le milieu scolaire et le milieu communautaire : une mesure clé pour la réussite éducative des jeunes (voir section « Outils et documents d'information »). Dans ce document, le Groupe de réflexion pour l'établissement d'un partenariat entre les écoles et les organismes communautaires (GREPEOC) donne les informations ou outils suivants :

conditions favorables au partenariat école-communauté;
besoins relevés chez des élèves, du personnel scolaire et des parents, accompagnés d'exemples d'activités pouvant concrétiser le partenariat et répondre aux besoins ciblés;
modèle de protocole d'entente pouvant inspirer les milieux scolaires dans le développement de leurs propres outils de collaboration.

Le site Internet de la Fédération des comités de parents du Québec, qui est un organisme sans but lucratif regroupant différents parents bénévoles engagés dans les écoles, offre du soutien (formation, information, etc.) aux parents qui s’impliquent dans la vie scolaire de leur enfant.

Le Conseil de la famille et de l’enfance rédige des avis concernant les réalités des familles du Québec.

5. The Role of Schools in Promoting Safe Fishing Communities Background: Accidents at sea are a major source of injury and disability among fish harvesters. Reductions in the rate of accidents require an integrated approach combining vessel design, enforcement of appropriate legislation and safety training. This project is concerned with the third component. Much fishery safety education has adopted a didactic approach. By this is meant that particular groups of fish harvesters (e.g. apprentices) are instructed in the hazards of certain behavioural practices and advised to adopt safer behavior. Evidence suggests that such programs can contribute to improvements in knowledge but there is less evidence that they actually contribute to safer behaviour. Contemporary developments in adult education theory emphasize the importance of a community-based participatory approach involving the whole community in program design and delivery. This approach adopts a cyclical model of sharing information, analysis and action using a variety of methods to involve the family and community members in learning. The program can involve various participatory action exercises to enable the whole community to discuss safety issues and how to integrate them into their everyday practice so as to develop a broad safety culture. In fishing and other communities schools are a potentially important resource in the development of community health programs. This project investigates the role of schools in assisting in the development of community safety activities. Aims The overall aim of this study is to develop a safety education program for fish harvesters, their families and communities. This study will draw upon information obtained from the connected studies that are investigating the extent of injuries in the fisheries, the particular safety features of fishing vessels, the provincial and federal safety legislation. The program will involve fish harvesters, their families and other members of their communities. Specifically it will consider the potential role of schools and arts based activities. Dr. Michael Murray Division of Community Health
Memorial University of Newfoundland
St. John's, NF, Canada, A1B 3V6 709 722-1181 murraym@mun.ca

6. Canadian Initiative for the Prevention of Bullying (CIPB) The mission of CIPB is to develop a national strategy to reduce bullying and victimization among children and adolescents throughout Canada. Headed by Drs. Debra Pepler, Wendy Craig, Shelley Hymel and Michel Boivin, the CIPB first three years is funded by the Government of Canada’s National Crime Prevention Strategy. The CIPB team combines the expertise of researchers and practitioners in the field of child development at York University, the Hospital for Sick Children, Queen’s University, the University of British Columbia, and Laval University. A Youth Coordinator facilitates participation by youth, a foundation of the CIPB. Through its partnerships and outreach, the CIPB collaborates broadly with national organizations, community groups, governments, and individuals that work with children and youth. Recognizing that bullying is a relationship problem, the CIPB framework comprises four integrated pillars to promote safe, healthy relationships for all Canadian children and youth: Education, Assessment, Intervention, and Policy. The Four Pillars approach, based on a research foundation, is an integrated and ongoing process that helps Canadian children and youth identify unhealthy social interactions and move towards more positive interactions that will build healthier relationships. The CIPB is committed to knowledge transfer for education and training, assessment and evaluation, intervention strategies, and policy development. · The Education Pillar, primarily in collaboration with child and youth organizations, develops awareness and understanding to address bullying problems among all Canadian citizens. · The Assessment Pillar provides empirically-validated assessment tools to determine the extent of bullying and/or victimization problems for children and adolescents, their families, schools, and communities and to verify that efforts to reduce bullying are effective. · The Intervention Pillar provides a guide to effective approaches and programs to reduce bullying and victimization among Canadian children and adolescents. · The Policy Pillar facilitates the development of specific policies for organizations and governments that address bullying and victimization among Canadian children and adolescents. The knowledge and strategies associated with each of the Four Pillars will be launched on the CIPB website www.bullyfreeCanada.com in December 2004. For further information contact Audrey Cole, CIPB Coordinator: acole@yorku.ca

7. Barriers to Physical Activity for Canadian Youth This study was funded through a strategic grant from SSHRC under the theme of Society, Culture, and the Health of Canadians. The Principal Investigator was Dr. Ken Allison, and Co-Investigators included Dr. John Dwyer (University of Guelph), Dr. Karen Yoshida (Department of Physical Therapy), and Dr. Irving Rootman (University of Victoria/University of Toronto). The study was funded for a period of four years (2000-2004). This study addressed the problem of age and gender-related declines in physical activity during the teenage years. In order to examine this problem, the research team conducted a comprehensive examination of barriers to physical activity. The first research approach consisted of a series of focus groups conducted with high school students, stratified by activity level and gender, in order to explore barriers and facilitating factors associated with physical activity. Another study was the completion of a telephone-administered (using CATI) national survey of youth in order to describe and analyze current activity levels and the factors they believe make participation difficult. Another approach involved conducting in-depth interviews with inactive female teenagers from a number of Toronto secondary schools in order to explore their experiences of physical activity in relation to perceptions about their bodies, and a number of other issues. Finally, some of the social and political factors influencing the physical activity opportunity structure in Ontario were examined. These studies have now been completed and the research team is disseminating results in a number of publications and presentations. Contact Information Kenneth R. Allison, Ph.D. Department of Public Health Sciences Faculty of Medicine University of Toronto McMurrich Building 12 Queen's Park Crescent West Toronto, Ontario M5S 1A8 k.allison@utoronto.ca

8. Health Literacy for Canadian Schools A recent report of the Institute of Medicine identified the Education System as a key point of intervention in relation to improving the health literacy levels of the population[1]. The committee found many obstacles and barriers to successful health-literacy education programs in schools. They include crowded curricula, overworked teachers and shortage of teachers with training in health education. The committee also found that health professionals and staff have limited opportunities to develop skills for improving health literacy. Based on these findings, the committee recommended, among other things, that educational institutions should require that National Education Standards[2], which include standards for health literacy, be implemented. The committee also recommended that actions be taken to improve health literacy though K-12 schools. These conclusions and recommendations also apply in Canada. In implementing them, it is important to develop appropriate measures of health literacy achievement for different levels of the school program. The National Education Standards published in 1995 provide an excellent starting point for developing such measures. The research team that consists of investigators in health, education and measurement from several universities in British Columbia, is ideally placed to develop such measures given their involvement in a project to develop new measures of health literacy for other populations. The objectives of this project are to: (1) develop and validate measures of health literacy for middle and high school populations in British Columbia;

(2) test the relevance and utility of these measures in diverse school districts in British Columbia;

(3) study differences in health literacy between genders, cultural groups, SES groups, urban/rural and other groups within middle and high school populations in British Columbia.

The team proposes to develop such measures in partnership with the British Columbia Ministry of Education as a pilot that might be used as the basis for the development of standardized measures for use across Canada. We will carry out the present research in three integrated steps over three years. These steps comprise: a) development and validation of measures of 'health literacy' appropriate for Canadian Schools; b) testing of the application of the identified measures in one high school and one middle school in British Columbia; and c) revising measures based on these tests and collecting data from several high schools and middle schools in British Columbia using the revised measures. Contact Information Dr. Irving Rootman (CoLead Investigator) Centre for Community Health Promotion Research, University of Victoria, Box 3060 STN CSC, Victoria, B.C. (250) 472-4102; irootman@uvic.ca 9. Examining the Impact of Health Education on Adolescent Health Literacy Summary This research will generate knowledge about the impact of health education on the health literacy of adolescents. The context for our study will be the newly mandated Planning 10 curriculum in British Columbia (BC). In order to discover whether or not, or to what degree, education can influence health literacy, we will identify, explore and document the health education module, with particular reference to the development of health literacy, in Planning 10. We will then follow the same students through grades 11 and 12 while they compile their Graduation Portfolio (which contains mandated and optional health components). In addition, we will examine external factors on health education such as other school programs, school neighbourhood programs and the popular media. This research is important because concern about the health of Canadian adolescents has greatly increased (BC Nutrition Survey, 2004; CFLRI, 1999). Rates of physical activity are plummeting while those of obesity are soaring, and levels of substance use have remained largely intractable (Windle et al, 2004; Katzmarzyk & Ardern, 2004) among our adolescent populations. As a society, we find ourselves at a loss about how to spend scarce resources to address this problem. Education of adolescents is one possible way to address our concern. Schools instill values - including behavioural ones - and provide students with the literacy skills to understand health information, and capacity to solve problems and make critical health decisions (Issacs & Schroeder, 2004). Our society believes that it is critical for our future citizens to be knowledgeable and health literate consumers, and to provide them with the “currency” (Ratzan & Parker, 2000) to navigate an increasingly complex and cluttered landscape of health information. We do not, however know how education mediates this knowledge. A paucity of research has explored the influence of health education on health literacy. Further, few studies have explored the health education with the joint lens of education and health promotion specialists. Finally, very few studies involve a study of the health education experiences of students. An increased ability to understand the influence of health curricula will assist policymakers, teachers and health promotion experts to shape their approaches to improving health literacy and therefore improving health. Our research will examine the impact of health education in developing such abilities in a broad context of external influences on health information and behaviour. We anticipate that this research may lead to future study tracking students’ health behaviours beyond the high school years. Contact Information Deborah Begoray University of Victoria (250)721-7812 dbegoray@uvic.ca

10. Comprehensive School Health Research Team (Atlantic Canada) The Comprehensive School Health Research Team is composed of a group of researchers and policy makers from universities, government and the community who are working with schools to develop a comprehensive strategy to promote healthy behaviours and communities for schools in Atlantic Canada. Purpose of CSHRT team: To develop a collaborative inter-sectoral team of researchers and educators focused on prevention research for schools in Atlantic Canada. Working with Schools: Schools are an ideal context for prevention research because with the exception of family, schools have more influence on children and youth than any other institution. Through connections with parents and community groups, the influence of schools extends beyond students, into families and the broader community. Who are we? Inter-disciplinary team from: University Prince Edward Island (Donna Murnaghan), Departments of Health and Education, the Atlantic Health Promotion Research Centre (Dalhousie University), the University of Ottawa, the University of Waterloo, and the University of Alberta. Engaging Community Partners: local school boards, and the Island Health Alliances (Active Living, Healthy Eating, and the Prince Edward Island Tobacco Reduction Alliance) Research Questions: How can schools take a leadership role in promoting health for young people, especially those at highest risk for preventable illness? How can educators and prevention researchers collaborate to build an integrated approach to prevention activities at the school level? What infrastructure resources are needed to assist educators and researchers to develop that agenda? How can schools be an effective “role model” for building healthy environments? Goals: 1) Develop a collaborative inter-sectoral team of researchers and educators focuses on prevention research for schools in Atlantic Canada. 2) Assess the status of prevention research and resources in schools in Atlantic Canada, and in doing so establish research-practice partnerships. 3) Build research partnerships in the education systems in each of the Atlantic provinces aimed at developing and promoting comprehensive school health better practices. Specific Objectives:

Conduct a scan of individual school programs and policies, and physical and social environments related to health in the four Atlantic provinces.
Identify prevention research which has been/is currently being conducted in Atlantic schools.
Develop a comprehensive, up-to-date database of prevention research activity in schools in Atlantic Canada.
Explore the capacity of schools to adopt and/or implement prevention strategies.

Our Projects: 1) Taking Action to Enhance Health Behaviours in Teens Purpose: To design a comprehensive, school-based health strategy that influences policy level initiatives and focuses on healthy eating, physical activity, and not smoking for intermediate school students. The intermediate school environment provides an excellent window of opportunity for influencing students’ adoption of healthy choices. Working with Adolescents: Cognitively, many in this age group are at a beginning level of thinking in abstract terms. They can think about possibilities and can think through a hypothesis and these are the skills that allow them to understand and make choices. They have a strong need for an identity, and acceptance by peers is extremely important. The Social Ecological Model (SEM) will guide the development and design of the comprehensive school health strategy. According to the SEM, effective and lasting health behaviour change at the individual level requires interventions that target the individual; the individual’s environment, social relationships, and communities; and government policies. Specific Objectives ▪ Conduct a systematic examination of the school strategies to identify lessons learned and better practices (policy, environmental, community, interpersonal, and intrapersonal influences) for designing a comprehensive school strategy that focuses on physical activity, healthy eating, and not smoking. ▪ Identify student level beliefs about physical activity, healthy eating, and not smoking that are predictive of healthy behaviours. ▪ Identify school level influences (contextual environment) on physical activity, healthy eating, and not smoking in intermediate schools. ▪ Develop and validate a comprehensive, school-based health strategy that focuses on physical activity, healthy eating, and not smoking. ▪ Identify key student beliefs which are predictive of not smoking and identify variables within the school environment which influence these student beliefs. 2) Reconfiguring Physical and Social Environments to Improve Health: Research Infrastructure Development in Atlantic Canada Project Summary The primary objectives of this project are: 1) to develop research infrastructure in Atlantic Canada to advance population health science and public health systems in the areas of illness and injury prevention; and 2) to develop a program of research, knowledge translation and training in environmental diagnostics in three environments: workplaces, schools and communities. Specific Objectives ▪ Build a multi-disciplinary, inter-sectoral team of school health researchers in Atlantic Canada. ▪ Build a comprehensive inventory of school health research interventions. ▪ Develop a model for system linked prevention research infrastructure. ▪ Build capacity to secure funding for 1-2 large scale school studies in Atlantic Canada. ▪ Increase knowledge translation. 3) Together 4 Health, Tool Kit for Elementary Schools Project Summary In this project, information and supporting materials have been developed to support parents, teachers, and school administrators in creating school environment which promote physical activity and healthy eating. The end product is a ‘tool kit’, that contains information directed towards stakeholders, giving these individuals clear and practical information on how to evaluate the elementary school environment and identify changes which can be implemented to promote active living and healthy eating. Examples of Tool Kit Materials: ▪ factual information describing why action is needed ▪ a checklist to allow schools to identify problem areas and develop a plan of action ▪ resources for parents, teachers and school administrators offering ideas and examples for promoting physical activity and healthy eating at home, in the classroom and in the school, including references to additional sources of information ▪ suggestions for the development of school policies promoting healthy behaviours ▪ an evaluation plan for assessing the impact of changes on physical activity and healthy eating 4) 2004 Youth Smoking Survey (YSS) The Youth Smoking Survey (YSS) of 1994 was unique in Canadian survey history in its combination of school-based and household-based methods and was the largest and most comprehensive survey on youth smoking behaviour since 1979. The Health Behaviour Research Group of University of Waterloo (UW/HBR) operates as the primary investigating group for the 2004 YSS project, with UPEI as one of its partner organizations (Provincial Investigator, Donna Murnaghan). 5) PEI Sports Strategy Youth/Schools Purpose: Develop a research strategy to work in concert with the implementation of the PEI Sports Strategy. · A stakeholder focus group will be used to identify the priority area for measurement and what indicators will be analyzed. · Develop an understanding of the rationale for youth choosing to participate in or drop out of sports. Qualitative measures will be used to explore the underlying lessons. · Surveys with sporting groups and interviews with athletes, coaches and community leaders. · Report findings and dissemination of results to the policy decision makers and community.

11. CIHR International Collaborative Centre for the Study of Social and Physical Environments and Health The University of Calgary The University of Calgary has recently been awarded funds from the Canadian Institutes of Health Research (CIHR) to establish a new Centre called the International Collaborative Centre for the Study of Social and Physical Environments and Health. The focus of this new Centre will be on understanding more about how everyday settings – schools, neighbourhoods and workplaces - influence health. The Centre links collaborators from Canada, Australia, the United States, and the United Kingdom and builds a “hub” of activity in Calgary on population-level prevention research. The Director of the Centre is Dr. Penny Hawe, who holds the Markin Chair in Health and Society in the Faculty of Medicine. Schools Research Program Our first priority has been to establish a program of work that examines how the social environment in schools contributes to child and adolescent health, well being, and learning. Our interest is in the design and evaluation of interventions in schools that improve outcomes for students and enhance work satisfaction for teachers and staff. We will be developing new research projects in Alberta over the next 6 years. In putting this together, we hope to provide helpful information about the state of the field so far. For example, there is evidence that some programs in schools are ineffective in bringing about behaviour change. Some programs even cause harm. Our intention is that our Centre could act as a resource in the province so that health regions and schools could be in a better position to choose wisely when it comes to new programs. We also need to improve our knowledge about how best to promote school health. Our interest is in building strong interconnections among researchers, practitioners and policy makers. Overall our mission is to provide the type of strong evidence that policy makers need to improve support to schools, because of the contribution schools make to child and youth health and development. This involves two strategies: (1) having data to back our case, and (2) being part of broader constituency of support. By this, we mean being part of a network of people and organizations that encourage evidence-based practice in school health. Key aspects of our work program in 2004 and 2005 will be:

Identifying and working with people and organizations with similar research and practice interests
Finding out about existing whole school health promotion programs in Alberta
Scanning existing data bases about youth health and development in Alberta
Raising awareness about the importance of youth health and whole school approaches to well being
Identifying and working on teacher/staff issues in schools (i.e., recognizing the school as a workplace)
Raising awareness about gaps in knowledge and what we need to get better at

The lead up work to our program involves pilot projects with a number of schools in Alberta (funded by the Alberta Heritage Foundation for Medical Research, AADAC and the Southern Alberta Child and Youth Health Network). These projects are being led by Dr. Laura Ghali. We are building on the evidence that schools engage willingly in facilitated opportunities to design strategies that enhance both teacher/staff satisfaction and student connection with school. When this happens, student health and well-being improves as a result. Our plan is to be in a position by 2006 to conduct a large-scale intervention study in Alberta schools, involving perhaps as many as 40 schools. We think it will take an effort of this size to provide convincing evidence on whether whole school approaches can make lasting differences to student health and well-being. Immediate tasks in 2004 will involve setting up the Advisory Committee for the Centre, setting up a Seminar Series to help with our awareness raising, connecting with other groups and assisting with professional development activities across the province in a manner consistent with our goals. Dr. David Casey is the Community and Policy Research Partnerships Coordinator affiliated with the centre. Dr. Casey will be leading most of our development and liaison work.

12. RECENSION DES ÉCRITS SUR L’ENVIRONNEMENT SCOLAIRE EN TANT QUE DOMAINE D’INTERVENTION POUR LA RÉUSSITE SCOLAIRE ET LA SANTÉ[3] DES ENFANTS ET DES ADOLESCENTS RÉSUMÉ Les réseaux de l’Éducation et de la Santé et des services sociaux au Québec ont élaboré conjointement un guide favorisant l’implantation des grands paramètres d’une « Intervention globale et concertée - IGC » (ou Écoles en santé) pour la promotion de la santé et de la réussite éducative des jeunes. Dans ce type d’intervention, trois grands domaines sont ciblés : le «curriculum formel » sur la santé, l’environnement scolaire et les interactions entre l’école et la communauté. Cependant, les cibles spécifiques d’intervention qui se rattachent à ces trois domaines d’activités reste à être priorisées, sur la base des plus récentes connaissances pour chacun des domaines. La présente recension des écrits entend fournir une synthèse des connaissances actuelles de l’influence de l’environnement scolaire sur la réussite éducative et la santé des élèves et vérifier dans quelle mesure les approches ou modèles d’intervention qui ciblent les aspects de l’environnement scolaire réussissent à produire des effets positifs sur la santé et la réussite éducative. Les résultats produits dans le cadre de cette recension permettront de soutenir un des trois domaines fondamentaux de l’IGC, soit l’environnement scolaire, dans l’optique de guider son implantation et son évaluation dans divers contextes. Une attention particulière sera dévolue aux facteurs tels que le style de leadership de la direction de l’école et les structures de collaboration (mode de gestion) adoptées dans l’école qui semblent particulièrement importants pour accroître la capacité des écoles à déployer ou faciliter la mise en place de conditions qui ont impact positif sur la réussite éducative et la santé des enfants et des adolescents. Marthe Deschesnes, Ph.D. Line Leblanc, Ph.D. School environment as an intervention target for school achievement and health promotion of children and adolescents: A literature review. ABSTRACT The Quebec Health and Education Ministries have jointly developed guidelines to support the implementation of a comprehensive school health program (Écoles en santé) for improving health and school achievement among children and adolescents. This program provides a multifaceted approach containing three levels of intervention: school curriculum, school environment and school-community relationships. Though it is a major step to help the implementation of this type of approach, the specific components related to each level have to be detailed, priorized and operationalized, based on the most recent literature. This literature review is intended to provide knowledge regarding one of the levels, i.e. the school’s social environment. Objectives are to identify the school factors that have the most significant impact on health and school achievement and to verify to what extent the interventions that target the school environment (e.g. school policies, management, facilities) succeed at improving health and/or school achievement. The results of this literature review will help to determine the key components of the school’s social environment and the more effective way to implement and assess them in different contexts. Particular attention will be paid to factors related to leadership, management and collaboration in school that seem to improve significantly the school’s capacity to put in place the conditions needed to influence positively the health and school achievement of children and adolescents. Marthe Deschesnes, Ph.D. Line LeBlanc, Ph.D.

[1] Institute of Medicine. 2004. Health Literacy: A Prescription to end Confusion, Washington: The National Academies Press.

[2] Joint Committee on National Health Education Standards. 1995. National Health Education Standards; Achieving Health Literacy. Atlanta, GA: American Cancer Society.

[3] Dans le présent document, la santé recouvre les dimensions physique, mentale et sociale de la personne. La santé est considérée comme une ressource de la vie quotidienne qui permet aux individus de mener une vie active, de réaliser leurs aspirations, de satisfaire leurs besoins et de s’adapter aux contextes dans lesquels ils évoluent. Il s’agit d’un concept positif mettant en valeur les ressources sociales et individuelles, ainsi que les capacités physiques (Organisation Mondiale de la Santé, 1986).

12. Findings re efforts to be congruent with education mandate & constraints

dmccall — Fri, 25 Apr 2008 17:56:43 CDT

(Under construction)
This page will summarize reports on data on national and provincial/territorial efforts to integrate heapth promotion and socila development programs closely with the primary mandateof schools to educate students and the fiscal, social and political constraints that schools must work within

Synthesis Report on SH in Canada

dmccall — Fri, 25 Apr 2008 17:53:08 CDT

This review of progress being made in SH in Canada will be taken from several sources and is being funded by the Health & Learning Knowledge Centre of the Canadian Council on Learning. Several authors will be asked to contribute to different sections of the report that are focused on the different health topics that can be addressed in SH programs. This report will be updated periodically. All comments, edits and chnages should be made by December 31, 2007, after which the paper will be released to the public. Thank you for your participation.

Foreword
Status Report on School Health in Canada in 2007
Prepared by Douglas McCall, Executive Director, Canadian Association for School Health
The purpose of this paper is to provide an overview of the current state of practice of school health promotion in Canada. It has been prepared for the Health & Learning Knowledge Centre of the Canadian Council on Learning as a means of assessing the current state of practice relating to one of the three priority content areas for that centre (promoting healthy settings for learning and human development)

Table of Contents (Each section is presented on sub-pages off of this page. See Navigation on left margin.)

Conceptual Basis of this Report
Evolution of School Health Promotion Practice
Data Sources & Methodology for this Report
Importance of this Report
Limitations of this Report
Organization of this Report
Findings on National & Provincial/Territorial Capacity
Findings by Health Topic
Findings by Elements of a CSH Approach
Findings re: Efforts to Address Local Community Contexts
Findings re: Efforts to Address System Characteristics & Change
Findings re efforts to be congruent with education mandate & constraints
Findings on the State of SH Research in Canada
Observations from this Consultation & wiki-dialogue
Future Directions of SH in Canada

Appendix: Principles, Key Concepts & Better Practices in SH

11. Findings re: efforts to address systems characteristics

dmccall — Fri, 25 Apr 2008 17:50:25 CDT

(Under construction)
This page will include a summary of data that relates to national and provincial/territorial efforts to address system characteristics

10. Findings re: efforts to address local context

dmccall — Fri, 25 Apr 2008 17:47:02 CDT

The findings by efforts to address community and other contextual factors are as follows:

Low income communities - head start continuation programs - school meal programs - community school programs/school as hub of services - pre-school/day care programs - toy lending libraries - parent resources/training programs - school dropout prevention/basic literacy - coordination with housing programs	Two provinces (MB, SK) have formal strategies on community schools. One province (NS) is considering “wrap-around” schools. Another (SK) is implementing Schools Plus. There is considerable attention being paid to social determinants in the public health sector but that has not yet translated into concerted action using the school as a site or hub of the community. The International School Health Network has engaged several organizations and individuals in Canada and other countries on a coordinated set of programs as listed in the left hand column.
Aboriginal Communities & Students	The International School Health Network is discussing a Canadian and international initiative on how school health approaches can be made more culturally relevant to aboriginal students, schools and communities.
Rural communities	There is a strong tradition and movement on rural/small schools in Canada but is it not clear as to whether those discussions have ever examined health and social development in a comprehensive manner.
Inner city, multi-ethnic communities

9. Findings by elements of a comprehensive approach, coordinated program, whole school strategies

dmccall — Fri, 25 Apr 2008 17:41:36 CDT

This page summarizes reports that have explicitly examined how well jurisdictions and agencies are developing elements of a comprehensive approach, coordinating multiple programs or developing whole school or school-community strategies.

School Health Policies - school boards - other agencies
Health Literacy/Health Education/ Health Careers/Health & Society - teaching methods/teacher development/pre-service training - curriculum design - media literacy/new media/web as social environment	Three jurisdictions have recently upgraded their physical education curricula and programs. Saskatchewan is reviewing its health education curricula. CCL has recently called for research proposals on health literacy. The Health & Learning Knowledge Centre has made health literacy (interpreted to mean basic literacy and access to services)
Health & Other Services/School Clinics/Links with Community Clinics - Early identification-referrals - Immunization - after school programs - youth friendly services - role, training of health care workers, physicians, clinics
Social Environment & Support - school climate/ethos - youth engagement - parent involvement - working with community groups and volunteers - working with media
Physical Environment/Practical Resources - indoor environment/air quality/school design/maintenance - outdoor environment/learning grounds/green schools - transportation to school

7. Findings on Provincial/Territorial Capacity

dmccall — Fri, 25 Apr 2008 17:25:55 CDT

The findings regarding national and provincial/territorial capacity are as follows. For more information on the sources used for this summary, contact dmccall@cash-aces.ca

Capacity Questions

Canada

A General and Brief History/Context

1. What are the key events (conferences, studies, reports, public events etc) in the development of school health programs and policies in the nation and in states/provinces?

2. Has research and knowledge development influenced the development of school health in the country or state/province?

3. Have practitioner organizations (either school health associations, professional groups or voluntary health/social groups) played an important role in the development of school health in the country or states/provinces?

4. What can be said about the general nature or philosophy of the SH approach being used in your jurisdiction?

National

The first national conference on CSH was held in 1988 and brought together national health and education organizations with Health Canada funding.

A 1990 Consensus Statement signed by over 25 organizations extended the US-led emphasis on curriculum to a “comprehensive approach” that involved multiple professionals, agencies and systems at all levels. This comprehensiveness (of seeking links among health issues, partners, interventions, agencies and systems) is likely the most significant contribution from Canada to the field of SH promotion.

A memorandum was signed in 1990 between Health Canada and the Council of Ministers of Education, Canada (There is no federal department of education in Canada.). However, this MOU was never really implemented in any systematic way. Several national projects involving a variety of partners increased stakeholder and government awareness of the CSH concept but most activities were issue-specific and project driven.

In the 1990’s, Health Canada support for CSH waned with budget cutbacks and the CSH movement was kept alive through ad-hoc projects and the ongoing efforts of the Canadian Association for School Health (CASH) and the consulting firm that works with the Association.

A 1999 survey of health and education ministries, local agencies and schools reported that about a third of the agencies supported the CSH concept and most health and education ministries included references (but not support) for CSH in their curriculum and policy documents.

In 2003, the School Health Research Network was formed and there are now several SH research projects and programs underway in Canada. However, research evidence was not often a factor in the major decisions about CSH at the national or provincial/territorial levels until recenty. Some exceptions to this general rule are:

the large 1985 US study on the impact of health education (School Health Education Evaluation led to improvements in health education curricula across the country (likely the use of this knowledge was enhanced by the emergence of the AIDS/HIV issue and a child drowning in Ontario that galvanized public concern about health).
the national evaluation and other reports supporting the SH Coordinator approach and SH program in England convinced health and education deputy ministers to name SH coordinators for their jurisdiction and to create an inter-governmental consortium.
research showing the impact of a comprehensive school health approach to diet led to investments in staffing in several jrisdictions
researchers in Quebec gradually build up the case for an inter-ministry agreement on prevention and school health
research on the apparently mimimal impact of anti-smoking education done in the US caused Canadian programs to focus on legislation, taxes and youth engagement projects
a research agenda funded by CIHR and other similar reports/papers that have focused on an ecological approach and systems change are gradually shifting some attention onto issues of system capacity, coordination and context. However, the tendency to develop and dump single programs into the schools is still prevalent.

In more recent times, the Canadian Institutes for Health Research have funded large scale projects investigating the impact of the social and physical environment of the school. As well, several intervention research projects have been started. Hopefully the results of these studies will consolodate the gains made in earlier years.

In 2004, the Canadian Association for School Health (CASH), working with the Council of Ministers of Education, Canada (CMEC), brought together the provincial/ territorial deputy ministers of education and health to form the Joint Consortium for School Health (JCSH). Education and health ministers as well as the country’s first ministers endorsed this new intergovernmental mechanism. A small budget and secretariat have been formed with all but oneprovincial jurisdictions participating. One of the federal health departments is also a member of the JCSH.

A national network of NGO’s, the Canadian School Health NGO Network, was also formed in 2005 and is beginning its collaborative advocacy for CSH. In 2007, this NGO Network adopted a Revised Consensus Statement on Comprehensive School Health. In 2005, a federally funded agency, the Canadian Council on Learning, established a Knowledge Centre on Health & Learning that includes a big focus on CSH.

The 1990 consensus statement on "Comprehensive School Health" advocating action in four areas (instruction, services, social environment and physical environment) was similar to the eight specfic programs recommended in the "Coordinated SH Programs" in the US and the values-laden 1997 Declaration of the European Network on "Health Promoting Schools". The Canadian statement placed more emphasis on inter-agency and multi-level cooperation.

The current Canadian approach includes more emphasis on systems capacity and change. The intergovernmental FPT consortium on SH has explicitly adopted eight key capacities. The revised NGO Consensus Statement preceeded this evolution and researchers have begun to investigate capacity related issues such as the role of the SH coordinator.

Provincial/Territorial
The SH movement in Canada began with coalitions in three provinces for three different reasons. The Manitoba association was developed by a health NGO in order to coordinate input being delivered to the education ministry about curriculum. The Nova Scotia association was developed by educators returning from a US conference on health education. The third, in BC, was developed through the efforts of the health consultant in the Vancouver School Board.

Federal funding in the 1980’s created coalitions in all jurisdictions but several went dormant when that funding was cut. Most provincial SH activities were issue specific and project-based.

Education and health ministry cooperation was sporadic and usually driven by crisis issues or external funding. At the turn of the century, however, several jurisdictions had recognized the need for a more coordinated approach. A variety of health related initiatives were started with slightly different names and focal points.

At the same time, most education ministries were responding to concerns about bullying and crime with programs as well as coordinators assigned on safe and caring schools. All education ministries have a safe schools plan and had named a provincial coordinator by the late 1990's. This approach is often described as "safe & caring" emphasizing positive youth development as well as seeking to prevent crime, delinquency and bullying.

Most PT jurisdictions are now developing healthy school plans and programs. All jurisdictions as well as one of the federal health departments have jointly named a SH Coordinator. The approaches being used in PT jurisdictions vary slightly. Saskatchewan is building from a tradition of inter-agency work on coordinated health and social services in its “schools plus” approach. Manitoba is developing its “healthy schools” approach from a comprehensive policy on children that started first with early childhood. Several jurisdictions such as Newfoundland, New Brunswick and British Columbia are developing their school health programs within a “chronic disease/healthy living/wellness” context. Nunavut is developing its school health plans within the context of its culturally relevant promise to children. Ontario is focused on physical activity and healthy eating. Quebec’s approach is based on a comprehensive inter-ministry agreement and plan on prevention for youth.

School Health coalitions are now being re-involved in the work in some PT jurisdictions. In the late 80’s, many government officials were actually on the national SH Association Board of Directors because this group provided the best access to national information. Research evidence has been used in several Canadian PT jurisdictions to develop specific school programs in physical activity but much less so on other issues. Most PT responses have been ad-hoc, with officials gradually learning the value of comprehensive approaches as they worked through activities and programs.

School health research networks and resource centres have recently been started in PEI, New Brunswick, Quebec, Ontario, Alberta and BC. SH email lists are operated in three jurisdictions by various organizations.

Systems Capacities

1. Comprehensive, coordinated policies,

a) Does the national and/or state/provincial governments have an explicit policy statement on:

- school health promotion?

- a holistic approach to child/youth health (rather than just a series of policy responses to health and social problems)?

- recognition that health and learning are interdependent and need joint action

b) Are national or state/provincial initiatives, programs or policies on specific health and social issues required or encouraged to include a comprehensive school health approach?

c) To what extent are national and state/provincial SH policies comprehensive and coordinated?

d) Does the national and/or state/provincial governments have a policy or priority that SH programs should address the needs of at-risk students as a priority within SH programs?

e) Are these school health policies actively supported by senior managers and policy-makers? How?

NationalCanada’s two health departments have provided implicit support and project funding to support SH promotion, but this has usually been done on an ad-hoc, piece-meal fashion. There is no federal policy requirement to use a comprehensive approach to SH promotion, nor to use a holistic approach to the health of children nor to coordinate initiatives that relate to health and learning. However, recently, Canada’s First Ministers have committed their governments to work intersectorially through healthy schools as part of a 2004 Health Care Accord. The country’s education ministers and health ministers have endorsed the creation of the federal-provincial/territorial Joint Consortium for School Health but joint policy-making is specifically excluded from that organization’s mandate.

There are several similar FPT and inter-provincial committees addressing specific health and learning issues that seek to promote cooperation and communication without having a policy coordination mandate. These committees overlap with the mandate of the Joint Consortium for School Health and their cooperation with JCSH is not required, nor yet evident. These difficulties related to policy coordination are reflective of the structure of the federal system in Canada, where there is no federal mandate for education or health delivery but there is a federal spending power that is used to respond to health and education issues and often overlaps with provincial/territorial activity. Sometimes this is helpful, when such projects create a consensus on better practices.

Other times federal project funding is duplicative of PT efforts. At the same time project activity within provinces and territories with larger jurisdictions spending funds on the same research and development activities and smaller jurisdictions following along with adaptations.

Provincial/Territorial

Progress is being made in policy coordination in some jurisdictions in Canada, notably Manitoba (a child-centered policy framework), Quebec (an inter-ministry agreement), British Columbia (jointly developed ministry service plans), Saskatchewan (Schools Plus) and to a lesser degree in Nova Scotia and Ontario (where a Ministry of Health Promotion is mandated to coordinate policy development.)

However, all Canadian jurisdictions do not have the mandate, nor influence except in times of crisis or financial largesse, to require their local education and health agencies to adopt comprehensive SH policies, programs or initiatives. These semi-autonomous agencies therefore need to be persuaded of the value of SH programs if they are to support their schools and staff in a sustained SH approach.

Nevertheless, progress has been made recently with comprehensive SH approaches being recommended (but not required) as part of government initiatives on health issues such as nutrition and physical activity. However, this trend is not necessarily being used in responses to other health issues such as drugs, tobacco, mental health, safety/bullying, infectious diseases, and injury prevention.

2. Formal mechanisms for coordination such as inter-ministry agreements and committees as well as informal mechanisms for cooperation such as shared vision statements, networks with NGO’s, shared PD activities, etc

a) Does your country and/or states have a formal definition/goal statement of school health promotion? Have governments adopted that definition? Have NGO’s adopted that definition?

b) Do your national and state/provincial governments have formal inter-departmental and inter-ministry agreements on school health promotion?

c) Do your national government and state/provincial governments have inter-departmental or inter ministry committees on school health (either as SH, or on youth that includes SH or on issues that have a specific SH components)?

d) Do you have SH coalitions (composed of NGO’s) at the national or state/provincial level? Or, do coalitions on specific health issues address SH regularly as part of their mandate?

e) Is there a regular conference on SH that brings together practitioners, researchers and officials on a regular basis?

NationalCanadian NGO’s developed a consensus statement on “Comprehensive School Health” (emphasizing a holistic multi-system, multi-level, multi-intervention approach rather than selected programs or values) in 1990. This statement has been revised and endorsed again by over 25 national organizations.

Various other national statements and declarations on various health issues have included this CSH approach as part of their terms. These statements have been adopted by a variety of organizations. The federal government, including several specific programs within the two federal health departments, has supported the development of these SH and SH related statements and declarations but has not adopted these statements as policy.

There are several national networks concerned with health issues at the national level. Many of these national networks implicitly or explicitly support SH promotion in their activities. The Canadian Association for School Health has existed since 1988 but has only recently led the development of a national network of NGO’s that share a concern for SH promotion. The Public Health Agency of Canada is attempting to create an informal network of program level staff concerned with SH promotion within the federal government.

A regular national SH conference has been started and has occurred in 2005, 2006 and 2007. A fourth conference is planned for April 2008 in Ottawa. School health is also a regular feature at the annual conference of the Canadian Association for Health, Physical Education, Recreation and Dance, usually in the form of workshop; sessions organized by a CAHPERD Advisory Committee on Quality School Health.

Provincial/Territorial

In recent years, provincial/territorial SH conferences have been organized or are being planned by the SH coalitions in Ontario, Alberta and Nova Scotia.

3. Assigned staff and dedicated infrastructure at all levels to ensure coordination and communication.

a) Are there national, state/provincial programs on school health?

b) Is there an office or government official named to coordinate the SH program at the - national level? - state/provincial level? - local level?

NationalThe Public Health Agency of Canada has named a SH coordinator who is part of the Joint Consortium for School Health. Other parts of the PHAC and the other federal health department, Health Canada, tend to have program staff assigned to youth aspects of their health issue. It is these atff members who tend to respond to or plan SH initiatives as part of their youth work.

Provincial/Territorial

Each province and territory has named a SH Coordinator. In most cases, this appointment has been a joint position of their health and education ministries. Nine of those appointments are full time and four are part time. Three jurisdictions (New Brunswick, Nova Scotia and Newfoundland) have established and funded local SH Coordinators. In two of these jurisdictions, these ate public health personnel embedded in school board offices. In the other case, the coordinators are responsible for school and community coordination. There are several local health authorities across Canada that have assigned staff to SH programs, usually pas part of a public health or youth health program. Three jurisdictions (Manitoba, British Columbia and Ontario) are considering or developing financial incentives programs to encourage local schools to become healthier.

4. Procedures and processes to develop, translate, disseminate and exchange knowledge.

a) Are there research centres that include SH as an explicit part of their mandate?

b) Is there an ongoing SH research program or initiatives?

c) Is there a national SH journal?

d) Are there web sites and regular email lists devoted to SH?

National
In 2003, the School Health Research Network was formed and there are now several SH research projects and programs underway in Canada. A SH Research Agenda has been developed, along with specific mini-agendas for various health topics. The SHRN web site also maintains links to SH research reviews and landmark studies/reports on various health topics.

The Canadian Institutes for Health Research funded two national projects on the impact of social and physical environments on health. These grants led to two SH projects. The University of PEI Centre on Comprehensive School Health is focused on knowledge transfer, specifically on data. The University of Calgary has a major research study on school-based mental health promotion. The National Institute for Public Health in Quebec has a research program on school health. The CRISP centre at the University of New Brunswick has taken an interest in school health promotion. Researchers at the University of Waterloo have been developing a program on school-based physical activity and healthy eating programs.

In 2005, a federally funded agency, the Canadian Council on Learning, established a Knowledge Centre on Health & Learning that includes a big focus on CSH. Its knowledge broker activities include a national teachers magazine, distribution of journal inserts to public health professionals, networking of local agencies, a documentation centre, national conference, consultation on surveillance/monitoring needs, research RFP’s, an international SH research seminar and informal networks on CSH applied to aboriginal students and French-language minority students. A small documentation centre/library is being maintained at a university with an accompanying comprehensive SH web site that seeks to be a central reference point for school health in Canada. A national SH email list is maintained currently by volunteers.

Provincial/Territorial

One PT jurisdiction (Ontario) has funded a Resource Centre in SH promotion. That same province has included SH promotion in reviews of best practices in public health done by another centre.

Occasionally, the resources centres that are funded in health promotion create a report, research review or resource on how schools can address a particular health topic, but rarely is there a sustained and organized and ongoing plan to exchange, analyze or disseminate SH knowledge.

5. Sustained workforce development through both pre-service and in-service staff development in all sectors (not just teachers?

a) Are there any statements on the pre-service training that teachers, nurses, social workers, police officers, school principals, guidance counsellors should have in preparation for SH practice?

b) Has there been any studies of the pre-service training or qualifications or current practices/attitudes of these same categories of professionals needed for school health?

c) Is there any sustained program to offer SH in-service training to these same categories of professionals to support their SH practice?

d) Is there any on-going program to train SH coordinators?

National
There have been occasional studies done by university-based researchers on the readiness of teachers to teach health education, physical education and sexual health education. But these studies have had no decision-maker audience and Canadian universities guard their academic freedom.

There have been very few Canadian studies of the qualifications, training, practices, attitudes or skills of the different categories of personnel involved in SH promotion. The only national study was done in 1999 as part of a larger policy/program study on sexual health and school health.

Further, while provincial/territorial governments in Canada have the right to impose requirements on universities, they have not done so in relation to health education or health promotion.

There are several initiatives underway in Canada that may have an indirect impact on the readiness of educators and public health professionals to work in school health promotion. Shortages of health care professionals have prompted a federal study on supply and demand in health professions. As part of a renewal strategy in public health capacity, several national organizations are examining public health competencies and post-graduate programs.

On the education side, education ministries are working to improve the accountability of post-secondary institutions and there are FPT discussions underway on increased federal funding for post-secondary education. All national agencies shy away from sustained funding on in-service programs because of the costs involved. There is no program to train SH coordinators in Canada but there may be a study on the role and impact of such coordinators in the near future.

Provincial/Territorial

No PT jurisdiction in Canada has defined or required any ratio, qualification, training or preferred set of practices for any of the categories of personnel that are involved in SH promotion. Some jurisdictions have done studies of heath education teacher practices (Saskatchewan) and public health nurses activities in schools (Niunavit and Ontario). Like their federal counterparts, most PT governments shy away from funding in-serve training programs because of their costs.

Occasionally, as part of a high profile initiative, funding will be provided to train teachers in a prevention program or to orient teachers to a new curriculum but this is usually not done in a sustained way.

6. Explicit procedures to identify priority and emerging issues and trends and to focus system attention on those issues in advance of a crisis.

a) Is there a regular report on emerging issues and trends in the health and/or health learning of children/youth or in school health promotion?

b) Does the national and/or state/provincial governments have an explicit statement on their health issue priorities?

NationalA recent report on child/youth health was the first government agency analysis of child/youth health in many years. Prior to that, non-governmental organizations received sporadic project funding to publish such analyses.

Provincial/Territorial

Two jurisdictions (BC and Manitoba) have inter-ministry statements identifying selected health priorities. Two provinces, Alberta and Quebec, now publish a regular report on child health. Other PT jurisdictions have recently begun inter-ministry work on identifying relevant data sources on child health and school health in response to a CCL project funded through the Joint Consortium for School Health.

7. Explicit, systematic means to monitor and report on:

a) Are there regular reports a the national and state/provincial levels on: - the health/social development of children and youth?

- the status and capabilities of local agencies and professionals in their policies, programs and practices?
- the health/social development learning outputs for students (including basic health literacy, optimal health knowledge/skills and preliminary exploration & training related to health, PE, and social services professions such as Home Ec, Nursing) as well as periodic assessments and analyses of local needs and resources

b) Is there regular analysis of the data sources relevant to SH that is published and disseminated?

c) Are local agencies receiving, analyzing and using data in their program planning?

d) Are there readily available self-assessment tools for schools and agencies to use in planning their SH programs or comprehensive responses to various health, social development and learning issues?

There is a patchwork of national and international surveys and data sources on the health status of children and youth that is being addressed by separate task forces and initiatives, a unit within the Public Health Agency of Canada and various FPT committees. Informal discussions have begun within federal departments on how to coordinate data collection from schools, as many schools are now refusing to participate in health surveys.

A 2006 project report has once again raised this as a problem for consideration by senior decision-makers and it is hoped that several subsequent steps will result. . The education ministries in Canada do not report on the health literacy and learning of their students.

A 2004 review of the Pan-Canadian Assessment Program of the Council of Ministers of Education, Canada decided to not add to other subjects to its roster of reading, mathematics and science education testing.

No regular reporting is done in Canada on the status of SH policies and programs.

One of Canada’s national newspapers will be publishing the results of its survey of school boards in August 2006. This will be the first national report of this type since 1999, when the Council of Ministers of Education, Canada did a study on sexual health and school health programs that reported on health and education ministries, agencies and school/nursing staff. Most of the self-assessment tools are aimed at school staff and school only actions (often excluding assessments of the role of the other SH partners).

The Public Health Agency of Canada has funded the development of a web-based student health survey and planning tool (Voices and Choices). The Joint Consortium for School Health is developing a school-based self-assessment tool that can help schools assess their nutrition, physical activity, tobacco and mental fitness programs.

The University of Waterloo has published a self-assessment tool on tobacco and schools and is developing similar tools on nutrition and physical activity. The Canadian Public Health Association has published a self-assessment tool on school safety and violence.

Provincial/Territorial

Many Canadian jurisdictions are considering an adapted version of the ASCD Healthy Schools Report card. Many have also looked at the SMART Tool from Adelaide, Australia. Several Canadian jurisdictions are now actively considering how health concerns can be integrated within the mandatory plans and procedures for school improvement, development t and accountability. Newfoundland and Quebec have developed questions and scenarios for use in their jurisdictions.

8. Explicit plans to ensure evaluation, evolution and sustainability of policies and programs

a) Is there an explicit plan to evaluate the impact of national and state/provincial SH plans and programs?

b) Is there an explicit plan to ensure the sustainability of national and state/provincial SH programs?

National

There is no national plan or program for school health promotion in Canada. Further, accountability measures at the federal level relate solely to project management and financial procedures rather than program impact in areas such as prevention, promotion or learning. Consequently, various national “initiatives” on specific health issues rarely, if ever, have evaluation components that assess their impact on child/youth health or on school health policies or programs at any level. There is no sustainability plan for the FPT Joint Consortium for School Health but there is a draft long-term evaluation plan being developed to assess its impact on inter-governmental cooperation.

Provincial/Territorial

Only one jurisdiction in Canada (British Columbia) has published its plan to evaluate the impact of its SH program (as part of its ministry service planning). Others are developing their respective plans in 2006-07.

Key Findings from Surveys of School Health Policies/Programs at Provincial/Territorial Level

The data from two national surveys done in the last decade indicate that we are making progress in school health promotion. (Note: The data from these two surveys is not directly comparable, so these observations should be considered to be only an indication.) A regular, reliable system for reporting on the status of policies and programs in Canada is required.

Principle/Capacity	1999 CMEC-Health Canada Survey	2006 SHRN Survey
1. Whole child, not just part		Most MOH had chronic disease focus for SH plans. All MOEs had designed curricula to address knowledge, skills, attitudes and behaviours for an extensive list of health and social issues.
2. All children, especially vulnerable children and disadvantaged children.		No MOH had plan for vulnerable disadvantaged, children. About half of MOEs funded school meal programs and higher student services ratios. Most MOEs have programs and structures for aboriginal students.
3. Understand and address local context		One MOH had plan for settings-based approach, one had commissioned research on settings
4. Comprehensiveness - build multi-level, integrate with other health issues		No PT had a tri-level (ministries, local agencies, schools) plan for SH. Some MOHs had linked healthy weight, overeating and physical activity. Some MOEs linked safety, violence, bullying.
5. Select evidence-based programs,		One MOH has defined early identification services.
6. Use evidence-based Implementation process		No questions were asked in relation to this key point.
7. Coordinate programs across five domains (policy, instruction, services, social and physical; environment)	One third of MOEs and one third of MOHs had explicitly stated support for CSH approaches. Over 60% said that they required coordination on sexual health programs from local agencies. All MOE’s reported that Health Education was mandatory. (About 75% of school boards said so. About 50% of school principals said so.) About one third of MOHs said that youth health service delivery was mandatory. (About 60% of health units said that such serves were required. About 90% of nurses said they were delivered. ) Three quarters of MOEs said they had required policies on universal hygiene precautions in schools.	All PTs have declared a CSH approach, vision. However, most initiatives are issue-specific, not coordinated and project orientated. Most MOH initiatives link education programs to public awareness campaigns but not to services, policy, work in other settings etc
8. Seek congruence with primary education mandate and constraints of schools	No MOE reported on health education results in their annual reporting.	Most MOHs review or publish curriculum supplements or instructional programs on health. Most MOE’s review and authorize instructional programs and materials. No PT had integrated health within school improvement planning procedures. No MOE required that school improvemenht plans address health. All MOEs had explicitly recognized the link between health status and learning. All MOEs had explicitly adopted an effective schools approach which includes attention to a safe, orderly school environment. Most MOEs had made similar statements about healthy schools, safe schools or community schools. Most of these statements were contained in curriculum documents.
9 Build capacity in eight areas (coordinate policy, staff for coordination, mechanisms for cooperation, workforce development, knowledge exchange, monitoring & reporting, issue management and sustainability	One third of MOEs reported that there was an inter-ministry agreement on HIV-AIDS and sexual health. Fewer MOHs reported such a agreement. About one third of both groups of ministries reported that there was an active inter-ministry committee on health issues. About one-half of MOHs had published a document on inter-ministry cooperation. About one-quarter of MOHs reported that they assigned staff to support cooperation with other ministries. One MOE had described the role of counsellors in health. One-third of MOHs reported that they had guidelines on the role of the nurse when working with schools. One-quarter of MOHs said they had a staffing ratio of PH staff to youth or schools. Most schools reported nurse presence for less than one day per month. Half of the MOEs and MOHs were reviewing their health curriculum or promotion assignments in 1999. Most MOEs had a full time health curriculum specialist, most has a PE specialist as well. About half of MOHs had assigned a person within their health promotion team to youth health. No MOH had assigned a person to SH. About half of MOHs reported that they encouraged different forms of knowledge exchange. About half of MOHs reported that they monitored the number of youth receiving health services. No MOE kept track of that type of data. About one third of MOHs reported periodically on sexual health status/behaviours of youth. (There was and is no national reporting) All MOEs reported health as being a lower priority than reading, math, science, social studies and vocational education. Sexual health/AIDS was reported as a higher priority than nutrition and injuries, and the same priority as drugs and tobacco by MOHs. Most MOHs and MOEs reported that they passed along data and studies about child/youth health to local agencies.	All MOHs and all MOE’s were developing SH action plans. Two MOHs included references to these plans in annual reports. Most MOEs reported SH as a priority within internal planning documents. 2-3 PT had have inter-ministry agreements on SH or preventio Half of MOHs require coordination with education at local agency level. No MOEs had a similar requirement for school boards. One MOH has described mandate of Health Authority to work with schools in a written document. Two MOHs have described role of nurse. No MOH has defined staffing ratio for such nurses. Few MOEs had described the role of counselors, psychologists and others related to health. All MOEs and MOHs had named SH Coordinators (usually half position in each, one jointly named) Most MOEs had a full time health curriculum and a full time PE curriculum specialist. Most MOEs had a full time student services specialist. Three MOHs have funded SH Coordinators within school boards. About 30% of Health Authorities have assigned staff explicitly to SH. n Most MOHs had investigated evidence on CSH program effectiveness. All MOHs have identified a list of priority health issues. Most MOEs had not identified an explicit list of health issues. No MOH had plan to report on all aspects of child/youth health. Some were tracking some health issues. No MOE was monitoring health literacy/health education results. No PT has monitoring system for SH policies and programs. Most MOHs were not revising their health monitoring systems. There was no coordination between ministries on data use and collection. No MOE was reporting on its implementation of SH action plans, nor did they require local school boards to do so. Most MOEs required school boards to report on numbers of students taking optional senior high school courses relating to health, PE and family studies but did not report that information to the public.
10. Address system & organizational characteristics		Two MOHs had conducted surveys of nurses on working with schools. One MOE had done a survey on teacher and principal practices re health.

Appendix: Key points, concepts, practices in SH

dmccall — Wed, 23 Apr 2008 10:31:55 CDT

Ten Key Points about School-based Health Promotion, Social Development, Human Rights, Safety, Environmental Sustainability & Learning

This report on school healthn in Canada is based on the accumulation of research evidence and experience about school programs that promote health, social development and learning. We have organized the various sources of data presented in this cu,ulative report to several key better practice guidelines that correlate with ten important points about school health promotion. These ten points are an attempt to collate and synthesize the wisdom from education, health and development sectors on several different continents and countries. A word of explanation about these ten points is offered here to introduce the reader to our global understanding of school-based and school-linked programs. For more on these ten points and to participate in an international wiki-discussion about these points, concepts and good practices, go to: www.schoolhealtheffectiveness.wetpaint.com

1. Address the needs of the whole child in a positive, principled approach over the life course. It is fitting that our first point comes from the education sector where research on brain development led to movements for more holistic approaches to learning. Too often the health, welfare and law enforcement sectors have been focused on short term results on one or a few problems without looking for clusters of problems, conditions and strengths among children, schools or communities. As well, the first European descriptions of health promoting schools identified the need for programs to be based on values and principles rather than simple production/medical models.

2. Serve all children, especially vulnerable children, families and communities. Although all sectors identify the need to serve the disadvantaged, there is rarely a program or service or school-based approach that truly places the needs of the poor above the needs of the mainstream. This idea emerged first in the health sector with the adoption of the Ottawa Charter.

3. Understand the context. Ecological approaches have identified the need to identify issues and subsequently plan programs that suit specific contexts and communities. Instead, local context is seen only as a factor in the delivery of a good program rather than the starting and end point of our endeavours.

4. Strive towards a comprehensive approach The need to identify and work with synergistic combinations of programs, programs that address more than one program, and linkages across sectors and among different levels in the same system emerged in Canada and the United States. Although we often use the term “whole school strategies”, we should really mean more comprehensive strategies that engage entire systems (not only the front line) as well as the community, agencies, professionals and families working closely with the school.

5. Use evidence-based programs. The consistent use of research-based programs still remains an elusive goal, as nations and states have only recently begun to invest more in intervention research, knowledge translation, knowledge exchange and work force development.

6. Use evidence-based implementation strategies and identify the local mechanisms/drivers of change, implementation and sustainability. New methods in health promotion research and practice have identified the need to examine the factors within communities, organizations and schools that will help or hinder the sustainability of programs.

7. Coordinate multiple programs, services and policies. The coordination of multiple programs has been proven to be more effective than single interventions in the prevention of a variety of health and social problems. This program coordination goal was first described by SH proponent s in the United States as an extension of their earlier work on curriculum-based strategies. A variety of eight part, three part and other models has been presented around the world.

8. Seek congruence with educational mandate and constraints of schools. Work in Australia and other parts of the western Pacific region has emphasized the need to work closely and in a practical way with educators and their goals, methods and constraints.

9. Build capacity within systems, agencies, schools and communities. The need to build capacity has been recognized in education and public health sectors. These capacities include leadership, policy coordination, workforce development, monitoring and reporting, coordination and cooperation and strategic planning.

10. Use a strategic approach to system characteristics and organizational cultures. Open, loosely-coupled and bureaucratic systems have boundaries, middle managers and other traits that need to be addressed.

6. Organization of this report

dmccall — Wed, 23 Apr 2008 10:31:02 CDT

The findings of this paper are organized as follows.

First, we present a synthesis describing national capacity in school health promotion. The synthesis responds to several questions derived from a framework developed by the World Health Organization. This framework, which has been adapted by the School Health Research Network here in Canada has eight broad capacities that are deemed to be necessary for effective school health promotion.

Second, we summarize what was found in various scans done on specific health topics and school health promotion. Observations are made about the comprehensiveness, coordination, evidence-base and strategic nature of the activities based on the concepts presented earlier in this paper.

Third, we examine if and how the various elements of a comprehensive, coordinated approach are being addressed in Canada. These include overall coordination, school/agency SH policies, health education, school health/other services, social environment and physical environment.

Fourth, we identify and discuss comprehensive Canadian attempts to address community contexts in a systematic CSH way, including contexts such as rural schools, aboriginal schools, inner-city schools, low-income schools and so on.

Fifth, we briefly examine the current work being done in Canada on knowledge development and research in school health promotion. We present the ecological, systems-based approach developed by the School Health Research Network and discuss if and how ten basic questions of a School Health Promotion Research Agenda developed through a national consultation and several workshops are being addressed by research funding agencies and researchers in Canada.

Sixth, we make some observations about the comments and suggestions that were made during the consultation process and through the wiki-based dialogue. (To be added subsequent to the process).

We conclude the paper with a series of questions, comments and suggestions about how future efforts in school health promotion can be guided by some selected principles, key concepts and good or promising practices.

5. Limitations of this report

dmccall — Sun, 20 Apr 2008 13:53:01 CDT

The data sources used for this paper sources are retrospective in nature and limited so this portrait or photograph provides only a overview that should be verified and validated through further research.

Further, those data sources are often web-based scans or based on one-time surveys or studies. Some interviews with key informants have been done, but with a total budget of $5,000.00 to develop this paper, we can only present parts of the picture and suggest more and better analysis. As well this report clearly does not represent the reality of what might exist at the community level.

Nevertheless, we present a viable framework and lens for future reports as well as a careful summary of the data that was available for this paper. By stepping back and assessing where we are in school health promotion in Canada, we are more likely better able to take the right steps to move forward

4. Importance of this report

dmccall — Sun, 20 Apr 2008 13:51:22 CDT

This paper is an attempt to summarize the state of the art and science of school health promotion in Canada as of 2007. The description is focused on the national level and overviews or observations about any patterns emerging from the provincial/territorial level. It is only a composite photograph of what exists or existed at those levels in this time frame.

The reality of local practices in school health practice is not captured in this overview. Most studies, including a large-scale significant study undertaken by the Council of Ministers of Education, Canada (McCall et al, 1999) would suggest that the progress being made at the local level lags behind the programs that are recommended or even required at national or provincial-territorial levels.

The image and pattern that emerges from these sources is both heartening and challenging. In recent years, Canada has emerged as a world leader in school health promotion despite its relatively low levels of resources committed to school health strategies. First Ministers and education and health ministers have agreed to work together on healthy schools. Partnerships on safe schools were established several years ago. Many jurisdictions have programs on community/wrap-around/full service schools. Many school-based educational improvement plans for more effective schooling include health-related objectives.

As well, several new initiatives in research, policy development and knowledge exchange have emerged. New capacities for school health promotion are being developed across the country. Local agencies have been engaged in more topic-based health initiatives and many are seeking more stable and secure policy frameworks and coordinated approaches rather than the sporadic, crisis driven projects of the past. Networks of researchers, practitioners and local agencies have been established and are growing. Knowledge exchange is more extensive. Research centres with a focus on school health have been established by several universities.

However, many of the recent changes are fragile and still dependent upon project-based funding. Practice in the health is still often focused on a few priority diseases. There are no coherent plans to address the needs of disadvantaged students through comprehensive and coordinated approaches. Monitoring and reporting systems are still non-existent and public pressure for regular, reliable reports on health literacy, program status and reports on all aspects of child/youth health is not yet evident.

So, we hope that this synthesis paper on the state of school health in Canada can be followed by regular reports, based on more reliable data and a regular system of reporting and analysis. This is a necessary conversation that should happen every three-four years.

2. Evolution of SH practice

dmccall — Sat, 19 Apr 2008 14:01:40 CDT

The evolution of school health promotion has tended to go across the table below from left to right as well as from top to bottom.


Interventions are aimed at the captive audience in schools. These are usually single interventions (most often instructional in nature) on single health issues that are controlled for quality as they are implemented over a few years, in the hope that they “stick” within the school system. The focus is on individual behaviour change and various theories are used as the basis for successful interventions. To enhance the effectiveness of the interventions, teacher training, parent involvement, youth engagement and coordination with the community are used to support the intervention. Diffusion of innovations theory is sometimes used to explain the process nut more often the focus is placed on whether health behaviour change can be affected by improved health knowledge after a year or two of intervening. Gradually, the intervention is adapted to reach all children and more focus is placed on children who are at higher risk from the problem.		Multiple interventions on single or a selected number of priority health issues are seen to be more effective. At first, these multiple interventions are simply added and not necessarily coordinated. These interventions become coordinated programs or services, rather than just activities or projects. Coordinating these programs is more effective so voluntary coordination mechanisms and processes are developed. Soon, the need to assign coordinators to support cooperation is recognized.	Attention is drawn to the “whole school” and models of health promoting schools, safe & caring schools, effective schools and community/wrap-around/full-service schools are developed as partnerships with the health, law enforcement and social/community services sectors. Educators begin to recognize that the needs of the “whole child” need to be recognized if educational achievement is to be improved. The health and other sectors realize that in order to be sustainable, the primary mandate of the school (educational attainment). The subsequent next step is often to seek evidence of the impact of health improvements on learning. Gradually, it is recognized that successful SH programs are based on realistic assessments of the constraints placed on teachers and other education personnel.	Comprehensiveness is recognized as being essential wherein actions are taken as multiple-levels (not only in schools) and responsibility for SH programs is shared among several sectors. Clusters of risk and protective factors are recognized. Synergies among strategies on single health issues are sought in areas such as chronic disease or social behaviours. Ecological approaches and systems thinking emerge as paradigms for program planning and evaluation.	Capacity building within ministries, agencies, school/agencies and professionals as well as within communities becomes recognized as being more important. These include capacities such as coordinated policy, assigned staff for coordination, mechanisms for cooperation, knowledge transfer, workforce development, monitoring and reporting, issue management and sustainability.	A better understanding of the impact of local community context and social determinants is sought through techniques such as GIS mapping, studies on place and health and other community-development theories. Programs are examined in relation to specific and similar contexts such as low-income communities, rural communities, aboriginal communities and others. Similarly, interest grows in explaining how open, loosely coupled and bureaucratic systems and organizations can be changed over time. These characteristics are examined through emerging theory such as complexity theory and new studies begin to examine how these affect institutionalization and sustainability.

1. Conceptual basis of this report

dmccall — Sat, 19 Apr 2008 13:58:28 CDT

The conceptual basis of this report is as follows:

Research evidence and two decades of practice in school health promotion that suggests that comprehensive approaches that link synergistic, multi-level and holistic responses to clusters of interrelated youth behaviours and contextual factors can lead to coordinated school health programs and services delivered by a variety of agencies and professionals that create and maintain health-promoting schools that not only support health and positive social development among youth but can also support school safety, more community-school cooperation and more effective schooling. There are several models of such comprehensive and coordinated approaches; we have organized them into five essential elements:
- Appropriate policies that are implemented/enforced and evaluated regularly
- Instructional strategies that include appropriate curricula, effective teaching, high quality materials and other supports
- Accessible health and other support services delivered in youth-friendly ways in, through or near schools
- Activities and programs such as parent involvement, youth engagement and community development that increase the social support for healthy behaviours and development
- Assurance that the physical environment of the school and its surroundings, as well as practical resources such as safe and convenient transportation, are available to support health, social development and learning.
Recent research indicating that ongoing system, agency, school, community and professional capacities are required in school health promotion programs are to be sustainable. The Rapid Assessment and Action Planning tool from the World Health Organization (2003) has been adapted for this purpose. These key capacities cover these eight areas:

Explicit policy and managerial support for inter-ministry and multisectoral cooperation,
Use of formal and informal mechanisms of cooperation,
Assigned staff and infrastructure support,
Mechanisms and processes to transfer knowledge,
Ongoing workforce development and pre-service training,
Explicit processes to identify and managing emerging or synergisitc health and social issues,
Regular monitoring and reporting of the health, social behaviours and connectedness, of children and youth to their parents, schools and the community, and monitoring of local agency policies, programs and capacities and monitoring of the health literacy, knowledge and skills of students as well as preparation of some students for health careers
Explicit plan for sustainability, program evaluation and evolution.

Research and practice about effective health promotion suggest that:

social determinants should be addressed directly,
specific sub-populations (eg children of addicts, FASD children) be identified,
decisions about selecting and adapting programs and other interventions should be based research evidence
data about prevalence and about conditions/factors that influence behaviour should be collected regularly and used effectively in program planning and evaluation
investments in promotion and prevention should be increased and gradually shifted awy from treatment and crisis response
well-planned and well supported efforts to engage all stakeholders and several sectors should be implemented and evaluated
the public, communities, parents and students should be engaged in all stages of the activities § realistic expectations about outcomes in health, health literacy/learning and social development/behaviours should be established and monitored.

Systems theory and ecological approaches to health promotion that suggest that perspectives, disciplines and other grounded theories such as diffusion of innovations, organizational development, and other such theories can identify and understand the characteristics. These include:

The core functions of any system should be carefully analyzed and understood (ie educational achievement is the primary consideration for all schools and must be taken into account)
Detailed aspects of the characteristics of open, loosely-coupled and bureaucratic systems will have an influence on adoption, implementation and institutionalization. These include specific items such as adopter concerns, organizational culture, professional norms etc)
Diffusion of innovations theory should be used to plan, implement and evaluate the progress of selected policies, programs and practices
Organizational development, education change research, capacity building and continuous improvement strategies should be mapped out prior to implementing specific interventions so that subsequent change is sustainable and effective

These concepts reflect an evolution in our thinking about effective school health promotion that can be depicted as follows. The evolution occurs across the horizontal and down the vertical axis as shown below as the practitioners become more skilled and knowledgeable:

3. Data Sources & Methodology for this Report

dmccall — Sat, 19 Apr 2008 13:55:37 CDT

The following data sources have been used to prepare this paper:

A survey of education and health ministry capacities undertaken in 2005-06 (McCall, 2006) and subsequently updated through key informant interviews and web searches
provincial/territorial scans on schools and substance abuse (Canadian Centre on Substance Abuse, 2007)
national scan on physical activity/physical education and schools (Canadian Association Health, Physical Education, Recreation & Dance, 2006)
national scan on aboriginal communities & schools (Health & Learning Knowledge Centre, 2006)
national scan on nutrition and schools (Health & Learning Knowledge Centre, 2006)
national scan on aboriginal communities & schools (Health & Learning Knowledge Centre, 2006)
national scan on tobacco & schools (Health & Learning Knowledge Centre, 2006)
national scan on safety/bullying and schools (Canadian Association for School Health, 2007)
preliminary scan of national activities on mental health & schools (Canadian Association for School Health, 2007)
preliminary scan of national activities in sexual health promotion in schools (Canadian Association for School Health, 2007)
review of provincial/territorial curricula in sexual health (Doherty, 2006)
Status Report on School Health and Sexual Health/HIV-AIDS (Council of Ministers of Education, Canada, 1999)
A national survey of school board and school programs in 2006 on air quality, safety, nutrition and physical activity undertaken by the Globe & Mail (2006)
A report on provincial/territorial school nutrition policies (Canadian Centre for Science in the Public Interest, 2007)
Baseline report on school capacities in physical education and physical activity promotion (Canadian Fitness & Lifestyle Institute (2006)
Status Report on School Health and Sexual Health/HIV-AIDS (Council of Ministers of Education, Canada, 1999)
Several selected articles on school health promotion or on comprehensive/coordinated approaches to selected health topics.

Methodology

The methodology for the preparation of this paper is as follows. The researcher who prepared this report is familiar with school health promotion practices in Canada reviewed the sources of information noted above and tentatively summarized the findings within this wiki.

These findings will then be circulated through several networks of national non-governmental organizations, researchers, provincial/territorial coordinators and a variety of other forums. The request to all concerned was to comment on accuracy of the summary and to add any additional information or correct any specific references.

The Board of Directors of the Canadian Association for School Health will be the group of people vetting the final product after it has been circulated among national networks representing 40+ researchers and 45+ non-governmental organizations.

A wiki-based process will be used to collect input from these sources as well as suggestions gathered from over 900 SH contacts in local agencies, participants in an email list of over 2000 and other sources. The final paper will reflect those comments and suggested changes. As well, the electronic record of comments and suggested changes retained by the wiki will be analyzed for a journal article on professional perceptions, awareness, current concerns and practical considerations of practitioners in Canadian school health promotion.

Home

dmccall — Sat, 19 Apr 2008 13:52:42 CDT

This wiki presents an opportunity for Canadian organizations and individual researchers, practitioners and officials to share their findings and throughts about the state and capacity of Canadian school, health and other systems to promote health, safety and social development through schools.

This opportunity is supported by this wiki technology that enables contributors to add, amend, upload, link and comment on the summaries of various reports on how well we are doing in school health promotion in Canada.

This has been done through the preparation of an extensive "report" (actually, it is a synthesis of several reports and data sources) that is meant to be cumulative, collaborative and constructive. The initial draft of this report has been circulated among school health leaders, non-governmental organizations and researchers in Canada. However, we do not see this forum as ever producing a final report. Rather, we see this wiki as a source of data, shared insights and east reference to other, more formal reports.

We thank the Health & Learning Knowledge Centre of the Canadian Council on Learning for the support enabling us to create this forum.

Status Report on School Health in Canada in 2007
Prepared by Douglas McCall, Executive Director, Canadian Association for School Health
The purpose of this paper is to provide an overview of the current state of practice of school health promotion in Canada. It has been prepared for the Health & Learning Knowledge Centre of the Canadian Council on Learning as a means of assessing the current state of practice relating to one of the three priority content areas for that centre (promoting healthy settings for learning and human development)

Table of Contents (Each section is presented on sub-pages off of this page. See Navigation on left margin.)

Conceptual Basis of this Report
Evolution of School Health Promotion Practice
Data Sources & Methodology for this Report
Importance of this Report
Limitations of this Report
Organization of this Report
Findings on National & Provincial/Territorial Capacity
Findings by Health Topic
Findings by Elements of a CSH Approach
Findings by Efforts to Address Local Community Contexts
Findings on Efforts to Address System Characteristics & Change
Findings on the State of SH Research in Canada
Observations from this Consultation & wiki-dialogue
Future Directions of SH in Canada

Appendix: Principles, Key Concepts & Better Practices in SH

Data Sources & Methodology for this Paper

The following data sources have been used to prepare this paper:

A survey of education and health ministry capacities undertaken in 2005-06 (McCall, 2006) and subsequently updated through key informant interviews and web searches
provincial/territorial scans on schools and substance abuse (Canadian Centre on Substance Abuse, 2007)
national scan on physical activity/physical education and schools (Canadian Association Health, Physical Education, Recreation & Dance, 2006)
national scan on aboriginal communities & schools (Health & Learning Knowledge Centre, 2006)
national scan on nutrition and schools (Health & Learning Knowledge Centre, 2006)
national scan on aboriginal communities & schools (Health & Learning Knowledge Centre, 2006)
national scan on tobacco & schools (Health & Learning Knowledge Centre, 2006)
national scan on safety/bullying and schools (Canadian Association for School Health, 2007)
preliminary scan of national activities on mental health & schools (Canadian Association for School Health, 2007)
preliminary scan of national activities in sexual health promotion in schools (Canadian Association for School Health, 2007)
review of provincial/territorial curricula in sexual health (Doherty, 2006)
Status Report on School Health and Sexual Health/HIV-AIDS (Council of Ministers of Education, Canada, 1999)
A national survey of school board and school programs in 2006 on air quality, safety, nutrition and physical activity undertaken by the Globe & Mail (2006)
A report on provincial/territorial school nutrition policies (Canadian Centre for Science in the Public Interest, 2007)
Baseline report on school capacities in physical education and physical activity promotion (Canadian Fitness & Lifestyle Institute (2006)
Status Report on School Health and Sexual Health/HIV-AIDS (Council of Ministers of Education, Canada, 1999)
Several selected articles on school health promotion or on comprehensive/coordinated approaches to selected health topics.

Methodology

The methodology for the preparation of this paper is as follows. The researcher who prepared this report is familiar with school health promotion practices in Canada reviewed the sources of information noted above and tentatively summarized the findings within this wiki.

School Health in Canada - Recently Updated Pages

8. Findings by health or social topic

15. Future directions of SH in Canada

14. Synthesis of comments and additions to this wiki

13. Findings on the state of SH research in Canada

An international and Canadian SH research agenda

Canadian SH research Initiatives

Overview of Research

Responsible for research

12. Findings re efforts to be congruent with education mandate & constraints

Synthesis Report on SH in Canada

11. Findings re: efforts to address systems characteristics

10. Findings re: efforts to address local context

9. Findings by elements of a comprehensive approach, coordinated program, whole school strategies

7. Findings on Provincial/Territorial Capacity

National

Provincial/Territorial

Provincial/Territorial

Provincial/Territorial

Provincial/Territorial

Provincial/Territorial

Provincial/Territorial

Provincial/Territorial

Provincial/Territorial

Appendix: Key points, concepts, practices in SH

6. Organization of this report

5. Limitations of this report

4. Importance of this report

2. Evolution of SH practice

1. Conceptual basis of this report

3. Data Sources & Methodology for this Report

MethodologyThe methodology for the preparation of this paper is as follows. The researcher who prepared this report is familiar with school health promotion practices in Canada reviewed the sources of information noted above and tentatively summarized the findings within this wiki.

Home

MethodologyThe methodology for the preparation of this paper is as follows. The researcher who prepared this report is familiar with school health promotion practices in Canada reviewed the sources of information noted above and tentatively summarized the findings within this wiki.

Methodology

The methodology for the preparation of this paper is as follows. The researcher who prepared this report is familiar with school health promotion practices in Canada reviewed the sources of information noted above and tentatively summarized the findings within this wiki.

Methodology

The methodology for the preparation of this paper is as follows. The researcher who prepared this report is familiar with school health promotion practices in Canada reviewed the sources of information noted above and tentatively summarized the findings within this wiki.