List of Better Practices in this Workbook

Detailed List of Better Practices

Here are the ten dimensions of a new paradigm for School Health Promotion (SHP).Scroll down this page for a detailed listing.
Note: As we complete the pages for each of the better practices listed below, we will activate a link to that page from this list/table of contents

Dimensions of SHP in the 21st Century
     - Before You Begin: Develop or Strengthen your Shared Vision & Goals
     A. Understand Your Context, Find Similar Jurisdictions to Share Knowledge
     B. Better Data, Focus Your Resources
     C. Address Needs of the Whole Child, All Children, Especially the Disadvantaged & Vulnerable
     D. Choose evidence-based and experience-tested interventions and then combine several into multiple intervention programs (MIP’s
     E. Combining these selected multi-intervention programs into a multi-component approach (MCA), Align with other MCA's
     F. Build & Maintain the Core Components
     G. Ensure High Quality Implementation leading to Maintaining, Scaling-up/down, Sustaining Programs and Approaches
     H. Build & Maintain System & Organizational Capacity
     I. Integrate Health & Social Programs Within the Core Mandates, Constraints, Concerns of Education Systems
     J. Use Tools from Systems Science/ Organizational Development
     - Addendum: Significant Research Questions and Lines of Inquiry

Detailed List of Better Practices

Preliminary: Verify, Develop, Strengthen your Shared Vision and Goal

A. Understand Your Context, Do a Situation Analysis, Find Similar Jurisdictions to Share Knowledge

Define & Learn about Country & Community Contexts
1. Low Resource Countries
2. Conflict/Disaster Affected Countries
3. Middle Resource Countries
4. High Resource Countries
5. Mega-Countries
6. Small Island Developing States
7. Indigenous Communities
8. Disadvantaged Communities in High Resource Countries
9. Affluent Communities
10. Religious Communities
Conduct a Situational Analysis
Regular knowledge exchanges with similar jurisdictions (e.g South to South (Low Resource Countries), Education in Emergencies,

B. Better Data, Focus Your Resources

Agree on national priority issues and strategies based on your situational analysis
1. The health & social issues to be addressed have been documented and jointly agreed to as priorities. These priorities have been communicated to all stakeholders.
2. Establish process allowing for local agency and school level choices as well
Focus your resources on these issues from your situational analysis
Select/develop/use surveys/databases tracking child/adolescent health & behaviours
Select/develop/use a SH policy/program survey
Select/develop/use a student HPSD learning survey
Establish format and frequency for reporting on student and school health promotion capacity

C. Address Needs of the Whole Child, All Children, Especially the Disadvantaged & Vulnerable

Define, describe & publish your values, vision of how health, personal, social and sustainable development of children will be acted upon in your SH promotion approach
Describe how your SH promotion approach and programs will increase access to schooling at all levels and how you will monitor enrolment, participation/dropout, truancy, chronic absences and/or student suspension rates
Describe how your SH promotion approach and various specific programs will support vulnerable student sub-populations, including girls in low resource countries, boys in high resource countries, cultural and sexual minorities, refugees, rural and urban poor students, students with disabilities or chronic illness etc.

D. Choose evidence-based/experience tested interventions, build multi-intervention programs (MIP’s)

The specific populations to be served by the priority interventions have been selected, described and analyzed.
Select core sets of interventions to be delivered on each priority issue based on research, data and/or experience as well as cost, complexity and feasibility. Indicators and targets have been established for each intervention and for outputs on the issue at the end of primary and secondary schooling.
A process has been established to ensure that the number of interventions on an issue accumulate/grow into a “multi-intervention program”. This process should use an evidence-based and experience-tested outline for addressing such broad health & social issues.
Processes and controls are in place to reduce the proliferation of projects and avoid attempts to address too many issues at once.

E. Combining these selected MIP’s into a multi-component approach (MCA) such as Health Promoting Schools, School Health & Nutrition etc. and ensure that this adopted MCA is aligned with other MCA’s being used by other sectors

Select/develop/define/describe your selected multi-component approach(es) (MCA) to promote the education, health and development of students, staff and parents.
If more than one multi-component approach is being used in the country/state, there is an agreement on how the application and operation of these MCA’s will be aligned or coordinated.

F. Build & Maintain the Core Components

Over-arching SH Policy
1. A cyclical policy-making/review process is used to regularly review and update the SH policy
2. Encourage or require multiple components/interventions
3. The policy emphasizes equitable opportunity
4. The policy is supported by a current action plan
Establish, Maintain a Strategic National/Sate Action Plan
    i) Health, Education, Other Ministry Service Plans
    ii) Local Health, Education, Other Agency Service Plans
    iii) School, Clinic, Professional Service Plans/Guidelines
Establish a Core HPSD Education/Instruction Program (overview, delivery options)
1. Core HPSD Curriculum/Subject & Classroom Instruction
2. Core Home Ec./Family Studies/Financial Literacy Curriculum
3. Core PE Curriculum/Instruction
4. Vocational/technical education in health, related careers
5. Planned, scoped, sequenced cross-curricular Instruction
6. Use of school routines, school organization
7. Correlations with school climate, school discipline
8. Use of co-curricular activities
9. Use of extra-curricular activities
10. School-linked web-based learning
11. School-linked, family-based learning
12. School participation in community education, youth programs
13. Teacher Education & Development
14. Teacher Wellness
Define Minimum Set of School Health Services & Waiting Times
1. Defined set/package of school-based, school-linked services
2. School Health Services (Preventive, Primary Care)
3. School-based Health Clinics
4. School-based Vaccinations/Immunization
5. School-based management of chronic, severe health conditions
6. School-based Management of students with disabilities
7. Role, training of school nurses
8. Role, training of school psychologists
9. Role, training of school preventive health care physicians
10. Role, training of donor-funded aid workers
11. Role, training of school health coordinators
Social Environment, Support, Involvement & Engagement
1. Build & maintain positive social environment, school climate
2. Adopt, enforce, school discipline/conduct codes for students, teachers, parents, volunteers
3. Consult, engage, empower students
4. Inform, consult, educate, support, involve parents
5. Inform, involve community elders, organizations, agencies, authorities
6. Awareness, safety, effective use of social media
Physical Environment, practical resources
1. School Construction, retro-fitting to reduce disaster risks
2. Clean water
3. Sanitary private, safe bathrooms, latrines
4. School meals/healthy food for all students
5. Safe routes to school
6. Disaster/emergency risk reduction planning
7. Stepped strategy for “greening” school grounds & facilities

G. Ensure High Quality Implementation leading to Maintaining, Scaling-up/down, Sustaining Programs and Approaches

Consider scope of your efforts: distribution? dissemination? Diffusion?
Explicit plan for scale-up, scale down, succession planning
Intervention Mapping
Intervention “fit” within your context, organization, other agencies
Use effective planning mechanisms
Use evidence-based, experience-tested implementation model
Anticipate local drivers/barriers to change
Identify threshold/levers for sustaining the SHP approach, multi-intervention programs

H. Build & Maintain System & Organizational Capacity

Identify and secure start-up and baseline, on-going staffing and funding needs
1. Transition from external project/start-up to ongoing program/budget
2. Estimated need/capacity in curriculum/other parts of school day for education
3. Estimated need/capacity-waiting time for defined minimum services/staffing
System/Organization Capacities (overview)
1. Coordinated Policy & Leadership (Designated senior manager as lead, support statement from CEO)
2. Assigned staffing to coordinate at all levels (At inter-ministry, inter-agency and school/neighbourhood levels)
3. Formal, informal mechanisms for coordination, cooperation (inter-ministry and inter-agency committees, national/state coalition, joint budgeting/service planning, joint professional development etc.)
4. Ongoing knowledge development and exchange (National SH Association/network, designated university centres, easy access to knowledge products etc.)
5. Pre-service education & ongoing in-service development of SH Workforce: workforce planning of educators, other professionals
6. Regular monitoring, reporting, evaluation and improvement planning (Integrated within MOE school improvement planning, integrated within MOH HP monitoring, regular use/analysis of GSHS/HBSC, regular use/analysis of international SH Policies, Program Survey, regular use/analysis of randomized testing of student KAB, effective use of school accreditation/awards scheme, periodic evaluations of different SH programs/initiatives etc.)
7. Early identification, joint, strategic management of issues (Joint list of priority issues, protocol to agree on new issues, discontinue older programs etc.)
8. Explicit planning for sustainability (Succession plans at ministry, agency and school levels)

I. Integrate Health & Social Programs Within the Core Mandates, Constraints, Concerns of Education Systems

Health, social services and other ministries have new formal partnership model to integrate their programs within core business of education system
1. Negotiated allocation of roles, resources across ministries, agencies, schools
2. All initiatives involving schools go through one designated SH team
3. Explicit and first consideration of education/learning related needs (health for learning approach), including girls education in LRC’s, integrated package of student services, reductions in chronic student absences, diverting troubled students from suspensions, multi-intervention dropout prevention programs etc.
Alignment of work within concerns, routines, structures of education system
1. Anticipate how community norms, values will contrain school’s ability to intervene (e.g. parental privacy, religious beliefs, stigma etc.)
2. Deepen understanding of impacts of teacher beliefs, professional norms, identities, work lives, concerns, stress, social backgrounds etc.
3. Recognize professional autonomy of teachers by providing easy access to updated collections of educational resources/lesson ideas rather than prescribed, prepared instructional packages that are welcomed, then discarded
4. Use updated pedagogical models (e.g. constructivist, project-based learning) but curtail expectations of coverage of the number of topics if such inter-active teaching/learning methods are to be used
5. Build teams of teachers & others within the constraints of limited planning time, professional norms
6. Fit within the stages/structures and current models used in teacher education and development, including support for induction, coaching, mentoring, adult learning and professional socialization/ developmental approaches
7. Invest more in the workforce, education and training of non-educational personnel that will work closely with educators in schools and other parts of the education system
Focus on the growth and development of the whole child rather than directing attention and resources only on specific diseases, behaviors, or conditions as separate or siloed entities
1. Choose and follow guidance from selected evidence-based, experienced-tested paradigms such as youth assets, positive youth development, global citizenship, social & emotional learning, resilience and others
2. Ensure that all issue/problem-focused initiatives are delivered within your selected multi-component approach and that part of the new resources assigned to these prevention programs are used to maintain the core components such as core HPSD education program, core set of school health services, core social support mechanisms and a safe, healthy physical environment
3. Health and other sectors should join with education to promote an HPSD education program within a broadly-based set of core subjects offering a wide breadth of learning opportunities for all students
Realign of health and other sector efforts based on a systems-based, organizational development approach that includes capacity-building and continuous improvement
1. All sectors should develop, implement and maintain “no-blame”, incremental, long-term strategies for working within the education sector that emphasize shared responsibility and leadership.
2. Recognize and address the characteristics of education (and health) systems including bureaucratic structures, loose-coupling, multi-layered, always open to competing demands, bias favouring knowledge rather than skills or attitudes etc.
3. Align systems change strategies with current published models being used by educators to guide educational change (e.g. Concerns-Based Adoption Model, Fullan’s Tri-Level Model etc.)
4. Health and other sectors should seek to influence a variety of school and education system structures, consultative and decision-making processes, practices and organizational routines (e.g. parent advisory meetings, staff councils, student councils, regular meetings of school principals, appointed or elected school boards, designated sections within education responsible for student services, curricula, disadvantaged students, basic education etc.)
5. Health & other sectors should designate how their respective core sections/mandates will function when working with school systems. For example, the health promotion function/section within health departments and ministries should take the lead with regard to schools with regard to promotion and prevention activities rather than health teams working on specific diseases or other problems. The health care section in health agencies should focus on school-based and school-linked health services.
6. Health and other systems/sectors should commit to using & maintaining long-term, multi-component approaches that are based on a shared responsibility for delivering multi-faceted approaches to school health promotion.
7. The health, social, safety, welfare, development, education and other sectors should jointly develop and maintain a joint monitoring and reporting system for assessing the reach and status of relevant policies, programs, practices and qualifications of personnel, agencies and ministries in several sectors that work with schools. Monitoring should not be solely reporting on the actions of educators or the education system.
Health and other systems should commit to maintaining long-term, multi-component approaches and to providing ongoing human and financial resources to work within education systems
1. Health and other sectors should make ongoing investments in capacity and capacity-building within their own sectors that go beyond the transfer of knowledge about effective programs to employees (See Section H above)
2. The health, social, development and other sectors should establish comprehensive policies and action plans to guide their partnerships with the education systems. They should:
  - define explicit goals for working with their respective education systems and then codify them in joint ministry statements, service agreements and protocols,
  - establish requirements for their local agency service delivery regarding their local partnerships with local education authorities,
  - identify and then provide the funding for the staffing and training for the front-line workers or local agency (e.g. school nurses, social workers, resource officers, youth workers, psychologists and others) that will work with teachers and within schools
3. The health and other sectors should define minimum service delivery levels/maximum waiting times as part of their relationship building with education systems.

J. Use Concepts/Tools from Systems Science/ Organizational Development

Explicit recognition in policy and practice guidelines that ecological approach and systems-focused actions are required
1. Discourage use of settings such as schools as a “way to reach individuals” (i.e. single interventions to captive audience) and insist on settings-based health promotion being aimed at the changing the conditions, structures, organization and capacities of the setting to better promote health
2. Insist that linear logic models on specific programs/interventions always be positioned within complex, multi-faceted ecological models that limit, affect, determine long-term effects and sustainability of the individual interventions
3. Develop or select a published model of continuous improvement or total quality management
4. Going from “systems thinking” and “ecological analysis” to explicit, planned use of concepts and tools from “systems science and organizational development” in policy/program planning, in calls/funding of research and practice guidelines
Examine, understand and plan for impact of system, organizational characteristics
1. Understand, address implications of open systems including open, adaptive organizations, system stasis, system boundaries, environmental-organization interactions, adsorptive capacity and others
2. Understand, address implications of decision-making in loosely coupled systems including adopter concerns, role/styles of CEO’s in hierarchies, bureaucracies, role of middle managers, organizational culture, influence of expert knowledge, etc.
3. Understand, address implications of “professional bureaucracies” including multi-level, complex, large organizations, structures, organizational routines, social/informal networks within large organizations, non-rational decision-making, sociological background of workers, professional norms and taboos, policy levers and others.
Understand, address complexities of working across multiple, multi-level systems, agencies
1. Understand, address inter-organizational cooperation and competition
2. Understand, plan for different types/degrees of cooperation, coordination and merger
3. Understand, plan, implement, maintain “whole of government” strategy
4. Understand implications and contradictions in strategies such as Health in All Policies (HiAP)

Addendum: Outline of a Research/Knowledge Development Agenda for School Health Promotion