Finding a place for health in the schooling process: a challenge for education.

Finding a place for health in the schooling process: a challenge for education. It is common in schools for health and education goals to be seenas agendas that are in competition. However schools do attempt to findtime in crowded curriculums to cover health issues as part of theirresponsibility towards advancing the health of their students. Aqualitative approach was used in this study to explore perceivedoutcomes of a Health Promoting School intervention A procedure used in a lawsuit by which the court allows a third person who was not originally a party to the suit to become a party, by joining with either the plaintiff or the defendant. project. The projectschools targeted for in-depth in-depthadj.Detailed; thorough: an in-depth study.in-depthAdjectivedetailed or thorough: an in-depth analysis study were purposefully pur��pose��ful?adj.1. Having a purpose; intentional: a purposeful musician.2. Having or manifesting purpose; determined: entered the room with a purposeful look. sampled to includediversity based on location, level, system and specific healthactivities. The results showed that the schools involved were movingbeyond oppositional constructions of health and education towardsapproaching health as an element of effective schooling. It is concludedthat in any effective health promotion activity in schools, the agendaneeds to be driven primarily by an education sector that hasdemonstrated it can embrace holistic approaches holistic approachA term used in alternative health for a philosophical approach to health care, in which the entire Pt is evaluated and treated. See Alternative medicine, Holistic medicine. to health, with thehealth sector acting as partner and facilitator. ********** We should be doing more in the health area but the curriculum is already overcrowded ... The development of literacy and numeracy skills must be priorities, and time and professional development opportunities must be found to continue progress in these area ... And we must develop initiatives to improve student welfare and continue to improve teaching and learning throughout the school ... How do we find the time for health? (Primary school principal) Health in schools: An acknowledged area of concern As part of a school review and forward planning forward planningn → planificaci��n f por anticipadoprocess, theprimary school principal above verbalised a range of demands that hisschool was facing, including learning outcomes, teaching, welfare andhealth. There are two key issues in this extract. First, the quotereflects a common discourse in schools that there is trade-off betweenhealth and education outcomes--you invest in one at the expense of theother. However recent work in comprehensive health promotion in schoolshas begun to call into question this kind of dichotomy di��chot��o��my?n. pl. di��chot��o��mies1. Division into two usually contradictory parts or opinions: "the dichotomy of the one and the many"Louis Auchincloss. . Although theresearch reveals differences in health and education agendas, it alsopoints to a good deal of overlap o��ver��lapn.1. A part or portion of a structure that extends or projects over another.2. The suturing of one layer of tissue above or under another layer to provide additional strength, often used in dental surgery.v. and synergy The enhanced result of two or more people, groups or organizations working together. In other words, one and one equals three! It comes from the Greek "synergia," which means joint work and cooperative action. between the agendas of thetwo sectors (Kolbe Kolbe is a surname, and may refer to: Adolph Wilhelm Hermann Kolbe (who gave name to Kolbe electrolysis and Kolbe-Schmitt reaction) Fritz Kolbe, World War I spy Georg Kolbe, sculptor Jim Kolbe, former Congressman from Arizona (1985-2007) , 1993; Samdal, Nutbeam, Wold, & Kannas, 1998;Symons Sy��mons? , Arthur 1865-1945.British poet and literary critic who translated many French symbolist works into English and wrote The Symbolist Movement in Literature (1899).Noun 1. , Cincelli, James James, person in the BibleJames,in the Gospel of St. Luke, kinsman of St. Jude. The original does not specify the relationship.James, rivers, United StatesJames. , & Groff groff - GNU roff.GNU's implementation of roff in C++.See also nroff, troff.Version 1.07 by James J. Clark <jjc@jclark.com>.FTP groff-1.07.tar.z from a GNU archive site. , 1997; World Bank, 1993; WorldHealth Organisation, 1996). Second, traditionally the health andeducation sectors have taken quite different approaches to promotinghealth. The health sector has tended to focus on single issues (e.g.nutrition, STDs, drugs) and conceive of Verb 1. conceive of - form a mental image of something that is not present or that is not the case; "Can you conceive of him as the president?"envisage, ideate, imagine schools as convenient settingsfor reaching a particular target group to influence behaviours (StLeger, 1992; St Leger & Nutbeam, 2000a). The education sector, onthe other hand, has understood health more as one of a number of keylearning areas and, in dealing with health, has focused on knowledge,understanding and cognitive skills cognitive skillPsychology Any of a number of acquired skills that reflect an individual's ability to think; CSs include verbal and spatial abilities, and have a significant hereditary component . In practice, the school contributionto health is seen by schools as finding time in a crowded curriculum todevelop knowledge and skills that will promote better learning andhealthier approaches. In this way, schools have accepted theirresponsibility to respond to wider community health concerns but, likethe principal in the above vignette VignetteA symbol or pictorial representation of the corporation on a stock certificate. Usually a complicated and artistic design, it is meant to make the counterfeiting of stock certificates as difficult as possible. , schools are aware of theirlimitations. Extending health education beyond curriculum content Health, as part of schooling, has been promoted since 1910. Fromthat time, the focus of school health has gone through three phases: 1 health instruction (1910 to mid- mid-pref.Middle: midbrain.1950s): where students wereinstructed to be fit (called physical culture), not use alcohol(temperance TemperanceAlcoholics Anonymous (AA)organization founded to help alcoholics (1934). [Am. Culture: EB, I: 448]amethystprovides protection against drunkenness; February birthstone. instruction), and have `pure thoughts'--the first forayinto Verb 1. foray into - enter someone else's territory and take spoils; "The pirates raided the coastal villages regularly"raidencroach upon, intrude on, obtrude upon, invade - to intrude upon, infringe, encroach on, violate; "This new colleague invades my moral education; 2 health education (mid-1950s to 1980s): where emerging healthknowledge was incorporated into the curriculum (particularly in thefields of nutrition and biological sexuality), and focused onclassroom-based education with few formal links to the health sector;and 3 health promotion (early 1980s until the present): wherehealth-related interventions in schools are incorporating the curriculumand include school-based policies and links to the local community. (StLeger, 1991) The basis for an extended view of school health in this third phasecan be found in the concept of the Health Promoting School (HPS See Seer*HPS. ). TheHPS movement, with its origins in the World Health Organisation's(WHO) Ottawa Charter, has become prominent in national and internationalefforts over the past decade to improve the health of students. Ratherthan focusing on individual behavioural Adj. 1. behavioural - of or relating to behavior; "behavioral sciences"behavioral change, the HPS concept wasdeveloped from a socio-ecological perspective in which health isconsidered to emerge from a range of individual, social and politicalconsiderations (Nutbeam, 1992; WHO, 1986). The HPS framework has beenembraced by the European Community European Community:see European Union. European Community (EC)Organization formed in 1967 with the merger of the European Economic Community, European Coal and Steel Community, and European Atomic Energy Community. , and closely resembles theCoordinated School Health initiatives (CSH csh - C shell ) in the United States ofAmerica UNITED STATES OF AMERICA. The name of this country. The United States, now thirty-one in number, are Alabama, Arkansas, Connecticut, Delaware, Florida, Georgia, Illinois, Indiana, Iowa, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Mississippi, Missouri, New Hampshire, (Allensworth 1995; Tones 1996). Essentially the HPS--while acknowledging the importance of thecurriculum--moves beyond the classroom in order to identify and providea framework for working with the various components of schooling thatimpact on health opportunities for students. Attention is directed notonly towards the curriculum, but also towards physical and socialenvironments; school-based health policies; links with health services health servicesManaged care The benefits covered under a health contract ;and school partnerships with various sections of the community. The HPSframework groups the range of school operations and characteristics intothree areas, as illustrated in Figure 1. Figure 1 The Health Promoting Schools framework (adapted from WHO1998) * Curriculum, teaching and learning--What the school teaches inrelation to health and health skills, and the nature of the teaching andlearning processes that are part of all classrooms. * School organisation, ethos e��thos?n.The disposition, character, or fundamental values peculiar to a specific person, people, culture, or movement: "They cultivated a subversive alternative ethos"Anthony Burgess. and environment--The school'svalues and ethos, its organisation, structures and policies, and itssocial and physical environments. * Community links and partnerships--Links between schools and theircommunities, particularly their relationships with parents and families,and their linkages with community agencies and services. Promoted by the WHO, the HPS framework has gained credibility overthe last decade, with many countries, including Australia, working onHPS programs to support schools and their communities in more holistichealth holistic health,n a concept in which concern for health requires a perspective of the individual as an integrated system rather than as a collection of parts and functions. actions (Ridge, Marshall, Northfield, Maher, St Leger, Sheehan,& Elisha, 2000; WHO, 1996). There is an emerging evidence-based casefor supporting HPS (Lister-Sharp, Chapman, Stewart-Brown, & Sowden,1999; St Leger & Nutbeam, 2000b). The impact of school healthpromotion initiatives on the health of students is positive andconsidered cost effective (Rothman, Ehreth, Palmer, Collins, Reblando,& Luce, 1994). Additionally the links between good health andfavourable education outcomes are now clearly established in theliterature (Brellochs 1995; National Health and Medical ResearchCouncil The National Health and Medical Research Council (NHMRC) is Australia's peak funding body for medical research, with a budget of nearly A$500M a year . The Council was established to develop and maintain health standards and is responsible for implementing the , 1996; Samdal et al., 1998; Symons et al., 1997; WHO, 1996). Given the emerging evidence of the need for a multifaceted mul��ti��fac��et��ed?adj.Having many facets or aspects. See Synonyms at versatile.Adj. 1. multifaceted - having many aspects; "a many-sided subject"; "a multifaceted undertaking"; "multifarious interests"; "the multifarious approachto health in schools, the Faculty of Health and Behavioural Sciences Behavioural sciences (or Behavioral science) is a term that encompasses all the disciplines that explore the activities of and interactions among organisms in the natural world. atDeakin University .*R1 refers to Academics' rankings in tables 3.1 - 3.7 in the report. R2 refers to Articles and Research rankings in tables 5.1 - 5.7. No. refers to the number of institutions compared with Deakin.. and the Victorian Department of Education, Employmentand Training (DEET) implemented a project (referred to as `theProject' in this paper) to establish the HPS framework in Victoriaas the basis for schools' approaches to comprehensive healthpromotion. VicHealth funded the HPS Project from 1997 until late 2000.In the Project, schools were expected to set priorities for action, andplan and then implement health promotion projects in their schools overa one-year period. In order to encourage a holistic approach, theProject provided a range of resources including a tool for staff toaudit what was already happening in their schools in terms of healthpractices and policies; professional development for teachers; fundingfor teacher release time; assistance in strategic planning Strategic planning is an organization's process of defining its strategy, or direction, and making decisions on allocating its resources to pursue this strategy, including its capital and people. ; and varioussupport resources such as regular newsletters and a guidebook (Ridge etal., 2000). A diverse range of 100 schools were chosen for inclusion inthe Project, based on criteria such as location (urban and rural schoolsincluded); past school health initiatives; level (primary andsecondary); and system (government, Catholic and independent). Formalevaluation and feedback In intelligence usage, continuous assessment of intelligence operations throughout the intelligence process to ensure that the commander's intelligence requirements are being met. See intelligence process. was also provided to schools. The current paperdraws predominately on qualitative data from the evaluation phase of theProject to explore the role of health in contemporary Victorianeducation. As discussed in this paper, some schools in Victoria aremoving beyond more limited and polarised constructions of health andeducation into an era where the concerns of health are beingconceptualised as consistent with contemporary approaches to goodschooling. As a consequence, certain opportunities and ways forward arepresenting themselves. Methodology Given the limited timeframe of the HPS Project, the developmentalnature of the Project, the foci of schools and evidence from evaluationsof major international school health intervention health interventionHealth care An activity undertaken to prevent, improve, or stabilize a medical condition programs, it was clearfrom the outset that the diverse activities under the Project'sumbrella would not clearly change the behaviour of students, or perhapseven improve their health within the evaluation timeframe. Even if suchchanges were noted, it would have been difficult to attribute them tothe Project given that it operated in complex contexts, whereinterventions were often multifaceted and operating alongside otherschool health initiatives (e.g. Turning the Tide--a Victorian drugeducation program, sun protection campaigns, tobacco reductionprograms). Instead of focusing on behavioural and health outcomes, itwas decided by the research team that the evaluation needed to focus onprocesses, meanings and perceptions of outcomes within an educationalsetting. The quantitative methods used in the HPS evaluation are describedin detail elsewhere in the literature (Ridge et al., 2000; St Leger,Maher, Ridge, Marshall, Sheehan, & Gibbons Famous people named Gibbons include: Beth Gibbons (born 1965), British singer Billy Gibbons, guitarist for ZZ Top Cedric Gibbons (1893–1960), American art director Christopher Gibbons (1615 - 1676), English composer, son of Orlando , in press). Briefly thesequantitative methods involved a pre- pre-word element [L.], before (in time or space). pre-pref.1. Earlier; before; prior to: prenatal.2. and post-audit Post-auditA set of procedures for evaluating a capital budgeting decision after the fact. to determine whatwas happening in all of the 100 schools in terms of health practices andpolicies under the main headings of the HPS framework before and afterthe intervention. The audit also investigated perceived outcomes fromthe Project. The qualitative arm of the evaluation--with a focus onprocesses, perceptions and meanings--provided the bulk of the dataunderpinning un��der��pin��ning?n.1. Material or masonry used to support a structure, such as a wall.2. A support or foundation. Often used in the plural.3. Informal The human legs. Often used in the plural. this paper. A case study design was incorporated into theevaluation since it can capture real-life complexities of processes andoutcomes using both qualitative and quantitative data, and theliterature suggests that such an approach is optimal in HPS evaluationwork (Inchley, Curry, & Young, 2000; Lister-Sharp et al., 1999; WHO,1996). In late 1999, 13 out of the 100 schools involved werepurposefully sampled for case study. These schools were invited forinterviews on the basis of a range of criteria, including level(primary, secondary, P-12); location (urban, regional); system(government, Catholic, independent); and kinds of HPS activities thatwere underway. Key questions asked in the interviews were: How did theschool become involved in the HPS Project and who worked in the Project?How did the HPS Project find a focus, and how was the Projectimplemented and kept on the school agenda? What unique contexts wereinvolved? What were the outcomes, and to what extent would changes haveoccurred without the Project? What kinds of partnerships were encouragedby the Project, if any? What was the comprehension comprehensionAct of or capacity for grasping with the intellect. The term is most often used in connection with tests of reading skills and language abilities, though other abilities (e.g., mathematical reasoning) may also be examined. of the HPS concept? Two researchers attended each school and interviewed between oneand four school community members. Where more than one person wasinterviewed at a school, interviews were conducted with pairs ofinterviewees in order to encourage discussion about answers. Althoughthe interviews tended to be informal and directed by the conversation, adetailed interview schedule was used to ensure that all questions wereadequately covered. All interviews lasted between 90 and 120 minutes.Financial support was made available for teachers and other schoolpersonnel to be released for interview. All of the interviews wererecorded and fully transcribed by a professional transcriber. Analysisof secondary documentation already collected from the schools (e.g. HPSschool's register, school charters, newsletters, strategic plans)was also undertaken in order to identify the extent of HPS-relatedactivities undertaken in schools, as well as to identify major patternsand themes in the implementation of projects. Case studies were writtenup for each of the schools. Schools were sent drafts of the case studiesto review, and each school was asked to approve the final version forinclusion in a handbook For the handbook about Wikipedia, see .This article is about reference works. For the subnotebook computer, see . "Pocket reference" redirects here. entitled en��ti��tle?tr.v. en��ti��tled, en��ti��tling, en��ti��tles1. To give a name or title to.2. To furnish with a right or claim to something: Health Promoting Schools in action: Aguide for schools. In addition, one urban and one rural focus group were conductedshortly after the case study interviews were completed. All 87 schoolsthat had not been involved in case study interviews were invited toattend these focus groups. The two focus groups were timed to permit thefeeding in of themes emerging from the earlier interviews. Focus groupsfurther investigated resources used in the HPS project, the role ofother projects (e.g. Turning the Tide), sustainability and outcomes. Theurban focus group included participants from all four urban DEETregions. The rural focus group included representatives from DEETregions not included in the case study interviews. In analytical analytical, analyticpertaining to or emanating from analysis.analytical controlcontrol of confounding by analysis of the results of a trial or test. sessions that were conducted after all of the focusgroup interviews, assertions were put forward by the authors anddebated. The assertions that could be defended were then used inconjunction with the transcripts and case study drafts to develop theanalysis being conducted by the first author. General themes emergingfrom the case study and focus group data were recorded manually. Otherresearchers in the team then critiqued the draft analysis. Feedback fromteachers was incorporated into the final analysis. Results and discussion The qualitative evaluation of the Project showed that schoolsinvolved in interviews were prepared to review and contest sometraditional school health and education assumptions of practice. The keyassumptions challenged are identified and discussed below. Reconceptualising school health School A `We were a growing school ... children outside were becoming involved in more conflict situations, they didn't have a great deal to do outside.' School A is a young primary school serving a number of developing housing estates in Melbourne's west. The school has always had a serious commitment to health, yet teachers were noticing more conflict among students in the playground. The initial focus for the HPS effort was to encourage student involvement in more useful outdoor activities. An equipment borrowing system was set up which promoted student responsibility in equipment distribution, use and return. This HPS effort was expanded after observations of the playground. These observations suggested that it was also important for teachers to take up issues emerging in the playground and spend some regular classroom time having students reflect on issues. Hence the `Take Five' program was established. Here childrens' experiences were used to raise issues such as bullying, relationships, co-operation and respect for differences. More recently, interest in health has expanded to the importance of staff welfare. A staff fitness competition was implemented to help encourage this new focus. The school is currently considering peer mediation and parent involvement in HPS efforts. `The HPS project ... gave us a target ... a framework to set out our goals ... something to aim for.' For a number of schools that participated in the case studyinterviews and focus groups, the conceptualisation (artificial intelligence) conceptualisation - The collection of objects, concepts and other entities that are assumed to exist in some area of interest and the relationships that hold among them. of school healthmoved from a perception of health as a content area of the curriculumtowards a perception of health as being shaped by a wide range of schoolcomponents including student and parental involvement in decisionmaking, physical environments, sense of belonging, adequacy of communityservices and professional development. This shift in healthunderstanding in schools was clearly anticipated by the authors from theoutset, given the equal emphasis on the three components of health inthe HPS framework (see Figure 1). The audit of school health activitiesconducted by individual schools at the beginning of the HPS project inearly 1997 indicated that much health promotion work was occurring inschools at a variety of levels, even if it was not labelled as such(Ridge et al., 2000). According to according toprep.1. As stated or indicated by; on the authority of: according to historians.2. In keeping with: according to instructions.3. schools that participated in thequalitative interviews, the audit turned out to be a valuable educative ed��u��ca��tive?adj.Educational.Adj. 1. educative - resulting in education; "an educative experience"instructive, informative - serving to instruct or enlighten or inform exercise in that it revealed the different components of school lifethat can shape health, what the school was doing, and what still neededto be done. The main directions each of the case study schools took in theProject are summarised in Table 1. From the table, it is clear that thecase study schools focused on a range of components shaping schoolhealth that went well beyond the curriculum. Practices and policies wereprominent around staff health and welfare, positive schoolrelationships, and student mental health, particularly bullying BullyingChowne, Parson Stoyleterrorizes parish; kidnaps children. [Br. Lit.: The Maid of Sker, Walsh Modern, 94–95]Claypole, Noahbully; becomes thief in Fagin’s gang. [Br. Lit. . A number of the schools promoted health agendas through aneducational focus. The development of student welfare policies andpractices, and improvement of teaching and learning approaches were seenby schools as important steps in promoting health at the school level(Ridge et al., 2000). Interviewees attributed changes in students, theirschools and associated community links to school involvement in theProject (see Table 2). The reported school achievements of the Projectincluded greater awareness of, and skills in: health promotion; betterlearning outcomes; better student participation; increased perceptionsof student and teacher wellbeing; better co-ordinated and morecomprehensive health promotion approaches; improved social environments;and better links with the community. Many of these kinds of changes arereally about better, more effective schools. Confirming these results,in the post-project audit 93 per cent of the 100 project schoolsindicated that they felt they were `better equipped to implementeducation system policies and requirements concerning studentwelfare', and 69 per cent indicated that they felt their teachingwas more student-centred (Ridge et al., 2000). Building community links School B School B is a large primary school with over 800 children in a growing western suburb of Melbourne. There is a tradition of community participation. The primary focus for the school's HPS effort was to build a beautiful `passive garden' area where students, staff and parents could go for quiet activities. A committee was formed including interested students, staff, parents and a community health officer. An implementation plan was developed, including a student competition to design the garden. An audit of parent skills to build the garden was undertaken. Newsletters kept the community informed, working bees were programmed and local businesses were drawn in (some even donated materials). In describing the project, one teacher said it `took on a life of its own'. The result was a garden with a paved area, amphitheatre, sails, gazebo, waterfall, sandpit, tables, chairs and a mural. The HPS activities of the school were expanded to include policies in the area of staff wellbeing, drugs and sexuality, all with an appreciation of the importance of community links. Analysis of the delivery of school health initiatives in theProject schools detected some shift away from the reliance on schoolstaff time and expertise and a focus on the curriculum to a greaterinvolvement of community agencies and partnerships with the healthsector (Ridge et al., 2000). This happened because the Project broadenedawareness of the wider community/agencies/services available to schools,and a range of relationships and partnerships were initiated or enhancedin project schools. There was something about the nature of tacklinghealth issues comprehensively that helped schools to overcome sometraditional barriers between them and their communities. The evaluationshowed a number of productive relationships emerged because of the HPSproject. It was clear from the qualitative analysis Qualitative AnalysisSecurities analysis that uses subjective judgment based on nonquantifiable information, such as management expertise, industry cycles, strength of research and development, and labor relations. that schools andtheir communities had a better understanding of how each otherfunctioned and what opportunities existed for useful links that enrichedthe core business of each partner. These findings reinforce earlierevaluations in Europe, North America North America,third largest continent (1990 est. pop. 365,000,000), c.9,400,000 sq mi (24,346,000 sq km), the northern of the two continents of the Western Hemisphere. and Australia (Brellochs, 1995;Cohen cohenor kohen(Hebrew: “priest”) Jewish priest descended from Zadok (a descendant of Aaron), priest at the First Temple of Jerusalem. The biblical priesthood was hereditary and male. , 1995; Kalnins, Ballantyne, Quataro, Love, Stuffs, & Pollack pollack:see cod. pollackor pollockEither of two commercially important North Atlantic species of food fish in the cod family (Gadidae). ,1994; Went, 1992). Partnerships took on a number of forms, including closer contactwith parents, working with outside agencies, referrals, ongoingtelephone contact with professionals, special community events, trainingand conferences. Despite these encouraging signs, it needs to beacknowledged that the Project only contributed to the limited formationof partnerships. It was frequently difficult for schools to establishand maintain meaningful relationships with sections of the community fora range of reasons. For instance, some schools were better served byrelevant agencies than others; some projects (e.g. outdoor activitiesprogram) were not so reliant on partnerships; some services were tooexpensive for schools; and cultural and social class differences couldmake it difficult to engage parents in school issues (e.g. someworking-class parents only have experiences of schools as alien andpunishing pun��ish?v. pun��ished, pun��ish��ing, pun��ish��esv.tr.1. To subject to a penalty for an offense, sin, or fault.2. To inflict a penalty for (an offense).3. from their own childhoods, and Vietnamese parents mightbelieve that they do not have the authority to participate with teachersin their child's learning). By giving as much emphasis to linkagesas it does to the curriculum and ethos/environment, the HPS frameworkcurrently works to highlight the potential for community linkages andlegitimise Verb 1. legitimise - make legal; "Marijuana should be legalized"decriminalise, decriminalize, legalise, legalize, legitimate, legitimatise, legitimatize, legitimize the resources teachers invest in developing these, ratherthan reflect the actual investment in community links. It was good to have the three areas because then you could ... you just make sure that you bulk them all up ... you're not `lop-siding'. I mean, we just wanted to have a balance to it all. I used to just check that we haven't left one of them out and the community was just as important in that as the other two. (teacher, government primary school, country) Redefining the outcomes of school health The Project supported a shift from an emphasis on school healthoutcomes for students that were concerned largely with knowledge andskills acquisition relevant to societal so��ci��e��tal?adj.Of or relating to the structure, organization, or functioning of society.so��cie��tal��ly adv.Adj. health issues towards conceptsof health literacy health literacyHealth care A measure of a person's ability to understand health-related information and make informed decisions about that information; HL includes interpreting prescriptions and following self care insturctions. Cf Literacy. (1), student autonomy and action competence. (2) Inthe Project, schools did come to recognise that tackling health andsocial issues helped in maximising learning outcomes. For instance, theHealth Promoting School framework assisted some schools to move furtheraway from hierarchical A structure made up of different levels like a company organization chart. The higher levels have control or precedence over the lower levels. Hierarchical structures are a one-to-many relationship; each item having one or more items below it. school structures towards more collaborative,student-centred and socially aware ways of working. School C School C is a medium sized Catholic primary school in a south-eastern suburb of Melbourne. This school placed a high priority on student welfare. As part of its Health Promoting School approach, the school implemented initiatives designed to positively affirm students and provide opportunities for them to take on greater responsibilities in the school. Along with ongoing support of the Student Representative Council, initiatives included peer mediation and regular affirmations via `Pupil of the Week'. They also used a system of `Behaviour Reports' that encouraged students involved in an incident to answer a list of questions designed to help them reflect on the particular incident, their behaviour, the consequences and their own responsibilities in rectifying the situation. The staff interviewed about the strategy were very positive. `When given the opportunities, kids rise to the occasion. They don't let you down ... [we need to] take the risk to let them [students] take responsibility'. `Having to take responsibility for rectifying that situation means there is a thought process going on that otherwise wouldn't have occurred.' Developing local ownership of school health-related initiatives School D School D is a secondary college in a town in Victoria's south-east where there has been considerable downsizing by key companies over the past 10 years. Added to this, recent workplace changes including amalgamations have resulted in a good deal of change including an influx of students who placed less value on academic education than previous cohorts. Given raised anxieties, the focus for the HPS effort became staff wellbeing and their participation in decision making and organizational aspects of the college. Staff wellbeing and participation were built into the formal college planning processes including the school charter. Links have been made with Community Services in the area which offers lifestyle programs to staff. An inhouse professional development program has also been established, covering topics such as health, wellbeing and approaches to teaching. A staff services committee keeps staff welfare issues on the agenda and maintains communication with the college administration. The committee monitors progress with the charter priority and analyses the results of staff surveys. The Project evaluation has illustrated how ownership of the schoolcontribution to health can shift from externally developed programs andcurriculum descriptions towards school-based development of initiatives,policies and procedures Policies and Procedures are a set of documents that describe an organization's policies for operation and the procedures necessary to fulfill the policies. They are often initiated because of some external requirement, such as environmental compliance or other governmental . The HPS projects in schools tended to becomelocated around issues that were pertinent PERTINENT, evidence. Those facts which tend to prove the allegations of the party offering them, are called pertinent; those which have no such tendency are called impertinent, 8 Toull. n. 22. By pertinent is also meant that which belongs. Willes, 319. to schools and already takingup time (e.g. violence, staff welfare). Indeed over 90 per cent ofproject schools in the post-intervention audit indicated that the HPSproject linked in with other projects already occurring within theschool and that it provided impetus Impetus is a stimulus or impulse, a moving force that sparks momentum.Impetus may also refer to: Theory of impetus, an obsolete scientific theory on projectile motion, superseded by the modern theory of inertia and momentum to extend on previousand current work (Ridge et al., 2000). There was a sense that beinginvolved in the HPS project helped people to reconceptualise andreorganise Verb 1. reorganise - organize anew, as after a setbackregroup, reorganizeform, organize, organise - create (as an entity); "social groups form everywhere"; "They formed a company"2. their activities to find better ways forward and to add valueto their work. Additionally many interviewees considered that the HPSproject provided an opportunity to bring specific projects togetherunder the one umbrella for a more unified and co-ordinated approach tohealth promotion. The qualitative analysis suggested that those who had a strongsense of what their school was trying to achieve in the long term, andwho understood how different projects could be co-ordinated to increaseeffectiveness and save time, were best able to adapt the multitude ofshort-term Short-termAny investments with a maturity of one year or less.short-term1. Of or relating to a gain or loss on the value of an asset that has been held less than a specified period of time. projects (with varying agendas) that come into their schoolsto their own benefit and use the HPS framework to their best advantage. Well, we know what we want and where we are going. I think ... we're aware that things open and shut and open and shut, so if there's an opportunity we'll take it and blend it into our purposes, so in a sense we've moved along fairly stoically and things pop in really, so we haven't been rocked and rolled and done over ... We can make things fit our model, we are good at that. (teacher, government primary school, country) Greater ownership of school influence on health is illustrated inthe way that the issue of staff health and wellbeing was taken up by theschools. At the time that the HPS project was implemented, teachers weremuch more used to thinking about the welfare of students. Teacherwelfare appeared to be an issue that the employing authorities were notadequately pursuing. A majority of the 100 schools (66) nominated nom��i��nate?tr.v. nom��i��nat��ed, nom��i��nat��ing, nom��i��nates1. To propose by name as a candidate, especially for election.2. To designate or appoint to an office, responsibility, or honor. teacher health and wellbeing for inclusion in the professionaldevelopment offered as part of the HPS project, making it the mostpopular topic chosen. The interviews revealed high levels of concernabout a perceived deterioration de��te��ri��o��ra��tionn.The process or condition of becoming worse. in teacher health associated with ageingstaff and workplace changes, including increased uncertainty, demandsand time pressures. Clearly teacher wellbeing was an issue whose timehad come. The shift here involved teachers giving themselves permissionto acknowledge that their needs were legitimate, and that they had aright to feel well. The approaches adopted to promote staff wellbeingwere diverse, taking in all aspects of the HPS framework. Approachesincluded professional development; time set aside for debriefing de��brief��ing?n.1. The act or process of debriefing or of being debriefed.2. The information imparted during the process of being debriefed.Noun 1. andsocialising; committees set up to develop policies; relaxationtechniques Relaxation techniqueA technique used to relieve stress. Exercise, biofeedback, hypnosis, and meditation are all effective relaxation tools. Relaxation techniques are used in cognitive-behavioral therapy to teach patients new ways of coping with stressful ; review of curriculum; and the use of outside services (e.g.facilitation FacilitationThe process of providing a market for a security. Normally, this refers to bids and offers made for large blocks of securities, such as those traded by institutions. , counselling and conflict resolution). Conclusions The HPS framework has shown itself to be a very flexible frameworkin the Project schools involved in qualitative interviews. In practice,the HPS project has operated in the schools at a number of levels. Ithas helped to broaden health from curriculum content to a morecomprehensive understanding of, and approach to, the elements of schoollife that affect health; increased the awareness of the community inwhich schools are situated and legitimised the allocation of resources allocation of resourcesApportionment of productive assets among different uses. The issue of resource allocation arises as societies seek to balance limited resources (capital, labour, land) against the various and often unlimited wants of their members. to develop links that are practical; strategically brought health morewithin the core business of schools, namely, educational outcomes andstudent welfare; increased ownership of what schools can do to increasehealth; and helped shift health more into a dynamic political domain toincrease student knowledge, skills and empowerment em��pow��er?tr.v. em��pow��ered, em��pow��er��ing, em��pow��ers1. To invest with power, especially legal power or official authority. See Synonyms at authorize.2. . The current study found that health perspectives will beincorporated into schools to the extent that they fit with the nature ofschooling and the demands being placed on schools and teachers. Schoolsthat are successful are clear about what they themselves stand for, whattheir critical issues are, and the directions they wish to take. Theythen shape the health perspectives to achieve their own agendas. While schools feel under pressure to deal with a range of societalissues (e.g. violence, drugs, suicide, mental health), there are realconstraints CONSTRAINTS - A language for solving constraints using value inference.["CONSTRAINTS: A Language for Expressing Almost-Hierarchical Descriptions", G.J. Sussman et al, Artif Intell 14(1):1-39 (Aug 1980)]. on what schools can do. Schools cannot remedy all socialills and health problems, and it is difficult for schools to sustainprojects that ultimately do not fit with their core business ofeducation. The Project evaluation results suggest that we need to moveaway from funding discrete, individual health projects around`illth' topics (e.g. drug use, injury, sedentary sedentary/sed��en��tary/ (sed��en-tar?e)1. sitting habitually; of inactive habits.2. pertaining to a sitting posture.sedentaryof inactive habits; pertaining to a fat, castrated or confined animal. behaviour, poordiet) and move towards funding programs that support the `corebusiness' already in existence in schools. Part of the success ofthe current HPS project was that it appeared to help schools conducttheir educational activities more effectively. From an educationperspective, the chief role of the HPS framework is in achievingeducation goals through treating health issues within an educationframework (St Leger & Nutbeam, 2000). The Health Promoting Schoolcontributes to lifelong learning Lifelong learning is the concept that "It's never too soon or too late for learning", a philosophy that has taken root in a whole host of different organisations. Lifelong learning is attitudinal; that one can and should be open to new ideas, decisions, skills or behaviors. skills; competencies and behaviours;specific cognate cognatedescribes two biomolecules that normally interact such as an enzyme and its normal substrate or a receptor and its normal ligand.cognate cooperation knowledge and skills; and self attributes--buildingblocks that are necessary for good health, health literacy and educationoutcomes. It was clear from the qualitative analysis that many schools in thestudy began to think more holistically about health and less aboutteaching health topics to target community morbidity and mortality Morbidity and Mortality can refer to: Morbidity & Mortality, a term used in medicine Morbidity and Mortality Weekly Report, a medical publication See alsoMorbidity, a medical term Mortality, a medical term trends. What schools actually did was focus on building the foundationsof health and wellbeing by using educational methods and by workingtowards some general educational goals (e.g. autonomy, democraticbehaviours, tolerance and respect for others). There is a strong body ofevidence that suggests this focus is likely to produce healthier andbetter educated students, as opposed to a focus on using classroom-basedhealth education to deal with the `illth' problems of society(Devaney, Schochet schochetsee shochet. , Thorton, Fasciano, & Gavin, 1993; NationalHealth and Medical Research Council, 1996; Symons et al., 1997; WorldBank, 1993; WHO, 1996). Despite the successes of the Project, there are real challenges forthe HPS movement, which are highlighted in the results contained in thispaper. Clearly the language of `health' that emanates from thehealth sector is not central to the running of schools, or a part ofteachers' thinking. On the other hand, teachers are committed tostudent welfare, building young people's knowledge andcompetencies, and safe and supportive environments for learning--allintegral to HPS. Although education-focused approaches to promotinghealth are well accommodated by the HPS model, the issue of differingdiscourses between education and health remain. It is apparent that theeducation sector is using concepts similar to the health sector, andvice versa VICE VERSA. On the contrary; on opposite sides. , but that there is a lack of acknowledgement of the linksbetween education and health models (Cleland, 2000). Because the HPSframework was developed by the health sector in circumstances CIRCUMSTANCES, evidence. The particulars which accompany a fact. 2. The facts proved are either possible or impossible, ordinary and probable, or extraordinary and improbable, recent or ancient; they may have happened near us, or afar off; they are public or where aclose collaboration Working together on a project. See collaborative software. with the education sector was not always practical,the framework has relied on teachers' understanding, motivation andcapacity to implement it (St Leger, 2000b). The qualitative resultssupport a future vision of health promotion in schools where projectsare more embedded Inserted into. See embedded system. within educational language, systems, policies andpractices. Ideally the agenda and priorities should be developed anddriven primarily by the education sector, with the health sector actingas a partner and facilitator. Reflecting the reality that the mental health agenda has convergedon schools, which are currently grappling with a range of social andmental health issues (e.g. bullying, suicide, belonging, familyconflict), many schools in the Project focused their HPS efforts here.Schools were concerned with promoting the emotional and social wellbeingof students, staff and families, particularly around respectful re��spect��ful?adj.Showing or marked by proper respect.re��spectful��ly adv. andsupportive relationships, student-focused learning and participation,mediation mediation,in law, type of intervention in which the disputing parties accept the offer of a third party to recommend a solution for their controversy. Mediation has long been a part of international law, frequently involving the use of an international commission, of disputes, and staff wellbeing. However the interviews madeit clear that teachers are asking for additional support and training inthese areas in order to adopt effective and sustainable approaches topromoting mental health in a comprehensive way. Indeed teachers arecentral to the success of school health initiatives. Teachers told usthat ongoing professional development is vital--teachers themselvesrecognise they need to build on their knowledge bases and skills inorder to promote health comprehensively. The training provided in theProject was considered central to the success of the Project in themajority of schools. It is acknowledged, however, that the currentlevels of professional development to assist teachers to work with theHPS concept and extend learning opportunities beyond the classroom aregenerally inadequate. The education sector has a challenge. There needs to be moreownership by the sector of health programs and less reliance on thehealth sector to fund interventions, packages and kits (Ridge et al.,2000). It became clear from this study that the educational goals ofschools will be achieved more easily if they embrace a holistic approachtowards health and if they own and define this work in their own terms.Keywordscommunity co-operation evaluation qualitative researchcurriculum health promotion school effectivenessTable 1 The main HPS-related activities undertaken at the variouscase-study schoolsSchool Key HPS related areas of activities 1 * Lending outdoor equipment * Promoting positive relationships 2 * Promoting healthy relationships * Resilience * Staff wellbeing * Healthy canteen food 3 * Student behaviour policy 4 * Developing a `passive' garden for student relaxation * ISDES 5 * Staff wellbeing * HPS as a School Charter priority 6 * Staff wellbeing 7 * Staff wellbeing * HPS as a School Charter priority 8 * Promoting positive school relationships * Staff health as a Charter priority * ISDES 9 * School attendance * Anti-bullying * Towards an HPS Policy 10 * Stress management for staff and students * Anti-bullying * Healthy canteen food 11 * Staff wellbeing 12 * Policies e.g. OH&S * ISDES * Anti-bullying 13 * Staff wellbeing * Peaceable school * ISDESLegend:ISDES = Individual school drug education strategiesOH&S = Occupational health & safetyTable 2 A range of reported changes that case study school intervieweesattributed to the Health Promoting School (HPS) projectChanges for students Changes for the school Changes in community links* Increased awareness * Increased awareness of * Networking with of health issues health promotion and local schools* Greater student related issues * Establishment of responsibility for * Dissemination of HPS new links with actions ideas and learning local agencies* Improved student to wider staff * Greater knowledge, learning outcomes body and use, of wider* Increased physical * Better physical service system activity environment * Moves to formalise* Sense of being cared * Improved relationships links with for and belonging * Better `atmosphere' in outside agencies* Happier students school * Greater parent* Greater student * Better organisation of satisfaction in the involvement in health promotion school decision making activities * Greater involvement * Better mediation of of parents in conflicts school life * Better staff morale * Community * Move toward more involvement in proactive health school projects strategies * Development of school health curriculum * Development of health related policies * Incorporation of health into the School Charter Acknowledgements We would like to thank Siobhan Bowler for editing this manuscript manuscript,a handwritten work as distinguished from printing. The oldest manuscripts, those found in Egyptian tombs, were written on papyrus; the earliest dates from c.3500 B.C. and all informants for their valuable contributions to the study. Notes (1) Health literacy is defined broadly by the WHO as representing`the cognitive and social skills which determine the motivation andability of individuals to gain access to, understand and use informationin ways which promote and maintain good health ... health literacy iscritical to empowerment' (Nutbeam, 2000). (2) Action competence is a key plank of the European Europeanemanating from or pertaining to Europe.European bat lyssavirussee lyssavirus.European beech treefagussylvaticus.European blastomycosissee cryptococcosis. Network forHealth Promoting Schools. It encourages schools to have programs thatenable students to take a major role in leading health-relatedinitiatives and to build a set of competencies based on the actions theytake in a democratic forum. For example, students may run theSchool's lunch program; set policies about appropriate behaviour;and decide on the major health issues for investigation. It is arguedthat following such experiences there is a shift in students'levels of empowerment (Brunn-Jensen, 1994). References Allensworth, D. (1995). The comprehensive school health programme:Essential elements. Feeder feederabbreviation for self-feeders. Used in feeding groups of animals at intervals of several days. Feed has to be dry and comminuted so that it will run down the spouts from the hopper into the troughs. paper to the World Health Organisation ExpertCommittee on Comprehensive School Health Education and Promotion.Geneva Geneva, canton and city, SwitzerlandGeneva(jənē`və), Fr. Genève, canton (1990 pop. 373,019), 109 sq mi (282 sq km), SW Switzerland, surrounding the southwest tip of the Lake of Geneva. : World Health Organisation. Brellochs, C. (1995). 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It was launched at the first international conference for health promotion that was held in Ottawa, Canada. . Geneva: Author. World Health Organisation. (1996). Research to improving schoolhealth programmes: Barriers and strategies. Geneva: Author. Dr Damien Ridge is the Research Fellow/Qualitative ResearchConsultant in the Social and Mental Health Research Priority Area,Faculty of Health and Behavioural Sciences, Deakin University, Burwood,Victoria Burwood is a suburb of Melbourne, Australia, in the state of Victoria. It is in the Local Government Area of the City of Whitehorse. The most prominent feature of the Burwood landscape is Building C (The Alfred Deakin Building) of Deakin University. 3125. Email: dridge@deakin.edu.au Dr Jeff Northfield is a Health Promotion Consultant in the Schoolof Health Sciences, Deakin University, Burwood, Victoria 3125. Email:jeffn@bigpond.com Dr Lawrence St Leger is a Professor of Health Promotion in theSchool of Health Sciences, Deakin University, Burwood, Victoria 3125.Email: saint@deakin.edu.au Bernie Marshall is a Senior Lecturer senior lecturern. Chiefly BritishA university teacher, especially one ranking next below a reader. in Health Promotion in theSchool of Health Sciences, Deakin University, Burwood, Victoria 3125.Email: marshall@deakin.edu.au Margaret Sheehan is a Lecturer lecturerA person who is primarily–if not entirely—involved in the teaching activities of an academic center, who is not expected to perform research or Pt management; in general, lectureships are non-tenured positions in the School of Health Sciences,Deakin University, Burwood, Victoria 3125. Email:sheehanm@vtn.wpro.who.int Shelley Maher is a Senior Project Officer in the field of sport andrecreation at VicHealth, 15-31 Pelham Noun 1. Pelham - a bit with a bar mouthpiece that is designed to combine a curb and snafflebit - piece of metal held in horse's mouth by reins and used to control the horse while riding; "the horse was not accustomed to a bit" St, Carlton, Victoria Carlton is an inner city suburb to the north-east of the city of Melbourne, Victoria, Australia. It was founded in 1851, at the beginning of the Victorian Gold Rush. 3053. Email:smaher@vichealth.vic.gov.au