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The International School Health Network is calling for contributors, reviewers and sponsors to develop a series of summaries that define and describe several topics relating to implementing and sustaining school health, safety and social development policies, programs, practices and multi-intervention approaches.

This discussion is being led
by Louise Rowling, (Adjunct Associate Professor, Faculty of Education & Social Work, University of Sydney), Oddrun Samdal, (Professor, Department of Health Promotion & Development, University of Bergen) and Marthe Déschenes, (Institut national de santé publique du Québec)

As with other topics in this knowledge exchange program and in this web site, it is hoped that each topic in the list below will eventually have a Glossary term (1-2 paragraphs), an Encyclopedia Entry (1-2 pages), a Handbook Section (10-15 pages with sub pages for case studies and a Bibliography or Toolbox that lists web-linked research articles, reports and resources such as educational programs, training tools and policy documents. These topics may eventually form part of an e-book version of a Practitioners/Policy-Makers Handbook on Implementing & Sustaining School Programs that will be prepared from materials in this knowledge exchange program.

However, we expect that we will move gradually towards that goal, with a series of webinars, online discussions and web summaries prepared and shared by participants over several months as resources and time permit. Please feel free to add additional topics to this page by using the "easy edit" tool found above. If you are interested in being part of the writers and contributors to any of these topics, please contact: dmccall@internationalschoolhealth.org

The following lengthy topics are anticipated as being among the many topics relevant to implementing and sustaining school health, safety and social development policies, programs, practices and approaches (this list is also open for amendment).

An Initial List to Start the Discussion

The lead editors of this discussion group have started to work on this theme and developed an initial description of their focus.


Leadership in implementation of health promoting schools
as leadership has been identified as a key component for implementation of health promoting schools.Building on implementation theories and principles of health promotioncollaboration, empowerment and competence development within and betweenrelevanttarget groups will be discussed with regard to achieving effective leadership.The relevant target groups are : principals, teachers, students, parents and health personnel. We intend to describe the individual concepts (collaboration, empowerment and competence development) as they relate to implementation of health promoting schools as well as how they relate to each of the target groups. Other concepts may of course emerge as we go through the writing process.

As well, ISHN has secured funding from the Mental Health Commission of Canada to conduct webinars and prepare brief summaries on several important topics in the implementation of comprehensive school mental health programs and approaches. These include:
  • Capacity and Capacity Building in School Health Promotion: An Overview
  • Inter-Ministry Policy, Collaboration & Leadership in School Mental Health
  • Inter-agency Policies, Collaboration & Leadership in School Mental Health
  • System & Agency Capacities & Capacity Building in School Mental Health Promotion
  • Evidence-based Implementation Planning Models in School Health Promotion
  • Complexity, Constant Change & Fidelity to a Developed Program, Practice or Approach in School Health Promotion
Note: This web site includes an draft, initial overviews of the concepts of implementation, capacity/capacity building and sustainability/institutionalization that were developed by members of two Communities of Practice in Canada. Please go to those pages to edit or comment on those initial summaries. As well, this series of topics was introduced by a webinar presentation and discussion that can be seen and heard by clicking on this link.

Implementation, Capacity, Sustainability and Systems Change Issues in School Health, Safety and Social Development

In the list of topics below we differentiate among these essential aspects:
  1. Some Preliminary Considerations
  2. Implementation of policies, programs, practices or approaches in a specified context
  3. Taking an effective program to scale through various means (ie diffusion)
  4. Capacity-building and continuous improvement
  5. Systems change: improvement and reform
  6. Achieving sustainability
In the list below, we have grouped several topics under each heading and listed related concepts along side them. However, there linkages among the topics that is not well represented by the groupings in this table. As well, this listing is not exhaustive one and other topics could be added or the topics could be grouped or identified in different ways.

To view the various draft and completed summaries, click on the acronyms that immediately follow the topic title. These acronyms stand for Glossary Terms (GT - one or two paragraphs), Encyclopedia Entry (EE- one or two pages), Handbook Sections (HS- about 15 pages, with additional case studies and articles and including recorded webinars, videos and other materials) and Bibliography/Toolbox (BT-listings of web-linked research articles/reviews and educational/planning/assessment tools).

Topics related to Implementation, Capacity and SustainabilityRelated Concepts and TopicsSub-topics and related topics
1. Some Preliminary Considerations

  • Implementing programs in complex ecology's /open systems such as schools requires us to consider new paradigms
  • Complexity theory,
  • Chaos theory
  • Linear vs non-linear models
  • Systems thinking (BT)

  • New approaches to school health promotion are emerging that place less emphasis on programs and more on comprehensive approaches that modify the interactions within or building the capacity of the setting

  • Ecological and systems-based approaches to school health, safety & social development (GT, EE )

  • The quality of the Implementation Practices is as important as the quality of the programs

  • Quality Implementation Practices

  • There is some confusion about basic concepts in SH promotion that will affect their implementation. (Is it an approach/ framework, a set of programs/interventions, or a set of health/social outcomes or knowledge/skills for students or for the entire school? (ie a healthy school)


  • There is also confusion about the terms Comprehensive Approach, Coordinated Agency-School Program or Whole School Strategy in regards their respective scope of actions (ie to which types of personnel are involved in delivery).

  • Comprehensive Approaches, Coordinated Agency-School Programs, Whole School Strategies (EE)



  • System, Ministry, Agency, School, Professional and Community Capacities are required to implement any program but can also be developed independent of or through the use of many different types of programs.

  • Capacity and Capacity-building in school health, safety & social development (EE)

  • Implementation, Organizational Development, Systems Change are intertwined.


  • What do we mean by "sustainable programs"


  • Recognizing the educational mandate and constraints of the school means that implementation process will confront several contradictions, challenges and opportunities.
  • Understanding core mandate of schools

  • Integration with basic operations of the school (Physical, social, student learning, testing, tracking students, reporting to parents, school size, etc)

  • Integration with school improvement planning processes

  • Integration with school/system reporting and accountability procedures

  • Impact of school's role in accrediting student achievement (ie failing some students each year)

  • Impact of school's role in socializing young people in dominant values (explicit& implicit) of their societies
Five functions of schooling are: safe custody of children, teaching basic numeracy & literacy skills/basic subject knowledge, accrediting students (sorting & selecting) for future studies, socializing students in dominant values of society, preparing for workforce


transportation routes/school busing, recess procedures & practices, school grounds & facilities, staffing practices and current assignments, reporting to parents,
influence of departments in high schools, professional days, etc





- adding health status & behaviours to regular student report cards,



- adding health and wellness considerations to school, district & ministry annual reports)

2. In discussing the implementation of a program or an approach in a specific school (s), agency of government ministries, we need to:


  • Define what we mean when we say "adoption" of a program or approach


  • Define what we mean when we say "institutionalization" of a program or approach


  • Define what we mean by "implementation" of a program or approach
  • Implementation of School Programs, Services, Policies or Practices (GT)

  • Define and discuss different "stages of implementation"


  • List and discuss various evidence-based "implementation models/plans"
  • Using Evidence-based Implementation Models and Theory (HS)

  • Identify and discuss factors that affect implementation


  • Identify and discuss "local mechanisms" that are essential for program implementation (champion, access to experts, parent and staff involvement etc)
  • Local Mechanisms in Implementation (HS)

  • Identify and discuss various "local drivers" (opportunities/barriers) to implementation such as local interpersonal relationships, incidents, local histories, extraneous events etc)
  • Local Drivers in Implementation (GT)
  • Situation Analysis

  • Engage in critical appraisal of the Innovation or reform
  • Characteristics of the Innovation
  • Competitors with similar innovations
  • Non-related competing issues and programs

  • Describe and discuss how we will define & measuring Implementation Quality
  • Defining Implementation Quality
  • Measuring Implementation Quality

  • Describe how to report on Implementation Quality


  • Discuss the application of Continuous Quality Improvement Based on Measured Implementation Quality


  • Understand the impact of the local neighbourhood/community context on school and program capacity
  • (Including rural schools, inner city, multi-ethnic schools, aboriginal schools, minority language schools, religious schools, schools in disadvantaged communities, schools serving affluent communities, schools disrupted by war, famine, natural disasters, epidemics, schools in low income countries)

3. In discussing how to take a Successful Program to a Larger Scale, we need to:


  • Define Distribution, Dissemination and Diffusion


  • Discuss Fidelity to a program or to core practices within a defined approach
  • Fidelity to a Program or Better Practice (GT, EE, HS, TB)

  • Examine Who Pays? Who Owns? Who Controls? the innovation


4. In discussing Capacity, Capacity-building and Continuous Improvement, we need to:
  • Capacity & Capacity-building in School Health, Safety & Social Development (EE, BT)

  • Examine the research and experience suggesting minimum staff levels, minimum budget requirements, minimum mandate requirements
  • Baseline capacity (see Capacity & Capacity Building in School Health, Safety & Social Development (EE)

  • Discuss eight types of system or organizational capacity (WHO, 2003)
  • Operational capacity (see Capacity and Capacity-building in School Health, Safety & Social Development (EE)

1. Coordination of policy,



2. Staff assigned to coordination,


3. Formal and informal mechanisms to support cooperation,


4. Monitoring, reporting and evaluation,




5. Regular Workforce development,









6. Ongoing knowledge exchange,








7. Strategic issue management,


8. Explicit plan for sustainability








Inter-ministry policy
, inter-agency policy, professional guidelines and standards



Role of SH coordinator/change agent, skills/training of coordinators




Joint program planning, joint budgeting, inter-ministry agreements, inter-agency agreements, school protocols with external service providers, inter-ministry committees, inter-agency committees, school-based health committees, joint professional development sessions, shared goal statements


Monitoring & Reporting Systems
(GT, EE, HS, BT) Indicator selection & development, Indicator relevance and reliability, survey development,data-based decision-making, school recognition programs, school accreditation/award programs, program evaluation methods and capacity, integration with school accountability reporting

Application of adult learning principles,
promoting reflective teaching and health promotion practice,staff development theories and models, role & training of teachers, accessing and using teacher professional days effectively, staff development as social development, evidence-based teacher in-service models and practices, better and current practices in university teacher education programs, role & training of school nurses, role & training of school resource officers, role & training of school psychologists, role & training of addictions workers, role & training of school social workers, role & training of school guidance counsellors, role & training of school principals, accessing and working with native teacher education programs

Perceptions/knowledge of health issuesstudies of knowledge needs & preferences among teachers, counsellors, principals, school district staff, school nurses, addictions workers, police officers, school psychologists, school social workers, effective use of consultations with experts/master practitioners as models of staff development, effective use of communities of practice withing districts, across provinces or countries,
among teachers, administrators, nurses, police officers, social workers etc,


Aligning with current or emerging organizational priorities, strategic issue management practices, strategic selection and maintenance of partnerships,

  • Examine baseline & operational capacities at different levels in the System
- individual professionals
- local school & neighbourhood
- school board
- other local agencies (health, police, social services, housing, employment, etc
- education ministry
- health ministry
- welfare ministry
- law enforcement ministries
- federal or national agencies
- research centres and funding agencies
-

5. In discussing Systems Change that might be required to sustain the program, we need to discuss:


  • the impact of the core (normal) aspects of the school
  • Influence of the School Environment (BT)

In schools, the physical environment, social environment, school organizational practices, transitions between levels of schooling and between schools affect health, safety & social development of children
  • the size and magnitude of the change: innovation or reform
- In education, reform changes the size and slope of participation/ graduation of students
- In health, reform shifts attention and resources from treatment to prevention
- In law enforcement, reform changes.....
In social/welfare services reform changes...

  • identify and discuss systems change models
From Education
- Fullan (Tri-level change)
- Hargreaves
- Hall & Hord

From Health Promotion


From Business
- Total Quality Management

  • how to manage change in "open, adaptive systems" that constantly respond to new demands being placed on them by external environment
- System stasis & stability,
- system boundaries,
- system-environment interactions,
- managing changes, trends of cycles in the context surrounding the system

  • how to address the characteristics of "loosely-coupled systems"
- Defining loosely coupled systems
- Addressing adopter concerns
- Effective use of policy levers
- Micro-politics of schools
- Role/styles/status of senior managers
- Role/styles/status of middle managers
- Role/styles/status of front-line workers
- Roles/styles/status of clients in system

  • Understand how schools, public health and other "professional bureaucracies" work and function in the real world
- Theories/models of professional bureaucracies
- Influence of structures
- internal/informal communications within bureaucracies
- Social networks within organizations
- multi-level systems
- Non-rational decision-making in organizations
- Knowledge as power & influence
- Organizational culture
- Organizational readiness to innovate
- Professional norms/ideologies/acculturation
- Sociology of teachers, nurses, social workers, police
- Work life and career trajectories for teachers, nurses, police, social workers, others

  • how to promoting aligned change across multiple systems, agencies and profession
- Types of cooperation

- Interprofessional cooperation


- Inter-agency cooperation


- Interministry cooperation




Models of inter-professional education & training
6. In discussing how to achieving sustainability, we should:


  • Define "sustainability"
  • Sustainability (Sustainable Programs (GT)

  • Identify and discuss factors that affect sustainability


  • Identify and discuss barriers to Achieving Sustainability