Comprehensive Approaches, Coordinated Programs, Whole School Strategies (EE)This is a featured page

This page contains the "first draft" of a Encyclopedia Entry that defines and discusses Comprehensive Approaches, Coordinated Agency-School Programs and Whole School Strategies to School Health, Safety and Social Development. Visitors to and members of this wiki-based web site are welcome to post comments on this summary using the "thread"" tool found at the bottom of this page or to use the "Easy Edit" tool found at the top of the page to edit the text. (All previous versions of the draft are retained by this web site system).

Comprehensive approaches to school health promotion, coordinated school health programs and health-promoting schools have been described in the published research literature and a variety of reports. These terms have been used interchangeably in most of these studies and reports. Indeed, an expert committee (World Health Organization, 1997) noted that the same terms are often used in different ways to describe approaches, programs, outputs, processes and values, thereby sometimes causing confusion and often resulting in time spent in developing new terms or re-interpreting the concept of school-based and school-linked health promotion, safety and social development efforts. As well, terms such as "healthy schools" are used to describe plans/approaches or programs that only cover one or two aspects of overall health.

However, there is considerable agreement among all of these definitions of school multiple intervention programs (SMIP). They almost always include an emphasis on the use of coordinated multiple interventions or programs that are grouped in certain components such policy, instruction, health/other services, social environment and changes to the physical environment (See our Typical List of CSH Interventions) . These statements and descriptions also often include a variety of health promotion and social development goals such as health promotion/universal programs, prevention of specific problems/targeted programs, assistance with treatment/indicated programs and re-integration after treatment. Most statements/models include values and principles such as inclusion, equity, democracy, environmental citizenship and social responsibility.

There are many, many descriptions, models, frameworks and statements describing these comprehensive approaches, coordinated programs and whole school programs. These include comprehensive school health approaches, coordinated school health programs, health promoting, child-friendly schools, school health/nutrition and other programs for low income countries, (including multi-intervention frameworks such as FRESH and the UNICEF/WFP Essential Package) as well as similar strategies such as effective schools, safe schools, community schools, open schools and eco-schools. All of these strategies strive to have all facets of the school support the development of the whole child. These comprehensive approaches, coordinated school-agency programs and health promoting, whole school programs are an application of the Ottawa Charter on Health Promotion (1986) and population health frameworks that emerged around the world in the 1990's.

In order to address some of this confusion, we make a distinction in this summary and in this knowledge exchange program that categorizes these various models multiple interventions and approaches in three ways based on their scope, the levels at which they are operationalized and the types of personnel delivering the programs or interventions. We suggest that there are at least three ways to sub-categorize these models:
  • comprehensive approaches” that link multiple actions taken by a wide variety of employees at various levels in multiple systems school programs on several health or social problems Such comprehensive approached or multi-intervention programs can also be part of community wide initiatives and programs that include other settings, community awareness campaigns and more.
  • coordinated agency-school programs" which have other agency staff (health authorities, police services, social/welfare agencies) and their respective agency professionals (nurses, police officers, social workers etc) working with school school board and staff to deliver several programs and services in or near the schools
  • "whole school strategies" where strategies using multiple interventions are delivered by school staff alone (eg classroom instruction, parent education, student/school activities etc)
The 2009 Vilnius Resolution, adopted by delegates attending the Schools for Health in Europe (SHE) Conference in that city illustrates a statement that emphasizes comprehensive approaches at multiple levels (local, regional, national and international). The 2007 Canadian Consensus Statement on Comprehensive School Health adopted by over 30 NGO's in that country is another example, calling for action across several government departments, systems and agencies. The Coordinated School Health Program model developed in the United States shows how a selection can be made among components or programs that are to delivered by agencies as well as the schools.

Whole school models, often called healthy schools or health promoting schools, are most often used to describe multiple intervention programs that are delivered primarily or solely education system/school personnel. The 1997 HPS model developed by the World Health Organization and the 2006 updated HPS model published by the International Union for Health Promotion and Education (IUHPE) are examples of these descriptions that outline the interventions that should be delivered by school personnel.

There are also new concepts being incorporated into more recent statements and models of school health promotion, safety and social development. One of the key new concepts is
capacity building. Canadian researchers have adapted a WHO (2003) capacity assessment tool that identifies eight capacities that should be present at all levels in several systems. The organizational capacities of health and education systems (ministries, agencies, schools, professionals, communities) can be defined as:
  1. Comprehensive and coordinated policies on school health, health issues and the elements of school health promotion that are actively supported by senior managers;
  2. Assigned staffing infrastructure to support interdisciplinary cooperation at all levels;
  3. Formal and informal mechanisms for coordination and cooperation;
  4. Active knowledge transfer and exchange within and across sectors;
  5. Ongoing workforce development of health and education professionals through professional preparation programs and staff development;
  6. Providing regular and reliable monitoring and reporting on the health status, determinants, behaviours, attitudes, skills and knowledge of children and youth, as well as periodic surveys and self-assessments of policy/program capacity;
  7. Regular scans of the environments, trends and emerging issues that affect the health of children and youth;
  8. Appropriate and sustained funding and explicit sustainability plans to ensure the continuance of programs which demonstrate effectiveness.
Another newer concept now being taken into account is local community context. Researchers are now starting to investigate how local neighbourhood, community and state/country contexts play a role in the delivery of school-based and school-linked programs. These local contexts include:
  • rural schools
  • affluent, suburban or elite private schools
  • urban schools
  • schools serving a high proportion of indigenous students
  • religious schools
  • schools disrupted by war, conflict, natural disasters or epidemics
  • schools in low income countries
A Consensus Statement developed at a WHO Technical Meeting in June 2007 noted the evolution in school health promotion concepts and included emphasis on capacity building, colcal context and linkages with basic education programs.

The complexity of school-neighbourhood ecologies as well as systems-related concepts such as open systems, loose-coupling, bureaucratic organization and working across several sectors is also an emerging concept in school health promotion and social development. Ecological, and systems-based approaches are emerging as a new paradigm for developing, evaluating and monitoring school health and social development programs where the school setting, rather than the students, is the target for the program.

Implementation, sustainability and diffusion issues are also an emerging concern in school programs. The International School Health Network has developed a description of how to implement these comprehensive approaches and coordinated programs in ten key implementation strategies.

Research Evidence on Effectiveness

There is considerable research showing that multiple, coordinated interventions (policy, education, services, social support, physical environment) delivered through schools can have an impact on child/adolescent health behaviours. Several recent rigorous, systematic reviews have cited school health promotion as being effective or promising. This is especially true if the targeted changes in health behaviour are specific and realistic (e.g. using a condom, limiting number of partners or differences in age of partners instead of expecting school sex education programs to persuade youth not to experiment with sex).

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