Você está na página 1de 95

Health Promoting Schools

A review of international literature and models


of practice

Report to the Ministry of Health

Pauline Dickinson
Glenalmond Research, IT & Counselling Ltd
2005
Contents
1. Executive Summary .............................................................................................................................. 4
Literature Review Findings........................................................................................................................ 4
2. Introduction ........................................................................................................................................... 8
2.1. Background....................................................................................................................................... 8
2.2. Methods .......................................................................................................................................... 10
2.3. Structure of this literature review .................................................................................................. 11
2.4. Acknowledgements ........................................................................................................................ 12
2.5. Terms, Definitions and Abbreviations........................................................................................... 12
3. Overview of international initiatives to promote wellbeing in school settings............................ 14
3.1. The World Health Organisation’s Global School Health Initiative ............................................. 14
3.2. UNICEF’s Child Friendly Framework .......................................................................................... 15
3.3. FRESH-Working together to Focus Resources for Effective School Health............................... 16
3.4. INTERCAMHS: the International Alliance for Child and Adolescent Mental Health and
Schools 16
4. International models of practice for the promotion of wellbeing in school settings .................. 19
4.1. A whole school approach ............................................................................................................... 19
4.2. International Models of Practice for Promoting Wellbeing in Schools ....................................... 22
5. The links between mental, emotional and social heath, nutrition, physical activity and
learning and achievement........................................................................................................................... 40
5.1. The promotion of mental, emotional and social wellbeing in school settings ............................. 40
5.2. Physical activity, nutrition and mental health ............................................................................... 50
6. Criteria for the effectiveness of Health Promoting Schools evaluation ....................................... 54
6.1. Issues for evidence-based practice for HPS .................................................................................. 54
7. International audit tools for schools ................................................................................................. 57
7.1. The psycho-social environment profile (PSE) (World Health Organisation, 2003).................... 57
7.2. MindMatters Audit Tools............................................................................................................... 58
8. Concluding comments ........................................................................................................................ 59
References..................................................................................................................................................... 62
Appendix: Audit Tools................................................................................................................................ 67

Health Promoting Schools: A review of international literature and models of practice


Pauline Dickinson, May 2005
Page 2
Table & Figures
Figure 1: The multiple words model .............................................................................................20
Figure 2: Health Promoting Schools Conceptual Framework......................................................21
Figure 3: Interconnected systems for meeting the needs of all children......................................31
Figure 4: The World Health Organisations’ Whole School Approach to School Change ..........34
Figure 5: The Gatehouse Project Conceptual Framework............................................................37

Table One: Self-esteem example of the ways in which EHWB can be fostered in the school
setting ....................................................................................................................................24
Table Two: Leadership and management/school culture and environment/policy development
...............................................................................................................................................25

Health Promoting Schools: A review of international literature and models of practice


Pauline Dickinson, May 2005
Page 3
1. Executive Summary
This literature review was commissioned by the Ministry of Health in Aotearoa/New
Zealand to provide information to inform the future development of Health Promoting
Schools at a national level. Specifically, the aims of this literature review were to
provide a summary of published literature, recent research and other unpublished
work on international HPS initiatives and models of practice

Literature Review Findings


(1) International Health Promoting School Initiatives

Findings from international literature have indicated that globally, HPS initiatives
share a socio-ecological model of wellbeing, which is characterised by building strong
partnerships and collaboration between schools, families and communities, children
and young people and key policy makers in the education and health sectors. Of
significance is the emphasis of these initiatives on quality teaching and learning
conditions based on respect, inclusiveness, safety, creativity and relevant curriculum
which can motivate learning and achievement for children and young people. Each of
these initiatives has, in recent years, begun to focus on the quality of the psychosocial
environment and the way in which this impacts on the mental, emotional, social and
physical wellbeing and learning and achievement processes and outcomes for children
and young people.

(2) International models of practice


Internationally, school health initiatives have been developed and implemented
through health and education sector collaboration and partnerships at a government
policy level. Throughout Europe, the European Network of Health Promoting Schools
has provided a platform for the coordination and sharing of effective practices among
the schools involved. Projects such as the Australian Mindmatters and Gatehouse
Projects have successfully engaged with secondary schools due to this strong
collaboration between the health and education sectors. National training has been an
integral component of the MindMatters Project with substantial increases in
participation by school personnel over the past two years. One of the critical factors in

Health Promoting Schools: A review of international literature and models of practice


Pauline Dickinson, May 2005
Page 4
the success of the Gatehouse Project was the challenging of systemic and individual
change through a whole school approach. Systemically, the Gatehouse Project aimed
to address the protective and risk factors in the school environment and the individual-
focused approach aimed to emphasise the importance of healthy attachments and
positive connections among teachers and peers.

(3) Learning and achievement and wellbeing

(a) Learning and achievement: links with mental health and emotional
competence

The literature reviewed indicated that school-based initiatives that focus on promoting
mental health and emotional competence have a direct effect on educational
achievement. These initiatives also affect factors such as achieving a more positive
school ethos, positive self-esteem, listening and communication skills among young
people. For schools to be effective in both learning and achievement, four key
elements were identified as essential for schools to develop among staff and students:
supportive relationships; a high level of participation; encouragement of autonomy;
and clear rules, boundaries and expectations.

(b) Learning and achievement: links with a supportive school environment


The literature reviewed indicated that there were associations between positive
learning and achievement outcomes when children and young people experience
schools as a caring, supportive social and learning environment. Addressing the issue
of bullying was also considered a high priority for schools due to the serious impact
this behaviour has been found to have on the mental, emotional, social and physical
wellbeing of children and young people.

(c) Learning and achievement: links between connectedness, quality


relationships and quality teaching and learning
The literature shows that being connected to school, being treated fairly, and learning
in a positive supportive classroom environment creates positive conditions for
wellbeing. Integral to the ‘classroom as community’ was the provision of quality
teaching and learning conditions that utilised cooperative and collaborative activities
to facilitate experiential learning.
Health Promoting Schools: A review of international literature and models of practice
Pauline Dickinson, May 2005
Page 5
Factors identified as contributing to a healthy school environment and the
development of emotional competence in children and young people were: the
commitment of senior school managers; a school culture that values children and
young people; clear policies and practices; skilful teaching; a high level of
participation in school life by staff and students; and supportive relationships.

(d) Learning and achievement: links with nutrition and physical activity
The literature reviewed indicated that there were strong associations between physical
activity, nutrition and learning and achievement. Of particular relevance were global
findings, which indicated that levels of regular physical activity had reduced for
children and young people over the past thirty years. Childhood obesity has also
increased nationally and elsewhere. Findings indicated that children and young people
who were overweight were more likely to experience poor mental health due to the
impact of teasing and bullying, which resulted in their feeling isolated and lonely as
well as impacting negatively on their learning and achievement. The literature
reviewed signalled that caution was needed in the design of health promotion
strategies to address child and adolescent obesity due to possible further
stigmatisation concerns.

4. The evaluation and monitoring of HPS initiatives


An exploration of the evidence-base for HPS has signalled that there has been
considerable debate as to the ways in which HPS can be evaluated and monitored.
Due to the ecological, multi-sectorial and long-term nature of HPS it has been
recommended that evaluations capture these more complex characteristics. This
means that it can be somewhat challenging for evaluators if the focus is on the sole
documentation of short-term, specific health outcomes. Recent literature in this field
has called for the need to consider the ways in which HPS initiatives enable or
empower individuals and communities as an important criterion. Therefore, the
documentation of factors such as monitoring decisions made, the decision making
process and changes that occurred, as well as having a realistic timeframe for the
evaluation that takes into consideration the complexity of the school system is
necessary.

Health Promoting Schools: A review of international literature and models of practice


Pauline Dickinson, May 2005
Page 6
(5) The development of tools to assess schools’ social environments
Given the significant attention provided in the literature to school climate,
connectedness and sense of belonging, this review has highlighted audit tools that
have been developed internationally to assess schools’ social environments. These
tools are available for use and can be adapted for use within primary and secondary
schools. As well, the audit tool developed for the Mentally Healthy Schools Initiative
in Aotearoa/New Zealand has provided a focus on these factors. Members of the
International Alliance for Child and Adolescent Mental Health in Schools
(INTERCAMHS) are currently planning an international research initiative to use the
Psycho-social Environment Profile (PSE) which is included as an appendix to this
review.

Health Promoting Schools: A review of international literature and models of practice


Pauline Dickinson, May 2005
Page 7
2. Introduction

2.1. Background
HPS in Aotearoa/New Zealand
In Aotearoa/New Zealand HPS was introduced to the education sector at a school
level and has been driven by health sector policy and personnel with the broad goals
being to improve the wellbeing of children and young people in schools. The way in
which HPS was introduced as a significant pilot initiative in the Auckland and
Northland regions, was gradually adopted throughout the country. However, there are
now diverse implementation models operating in different regions.

The Health Promoting Schools Programme in Aotearoa/New Zealand is in a growth


stage of development. There are many factors contributing to this growth, in particular
a growing interest from Ministers and their Ministries. In addition, a new Partnership
Agreement has recently been negotiated between the Ministry of Health, Ministry of
Education, and Sport and Recreation New Zealand, acknowledging the shared
objectives of promoting student wellbeing.

Health Promoting Schools Practitioners around the country have been expanding their
work with schools and their communities with the HPS model and success stories
being promoted through many avenues. This activity has resulted in increasing
interest and demand from schools throughout the country, beyond the capacity of HPS
Practitioners. HPS Practitioners have asked for a “do it yourself” toolkit for schools
and have, in recent feedback, reflected the need for reorientation of HPS Practitioners
towards more of an advisory role with HPS being driven from within schools. To
champion HPS as a lead model, practitioners have expressed their need for nationally
consistent training, tools, language, planning, implementation, and assessment
approaches that strengthen capacity and build a robust national workforce.

A stocktake of HPS resources has recently been completed as stage one of of a two-
stage project towards developing a nationally consistent toolkit for use by HPS
practitioners and schools in the implementation of HPS. This stocktake identified that

Health Promoting Schools: A review of international literature and models of practice


Pauline Dickinson, May 2005
Page 8
each region has been developing a range of different materials, criteria, awards
systems, assessment tools, and memoranda of understanding. The stocktake provided
a national picture identifying gaps and requirements to achieve national consistency.
The stocktake also indicated that further project work is needed to build on what has
been started towaards addressing issues of national consistency, sustainabilty and
capacity.

More recently, the Ministry of Health, Ministry of Education and SPARC have signed
a tripartite agreement which has initially prioritised nutrition and physcial activity as
the key areas of action for HPS in Aotearoa/New Zealand. Mental health has also
been prioritised by the Ministry of Health through various regional contracts. Given
the inextricable links between nutrition, physical activity and mental, emotional and
social wellbeing, the literature and initiatives reviewed for this report highlight
research findings in these three key areas.

International HPS initiatives


Over the past decade innovative, comprehensive approaches to promoting and
supporting the wellbeing of children and young people in school and community
settings have been developed both internationally and nationally. Guiding the
development of much of this work is the Health Promoting Schools (HPS) conceptual
and operational framework developed by the World Health Organisation (WHO)
through its Global School Health Initiative.

Initiatives, internationally, have been developed strategically, with partnerships being


formed at a policy level with both health and education sectors. The European
Network for Health Promoting Schools (ENHPS), for example, has become a well-
established network in Europe. The strategic development of the ENHPS has been
supported by the Council of Europe, the European Commission and the WHO
Regional Office for Europe. This programme seeks to integrate the policy and practice
of HPS into the wider health and education sectors. Each of the HPS initiatives
implemented across schools in the European Network has placed emphasis on the
importance of a healthy psycho-social environment.

Health Promoting Schools: A review of international literature and models of practice


Pauline Dickinson, May 2005
Page 9
In the United Kingdom the National Healthy Schools Standard (NHSS) has been
developed to contribute to raising children and young people’s achievement,
promoting inclusiveness at school and reducing health inequalities. More recently
focus for the NHSS is the theme of emotional heath and wellbeing (including
bullying). Within a national policy context emotional health and wellbeing has
increasingly become a feature of government policy for children and young people. A
recent strategy document titled ‘Every child matters’ outlined five key areas that were
considered vital for the wellbeing of children and young people. The areas are: (1)
being healthy; (2) staying safe; (3) enjoying and achieving; (4) making a positive
contribution; and (5) economic wellbeing. Comprehensive School Heath programmes
developed in the United States and Canada are also based on the HPS framework.
This framework has been adopted in Australia with a major focus being on the
promotion of adolescent mental, emotional and social wellbeing, through the National
Australian MindMatters Project.

2.2. Methods
Literature review

The focus of this review is on international and national literature and models of
practice for HPS. The materials reviewed fall into the following categories:

• Reviews of research
• Reports of initiatives
• Research reports
• International and national survey reports
• Discussion documents and articles

As well as research published in peer reviewed journals, ‘grey’ literature has been
included that represents work that is well-respected by various government
departments. Case studies are one example from this ‘grey’ literature that represents a
considerable body of work that has been done in the HPS field. A search of the World
Wide Web also identified a range of school-based health promotion initiatives. The
data bases searched for peer-reviewed research were:

Health Promoting Schools: A review of international literature and models of practice


Pauline Dickinson, May 2005
Page 10
• Medline
• Sociofile
• Psychinfo
• ERIC
• Social Sciences Citation Index

The following key words were used alone or were combined: schools / health
promoting schools / mentally healthy schools / psychosocial environment /
psychosocial/ young people / children / school-based / schools / teaching / learning /
achievement / nutrition / bullying / student wellbeing / adolescent health / child health
/ emotional competence / emotional wellbeing / whole school approach /. Key word
searches were also combined with countries known to be developing and
implementing Health Promoting/Healthy School initiatives such as Australia, New
Zealand, Canada, United Kingdom, and United States.

2.3. Structure of this literature review


This review has been divided into eight sections: (1) Executive Summary; (2)
Introduction; (3) Overview of international initiatives to promote wellbeing in school
settings; (4) International models of practice for the promotion of wellbeing in school
settings; (5) The links between mental, emotional and social heath, nutrition, physical
activity and learning and achievement; (6) Criteria for the effectiveness of HPS
evaluation; (7) International audit tools for schools; and (8) Concluding comments.
Samples of two international audit tools for assessing the psychosocial environment of
schools are included as an appendix to this review.

Scope of this review

The literature reviewed within the timeframe for this project provides an overview of
key areas of HPS policy and practice internationally. While current HPS/school health
literature acknowledges a holistic approach to wellbeing, considerable attention has
been given to the promotion of mental, social and emotional wellbeing, particularly at
a global level and through the European Network of Heath Promoting Schools. It is
also important to acknowledge that while there are many regional networks
Health Promoting Schools: A review of international literature and models of practice
Pauline Dickinson, May 2005
Page 11
throughout developed and developing countries, it is likely that there may be other
HPS initiatives, particularly within indigenous groups, that have not yet been
documented.

2.4. Acknowledgements
Thank you to the Health Promoting Schools practitioners throughout Aotearoa/New
Zealand who have shared their resources.

2.5. Terms, Definitions and Abbreviations


Health promoting schools

A Health Promoting School can be characterised as a school that is constantly


strengthened by its capacity as a healthy setting for living, learning and working

A whole school approach

A whole school approach to promoting wellbeing is based on an ecological


perspective, which locates children and young people in the environments that
influence their development, with the key contexts being the family and local
community, the school and the peer group. These contexts have been referred to as the
microsystem which can be viewed as the intimate social and immediate physical
environmental setting in which children and young people develop (Bronfenbrenner,
1979). The transitions that children and young people make between these settings
influence the course of their development, either supporting or impeding it.

Mental health

Mental health represents the need for individuals to be connected socially,


emotionally and spiritually in a way that enables them to have a sense of belonging
and to feel valued and acknowledged as members of family and the wider community.

Mental health promotion

Mental health promotion is the enhancement of the capacity of individuals, families,


groups or communities to strengthen or support positive emotional, cognitive and
related experiences (Hodgson, Abbasi, & Clarkson, 1996).

Mental health promotion can be applied to a whole population, to those known to be


at risk of mental health problems and to those who have a mental health problem
ranging form mild to severe illness. Mental health promotion may focus on the social
environment as well as the individual. It may also address life events, transitions and
coping skills, providing a developmental approach to mental health development
(Harden et al., 2001; Hodgson et al., 1996).

Health Promoting Schools: A review of international literature and models of practice


Pauline Dickinson, May 2005
Page 12
A healthy psycho-social environment

A school’s environment can enhance social and emotional wellbeing, and learning
when it: is warm, friendly and rewards learning; promotes cooperation rather than
competition; facilitates supportive, open communications; views the provision of
creative opportunities as important; prevents physical punishment, bullying,
harassment and violence, by encouraging the development of procedures and policies
that do not support physical punishment and that promote non-violent interaction on
the playground, in class and among staff and students; and promotes the rights of
children and young people through equal opportunities and procedures (World Health
Organisation, 2003).

Clarification of reporting

This report uses abbreviations of commonly used terms:


HPS – Health Promoting Schools
MHS – Mentally Healthy Schools
ENHPS – European Network of Health Promoting Schools
NHSS – National Healthy Schools Standard
WHO – World Health Organisation
INTERCAMHS – International Alliance for Child and Adolescent Mental
Health in Schools
FRESH – Working together to Focus Resources for Effective School Health
EHWB – Emotional Health and Wellbeing
CSH – Comprehensive School Health
HBSC - Health Behaviour in School-Age Children

Health Promoting Schools: A review of international literature and models of practice


Pauline Dickinson, May 2005
Page 13
3. Overview of international initiatives to promote wellbeing
in school settings

It is readily acknowledged that health and education outcomes for young people are
inextricably linked, and that the school, as a setting, has the capacity to both promote
and support health and wellbeing as well as learning and achievement (Battistich,
Schaps, & Wilson, 2004; Resnick et al., 1997; Resnick, Harris, & Blum, 1993;
Samdal, Nutbeam, Wold, & Kannas, 1998).

Over the past decade international initiatives that have focused on promoting and
supporting the wellbeing and education of young people, in the contexts of school,
family and community, have been championed by the World Health Organisation
(WHO), UNICEF, Education for All (EFA) and a recent interagency initiative by
WHO, UNICEF, UNESCO, Educational International, Education Development
Centre, Partnership for Child Development and the World Bank, titled Focusing
Resources for Effective School Health (FRESH) (World Health Organisation, 2003).

3.1. The World Health Organisation’s Global School Health


Initiative
The WHO, through its Global School Health Initiative, promotes the concept of a
Health Promoting School (HPS). Specifically, WHO defines a Health Promoting
School as one that continually works towards strengthening its capacity as a healthy
setting that provides optimal conditions for learning, achievement and social
development (World Health Organisation, 2003). It does this by:

• fostering health and learning using available resources;


• partnering and working in collaboration with health and education policy
makers, teachers, students, parents, health providers and community leaders in
efforts to ensure that the school is a healthy setting;
• striving to provide a healthy environment, school health education and school
health services along with school/community projects and outreach which may
include health promotion initiatives for staff, nutrition and food safety
programmes, opportunities for physical education and recreation, and
programmes for counselling, social support and mental health promotion;

Health Promoting Schools: A review of international literature and models of practice


Pauline Dickinson, May 2005
Page 14
• implementing policies and practices that respect an individual’s wellbeing and
dignity, provide multiple opportunities for success and acknowledge good
efforts and intentions as well as personal achievements; and
• striving to improve the health of school staff, families and community
members as well as students.

3.2. UNICEF’s Child Friendly Framework


UNICEF’s child friendly framework focuses on schools being sensitive to the rights
of children and young people, healthy for them, effective with them, protective of
them, as well as being involved with families and communities. UNICEF’s child
friendly framework considers the following:

• the school is a significant personal and social environment in the lives of its
students;
• the school environment is physically safe, emotionally secure and
psychologically enabling;
• teachers are the single most important factor in creating an effective and
inclusive classroom learning and teaching environment;
• the school recognises, encourages and supports students’ growing capacities as
learners by providing a school culture, teaching behaviours and curriculum
content that are focused on learning and the learner;
• the ability of a school to be and to call itself child-friendly is directly linked to
the support, participation and collaboration it receives from families;
• the school develops a learning environment in which girls and boys are
motivated and able to learn, and staff members are friendly and welcoming to
children and attend to their health and safety needs.

Education for All (EFA) is an initiative with a vision to enable children, young people
and adults to experience educational opportunities that will enable them learn, achieve
and have their basic needs met. The Dakar Framework for Action, Education for All:
Meeting our Collective Commitments includes the creation of safe, healthy, inclusive
and equitably resourced educational environments that enable children and young
people to learn effectively. The EFA framework calls for policies and codes of
conduct that enhance the physical, social and mental and emotional wellbeing of
teachers and learners (UNICEF).

Health Promoting Schools: A review of international literature and models of practice


Pauline Dickinson, May 2005
Page 15
3.3. FRESH-Working together to Focus Resources for Effective
School Health
Collaboratively, the WHO, UNICEF, UNESCO and the World Bank have worked
together to establish FRESH-Working together to Focus Resources for Effective
School Health. The focus of FRESH has been the development of a core group of cost
effective components of a school health, hygiene and nutrition programme. This
initiative consists of the following four components:

• health-related policies that help ensure a safe and secure physical environment
and a positive psychosocial environment, and address all types of school
violence, such as the abuse of students, sexual harassment and bullying;
• safe water and sanitation facilities;
• skills-based health education that focuses on the development of knowledge,
attitudes, values and life skills needed to make and act on, the most
appropriate and positive decisions concerning health; and
• school-based health and nutrition services which are simple, safe and familiar,
and address concerns that are prevalent and recognised as important in the
community (UNICEF).

3.4. INTERCAMHS: the International Alliance for Child and


Adolescent Mental Health and Schools
The International Alliance for Child and Mental Health and Schools
(INTERCAMHS) is an international network of agencies and individuals who believe
that addressing mental health issues in schools is vitally important to the wellbeing of
school community members (Weare, 2004).

INTERCAMHS currently has over 250 members who represent 26 countries. The
Alliance aims to promote the exchange of ideas and experience through strong links
with people with expertise in child and adolescent mental health with the aim being to
enhance the wellbeing of children and young people. An advisory board was formed
which includes members from Australia, Germany, United Kingdom, United States,
Ireland, New Zealand, Vietnam, Canada, Azerbaijan and Iceland.

The Alliance was established in 1998 and in October 2003, INTERCAMHS inaugural
meeting was held in conjunction with the 8th Annual Conference on Advancing
School Mental Health in Portland, Oregon. The theme for the meeting was

Health Promoting Schools: A review of international literature and models of practice


Pauline Dickinson, May 2005
Page 16
“Promoting Growth, Improvement, and Sustainability of School Mental Health
Programs Worldwide”. Weare (2004), in her summary of some of the presentations at
this meeting, signalled that “a paradigmatic change is occurring to move mental health
from a deficit to a strength perspective” (p.66). She has also pointed out that
promoting the mental health of children and young people should focus on “all youth,
not just those who are ‘normal’ and those who present ‘disorders’ and to stop
pathologising children – a significant challenge for many adults and in particular
health professionals” (p, 66). Another significant issue raised by Weare (2004) was
the need to ‘normalise’ language and ensure that positive approaches to mental health

represent the full continuum of mental health promotion, early interventions and
treatment in schools. Such an approach will also help overcome the stigma that so
damagingly continues to surround the whole issue of mental health (p.66).

The Alliance, in focusing on global mental health, aims to connect the promising
work in school based mental health through the development of collaborative
approaches across states, regions and countries. As Weare (2004) has stated:

there is a particular need for strategies to ‘bridge the cultural divide’ between
education and mental health, as schools often find it hard to see the relevance of
mental health to their central concern with learning. A critical issue will be to
understand the nature of schools, their role in society, their culture, and how these
factors promote or mitigate against school mental health promotion efforts. The
meeting uncovered some significant cross-systems (e.g., education and health)
initiatives for whole school mental health promotion efforts such has MindMatters,
originally an Australian project which has been adapted and adopted in Germany and
is being considered elsewhere in Europe. (p.66).

A special issue of the International Journal of Mental Health Promotion, Summer,


2004, was dedicated to the theme of sustainability of mental health efforts in school
settings. The Alliance is currently initiating an international research project using the
Psycho-social Environment Profile (PSE) as a way to explore schools’ psychosocial
environments. This tool is described in more detail in Section Four of this report.

Health Promoting Schools is also a well-established network in Europe. The European


Network of Health Promoting Schools is a strategic programme for the European
Region, which is supported by the Council of Europe, the European Commission and
the WHO Regional Office for Europe. This programme seeks to integrate the policy

Health Promoting Schools: A review of international literature and models of practice


Pauline Dickinson, May 2005
Page 17
and practice of the HPS into the wider health and education sectors. Each of the HPS
initiatives implemented across schools in the European Network has placed emphasis
on the importance of a healthy psycho-social environment in schools (World Health
Organisation, 2003).

In summary the global school-based health promotion initiatives reviewed share the
following characteristics:

• the school is a significant personal and social environment in the lives of


young people;
• the school setting is physically safe, emotionally secure and psychologically
enabling;
• the school fosters health and learning using available resources;
• the school works collaboratively with families and the school community; and
• the school has developed relevant policies and practices that support the
wellbeing of children, young people and staff.

Health Promoting Schools: A review of international literature and models of practice


Pauline Dickinson, May 2005
Page 18
4. International models of practice for the promotion of
wellbeing in school settings

This section describes a ‘whole school approach’ to promoting wellbeing and includes
examples of international models of practice for Health Promoting Schools/Healthy
Schools from the United Kingdom, Scotland, United States of America, Canada,
Europe and Australia.

4.1. A whole school approach

A whole school approach to promoting wellbeing is based on an ecological


perspective, which locates children and young people in the environments that
influence their development, with the key contexts being the family and local
community, the school and the peer group. These contexts have been referred to as
the microsystem which can be viewed as the intimate social and immediate physical
environmental setting in which children and young people grow and develop
(Bronfenbrenner, 1979). The transitions that children and young people make between
these settings influence the course of their development, either supporting it or
impeding it. Roeser and colleagues (2000) have referred to the important role of
school-based initiatives in “enhancing a variety of educational and non-educational
outcomes” (p.477). In their view
schools in the twenty-first century will need to continue to focus on a dual mission:
(a) providing classroom and school environments that address the developmental
needs of all students and (b) providing a ‘hub’ for additional support services needed
to ensure that high-risk students get on track academically toward a successful future
(Roeser et al., 2000, p.465).

Within an ecological framework, there is scope for both the enhancement and
promotion of protective factors, both at an individual and an environmental level.
Kalafat (2003) has suggested that even when there are risk conditions present among
groups, whole school approaches to promoting wellbeing can assist in mediating
against risk. With regard to mental health, Beautrais (1998) has identified a wide
range of components of positive mental health promotion programmes such as:
increasing the awareness of mental health concerns; destigmatising mental illness;
encouraging students to recognise signs of poor mental health among themselves and
Health Promoting Schools: A review of international literature and models of practice
Pauline Dickinson, May 2005
Page 19
their peers; ensuring that young people are able to access appropriate support/help
seeking for themselves and their friends; and life skills development/enhancement in
the areas of self-awareness, coping, social and problem-solving skills.

In keeping with this ecological perspective, Phelan and colleagues (1994) have
proposed a concept of multiple worlds as a framework for conceptualising the various
transitions that occur for children and young people. These multiple worlds (Figure 1)
comprise the family, peer group, school and wider community in which children and
young people engage and interact, with these worlds being interrelated. The meanings
and understandings that they derive from their multiple worlds combine to influence
the way in which they navigate the mental, emotional and social challenges that they
face and the way in which they engage with schools and learning. The concept of
transition and change in this model is considered in its broadest sense and offers a
framework for schools to support children and young people to successfully navigate
their worlds. One of the most useful features of the multiple worlds’ model is that it
directs attention to the nature of boundaries and borders as well as processes of
movement between the worlds. In this way children and young people are construed
as mediators and integrators of meaning and experience, as they adapt to the different
contexts and settings in which they grow and develop.
Figure 1: The multiple words model

FAMILY SCHOOL
• Home • norms
• values • values
• beliefs • beliefs
• expectations SELF • expectations
• actions • meanings • actions
• perceptions
• understandings
• thoughts
• feelings
• adaptation
LARGER strategies LARGER

SOCIO- SOCIO-
PEERS
ECONOMIC • norms ECONOMIC
• values
COMMUNITY • beliefs COMMUNITY

expectations
• actions

Health Promoting Schools: A review of international literature and models of practice


Pauline Dickinson, May 2005
Page 20
The development of a comprehensive whole school approach to wellbeing requires
effective, evidence-based and promising models of practice. Available evidence has
indicated that comprehensive and integrated health promotion approaches that include
the curriculum, the environment and the community, are likely to enhance the overall
wellbeing of children and young people (Fertman & Chubb, 1992; Patton et al., 2000;
Wyn, Cahill, Holdsworth, Rowling, & Carson, 2000). The HPS conceptual framework
typifies the essence of a whole school approach (Figure 2).

Figure 2: Health Promoting Schools Conceptual Framework

Curriculum Teaching School Organisation


and Learning And Ethos

Community Links
And Partnerships

With the core business of schools being education, effective health promotion requires
that the emphasis shifts from an exclusive focus on classroom specific education or
programmes, towards a more comprehensive outlook in which health promotion
operates consistently across the curriculum, the school environment, and school
partnerships and services, and is integrated with appropriate structures, policies and
programmes with in the school (Bennett & Coggan, 1999; Patton et al., 2000; Wyn et
al., 2000). Hence, education outcomes and health promotion become inextricably
linked in enhancing the healthy development of children and young people. In
adopting a whole school approach to wellbeing schools can serve as a protective
shield to help children and young people navigate their various life challenges and
daily experiences within the context of a supportive social, emotional and physical
environment.

Health Promoting Schools: A review of international literature and models of practice


Pauline Dickinson, May 2005
Page 21
For significant systemic change to occur, policy and programme commitments must
be demonstrated through effective allocation and reorienting of available resources
e.g., finances, personnel, time, space, equipment that can be used in ways that enable
policy and promising practice to be operationalised (Alderman, 2004). These authors
have stated that “institutionalisation of comprehensive, multi-faceted approaches
necessitates restructuring the mechanisms associated with six infrastructure concerns
which encompass processes for daily (1) governance; (2) leadership; (3) planning and
implementation of specific organisational and programme objectives; (4) coordination
and integration for cohesion; (5) management of communication and information; and
(6) capacity building (D-14). Included in the development of infrastructure is the
need for more collaborative arrangements. Alderman and Taylor (2004) have
proposed that clustering and networking of schools is one way of maximising the use
of limited resources. Specifically, when:

a ‘family of schools’ in a geographic area collaborates to address barriers, they can


share programmes and personnel in many cost-effective ways. This includes
streamlined processes to coordinate and integrate assistance to a family that has
children at several of the schools…connecting with community resources, a group of
schools can maximise distribution of scarce resources in ways that are efficient,
effective and equitable (D-14).

4.2. International Models of Practice for Promoting Wellbeing in


Schools
United Kingdom

In the United Kingdom the National Healthy School Standard (NHSS) sponsored by
the Department for Education and Skills (DfES) and the Department of Health and
managed by the Health Development Agency (HDA) aims to contribute to raising the
achievement of children and young people, promote social inclusiveness and reduce
health inequalities (World Health Organisation, 2003). One theme of the NHSS
focuses on the emotional health and wellbeing (EHWB) of children and young people.
To meet the NHSS criteria for EHWB schools are required to demonstrate that they:

• provide opportunities for student participation and obtain their views to inform
policy and practice;

Health Promoting Schools: A review of international literature and models of practice


Pauline Dickinson, May 2005
Page 22
• have a policy and code of practice to address bullying which is owned,
understood and implemented by all members of the school community and
includes contact with external agencies;
• openly address issues of EHWB by enabling young people to understand what
they are feeling and by building their competence to learn; and
• identify and support the emotional health needs of staff.

The National Healthy Schools Standard (Emotional health and wellbeing – including
bullying) – United Kingdom
It is worth remembering that there are no quick fixes for achieving the full benefits of
a concerted EHWB programme. It takes time to develop whole school practice that
truly promotes EHWB, and programmes need to be implemented rigorously,
continuously and in an emotionally literate way to get results (NHS Health
Development Agency, 2004).

The National Healthy Schools Standard (NHS) document has been developed by the
NHS to provide support for staff and practitioners working in or with schools to
promote emotional health and wellbeing (EHWB). It is noted in the document that the
primary school sector has more readily embraced the promotion of emotional health
and wellbeing than the secondary school sector. The National Healthy Schools
Standards whole school approach to promoting emotional health and wellbeing
focuses on ten elements:
• Policy development
• Curriculum planning and resourcing
• Teaching and learning
• School culture and environment
• Giving students a voice
• Provision of students’ support services
• Staff professional development needs, health and welfare
• Partnerships with parents, carers and the community
• Assessing and recording and reporting achievement
• Leadership, management and maintaining change

Each aspect builds on and supports each other and the activities that support them
often overlap. The initiatives/activities have been referred to as ‘taught’ elements
(e.g., curriculum based) and ‘caught’ elements (e.g., a positive whole school
approach). The National Healthy Schools Standard emphasises action planning and
Health Promoting Schools: A review of international literature and models of practice
Pauline Dickinson, May 2005
Page 23
the development of both short-term and long-term targets with the central premise
being that “a piecemeal adoption of strategies, important as each of them might be, is
less effective in terms of the impact on pupils and staff than a whole school approach,
and less sustainable over the longer term” (NHS Health Development Agency, 2004).

This document also provides information and practical strategies for schools to
become more emotionally healthy by enabling them to meet the specific criteria for
the NHSS theme of EHWB and to reinforce and extend good practice in this area,
beyond that described in the NHSS criteria. Section one discusses the language of
emotional wellbeing, social, emotional and behavioural skills necessary for EHWB,
reasons why schools should promote EHWB and provides a case study of an
emotionally healthy school. Section two describes the links between emotional health
and learning and the ways in which children and young people can achieve their
potential. Five areas of need are presented: (1) physiological or survival needs; (2)
safety needs; (3) love, affection and belonging; (4) self-esteem; and (5) self-
actualisation. For each area of need, the document describes the desirable experiences
for individuals and what this might look like in the school setting.

Table One: Self-esteem example of the ways in which EHWB can be fostered in the school setting

Range of needs Desirable experiences In school this might look like

Self-esteem • Being valued, accepted • ‘Star of the day’ events to be the focus of
and celebrated positive attention
• Being noticed and • Use of praise
listened to • Use of appropriate language to correct
• Influencing outcomes behaviour
• Being supported to take • Rewards and recognition systems
responsibility for • Opportunities to have special
outcomes with responsibilities
increasing
independence
(NHS Health Development Agency, 2004)

Section three presents an overview and practical examples of the ten elements of the
NHSS whole school approach. For example, the element ‘Leadership, management
and managing change’ is considered critical in providing support and direction for
promoting EHWB in the school community. As with other HPS initiatives, “leaders
set the tone for all interactions within the school environment, so their use and
modelling of SEBS is critical” (p.26) The EHWB resource also provides an overview
Health Promoting Schools: A review of international literature and models of practice
Pauline Dickinson, May 2005
Page 24
of the policy context for the ‘emotionally healthy school’ (p.26), national education
strategies, other policies and strategies such as local preventive strategies, child and
adolescent mental health services; and a comprehensive analysis of a range of
resources that schools could find helpful in supporting their work under the different
strands of the EHWB theme. One example of the analysis framework as related to
inclusiveness is shown in Table Two.

Table Two: Leadership and management/school culture and environment/policy development


Index for
inclusion
Helps schools School The materials are organised in http://inclusion.uwe.ac.uk
analyse cultures, managers three dimensions; creating /csie/indexlaunch.htm
policies, practices, responsible for inclusive cultures; producing
and barriers to inclusion inclusive policies; evolving
learning and inclusive practices. Each section
participation contains up to 11 indicators and a
series of questions
(NHS Health Development Agency, 2004)

In summary, the NHSS Promoting emotional health and wellbeing briefing document
provides a sound rationale, practical strategies and case study examples to enable
schools to achieve this standard. Two useful features of this document are: the ways
in which each of the ten NHSS standards function with regard to the promotion of
emotional health and wellbeing; and the comprehensive analysis of available
additional community and national resources available to schools.

The Leicestershire Health Promoting Schools Programme


This programme requires schools involved to work towards accreditation as a health
promoting school. An audit tool is provided to clarify the current practices of the
school and includes general questions related to teaching and learning,
communication and collaboration with parents and community members, and links
and partnerships with health providers. Steps towards accreditation as a HPS school
are:
• An expression of interest in HPS and expression of intent to network with
other schools
• Forming a task group and identifying a coordinator. Registering to be involved
with of HPS

Health Promoting Schools: A review of international literature and models of practice


Pauline Dickinson, May 2005
Page 25
• Carrying out an audit, developing an action plan and incorporating this in the
schools development plan. Once approved, the school can use the ‘Working
towards Healthy Schools’ logo
• A service level agreement is drawn up between the school and the HPS
provider, which reflects the needs of the school, health priorities and the
number of schools working together on the programme. A minimum of four
themes are chosen.
• Schools begin work on their action plans
• Once work on the four themes is completed and evidence is provided, the
school is then accredited with the National Healthy School Standard and uses
the ‘National Healthy Schools’ logo
• The school uses the next two years to ensure that developments are securely in
place and review progress.
• Once two years have lapsed following accreditation the school may retain their
Healthy School status by working towards remaining themes,

The Leicestershire HPS initiative identifies eight key themes and includes an audit
tool for each one. The eight themes are:
• Personal, social and health education (PSHE)
• Citizenship
• Drug education
• Emotional health and wellbeing
• Healthy eating
• Physical activity
• Safety
• Sex and relationships

To gain recognition as a Leicestershire HPS school the school will need to show that
they have:
• a commitment to a whole school approach in implementing appropriate policy
development in the area of health promotion;
• a named person to coordinate developments;
• an action plan for school development;
• a task group to lead activities; and
• involvement at some level of students, parents/caregivers, staff, senior
management, governors, school nurse, and outside agencies as appropriate.
(http://www.leics.gov.uk/print/health_school_process)

Health Promoting Schools: A review of international literature and models of practice


Pauline Dickinson, May 2005
Page 26
Scotland

‘Health’ is taken to mean physical, social, spiritual, mental and emotional wellbeing
in relation to oneself, society and the environment (Scottish Health Promoting
Schools Unit, 2004, p.iii).

In Scotland, the Being Well – Achieving Well initiative has been established with the
goal being that by 2007 all schools will become HPS (Scottish Health Promoting
Schools Unit, 2004). This project has been established by the Scottish Health
Promoting Schools Unit (SHPSU) in partnership with national and local authorities
that include the Scottish Executive Education and Health Departments, the
Convention of Scottish Local Authorities, Learning and Teaching, Scotland, NHS
Health Scotland, Her Majesty’s Inspectorate of Education and the National Health
Promoting Schools Network. Importantly, these partnerships signal high policy level
collaboration between the education and health sectors. The Being Well – Achieving
Well approach has highlighted the fact that
for the first time, education legislation recognises that pupils have educational rights
and must be seen as partners in the school. The Act (2002) makes it clear that every
child has the right to receive a school education. The Act also sets out a framework
for improvement within which there is a duty on education authorities to provide
school education directed at developing the personality, talents and mental and
physical abilities of the child or young person to their fullest potential (p.4).

The Achieving Well – Doing Well document has pointed out the diversity of national
and local policy initiatives under which HPS has been developed with the challenge
being for strategic planners in the various sectors mentioned in the previous paragraph
to “create an integrated implementation strategy that takes account of the full range of
policy initiatives and yet has within it a clearly defined element that will ensure that
schools develop and can be recognised as HPS” (p.15). The areas for strategic
development of HPS in Scotland have been identified as: (1) community planning and
the integrated delivery of services; (2) building on current progress in the
development of HPS; (3) extending the concept of effective education; (4) developing
integrated community schools; and (5) staff development. In order to assist the
development of HPS within a broader policy framework, the Scottish HPS Unit has
been established by the Scottish Executive. This network comprises a member from
every local authority and National Health Service board in Scotland. A national
website has been established at www.healthpromotingschools.co.uk. One of the

Health Promoting Schools: A review of international literature and models of practice


Pauline Dickinson, May 2005
Page 27
principal aims of the Scottish HPS Unit is to: champion, facilitate and support the
development of HPS throughout Scotland.

Canada

Health promoting schools initiatives in Canada are based around the Comprehensive
School Health (CSH) Model (Johnston, 1999). A key component of the CSH is the
Student Health Model, which is a strategic systems approach to assist schools and
school boards in their implementation of the CSH. Specifically, the aim of the Student
Health Model is to “create students who are healthier, and thus learn better”
(Johnston, 1999).

The Student Health Model: Five Major Health Influences

• Psychosocial environment: relates to a safe, supportive environment which


enhances self-esteem, fosters caring supportive behaviour and is free from
bullying, violence, discrimination and racism;
• Personal resources: the developing of young peoples’ coping and social skills
in a safe supportive environment;
• Personal health practices: relates to the development young peoples’
knowledge, values, attitudes, beliefs and skills needed to make health-
enhancing decisions;
• Physical environment: a healthy and safe environment can reinforce and
promote health; and
• Support services: such as counselling support, learning difficulties support,
anger management, conflict resolution, time management

Seven Principles of Student Health Promotion

• Health is a prerequisite for learning;


• Opportunity to develop the knowledge, values, attitudes, beliefs and skills
needed for positive health practices and coping skills;
• Accessible programmes;
• Inclusive programmes;
• Variety to ensure that programmes address a range of needs;
• Adaptable programmes that relate to the special features of each school; and
• Policies that convey support for student health (Johnston, 1999,p. 44).

Health Promoting Schools: A review of international literature and models of practice


Pauline Dickinson, May 2005
Page 28
Johnston (1999) has outlined the key factors that are needed to implement the Student
Health Model. These are, in order of priority, commitment, establishment of a school
health committee, needs assessment, development of a school health profile,
development of a school health plan and a programme action plan and review and
evaluation. The Model and the needs assessment tool were tested in six schools across
Canada and in all but one school the model was successfully implemented. Johnston
(1999) has pointed out that the
only school that did not succeed with the model excluded students and parents from
the planning committee and steered the process away from school administration.
They felt that the process was too much work and the planning stages took too long.
While they had trained staff from outside agencies to assist with implementation, they
may not have understood the importance of commitment to the participatory process
(p.45).

United States of America (USA)

The advancement of school-based mental health has been a significant focus across
the USA, particularly over the last decade. A 2002 state survey of school-based health
centre initiatives found that there were 1498 centres in 43 states of the USA (The
Center for Health and Health Care in Schools, 2002). Of the 30 states that reported
encouraging or supporting school-based health centres, nutrition was cited as the most
important prevention-related topic.

However, recent predictions of where the field of mental health in schools is going
have indicated that the field is in a state of flux (UCLA School Mental Health Project,
2004). While there appears to be no specific perspective or agenda dominating policy,
practice, research and training, the emerging view is that there is a need for “more
than expanded services and full service for schools” (p.8). The emerging view calls
for “enhancing strategic collaborations to develop comprehensive approaches that
strengthen students, families, schools, and neighbourhoods and doing so in ways that
maximise learning, caring and wellbeing” (UCLA School Mental Health Project,
2004, p.8). It has also been recognised that schools show less enthusiasm for
advancing school-based mental health when the focus is on mental disorders and the
emphasis for schools is to educate students. What is proposed is a systemic approach,
whereby changes can weave school resources with community resources to develop

Health Promoting Schools: A review of international literature and models of practice


Pauline Dickinson, May 2005
Page 29
comprehensive, integrated approaches. In keeping with a Health Promoting Schools
model, the emerging view focuses on:

• promoting the wellbeing of staff so that they can do more to promote the
wellbeing of students;
• fostering staff and student resilience;
• creating an atmosphere that encourages mutual support, caring and sense of
community;
• fostering smooth transitions, positive informal encounters, and social
interactions;
• facilitating social support;
• providing opportunities for ready access to information and for learning how
to function effectively in the school culture;
• encouraging involvement in decision-making; and
• welcoming and supporting staff, students and families at school every day as
an integral part of creating a mentally healthy school.

Access to resources to advance school based mental health has been challenging and
the current focus is on rethinking the ways in which existing resources can be
redeployed and by “taking advantage of the natural opportunities at schools for
encountering psychosocial and mental health problems and promoting personal and
social growth” (p.8). Key drivers at a political level for advancing school-based
mental health in the US are the mandates of No Child Left Behind Act and the
Individuals with Disabilities Education Act and the recommendations of the
President’s New Freedom Commission on Mental Health. The proposed model for
advancing mental health in schools incorporates mental health into the core business
of schools with the need to ensure that a full continuum of promotion, prevention and
early intervention and systems of care are implemented. This continuum is illustrated
below (Figure 3):

Health Promoting Schools: A review of international literature and models of practice


Pauline Dickinson, May 2005
Page 30
Figure 3: Interconnected systems for meeting the needs of all children

Systems for Promoting Healthy


Development & Preventing Problems
primary prevention - includes universal
interventions (low end need/low cost
per individual programmes)

Systems of Early Intervention


Early-after-onset – includes selective
& indicated interventions (moderate
need, moderate cost per individual)

Systems of Care
treatment/indicated
interventions for severe and
chronic problems (High end
need/high cost per individual
programmes)

(Alderman, 2004)

Policy directions related to the advancing of school-based mental health include:

• ensuring that there is holistic understanding of mental health which is


understood both in terms of strengths and deficits;
• countering marginalisation and fragmentation of mental health in schools;
• assuring equity of access to opportunities (e.g., resources, programmes,
interventions);
• designing and implementing appropriate interventions using evidence-based
and promising approaches which have been evaluated; and
• ensuring the roles of schools/communities/homes are enhanced.

Emerging approaches have also resulted in the development of a new group called the
School Mental Health Alliance. This alliance developed the following statement to
build consensus, with the statement being endorsed by over 20 key organizations that
represent education, health and mental health:

Health Promoting Schools: A review of international literature and models of practice


Pauline Dickinson, May 2005
Page 31
Both academic and non-academic barriers to learning exist. Well-documented non-
academic barriers include a host of community, family, school, peer, and individual
factors that contribute to behaviour, emotional and learning problems. A large body
of research underscores the urgency of removing these non-academic barriers to
student learning. Moreover, an impressive science-base supports school-based
strategies for doing so…failure to act has consequences. The burden of suffering
caused by insufficient attention to students’ social, behavioural and emotional
development has contributed to leaving too many children behind at the same time
that federal legislation calls for just the opposite (cited in UCLA School Mental
Health Project, 2004).

Australia

In Australia HPS has been implemented in most states. However, the significant
national focus has been on the development and implementation of the MindMatters
Project in secondary schools. This focus has largely been determined by findings that
have highlighted significant mental health concerns among young people such as
anxiety, depression, conduct and behavioural concerns, psychosis, drug and alcohol
related concerns, suicidal behaviour and suicide. The Australian National Mental
Health Strategy also highlighted the issue of stigma in relation to mental ill health.

MindMatters - Australia
The national MindMatters Project implemented throughout Australia is currently
being conducted in collaboration with the Australian Principals Associations
Professional Development Council (APAPDC) www.apapdc.edu.au and Curriculum
Corporation (CC) www.curriculum.edu.au and is funded by the Commonwealth
Department of Health and Ageing www.mentalhealth.gov.au. The uptake of the
MindMatters Project across Australia has been considerable. As of November 2003,
68 percent (1894) of Australian secondary schools have been involved in
MindMatters professional development with over 31,928 people (teachers, principals,
indigenous workers, community service providers) whereas in 2001 sixty school staff
participated in whole school professional development compared with 6,000 during
2003.

In recent years a suite of MindMatters initiatives have been developed to be used as


“comprehensive and complementary set of promotion, prevention and early
intervention mental health and suicide prevention components to fit a ‘whole school’
framework” (Wyn et al., 2000). The project is supported by a National Reference
Health Promoting Schools: A review of international literature and models of practice
Pauline Dickinson, May 2005
Page 32
Committee which: provides strategic advice, oversees and coordinates feedback from
various MindMatters committees as well as linking with a range of national providers;
nationally consistent professional development programme for schools and
communities; national funding; and a MindMatters Project Officer based in the
various states and territories of Australia. The MindMatters National Aboriginal and
Torres Strait Islander Committee provider network has been established to provide
advice relating to health and wellbeing issues for Aboriginal and Torres Strait
Islanders including the development of relevant resources and community based
strategies for promoting and supporting mental health.

MindMatters conceptual framework


The MindMatters Project has adapted the World Health Organisations school change
model (Figure 4) as a way to conceptualise the multiple layers to supporting the
mental health of children and young people in schools. Promoting mental health in
schools is represented in the widest part of the triangle, and this involves a whole
school approach with the emphasis being on creating an environment that is
conducive to learning. The second layer of the triangle signals the need to educate for
and about mental health for everyone. In this way, children, young people and adults
can gain understanding, knowledge and skills to support their own mental health and
the mental health of others. The third level of the triangle signals the need for some
targeted initiatives to support those children and young people with high mental
health needs. These initiatives may be in the form of peer support groups, peer
mediation programmes, counselling and guidance, drug and alcohol programmes,
grief support groups, and anger management programmes. The tip of the triangle
signals the need for some professional support, which may involve individual, school-
based counselling or referral when necessary to community agencies, child and
adolescent mental health services.

Health Promoting Schools: A review of international literature and models of practice


Pauline Dickinson, May 2005
Page 33
Entire Create environment conducive to promoting Whole school
school psychosocial competence and wellbeing environment
community

All students Mental health education: Part of general


and teachers Knowledge, attitudes and behaviour curriculum

Targeted Students needing


20%-30% programmes additional help at
of students school

3%-12% of Professional Students needing


students support additional mental
health support

Who is Level of
involved intervention

Figure 4: The World Health Organisations’ Whole School Approach to School Change

(Wyn et al., 2000)


The components of Mind Matters currently in operation within schools are:

MindMatters: A Mental Health Promotion Resource for Secondary Schools.


This resource provides a ‘whole school’ framework that highlights the ways in which
schools can enhance known protective factors for students through the provision of a
safe, inclusive and supportive environment. As well, MindMatters aims to influence
the school curriculum so that student wellbeing is promoted and supportive. Schools
are also encouraged and supported to work in partnerships for the wellbeing of the
whole school community.

MindMatters Plus
This component of MindMatters builds on and operates within the already established
whole school framework. The focus of MindMatters Plus the improvement of mental
Health Promoting Schools: A review of international literature and models of practice
Pauline Dickinson, May 2005
Page 34
health outcomes for students with high support needs through the implementation of
evidence based prevention and early intervention programmes. The Australian
Guidance and Counselling Association (AGCA) are currently managing this
component. AGCA supports schools to make links with appropriate services, thus
increasing the local infrastructure to support more vulnerable students’ mental and
emotional wellbeing. Information on MindMatters Plus is available on the
MindMatters website http://www.curriculum.edu.au/mindmatters.

MindMatters Plus General Practice


This initiative is currently being developed and aims to develop and promote
sustainable partnerships between schools and their Divisions of General Practice for
mental health promotion, prevention and early intervention pathways for more
vulnerable young people.

FamiliesMatter
This initiative is currently being developed and aims to engage parents in the
MindMatters Project. The project began in June 2002 and has involved a series of
focus groups nationwide with a total of 83 parents currently involved in the
development of a parent resource package. FamiliesMatter is currently being trialled
in 15 MindMatters Plus schools from each state with the aim being to implement the
strategy in 300-400 MindMatters schools across Australia.

A recent case study highlighted the following components as being critical to the
implementation of MindMatters (Hazell, O'Neill, Vincent, Robson, & Greenhalgh,
2004):

• a pre-existing positive school ethos and commitment to pastoral care and


student wellbeing;
• MindMatters professional development that involves school representatives
from both management and teaching staff;
• leadership and responsibility within the school;
• planning and consultation;
• resource allocation within the school;

Health Promoting Schools: A review of international literature and models of practice


Pauline Dickinson, May 2005
Page 35
• MindMatters being utilised as a overarching framework for initiatives related
to student wellbeing;
• MindMatters in the curriculum; and
• opportunities for staff to critique the culture of their school, their pedagogical
practices and the way in which they relate to young people.

The Gatehouse Project –Australia


The Gatehouse Project has been developed to address the social context of secondary
schools with the principle aim being to foster young peoples’ sense of connection to
schools, and in turn, health risk behaviour and wellbeing (Patton, Bond, Butler, &
Glover, 2003). The “intervention is based on an understanding of individual and
social risk processes for adolescent depression and emotional well-being (Bond,
Glover, Godfrey, Butler, & Patton, 2001). Firstly, and importantly, the Gatehouse
Project team acknowledged that “it is a normal part of schools’ daily and long-term
planning to develop social and learning environments that promote emotional
wellbeing at all levels” http://www.rch.org.au/gatehouseproject/.

Therefore, the approach the project team adopted in working with schools was to
explore the ways in which the conceptual and operational frameworks of the
Gatehouse Project could provide added value to what schools were already doing. The
conceptual framework emphasised the importance of healthy attachments and positive
connections among teachers and peers. The three areas of action that were identified
are: building a sense of security and trust; (2) enhancing communication and social
connectedness; and (3) building a sense of positive regard through valued
participation in aspects of school life.

Secondly, the Gatehouse Project also utilised the HPS framework, which is referred to
as the projects ‘operational framework’ to establish a whole school approach that
“introduces relevant and important skills through the curriculum; makes changes in
the schools’ social and learning environments; and strengthens links between the
school and its community http://www.rch.org.au/gatehouseproject/. The two arms of
the project embrace both an individual-focused approach in the context of supportive
Health Promoting Schools: A review of international literature and models of practice
Pauline Dickinson, May 2005
Page 36
classroom environments and an environment-focused approach that aimed to address
the protective and risk factors in the school environment. Figure five below, provides
a conceptual model for the Gatehouse Project (Patton et al., 2003).

Figure 5: The Gatehouse Project Conceptual Framework

An important consideration in the Gatehouse conceptual framework was the emphasis


on the curriculum (i.e., the content) and the classroom (i.e., the context) with an
emphasis on the classroom environment and the ways in which students and teachers
related to each other. A supportive classroom environment was viewed as one
whereby students felt secure, that communication was open and respectful
relationships occurred. As well a classroom environment that is conducive to both
learning and emotional and social wellbeing is one in which all students feel that they:
• can express a point of view;
• are part of a group and have something to contribute;
• they understand the teacher’s expectations about behaviour in the classroom;
• are able to ask and answer questions about each other’s work;
• understand the agreed rules for conducting classroom conversations and other
activities;
• can respect the confidences of others who wish to share experiences;
• benefit from working in a team; and

Health Promoting Schools: A review of international literature and models of practice


Pauline Dickinson, May 2005
Page 37
• are comfortable with sometimes working in small groups which are not the
same as their usual friendship groups
http://www.curriculum.edu.au/eq/archive/eq_01/gatehouse.htm

Within such an environment (sometimes referred to as ‘classroom as community’) the


health-promoting role of teachers, both in teaching and daily interactions with young
people was considered the most critical school-based factor in promoting wellbeing.
A teacher in the Gatehouse Project reported that having a classroom agreement
contributed greatly to the classroom environment:
Student ownership of the class agreement has been central to its success. The process
of arriving at the agreement took some time, but it was time well spent. In the long
run, it proved to be a very powerful tool for maintaining a positive classroom climate
…the need to control their own behaviour and to adhere to the established code
became self-evident. It wasn’t a matter of being told by a teacher how to behave; it
was a matter of following what their peers had already set down and valued – a very
different type of peer group pressure.
http://www.curriculum.edu.au/eq/archive/eq_01/gatehouse.htm

The Gatehouse Project has also adopted an evidence-based process for planning,
implementing and evaluating a practical initiative, which included both individual-
focused and environment-focused approaches to change. This process is outlined in
numerous health promoting schools resources worldwide and includes the five
process steps of: (1) establishing health teams of staff and students; (2) reviewing
policies, programmes and practices to identify priority areas for action; (3) planning
strategies to address identified areas; (4) training and implementation: and (5)
monitoring and evaluation (Bennett & Dickinson, 1997; Brunn Jensen & Simovska,
2002; Butler, Bond, Glover, & Patton, 2002; Dickinson, 2001; Patton et al., 2000;
Public Health Promotion & Mental Health Foundation, 2001).

The Gatehouse Project team conducted a survey which provided schools with data
specifically relating to “students’ perceptions of the school’s social and learning
environments, with the data being arranged to provide information on peer
relationships, teacher –student relationships, and relationships with learning and
schooling in general” (Bond et al., 2001, p.373). The resulting profile presented to the
project schools indicated the protective and risk factors in the school environment.

Health Promoting Schools: A review of international literature and models of practice


Pauline Dickinson, May 2005
Page 38
A critical factor in the success of the Gatehouse Project was the challenging of
systemic and individual change by working at both of these levels, with evaluation
processes designed to capture the ways in which change occurred with each level.
Bond et al., (2001) have concluded by stating that:
At the outset of this project, many of the schools may have felt that the project was
located in the area of welfare and student support. What they found was that student
welfare and support could be enhanced not simply by looking at health and welfare
programmes differently but by looking at different ways of doing the core business of
education. This has led schools to focus on student engagement and connectedness to
school as the way to promote both emotional well being and learning outcomes
(p.381).

In summary, these global initiatives share a socio-ecological model of wellbeing,


which is characterised by building strong partnerships and collaboration between
schools, families and communities, children and young people and key policy makers
in the education and health sectors. Of significance is their emphasis on quality
teaching and learning conditions based on respect, inclusiveness, safety, creativity and
relevant curriculum which can motivate learning and achievement for children and
young people. Each of these initiatives has, in recent years, begun to focus on the
quality of the psychosocial environment and the way in which this impacts on the
mental, emotional, social and physical wellbeing and the learning and achievement
process and outcomes for children and young people.

Health Promoting Schools: A review of international literature and models of practice


Pauline Dickinson, May 2005
Page 39
5. The links between mental, emotional and social heath,
nutrition, physical activity and learning and achievement

Learning and health go hand in hand. Good health of children and young people is a
prerequisite for educational achievement. Good health of teachers is important to the
development of effective schools. Health promoting schools aim at empowering
students, staff and parents to actively influence their lives and their living conditions
(European Conference, 2002).

It is readily acknowledged that children and young people experience more positive
learning and achievement outcomes when they are well nourished, engage in regular
physical activity and experience school as a caring supportive social and learning
environment. This section highlights evidence from international studies that
demonstrate these links to learning and achievement and wellbeing. Nutrition and
physical activity are the two key factors stated in the recently signed tripartite
agreement in Aotearoa/New Zealand between the Ministries of Health and Education
and Sport and Recreation. However, given the holistic model of health that is the
focus of health promoting schools in Aotearoa/New Zealand, mental, social,
emotional and spiritual wellbeing are very much an integral part of this equation.

5.1. The promotion of mental, emotional and social wellbeing in


school settings
Ask any teacher and you will hear the litany of mental health concerns that arise daily
and at critical times during the school year. The kids who are misbehaving, the ones
who seem emotionally upset, the ones who are victims of physical and sexual abuse,
the ones who can’t get along with others, those who have difficulty adjusting to
school requirements, and more…Anyone who has spent time in schools can itemise
the multifaceted mental health and psychosocial concerns that warrant attention. The
question for all of us is: How should our society’s schools address these matters?
(Alderman, 2004).

Schools have been viewed as an ideal setting or entry point for health sector targeting
of research and initiatives that focus on the promotion of mental, emotional and social
wellbeing and the prevention of mental illness. As with many other health promotion
initiatives, the initial focus has been driven from an illness perspective with the focus
being on addressing risk factors rather than an educational or health promotion
perspective (Rowling & Gehrig, 1998). Increasingly, evidence suggests that the
education sector has a crucial role in promoting and supporting mental health due to

Health Promoting Schools: A review of international literature and models of practice


Pauline Dickinson, May 2005
Page 40
poor mental health being associated with: low academic achievement; higher rates of
school suspension and expulsion (Zubrick, Silburn, Burton, & Blair, 2000);
experiencing bullying, harassment and stressful life change events (Olweus, 1992)
and the impact these experiences have on health and learning. Better educational
outcomes for children and young people have been associated with protective factors
such as individual resilience, coping, connectedness to school, caring adults and peer
group and social support (McNeely, Nonnemaker, & Blum, 2002). Until recently,
evidence based and promising approaches to promoting wellbeing, and particularly
mental heath, have been hindered due to:
mental, emotional and social wellbeing being the ‘poor relation’ in all the disciplines
that are concerned with it: in psychology, health promotion, education and health
service, the area has never been well-resourced or taken as seriously as other issues
(Weare, 2000, p.1).

More recently, Weare (2000) has pointed out that significant changes in the status of
mental, emotional and social health have been occurring due to emerging evidence
from research and practice that demonstrates “the importance of this issue in new and
dynamic ways, creating a new interest in social and affective health in schools” (p.2).
Weare (2000) has provided several reasons for this shift in focus:

• the new biology which recognises the importance of emotions and the need to
manage them;
• the breakdown of social structures;
• increased pressure on children and young people;
• effective schools affect mental, emotional and social health;
• intelligence is ‘multiple’ and can be emotional and social;
• new demands on teachers with regard to pressures on young people that can
make them difficult to engage in learning and the increasing pressure for
teachers to perform; and
• mental, emotional and social health as the ‘missing piece’ and the generic key
to addressing more detailed educational and social concerns (Elias et al., 1997;
Weissberg, Jackson, & Shriver, 1995).

The importance of a positive, school climate in promoting and supporting wellbeing


It is readily acknowledged in the fields of community psychology and ecological
systems theory that everyday setting such as schools and neighbourhoods have a
significant influence on human development (Bronfenbrenner, 1989). According to
Health Promoting Schools: A review of international literature and models of practice
Pauline Dickinson, May 2005
Page 41
Kingston and colleagues (1999) a sense of connectedness is central to the interface
between individuals and their settings. Connectedness includes dimensions such as:
informal social control, participation, spirit, trust, and social support (Bowles &
Gintis, 1998).

Reflecting the view of many researchers in the fields of health and education are these
words from researchers Hargreaves, Earl and Ryan (1996) who have pointed out that:
“one of the most fundamental reforms needed in secondary or high school education
is to make schools into better communities of caring and support for young people
(p.77). Osterman (2000) has stated, the concept of experiencing a ‘sense of belonging’
is one of the most commonly stated factors in definitions of ‘community’ in the
literature. She has cited the work of McMillan and Chavis (1986) as providing the
guiding perspective and definition for her work on ‘’belonging’ in the school
community. Specifically, these authors have defined ‘community’ in two ways: (1)
community is a geographical unit; and (2) community is relational and describes the
quality of interpersonal relationships. As well, four components are integral to
McMillan and Chavis’s definition of community: (1) being a member of the
community; (2) experiencing influence within the community; (3) being integrated
within the community; and (4) sharing emotional connections within the community.

In a review which included over 300 citations, authors Baumeister and Leary (1995)
found that a sense of belonging was associated with: (1) perceiving friends and peers
more positively; and (2) experiencing more positive emotions (e.g., happiness,
calmness, contentment) which contributed to feeling accepted, included and
welcomed. In contrast, a wide range of mental health and behavioural concerns (e.g.,
anxiety, depression, suicidal ideation, violence, substance misuse and sexual activity)
were found to be associated with a lack of belongingness. According to Osterman
(2000) “being part of a supportive network reduces stress, whereas being deprived of
stable and supportive relationships has far-reaching negative consequences” (p.327).

Factors that characterise schools as supportive environments


The school as a supportive environment for children and young people has been
characterised by a number of factors which include: shared norms and values; caring

Health Promoting Schools: A review of international literature and models of practice


Pauline Dickinson, May 2005
Page 42
and supportive relationships; and opportunities to participate in school activities and
decision making (Battistich & Hom, 1997; Battistich et al., 2004). Research
conducted by Battistich and Hom (1997) focused on exploring the relationship
between students’ sense of their school as a community and their involvement in
problem behaviours. Findings indicated that “the social context of school is related to
a wide range of student attitudes, motives, and behaviours and thus merits attention in
future research as an important determinant of children’s developmental outcomes
(p.2000). The most significant finding was that in schools in which young people
experienced higher levels of school sense of community, there was significantly less
“student drug use and delinquent behaviour” (p.2000). Battistich and Hom (1997)
have stated that while there is a growing accumulation of empirical evidence for
contextual influences on the development of children and young people, as yet, there
are few theoretical models of contextual effects.

Research has indicated that schools’ can be proactive in developing a positive school
climate by attending to: (1) enhancing the quality of life at school and especially in
the classroom for students and staff; (2) pursuing both academic and social and
emotional learning; (3) enabling teachers and other staff to be effective with a wide
range of students; and (4) fostering motivation for learning and teaching (Samdal et
al., 1998). To achieve this, school climate research literature has advocated for:

• a welcoming, caring and hopeful atmosphere;


• social support mechanisms for students and staff;
• meaningful participation by students and staff in decision making;
• transforming the classroom infrastructure from a big classroom into a set of
smaller units organised to maximise motivation for learning and not based on
ability or problem-oriented grouping;
• providing instruction and responding to problems in a personalised way;
• use of a variety of strategies for preventing and addressing problems as soon
as they arise; and
• a healthy and attractive physical environment that is conducive to learning and
teaching (Loukas & Robinson, 2004; Samdal et al., 1998).

Health Promoting Schools: A review of international literature and models of practice


Pauline Dickinson, May 2005
Page 43
The classroom as a supportive social and learning community
Within schools, the classroom can be referred to as a small, more intimate micro
system, which in itself has important implications for students’ social and academic
learning and achievement. The concept of ‘community belongingness’ as applied to
the classroom community relates to the social nature of schools and the importance of
meeting the interpersonal needs of students, particularly with regard to learning and
achievement (Solomon, Watson, Battistich, Schaps, & Delucchi, 1996). In
Aotearoa/New Zealand and elsewhere school curriculum implementation guidelines
have emphasised the need for children and young people to develop cooperative
group work skills through activities for experiential learning (Education, 1999).
Osterman (2000), in her review of a small group of studies relating to belonging in
school and classroom communities, has summed up the available evidence as follows:
When children experience belongingness or acceptance, their perceptions differ in
predictable ways and these perceptions are associated with psychological differences.
When children experience positive involvement with others, they are more likely to
demonstrate intrinsic motivation, to accept the authority of others while at the same
time establishing a stronger sense of identity, experiencing their own sense of
autonomy, and accepting responsibility to regulate their own behaviour in the
classroom context consistent with social norms (p. 331)

Influences on young peoples’ experiences of school as a supportive environment for


mental, emotional and social wellbeing
While schools, as key settings, have the potential to be a positive resource for the
healthy development of children and young people, there are also conditions within
schools that can contribute to poor educational achievement and health outcomes. For
example, the WHO Health Behaviour in School–Age Children cross national study
(HBSC) findings indicate that young people who perceive school as unsatisfying are
more likely to be: underachieving academically; adopting unhealthy behaviours such
as smoking tobacco and misusing drugs and alcohol; experiencing more
psychosomatic problems; as well as more generally experiencing a reduced quality of
life. In contrast, the HBSC findings indicated that when young people report that they
are satisfied with school they are better motivated and achieve more according to their
ability level than their unsatisfied peers (World Health Organisation, 2004).

The most common factors associated with children and young people liking school
were experiencing: school as a nice place to be; a sense of belonging at school; fair

Health Promoting Schools: A review of international literature and models of practice


Pauline Dickinson, May 2005
Page 44
treatment by their teachers; school rules that were fair; teachers showing a personal
interest in them; and achievement at school. While performing well academically is
typically equated with overall school success, not all young people are able to achieve
at a level that equates with definitions or expectations of success. The HBSC study
findings indicated that parents’ and teachers’ expectations created considerable mental
health distress for those young people who were unable, for various reasons, to
achieve ‘high marks’. Young people were also more likely to disengage from their
parents if parental expectations were unrealistically high.

A recent systematic review which looked at seventeen individual project evaluations


specifically asked: Do school-based universal mental health promotion initiatives
improve the mental health of children and young people, and is it possible to identify
attributes that are common to successful interventions? (Wells, Barlow, & Stewart-
Brown, 2003). Findings from this review indicated that it is possible to have a positive
impact on the mental health of children and young people through school-based
programmes. The most positive aspect of effectiveness was for programmes that
adopted a whole school approach, were implemented continuously for more than a
year and were aimed at the promotion of mental health rather than the prevention of
mental illness, although lines are blurred between the two.

Those programmes which measured self-concept, emotional awareness and positive


interpersonal behaviours rather than conduct problems and anti-social behaviour were
more likely to show moderately positive results (Wells et al., 2003). Features of
schools that directly focused on the promotion of mental health were identified as
sharing the following features:
• the commitment of the senior management team to promoting mental health;
• an emphasis on a culture of trust, integrity, democracy and equal opportunity;
• a school culture that values all staff;
• a school culture that values children and young people regardless of their
ability;
• clear policies and procedures for issues such as behaviour and bullying
(including sanctions) which are accepted and implemented throughout the
school;
• professional standards;

Health Promoting Schools: A review of international literature and models of practice


Pauline Dickinson, May 2005
Page 45
• skilful teaching which arouses student interest and motivates; and
• proactive work with parents.

Findings from the Health in Schools Survey (392 young people from 41 secondary
schools in London) invited young people to express what they felt the priorities
should be in creating healthier schools (Healey, 2002). Three issues emerged as key
concerns: the quality, price and appropriateness of school food; the lack of provision
of regular enjoyable exercise; and the problem of bullying (p.3).

Support for transitions


School transitions are mostly experienced by children and young people at the start of
a school year and coincide with key movements between schools (e.g., in
Aotearoa/New Zealand, pre-school to primary, primary to intermediate, and
intermediate to secondary school). The most significant of these transitions has been
identified as the transition to secondary school which occurs around the same time as
pubertal changes during early adolescence (Eccles et al., 1993; Wigfield, Eccles,
MacIver, Reuman, & Midgely, 1991). While these transitions can represent
opportunities for personal growth and development, they are stressful for some
children and young people (Simmons, Burgeson, Carlton-Ford, & Blyth, 1987). For
children and young people, the transition to a new school environment can be
supported by schools adopting well organised processes such as: providing orientation
days prior to the school transition and/or supporting students who transition during the
school year by giving them a tour of the school and assigning others in the peer group
to help them (Koizumi, 2000). These processes have been found to help reduce stress
and feelings of loneliness and isolation (Education Review Office, 1997). As stated by
Koizumi (2000)
school-aged children and young people are so sensitive to their surrounding
environment that every effort must be made to enhance students’ growth and progress
through school-related transitions (p.184).

Social inclusiveness
Social inclusiveness, which is not dissimilar to belonging and connectedness, has also
been identified as a critical factor for positive mental health (Weare & Gray, 2003).
Research conducted by (Catalano, Berglund, Ryan, Lonczak, & Hawkins, 2002) has
provided evidence that initiatives that focus on positive behaviour management and
Health Promoting Schools: A review of international literature and models of practice
Pauline Dickinson, May 2005
Page 46
enable young people to resist negative social influences and avoid trouble are
effective. Their long term evaluation of 800 young people who participated in the
Seattle Social Development Project indicated that post programme young people were
less likely to engage in criminal acts, were less violent and were less likely to
participate in alcohol misuse.

In contrast, a study conducted by researchers Maes and Lievens (2003) found that
young people who truanted from school were more likely to be alienated and
experienced poor academic achievement. Those young people who were alienated
from school were also more likely to engage in smoking and drinking alcohol.
Findings from this study also indicated that there were individual characteristics
associated with young people who truanted and repeated classes as well as school
climate characteristics, which indicated that “some schools seem not to be able to
provide “meaning” and a sense of belonging for the pupils,” (p.525).

The promotion of emotional competence


School based initiatives that focus on promoting mental health and emotional
competence have been shown to have a direct effect on educational achievement as
well as factors such as achieving a more positive school ethos, positive self-esteem,
listening and communication skills among young people (Weare & Gray, 2003).
According to Weare and Gray (2003) emotions such as sadness and anger can block
learning, while others such as experiencing a sense of wellbeing and belonging,
feeling safe and feeling valued are more likely to promote learning. They argue that
children and young people who are taught the ways in which they can manage
emotions are better able to engage in learning.

One explanation provided by Elias and colleagues (1997) is that when people are
overwhelmed by powerful negative or distressing emotions they are not able to think
clearly. A recent review of a range of educational studies indicated that the
achievement of academic goals was complemented by a focus on emotional wellbeing
rather than being in conflict with them (Weare, 2000). Conclusions drawn from these
study findings were that four key elements were essential if schools were to be
effective in both learning and achievement and affective domains:
Health Promoting Schools: A review of international literature and models of practice
Pauline Dickinson, May 2005
Page 47
• supportive relationships, especially understanding, helpful and friendly
teachers;
• a high level of participation in school life by staff and students, particularly
where schools had a strong sense of community, the whole staff were engaged,
communication was open and participatory decision-making processes
involving staff and students;
• the encouragement of autonomy among staff and students whereby the school
promoted independent learning and where teachers had a degree of control
over their own work; and
• clear rules, boundaries and expectations such as everyone in the school and
surrounding community understood their role and the norms, values and
expectations of the school (Weare, 2000).

Each of these four key elements, individually, have been found to be associated with
improved academic success, students being more engaged in their learning, greater
retention at school, more competent teaching, improved social competence and
morale and less absenteeism. Together, these four elements are even more effective
(Weare, 2000). When children and young people gain social and emotional skills, they
experience educational gains, which include improved school attendance, higher
motivation and higher morale (Durlak & Wells, 1997).

Weare and Gray (2003) have also explored research relating to the way in which the
brain operates under different conditions. For example, findings indicated that
individuals need to experience positive emotions in order to learn effectively.
Likewise when a person is experiencing considerable stress, the brain reverts to more
primitive survival needs. This sense of stress can be the result of personal or
environmental threat such as witnessing violence or being bullied or within the
classroom environment such as a student struggling with a task set by the teacher.
These authors have suggested that emotions constitute part of higher order thinking
and therefore require people to think about emotions, organise them, modulate them,
moderate them and shape them through reflection and learning, rather than simply
responding reactively or blindly to different emotions.

Health Promoting Schools: A review of international literature and models of practice


Pauline Dickinson, May 2005
Page 48
The impact of bullying behaviour on the wellbeing of children, young people and
learning and achievement
While there are numerous factors that influence the wellbeing of children and young
people in school settings, the issue of bullying warrants discussion due to the
considerable body of international and national research that indicates that bullying
behaviour is a worldwide occurrence among young people (Coggan, Bennett, Hooper,
& Dickinson, 2003; World Health Organisation, 2004). Exclusion, as a result of being
bullied, was found to be endemic across the 35 countries in the HBSC study (World
Health Organisation, 2004, p.148). Students who had been bullied were found to: be
more likely to be left alone at school; have bullied others; have said that other students
do not accept them as they are; feel like an outsider; and say that their peers were not
kind and helpful. Bullying was found to be more common in the 11 and 13-year-old
age groups and then dropped substantially by age 15. Boys were more likely than
girls, in every country and age group, to bully others.

Similarly, the Gatehouse Project found that the most immediate priority for schools
was to address concerns relating to bullying and harassment among students. This was
due to findings from the Gatehouse Project Adolescent Health Survey of Year 8
students during 1997, whereby fifty-three percent of students in their first year of
secondary school reported that they had recently been victimised in some form at
school and 16% indicated that this occurred for them on a daily basis. Of significance
was the impact of this behaviour on the mental health of young people with those who
reported being victimised being three times as likely to be at risk of having depressive
symptoms (Bond et al., 2004; Butler et al., 2002; Patton et al., 2000).

Young people who were more likely to experience being bullied had difficulty
making friends, felt helpless, lacked confidence, were less likely to be happy and
often felt depressed. Similarly, findings from a study conducted by Natvig and
colleagues (2003) indicated that those young people who experienced a number of
school related stressors such as feeling alienated, being bullied, putdown and harassed
were unhappier than those who reported experiencing positive social support from
peers and teachers. Healey’s (2002) study, found that of the 392 young people
surveyed, more than half of them had experienced bullying and one in five young

Health Promoting Schools: A review of international literature and models of practice


Pauline Dickinson, May 2005
Page 49
people admitted bullying others. Of all the factors that impacted on their wellbeing,
young people stated that bullying was the factor that created the most stress.

Recent research in Aotearoa/New Zealand has also indicated that being bullied at
school correlates with anxiety and depression (Coggan et al., 2003). Findings from a
recent New Zealand school-based study indicated that many young people considered
that their schools did not treat the issue of bullying seriously enough (Trenwith,
2001). Carr (2000) in his comprehensive review of effective programmes to counter
bullying in schools found that a whole school approach was essential in addressing
this concern. The most effective classroom approaches were the promotion of social
and emotional competencies. He maintained that the key factors that contributed to
addressing bullying behaviour were:

• regular staff meetings to discuss bullying related issues;


• the establishment of class guidelines and sanctions against bullying jointly
negotiated by students and staff;
• pro-social student behaviour praised by staff;
• consistent application of sanctions for bullying carried out by staff; and
• the promotion of cooperative learning through group projects and activities
where participation and effort were rewarded by staff.

5.2. Physical activity, nutrition and mental health


Findings from the World Health Organisation’s Health Behaviour in School-aged
Children’s study (World Health Organisation, 2004) have indicated that while it is
recommended that young people participate in moderate exercise for a minimum of
one hour five or more times per week, less than half of young people do so in all 35
countries and regions surveyed. Findings also indicated gender differences across all
countries with girls spending less time on physical activity than boys with this gap
increasing with age. Girls were also less satisfied with their body size (feeling too fat)
and once again this gap lengthened with age. Similarly, in England, the Health
Education authority’s survey of Young People and Health, found that only 15% of
adolescent females and 29% of males between the ages of 11-16 took part in regular
exercise on a daily basis (Mulvihill, Rivers, & Aggleton, 2000). These researchers
adopted a qualitative and exploratory approach to gain understanding of the meanings
Health Promoting Schools: A review of international literature and models of practice
Pauline Dickinson, May 2005
Page 50
that young people ascribed to their engagement in physical activity. Young people’s
motivations to increase their participation in physical activity were: an improved
feeling of wellbeing; enjoyment and to prevent feeling bored; and to control body
weight, particularly for young women (p.196). Barriers to involvement in physical
activity were described by young people as: experiencing a general feeling of inertia,
especially among older females; a preference for other non-physical activities; feeling
embarrassed and self-conscious about the body (mainly young women); and not
having sufficient time to exercise due to homework commitments. As well, young
people stated that transport was a barrier, particularly for those who lived in rural
areas.

Internationally, childhood obesity has been recognised as a significant and increasing


public health concern (World Health Organisation, 2004). The American Academy of
Child and Adolescent Psychiatry have stated that children are considered obese when
their weight is at least 10 percent higher than recommended for their age and height
(American Academy of Child and Adolescent Psychiatry, 2004). Recent research
indicates that in the USA the percentage of school-age children in the 6-11 year old
age group that were overweight has more than doubled between the late 1970s and
2000, rising from 6.5 percent to 15.3 percent. The percentage of overweight
adolescents aged 12-19 tripled from 5.0 percent to 15.5 percent during the same time
period (The Center for Health and Health Care in Schools, 2003).

While there does not appear to be a strong evidence-base on the relationship of


childhood obesity on mental health, the prevailing view presents obesity as a mental
health concern. For example, an online article entitled “Obesity can be Harmful to
your child’s Mental Health” states that obese children are at increased risk for
emotional problems that last well into adulthood (American Academy of Child and
Adolescent Psychiatry, 2004). Researchers at the University of Medicine and
Dentistry of New Jersey have reported that 13 to 14 year old girls who are obese are
four times more likely to experience low self-esteem than non-obese girls. They also
reported that obese boys and girls with low self-esteem had higher rates of loneliness,
sadness and nervousness and were more likely to smoke and drink alcohol.
Furthermore, they noted that depression, which has been associated with experiencing

Health Promoting Schools: A review of international literature and models of practice


Pauline Dickinson, May 2005
Page 51
low self-esteem, affects as many as 750,000 adolescents in the USA (Source:
Paediatrics, “Childhood Obesity and Self-Esteem” Jan, 2000).

Another study reported that children who experienced teasing about their weight were
more likely to have poor body image, low self-esteem, and symptoms of depression
(Janssen, Craig, Boyce, & Pickett, 2004). Additionally, findings have indicated that
26 percent of adolescents who were teased at school and home reported they had
considered suicide and nine percent had attempted suicide (Source: Archives of
Paediatrics and Adolescent Medicine, “Associations of Weight-Based Teasing and
Emotional Wellbeing Among Adolescents” August, 2003). Various researchers
(Alfermann & Stoll, 2000; Hagger, Chatzisarantis, & Biddle, 2001) have also found
that there are associations between self-concept and physical activity, with children
and young people with a strong self-concept being more likely to engage in physical
activity . However the direction of this relationship remains unclear. Park (2003)
reviewed data from Statistics Canada’s National Population Health Survey (1994/95
to 2000/2001), which followed young people who were aged 12 to 19 in 1994/95 to
2000/01 when they were aged 18 to 25 years. Findings indicated that low self-concept
was related to depression, physical activity and obesity in young adulthood,
particularly for girls. In contrast young people with a strong self-concept were more
likely to experience positive mental health. Park has also suggested that
while parents, educators and practitioners are undoubtedly aware of the immediate
effects of adolescent self-concept, they may be less cognizant of the longer-term
effects. Moreover, given such consequences, health promotion policies and health
education programmes might benefit from including mechanisms to enhance
adolescent self-esteem and mastery (Park, 2003, p.49).

Health promotion campaigns against child and adolescent obesity


In the USA, concerns have been expressed that current campaigns against obesity may
have “unintended negative effects” (p.9) which may increase a young person’s self
consciousness and embarrassment about their body size. As well, they may experience
increased harassment from their peer group, pressure to reach an “ideal” weight
without the consideration of genetic predispositions, and the onset of eating disorders
(UCLA School Mental Health Project, 2004). Rather than campaigns which have the
potential to stigmatise, there has been a “call for approaches that focus on a healthy

Health Promoting Schools: A review of international literature and models of practice


Pauline Dickinson, May 2005
Page 52
lifestyle and physical fitness for all children and youth” (UCLA School Mental Health
Project, 2004, p.9).

In summary the literature reviewed has indicated that there are associations between
positive learning and achievement outcomes when children and young people are well
nourished, engage in regular activity and experience school as a caring supportive,
social and learning environment. As well, being connected to school, being treated
fairly, and learning in a positive supportive classroom environment all create positive
conditions for wellbeing. Key factors that contribute to a healthy school environment
and the development of emotional competence in children and young people are: the
commitment of senior school managers; a school culture that values children and
young people; clear policies and practices; skilful teaching; a high level of
participation in school life by staff and students; and supportive relationships.

The literature reviewed has also highlighted the issue of bullying and harassment as
being endemic internationally and nationally. This issue has been considered a high
priority for schools to address due to the serious impact that this behaviour has been
found to have on the mental, emotional and physical wellbeing of children and young
people.

Health Promoting Schools: A review of international literature and models of practice


Pauline Dickinson, May 2005
Page 53
6. Criteria for the effectiveness of Health Promoting Schools
evaluation

Evaluating the health promoting school and its effectiveness is crucial to its future
development and sustainability. The research needs to be sound, relevant, respond to
the full array of elements, which constitute HPS and satisfy the criterion of utility
(Stears and Parsons, cited in Weare, 2002, p.9).

This section provides an overview of issues relating to the evaluation of Health


Promoting Schools, criteria for effectiveness of evaluation, tools for evaluation and
outcomes from the practice of evaluation of HPS internationally.

6.1. Issues for evidence-based practice for HPS

In recent years there has been considerable debate as to the ways in which HPS can be
evaluated and monitored (Nutbeam, 1998). It is readily acknowledged that HPS is
ecological in nature, complex, multisectoral and long-term. Therefore, it is essential
that evaluations aim to capture these characteristics (Stears & Parsons, cited in Weare,
2002, p.9). Due to the many different levels of HPS and the value factors inherent in
community development approaches, evaluation is particularly challenging. Rather
than the rather ambitious focus on achieving short-term specific health outcomes,
consideration of the ways in which health-promoting school initiatives involve the
process of enabling or empowering individuals or communities is an important
criterion (Stears & Parsons, 2002, cited in Weare, 2002, p.9).

The current emphasis on the need for evidence-based practice has highlighted the
complexities of “determining what is acceptable as evidence in the context of HPS,
and what are the most appropriate methods for collecting this evidence (Rowling &
Jeffreys, 2000, p.117). One such complexity highlighted by these authors is that
there are different interest groups at work with the HPS approach in Australia, each
with varying sets of concepts and principles as to what constitutes effective health
promotion in schools, and thus what makes for appropriate evaluation criteria and
processes (Rowling & Jeffreys, p.118).

Importantly, they have argued that evaluation needs to involve: monitoring decisions
made, the decision making process and the changes that occurred; and having a

Health Promoting Schools: A review of international literature and models of practice


Pauline Dickinson, May 2005
Page 54
realistic timeframe for the evaluation due to the complexity of the school system.
Rowling and Jeffreys (2000) have used the example of destigmatising mental illness
to describe a series of indicators that would be operating at different levels of an
evaluation. They have suggested that
one of the health promotion strategies might be education through the school
curriculum. The first layer of the evaluation would then be the teacher’s increased
comfort and knowledge about teaching about mental illness, and indirect indicator. A
second level…might be the assessment of the students’ knowledge and attitudes
about mental illness, achieved not only through school curriculum implementation,
but also through schools level policy support for the acceptance of diversity within
the school community (p.121).

These authors have concluded that the monitoring of good heath promotion practice in
school and community settings needs to be acknowledged as an “indirect or
intermediate indicator of heath outcomes and an essential and legitimate form of
evidence” (p.123).

Criteria for the effectiveness of evaluation were developed at a workshop on the


Evidence for Effectiveness of HPS, at the International Union for Health Promotion
and Education (IUHPE) World Conference in Paris, in July 2001 (Weare, 2002, p.8).
These criteria were:

• the presence of controlled study data showing an impact


• a positive change in behaviour and/or school organization
• preserving the good
• a significant number of people participating
• the supporting testimony of participants
• teachers who are satisfied and feel empowered
• a response from the community in affirmation of the work done
• external recognition of the programme
• continued support
• the integration of evaluation as a normal part of a school’s activities

Van den Broucke (cited in Weare, 2002, p.8) has provided a list of tools for
evaluation HPS that have been tried and tested:

Health Promoting Schools: A review of international literature and models of practice


Pauline Dickinson, May 2005
Page 55
• Tracking down Success for Sustainable Development – the EVA 2 Project
(Piette et al.,) diagnoses the implementation of the ENHPS netowork;
• ENHPS indicators of HPS (WHO/EC/Council of Europe) assess and monitor
the development of HPS;
• The HPSC Survey monitors health-related behaviour among adolescents;
• The Healthy Schools Assessment Tool (Parsons et al.,) evaluates health-
promoting assets in schools and measures progress against established
criteria;
• Monitoring and Recording Health Promoting Schools Assets (Irish HPS
Network);
• School Health and Behaviour Questionnaire (Victoir et al.,);
• Self-appraisal checklists in formative school health education; and
• Measures of school/educational innovation e.g., Level of Institutionalisation
scales, Health Teaching Self-Efficacy Scale.

In summary, the literature reviewed has suggested that criteria for effectiveness of
HPS evaluation encompass the capturing of processes, decisions made and outcomes
achieved. The long-term nature of HPS means that care must be taken by those
evaluating HPS to create realistic evaluation aims rather than a sole focus on trying to
assess health outcomes in the short term.

Health Promoting Schools: A review of international literature and models of practice


Pauline Dickinson, May 2005
Page 56
7. International audit tools for schools

This section provides a brief overview of two tools that have been developed and used
internationally that enable schools to focus on assessing their current policies and
practices and the way in which these support the wellbeing of staff and students.
These tools can be adapted for consultation, needs analysis and evaluation purposes.
The tools included are: (1) the psycho-social environment profile (PSE); and (2)
examples of MindMatters tools which assess school organisation, ethos and
environment, students opinions and experiences of school, and SchoolMatters whole
school audit. Each of the tools has been included in the Appendices to this report.

7.1. The psycho-social environment profile (PSE) (World Health


Organisation, 2003)
A study of health behaviour among school-age children and young people coordinated
by WHO showed a strong relationship between feeling ‘alienated’ from school and
smoking and alcohol misuse (Nutbeam, Smith, Moore, & Bauman, 1993).Similarly,
Bonny and colleagues (Bonny, Britto, Klostermann, Hornung, & Slap, 2000), in their
study of 12-18 year olds in the USA found that school connectedness or experiencing
a close relationship with teachers and to the school’s social environment decreased the
likelihood of health risk behaviours during adolescence. Research on the impact of
school climate on the mental health of children in the Czech Republic found that
schools where there was a climate of confidence and respect among all members of
the school community had less mental health distress e.g., anxiety, emotional and
psychosomatic problems than schools that had not achieved a similar positive climate
(Havlinova & Schneidrova, 1995).

The PSE has been developed as a tool to assist teachers, students and parents in the
creation of a positive psychosocial environment in their school. The questions are
designed to explore: the importance of a healthy psychosocial environment; identify
positive characteristics of a school’s environment and which characteristics can be
amenable to change. The issues addressed in the PSE Profile (Appendix Two) are
common to many schools globally and the WHO recommends that the profile be used
as is rather than deleting or changing parts. While the PSE Profile is not designed for
Health Promoting Schools: A review of international literature and models of practice
Pauline Dickinson, May 2005
Page 57
students, it is important that students are involved in discussions about the findings.
Children and young people should also be included in the implementation of any
changes. The items in the PSE Profile Questionnaire were developed largely from a
systematic review of evidence from over 650 research articles in the international
literature. Schools in 20 countries then reviewed the profile. The profile assesses
seven quality areas, each representing an aspect of a healthy psychosocial school
environment:

• providing a friendly, rewarding and supportive atmosphere


• supporting cooperation and active learning
• Forbidding physical punishment and violence
• Not tolerating bullying, harassment and discrimination
• Valuing the development of creative activities
• Connecting school and home life through involving parents
• Promoting equal opportunities and participation in decision-making.
(World Health Organisation, 2003)

7.2. MindMatters Audit Tools


The MindMatters Project has developed a wide range of audit tools for school and
community use. Three examples have been included in Appendix Two (1)
SchoolMatters whole school audit; (2) School organisation, ethos and environment;
and (3) Principal’s check list. A comprehensive list of audit tools can be downloaded
from the MindMatters website:
http://cms.curriculum.edu.au/mindmatters/resource/school.htm

In summary there are a number of tools that have been developed internationally that
can be used to assess schools’ social environments. These tools are available for use
and can be adapted for use within primary and secondary schools.

Health Promoting Schools: A review of international literature and models of practice


Pauline Dickinson, May 2005
Page 58
8. Concluding comments

Internationally, innovative initiatives have been developed to promote and support the
wellbeing of children and young people in school and community settings. Global
initiatives have signalled the need to prioritise mental, emotional and social wellbeing,
nutrition and physical activity. This is due to research findings that have indicated that
children and young people are better able to learn, achieve and develop socially
within the context of a safe, supportive and quality teaching and learning school
environment.

There was little mention of spirituality as a component of holistic models of wellbeing


in the international literaure reviewed for this report, other than in the Scottish
definition of health. Possible explanations for this omission could be due to:
spiritualtiy being implicit within models of wellbeing and therefore not always stated;
spirituality as emcompassing a broader defintion than religion may not be well-
defined; and spiritualtiy with regard to the beliefs and concepts of indigenous
populations may not be as central to education and health policy and practice as is the
case in Aotearoa/New Zealand. The Whare Tapa Wha model of hauora/wellbeing
developed by Mason Durie includes spirituality as an integral and interrelated
component of health, education and social policy in this country. This model is also
integral to the HPS conceptual framework and is a compoment of the underlying
conceptual framework of the Health and Physcial Education Curriculum in New
Zealand.

Internationally, school health initiatives that have been developed and implemented
through health and education sector collaboration and partnerships at a government
policy level. Throughout Europe, the European Network of Health Promoting Schools
has provided a platform for the coordination and sharing of effective practices among
the schools involved. As well, many of these schools are involved in the World Health
Organisation’s Child Health Behaviour survey mentioned earlier in this report.

Health Promoting Schools: A review of international literature and models of practice


Pauline Dickinson, May 2005
Page 59
Findings on the significance of a positive school climate in fostering a sense of
belonging and connectedness to school and the positive associations between health,
learning and achievement has indicated that this is an important focus for Health
Promoting Schools now and in the future. International audit tools such as those
developed for Australian MindMatters Project and the World Health Organisation’s
Psycho-social Environment Profile could be adapted for use within HPS in
Aotearoa/New Zealand .

While the international literature reviewed for this report lacked a focus on indigenous
HPS initiatives, this is not to say this work does not exist. One possible explanation is
that this work may not have been documented in the types of literature reviewed for
this report. In Aotearoa/New Zealand the establishment of a Maori specific focus
through a strategic planning positon and Maori practitioner workforce in the Auckland
region and the development of a Maori HPS resource has provided a developing
model of practice that could be adopted nationally over time.

With regard to evaluation of HPS initiatves internationally, there is a paucity of


evidence-based research as to the effectiveness of such initiatives. The literature
reviewed indicated the need for the focus of evaluation to more fully capture the
processes and decisions made and the ways in which these may contribute to
anticipated or achieved outcomes. Criteria for the effectiveness of evaluation
developed at an international workshop on the evidence for effectiveness of HPS
included factors such as: the presence of controlled study data showing impact;
positive changes in behaviour and/or school organisation, a high level of participation
both within the school and from the community, external recognition of the
programme and the way in which evaluation could be integrated as a normal part of
schools’ activities.

The international literature reviewed has indicated that there is a wealth of innovative
HPS work which has gained momentum through promising models of practice that
are ecologically based and focus on building supportive school social and learning
environments. Given that positive learning and achievement experiences and

Health Promoting Schools: A review of international literature and models of practice


Pauline Dickinson, May 2005
Page 60
outcomes for children and young people are linked to wide range of conditions for
achieving wellbeing provides a strong rationale for schools to be health-promoting.

Health Promoting Schools: A review of international literature and models of practice


Pauline Dickinson, May 2005
Page 61
References

Alderman, H. T., L. (2004). Mental health in schools: Reflections on the past, present
and future - from the perspective of the Center for Mental Health in Schools at
UCLA. Los Angeles: Department of Psychology, UCLA.
Alfermann, D., & Stoll, O. (2000). Effects of physical exercise on self-concept and
wellbeing. International Journal of Sport Psychology, 31(1), 47-65.
American Academy of Child and Adolescent Psychiatry. (2004). Child Obesity.
Retrieved 22/10/04, 2004
Battistich, V., & Hom, A. (1997). The relationship between students' sense of their
school as a community and their involvement in problem behaviors. American
Journal of Public Health, 87(12).
Battistich, V., Schaps, E., & Wilson, N. (2004). Effects of an elementary school
intervention on students' "connectedness" to school and social adjustment
during middle school. The Journal of Primary Prevention, 24(3), 243-262.
Baumeister, R. F., & Leary, M. R. (1995). The need to belong: Desire for
interpersonal attachments as a fundamental human motivation. Psychological
Bulletin, 117(3), 497-529.
Beautrais, A. (1998). A review of the evidence: In Our Hands - The New Zealand
Youth Suicide Prevention Strategy. Wellington: Ministry of Health.
Bennett, S., & Coggan, C. (1999). A comprehensive evaluation of the Mentally
Healthy Schools initiative. Auckland: Injury Prevention Research Centre.
Bennett, S., & Dickinson, P. (1997). Mental health promotion in schools: A literature
review. Auckland: Injury Prevention Research Centre. University of Auckland.
Bond, L., Glover, S., Godfrey, C., Butler, H., & Patton, G. C. (2001). Building
capacity for system-level change in schools: Lessons from the Gatehouse
Project. Health Education & Behavior, 28(3), 368-383.
Bond, L., Thomas, L., Coffey, C., Glover, S., Butler, H., Carlin, J. B., et al. (2004).
Long-term impact of the Gatehouse Project on cannabis use of 16-year olds in
Australia. Journal of school Health, 74(1), 23-29.
Bonny, M. D., Britto, M. T., Klostermann, B. K., Hornung, R. W., & Slap, G. B.
(2000). School disconnectedness: Identifying adolescents at risk. Pediatrics,
106(5), 1017-1021.
Bowles, S., & Gintis, H. (1998). The moral economy of communities: Structured
populaitons and the evolution of pro-social norms. Evolution and Human
Behavior, 19, 3-25.
Bronfenbrenner, U. (1979). The ecology of human development: Experiments by
nature and design. Cambridge: Cambridge, MA: Harvard University Press.
Bronfenbrenner, U. (1989). Ecological systems theory. In R. Vasia (Ed.), Annals of
child development (Vol. 6). Greenwich, CT: JAI Press.
Brunn Jensen, B., & Simovska, V. (Eds.). (2002). Models of Health Promoting
Schools in Europe. Copenhagen: WHO Regional Office for Europe.
Butler, H., Bond, L., Glover, S., & Patton, G. (2002). The Gatehouse Project: Mental
health promotion incorporating school organisational change and health
education. In L. Rowling, G. Martin & L. Walker (Eds.), Mental health
promotion and young people: Concepts and practice (pp. 128-141). Sydney:
McGraw-Hill.

Health Promoting Schools: A review of international literature and models of practice


Pauline Dickinson, May 2005
Page 62
Catalano, R. F., Berglund, L., Ryan, J. A. M., Lonczak, H. S., & Hawkins, D. (2002).
Positive youth development in the United States: Research findings on
evaluations of positive youth development programs. Retrieved 11/11/2003
Coggan, C., Bennett, S., Hooper, R., & Dickinson, P. (2003). Association between
bullying and mental health status in New Zealand adolescents. International
Journal of Mental Health Promotion, 5(1), 16-22.
Dickinson, P. (2001). Guidelines for Mentally Healthy Schools: A resource to assist
schools in the implementation of mental health promotion initiatives in the
school community. Auckland: Mental Health Foundation of New Zealand.
Durlak, J. A., & Wells, A. M. (1997). Primary prevention mental health programs: the
future is exciting. American Journal of Community Psychology, 25(2), 233-
243.
Eccles, J., Midgley, A., Wigfield, A., Buchanan, M., Reuman, D., Flanagan, C., et al.
(1993). Development during adolescence: The impact of stage-environment fit
on young adolescents' experiences in schools and in families. American
Pyschologist, 48(2), 90-101.
Education, M. o. (1999). Health and physical education in the New Zealand
curriculum. Wellington: Learning Media.
Education Review Office. (1997). Student's at risk: Barriers to learning. Wellington,
NZ: Education Review Office.
Elias, M., Zins, J., Weissberg, R., Frey, K., Greenberg, M., Haynes, N., et al. (1997).
Promoting social and emotional learning. Alexandria, Virginia: ASCD.
European Conference. (2002). Education and Health in partnership. Paper presented
at the European Conference.
Fertman, C. I., & Chubb, N. H. (1992). The effects of a psychoeducational program
on adolescents' activity involvement, self-esteem, and locus of control.
Adolescence, 27(107), 517-526.
Hagger, M. S., Chatzisarantis, N., & Biddle, S. J. (2001). The influence of self-
efficacy and past behaviour on the physical activity intentions of young
people. Journal of Sports Science, 19(9), 711-725.
Harden, A., Rees, R., Shepherd, J., Brunton, G., Oliver, S., & Oakely, A. (2001).
Young people and mental health: A systematic review of research on barriers
and facilitators. London: EPPI-Centre.
Hargreaves, A., Earl, L., & Ryan, J. (1996). Schooling for change: Reinventing
education for early adolescents. Bristol, PA: Falmer.
Havlinova, M., & Schneidrova, D. (1995). Stress characteristics in school children
related to different educational strategies and school climates. Central
European Journal of Public Health, 3(4), 205-209.
Hazell, T., O'Neill, D., vincent, K., Robson, T., & Greenhalgh, S. (2004).
MindMatters evaluation: Schools case study. Newcastle: Hunter Institute of
Mental Health.
Healey, K. (2002). A good place to learn? What young people think makes schools
healthy. London: Kings Fund Bookshop.
Hodgson, S., Abbasi, T., & Clarkson, J. (1996). Effective mental health promotion: A
literature review. Health Education Journal, 55, 55-74.
Janssen, I., Craig, W. M., Boyce, W. F., & Pickett, W. (2004). Associations between
overweight and obesity with bullying behaviors in school-aged children.
Pediatrics, 113(5), 1187-1194.

Health Promoting Schools: A review of international literature and models of practice


Pauline Dickinson, May 2005
Page 63
Johnston, M. (1999). Student health model: A site based strategic planning tool.
CAHPERD Journal de L'ACSEPLD, Spring, 43-45.
Kalafat, J. (2003). School approaches to youth suicide prevention. American
Behavioral Scientist((in press)).
Kingston, S., Michell, R., Florin, P., & Stephenson, J. (1999). Sense of community in
neighbourhoods as a multi-level construct. Journal of Community Psychology,
27, 681-694.
Koizumi, R. (2000). Anchor points in transitions to a new school environment. The
Journal of Primary Prevention, 20(3), 175-187.
Loukas, A., & Robinson, S. (2004). Examining the moderating role of perceived
school climate on early adolescent adjustment. Journal of Research on
Adolescence, 14(2), 209-233.
Maes, L., & Lievans, J. (2003). Can the school make a difference? A multilevel
analysis of adolescent risk and health behavior. Social Science & Medicine,
56, 517-529.
McNeely, C. A., Nonnemaker, J. M., & Blum, R. W. (2002). Promoting school
connectedness: Evidence from the national longitudinal study of adolescent
health. Journal of School Health, 72(4), 138-146.
Mulvihill, C., Rivers, K., & Aggleton, P. (2000). Views of young people towards
physical activity: Determinants and barriers to involvement. Health Education,
100(5), 190-199.
Natvig, G. K., Albreksten, G., & Qvarnstrom, U. (2003). Associations between
psychosocial factors and happiness among school adolescents. International
Journal of Nursing Practice, 9, 166-175.
NHS Health Development Agency. (2004). Promoting emotional health and
wellbeing through the National Healthy School Standard. Wetherby:
Department for Education and Skills.
Nutbeam, D. (1998). "Evaluating health promotion - progress, problems and
solutions". Health Promotion International, 13(1), 27-44.
Nutbeam, D., Smith, C., Moore, L., & Bauman, A. (1993). "Warning! Schools can
damage your health: Alienation from school and its impact on health
behaviour". Journal of Paediatrics and Child Health, 29(1), S25-30.
Olweus, D. (1992). Victimization among school children: Intervention and
prevention. In G. W. Albee, L. A. Bond & T. V. C. Monsey (Eds.), Improving
Children's Lives. Newbury Park: Sage Publications.
Osterman, K. F. (2000). Students' need for belonging in the school community.
Review of Educational Research, 70(3), 323-367.
Park, J. (2003). Adolescent self-concept and health into adulthood. Ottawa: Health
Statistics Division at Statistics Canada.
Patton, G., Bond, L., Butler, H., & Glover, S. (2003). Changing schools, changing
health? Design and implementation of the Gatehouse Project. Journal of
Adolescent Health, 33(231-239).
Patton, G., Glover, S., Bond, L., Butler, H., Godfrey, C., Di Pietro, G., et al. (2000).
The Gatehouse Project: A systematic approach to mental health promotion in
secondary schools. Australian and New Zealand Journal of Psychiatry, 34,
586-593.
Phelan, P., Yu, H., & Davidson, A. (1994). Navigating the psychosocial pressures of
adolescence: The voices and experiences of high school youth. American
Educational Research Journal, 31(2), 415-447.
Health Promoting Schools: A review of international literature and models of practice
Pauline Dickinson, May 2005
Page 64
Public Health Promotion, & Mental Health Foundation. (2001). Health promoting
schools in action in Aotearoa/New Zealand: A resource to assist schools in the
implementation of Health Promoting Schools. Auckland: Brebner Print.
Resnick, M. D., Bearman, P. S., Blum, R. W., Bauman, K. E., Harris, K. M., Jones, J.,
et al. (1997). Protecting adolescents from harm: Findings from the national
longitudinal study on adolescent health. Journal of the American Academy of
Child and Adolescent Psychiatry, 278, 823-832.
Resnick, M. D., Harris, I., & Blum, R. W. (1993). The impact of caring and
connectedness on adolescent heatlh and wellbeing. Journal of Paedriatrics
and Child Health, 29, 823-832.
Roeser, R. W., Eccles, J. S., & Sameroff, A. J. (2000). School as a context of early
adolescents' academic and social-emotional development:A summary of
research findings. The Elementary School Journal, 100(5), 443-549.
Rowling, L., & Gehrig, S. (1998). Mental health of young people: Exploring the
relationship between alienation from school, resilience, coping and spiritual
health, 9/12/2004, from http://www.aare.edu.au/98pap/row98371.htm
Rowling, L., & Jeffreys, V. (2000). Challenges in the development and monitoring of
health promoting schools. Health Education, 100(3), 117-123.
Samdal, O., Nutbeam, D., Wold, B., & Kannas, L. (1998). Achieving heatlh and
educational goals through schools: A study of the importance of school
climate and students' satisfaction with school. Health Education Research,
13(383-397).
Scottish Health Promoting Schools Unit. (2004). Being Well - Doing Well: A
framework for health promoting schools in Scotland. Dundee: Scottish Health
Promoting Schools Unit.
Simmons, R., Burgeson, R., Carlton-Ford, S., & Blyth, D. (1987). The impact of
cumulative change in early adolescence. Child Development, 58, 1220-1234.
Solomon, D., Watson, M., Battistich, V., Schaps, E., & Delucchi, K. (1996). Creating
classrooms that students experience as communities. American Journal of
Community Psychololgy, 24(6), 719-748.
Stathakos, P., & Rpehrle, B. (2003). The effectiveness of intervention programmes for
children of divorce - A meta-analysis. International Journal of Mental Health
Promotion, 5(1), 31-37.
The Center for Health and Health Care in Schools. (2002). 2002 State Survey of
School-Based Health Centres in the United States. Washington: George
Washington University.
The Center for Health and Health Care in Schools. (2003). Childhood obesity: What
the research tells us. Washington: The George Washington University.
Trenwith, T. A. (2001). Ending the silence - encouraging teenagers to report school
bullying. Unpublished Masters of Educational Management, UNITECH
Institute of Technology, Auckland.
UCLA School Mental Health Project. (2004). Addressing barriers to learning. UCLA
Mental Health in Schools Center: Training and technical assistance, 9, 1-12.
UNICEF. Retrieved 1/12/04, 2004, from
http://www.unicef.org/girlseducation/index_focus_schools.html
Weare, K. (2000). Promoting mental, emotional and social health: A whole school
approach. London: Routledge.

Health Promoting Schools: A review of international literature and models of practice


Pauline Dickinson, May 2005
Page 65
Weare, K. (2002). Second workshop on practice of evaluation of the Health
Promoting School - models, experiences and perspectives. Nottwill:
International Planning Committee.
Weare, K. (2004). The International Alliance for Child and Adolescent Mental Health
and Schools (INTERCAMHS). Health Education, 104(2), 65-67.
Weare, K., & Gray, G. (2003). What works in developing children's emotional and
social competence. Southhampton: University of Southhampton.
Weissberg, R., Jackson, A., & Shriver, T. (1995). Promoting positive social
development and health practices in young urban adolescents. In M. Elias
(Ed.), Social Decision Making and Life Skills Development: Guidelines for
Middle School Educators (pp. 45-77). Gaithersburg, MD: Aspen Publications.
Wells, J., Barlow, J., & Stewart-Brown, S. (2003). A systematic review of universal
approaches to mental health promotion in schools. Health Education, 4, 197-
220.
Wigfield, A., Eccles, J., MacIver, D., Reuman, D. A., & Midgely, C. (1991).
Transitions during early adolescence: Changes in children's domain-specific
self-perceptions and general self-esteem across the transition to junior high
school. Developmental Psychology, 27(4), 552-565.
World Health Organisation. (2003). Information series on school health Document
10: Creating an environment for emotional and social well-being. An
important responsibility of a Health-Promoting and child friendly school.
Geneva: World Health Organisation.
World Health Organisation. (2004). Young people's health in context: Health
behavior in school-aged children (HBSC) study: International report from the
2001/2002 survey. Geneva: World Health Organisation.
Wyn, J., Cahill, H., Holdsworth, R., Rowling, L., & Carson, S. (2000). MindMatters,
a whole-school approach promoting mental health and wellbeing. Australian
and New Zealand Journal of Psychiatry, 34, 594-601.
Zubrick, S. R., Silburn, S. R., Burton, P., & Blair, E. (2000). Mental health disorders
in children and young people: Scope, cause and prevention. Australian and
New Zealand Journal of Psychiatry, 34(570-578).

Health Promoting Schools: A review of international literature and models of practice


Pauline Dickinson, May 2005
Page 66
Appendix: Audit Tools
The Psycho-Social Environment (PSE) Profile Questionnaire

Health Promoting Schools: A review of international literature and models of practice


Pauline Dickinson, May 2005
Page 67
Health Promoting Schools: A review of international literature and models of practice
Pauline Dickinson, May 2005
Page 68
Health Promoting Schools: A review of international literature and models of practice
Pauline Dickinson, May 2005
Page 69
Health Promoting Schools: A review of international literature and models of practice
Pauline Dickinson, May 2005
Page 70
Health Promoting Schools: A review of international literature and models of practice
Pauline Dickinson, May 2005
Page 71
Health Promoting Schools: A review of international literature and models of practice
Pauline Dickinson, May 2005
Page 72
Health Promoting Schools: A review of international literature and models of practice
Pauline Dickinson, May 2005
Page 73
Health Promoting Schools: A review of international literature and models of practice
Pauline Dickinson, May 2005
Page 74
Health Promoting Schools: A review of international literature and models of practice
Pauline Dickinson, May 2005
Page 75
Health Promoting Schools: A review of international literature and models of practice
Pauline Dickinson, May 2005
Page 76
Health Promoting Schools: A review of international literature and models of practice
Pauline Dickinson, May 2005
Page 77
Health Promoting Schools: A review of international literature and models of practice
Pauline Dickinson, May 2005
Page 78
Health Promoting Schools: A review of international literature and models of practice
Pauline Dickinson, May 2005
Page 79
Health Promoting Schools: A review of international literature and models of practice
Pauline Dickinson, May 2005
Page 80
Health Promoting Schools: A review of international literature and models of practice
Pauline Dickinson, May 2005
Page 81
Health Promoting Schools: A review of international literature and models of practice
Pauline Dickinson, May 2005
Page 82
SchoolMatters Whole School Audit

Health Promoting Schools: A review of international literature and models of practice


Pauline Dickinson, May 2005
Page 83
Health Promoting Schools: A review of international literature and models of practice
Pauline Dickinson, May 2005
Page 84
Health Promoting Schools: A review of international literature and models of practice
Pauline Dickinson, May 2005
Page 85
Health Promoting Schools: A review of international literature and models of practice
Pauline Dickinson, May 2005
Page 86
Health Promoting Schools: A review of international literature and models of practice
Pauline Dickinson, May 2005
Page 87
Health Promoting Schools: A review of international literature and models of practice
Pauline Dickinson, May 2005
Page 88
Health Promoting Schools: A review of international literature and models of practice
Pauline Dickinson, May 2005
Page 89
MindMatters: What do our students think? Survey

Background Information

Are you female or male? Female Male

Were you born in Australia? Yes No

Disagree
Strongly

Strongly
disagree
Unsure
Agree
agree
Questions

1 Do you enjoy school generally?

2 Have you skipped many days at this school?

3 Do you like your teachers this year?

4 Do you have a teacher who listens to you?

5 Do your teachers teach you in a way that you can


understand?

6 Do you have a staff member or another adult in the


school who listens to you?

7 Are your lessons generally enjoyable?

8 Do you learn something useful most days at school?

9 Do you like your classmates?

10 Do you work well by yourself?

11 Do you work well within a group?

12 Do you try hard at school?

Health Promoting Schools: A review of international literature and models of practice


Pauline Dickinson, May 2005
Page 90
Background Information

Are you female or male? Female Male

Were you born in Australia? Yes No

Disagree
Strongly

Strongly
disagree
Unsure
Agree
agree
Questions

13 Do you find it easy to work at school?

14 Do you find school interesting?

15 Do you feel safe and secure at school?

16 Do other students seem safe and secure at school?

CommunityMatters: Working with Diversity for Wellbeing © Commonwealth of Australia 2001


Continued Disagree
Strongly

Strongly
disagree
Unsure
Agree
agree

Questions

17 Do you feel comfortable at school – like you’re a part


of the place?

18 Do you think your parents/guardians feel like they’re a


part of the place?

19 Do you answer questions from teachers in class?

20 Do you feel successful at some part of your


schoolwork?

Health Promoting Schools: A review of international literature and models of practice


Pauline Dickinson, May 2005
Page 91
Disagree
Strongly

Strongly
disagree
Unsure
Agree
agree
Questions

21 Are you up to date with schoolwork?

22 Are you bored with schoolwork?

23 Do you feel you work too many hours on schoolwork?

24 Do your marks really show what you can do?

25 Do you think you are up to date with homework?

26 Do you find it easy to talk over problems with some


teachers?

27 Is high school as enjoyable as primary school?

28 Do you feel you achieve as much at high school as you


did at primary school?

29 Do you have friends you can talk to at school?

30 Do your friends enjoy school?

31 Do your friends do well at school?

32 Will you carry on and finish school?

33 Are your friends likely to stay at school?

34 Do your friends feel safe at school?

35 Do your friends have teachers or staff at school who


they can talk to if they have problems?

CommunityMatters: Working with Diversity for Wellbeing © Commonwealth of Australia 2001 Con

Health Promoting Schools: A review of international literature and models of practice


Pauline Dickinson, May 2005
Page 92
Disagree
Strongly

Strongly
disagree
Unsure
Agree
Questions

agree
36 Do your friends listen to you if you have problems?

37 Have you been ignored by your friends at some time at


school, so that it was a problem?

38 Have your friends been ignored by the group at this


school at some time?

39 Have you had rumours spread about you at this


school?

40 Have you been called names at this school?

41 Have your friends had rumours spread about them?

42 Have you been teased at this school?

43 Have your friends been teased at this school?

44 Have your friends been called names at this school?

45 Have you been physically hurt at this school?

46 Have your friends been physically hurt at this school?

47 Have you had things stolen at the school?

48 Have your friends had things stolen at the school?

49 Have you had your things damaged?

50 Have your friends had their things damaged?

51 Have you an adult or another person you could go to

at this school if you need help?

Health Promoting Schools: A review of international literature and models of practice


Pauline Dickinson, May 2005
Page 93
Disagree
Strongly

Strongly
disagree
Unsure
Agree
Questions

agree
52 Do you think you have a friend or someone who
listens and who understands you?

53 Have you a friend or group of friends you can depend


on?

54 Do you think you will do well this year?

CommunityMatters: Working w i t©h DC


i voemr smi toyn w e a l f tohr Woefl l b e i n g A u s
Continued

Disagree
Strongly

Strongly
disagree
Unsure
Agree
agree
Questions

55 Will you do as well as last year?

56 Have you felt successful at some task this year?

57 Have you done something you like doing while at


school?

58 Have you moved house more than once while you


have been at this school?

59 Do you think what you are learning at school will help


you get a job?

60 Do you think people are friendly to new people at the


school?

61 When you leave school would you come back to meet


classmates the following year?

Health Promoting Schools: A review of international literature and models of practice


Pauline Dickinson, May 2005
Page 94
Disagree
Strongly

Strongly
disagree
Unsure
Agree
agree
Questions

62 Do you find that there are big sections of some


subjects you do not understand?

63 Do you generally think that you are successful at


school?

64 Do you know what to do to stop feeling stressed out?

65 Are you proud to be part of this school?

66 Would you want to come to school if you didn’t have


to?

67 Would anyone at school notice if you were feeling


down?

68 Would school be helpful if you were having troubles


in your life?

69 Do you look forward to your future at school?

70 Do you look forward to your future once you finish


school?

71 How accurate do you think your answers in this survey


have been?

0
CommunityMatters: Working with Diversity for Wellbeing © Commonwealth of Australia 2001

Health Promoting Schools: A review of international literature and models of practice


Pauline Dickinson, May 2005
Page 95

Você também pode gostar