School Health Committees: A Vital Piece in Coordination

1. School Health Committees:A Vital Piece in Coordination Carol MacDougall & Yvette Laforêt-Fliesser CASH Conference, Gatineau, QC April 22, 2008

2. Objectives To examine school health committees in an interactive format: • Provide rationale for this focus • Provide a brief overview of practice-based evidence • Share “real-life” stories & lessons learned

3. Rationale A focus on school health committees is important because: • Know “what” (essential elements of CSH/HPS/HS), • Less clear about “how” (structure and process) • Makes “partnership” more concrete • Helps to ensure “sustainability”

4. Protocols & Guidelines for Health Promoting Schools • Supportive policy for HPS • Senior management support • Small group of activists • Audit/assessment of strengths and needs in relation to “essential elements” • Agreed goals and plan comprised of “essential elements”

5. Protocols & Guidelines for Health Promoting Schools • Commitment to shared vision • Capacity building • Celebration of successes • Sustained effort 2-3 years plus

6. Research Question What factors do public health professionals report as contributing to sustainable school health committees?

7. Methodology • Qualitative study • Purposive sampling to ensure: • representativeness (i.e. elementary school vs. secondary school experience) • that school health committees had been operational two or more years • Semi-structured interviews 1-1½ hours in length • Data analyzed with “Ethnograph” software

8. Study Participants • 4 PHNs and 1 health promoter from 3 health units in Southern Ontario • Combined experience: 35 school health committees—18 elementary, 17 secondary • 24 of the committees in existence 3-13 years • All had experience working in schools both with and without school health committees

9. School Health Committees • Adoption of “health” as a core value of the school • Mobilize relevant school stakeholders • Commit to shared vision of a healthy school • Conduct “strengths and needs” assessment • Prioritize • Plan action • Implement • Evaluate and Celebrate

10. Findings: Initiation & Activities of School Health Committees • Method of initiating school health committees varied • Membership and meeting times varied • Activities ranged from P.A. announcements to brief events, year-long campaigns, and policy changes

11. Facilitating Factors • Principals • e.g. commitment, presence at meetings, valuing and willingness to work collaboratively • Students • e.g. school valuing the development of student leadership skills through SHC, students having a voice and being involved in decision-making • Committee-related • e.g. effective leadership of meetings, voluntary membership, task-oriented doers

12. Facilitating Factors • Reinforcement • e.g. having successes, school-wide recognition, support from student body • Minimal work for staff • e.g. public health as a resource; personal touch/relationships

13. Perceived Benefits • Enhanced school awareness about health • Enhanced student voice and leadership development • Enhanced accountability for health

14. Perceived Benefits • Healthier school environment • Enhanced access to community resources • Community building • Enhanced learning

15. Perceived Negatives • Turf issues • Frequent member turnover • Workload concerns • Lack of support

16. Perceived Negatives • Contentious issues • Scheduling difficulties • Political climate • Lack of fluency with other sector

17. Lessons Learned in Middlesex-London • Focus groups & principal interviewstoidentify processes that enable school communities • Surveys to assess perceptions of participating principals, students, parents and staff in relation to specific activities in logic model

18. Student Benefits • Students feel empowered through: • learning • positive self-esteem • leadership experiences • speaking out and taking action

19. Student Benefits • Learning is enhanced through: • discussing issues • helping to identify possible solutions • planning and participating in activities • writing, creating posters, reading announcements

20. Student Benefits Self-esteem is enhanced through: • making a positive contribution • participation on the committee with adults • committee acting on their ideas • leadership roles in their classroom or grade level

21. Student Benefits • Leadership experiences: • reporting back to peers • encouraging other students to bring their concerns to the HSC • increased sense of accountability and caring

22. Student Benefits • Speaking out and taking action: • expressing concerns • using suggestion box • writing and making announcements • writing messages/letters • active involvement in planning and action to address issues and concerns

23. 2005 Survey of High School Students • 83% of respondents reported : • an improvement in their discussion and problem-solving skills • that students working together can make a difference • were more likely to speak out and take action on identified health and social issues as a result of their membership

24. Principal Perceptions N=22

25. Perceived Barriers - Parents

26. Perspectives of Parents and Staff

27. Perceived Barriers -Staff

28. Conclusions • Competing demands for time and resources to effectively implement • Support of PHN and public health expertise are essential to success • High degree of interest and enthusiasm for Healthy Schools • Increased understanding of CSH, health and social issues, school’s strengths

29. Comparison with Other Health Promotion Methods • More comprehensive action (multiple strategies, multiple issues, multiple target populations) • More “people power” e.g. ideas, work • More outcomes • Long-term action e.g. policy development, multi-year action • Expanded number of community partners

30. Comparison with Other Health Promotion Methods • Increased opportunity for a wide range of health issues to surface • Increased accountability / ownership of health issues • Increased opportunity for school community to provide input, esp. students [equal voice] • More public health insight into the issues and resources of the school • Increased valuing of health by the school

31. Stories from the Field York Region Hastings Prince Edward County Middlesex-London

32. Discussion—Key Themes • Student Voice (entire student body) • Flexibility (recruitment/ membership, “learning by doing”, assessment process, meetings) • Power (Positive: enhanced accountability and student voice; Negative: turf issues)

33. Discussion—Key Themes • Collaboration (facilitating access, leadership, overcoming fear, fluency, commitment, flexibility) • Sustainability (reinforcement/recognition, commitment/support, constant recruitment, collaboration, leadership)

34. Recommendations for Public Health • Leadership • (not primary doer, but may need to facilitate for 2-3 years; students and staff advisor; parents; co-chair with principal; catalyst) • Consulting/ health promotion/ health education • (connect school with community & health unit resources)

35. Recommendations for Public Health • Flexibility/ Being realistic • open to dealing with needs of the school; limited resources • Collaboration • Clear communication • Fluency

36. Recommendations for the Education Sector • Access • invite outside in; use resources; nurture relationships; LISTEN to students and staff; be open to trying new ideas • Awareness/ Commitment/ Support • show support; dove-tail committees; board support • Power • equal voice for all committee members, esp. students

37. “The greatest advantage to having these health committees is that we work at changing the culture of the school and at making health an important issue that people value and think about!”

38. Lessons Learned by Public Health Units • Importance of relationships at all levels • Importance of “point person” / champion • Importance of coordinating committees at all levels, and both internal and external • Both top-down and bottom-up approaches can work

39. Lessons Learned by Public Health Units • Must start where board or school is at—must fit with THEIR core mandate • Must have board/school representative involved in ALL planning/program development • Importance of involving youth

40. Lessons Learned by Public Health Units (cont’d) • Use straightforward language, e.g. Healthy School • Focus on the concrete element of a school-level committee • Seek funding—is a necessary incentive • Importance of capacity-building/inservicing of all stakeholders

41. Lessons Learned by Public Health Units (cont’d) • Requires long-term commitment and vision—is an evolutionary process • Have sustainability as an important focus • Advocacy at all levels is necessary

42. Lessons Learned by Public Health Units (cont’d) • Maximize staff and manager solidarity • minimize silos/competition/adversarial relations • Manageable workloads • consider school readiness for extra Healthy School support vs. regular core services

43. Discussion • In your experience, what challenges or barriers have you encountered in working with school health committees, and how did you overcome these? • The phrase “comprehensive health promotion approach with schools” is often used. Can you provide an example of this?

44. For More Information Carol MacDougall (519) 271-7600 ext. 322 cmacdougall@pdhu.on.ca Yvette Laforêt Fliesser (519) 663-5317 ext. 2242 yvette.laforetfliesser@mlhu.on.ca