Creating a Health Promoting School Environment: Lessons from a Healthy School’s Programme Presented by Dr Sinéad McNally and Gráinne Smith (CDI) The Institute of Public Health Conference, QUB 11th October 2012

Presentation Aims Introduce CDI; Outline the context for health promotion in schools and describe CDI’s Healthy School’s Programme (HSP); Describe the main outcomes of, and the challenges faced in implementing, the HSP; Outline recommendations for overcoming these challenges.

Overview of CDI A community led initiative; Strategy developed by an inter-agency Consortium of 23 people; Jointly funded by the DYCA and the AP: €15m over 5 years; Seven evidence-informed interventions identified following three years of consultation; Eight independent evaluations. Use existing slide on what CDI is and how it developed Main aims and goals Role of services and evaluations

Healthy School’s Programme One of CDI’s seven interventions; A whole-school approach to health promotion (Lahiff, 2008); Objectives: To Improve children's physical and psychological well-being; To improve access to and uptake of health care services through effective referral systems; To promote greater involvement of parents and families in their children’s health.

Healthy School’s Programme Implemented in five primary schools in Tallaght West (children aged 4-12); Two Coordinators employed by schools to deliver a manualised programme; Inter-agency Steering Committee established; Work programme focused on HSP activities and Speech and Language Therapy. To Improve children's physical and psychological well-being; To improve access to and uptake of health care services through effective referral systems; To promote greater involvement of parents and families in their children’s health. Development of the programme Key objectives Manual, structure etc.

Short-term Outcomes Independent evaluation of the programme using a quasi-experimental design: Comiskey, O’Sullivan, Quirke, Wynne, Kelly and McGilloway (2012). The Healthy School’s Programme Evaluation. Dublin: Childhood Development Initiative (CDI) No significant differences between the intervention and comparison schools; No significant short term impact on improving Health Related Quality of Life; reducing depressive symptoms; reducing rates of children who were obese (BMI); rates of school absenteeism over time. Rigorously evaluated in quasi-experimental design (not going to report the findings here) We know that this this and this worked/improved We could see changes…

Longer-term Outcomes Establishment of school-based committees to sustain the focus on health promotion; The schools have begun the process of change that is required to become a WHO defined ‘health promoting school’ (WHO, 1997); Improved understanding within schools of HSE/specialist services - ‘demystifying’; Masters programme developed in response to increasing teacher capacity.

Recommendations Bringing about change is challenging; A strategic, whole-school approach to planning undertaken by schools. Informed by a self-evaluation and inclusive of the views of the entire school community i.e. staff, parents, children, and services; Manualised approach seems to be useful but needs careful consideration. However, huge mountain to climb in bringing about change Outcomes not affected (short time frame of study though!) Main challenges were…

Recommendations Help schools make structural-level changes i.e. in policy development, teacher capacity building, service level agreement development: More likely to bring about sustainable change within schools; Provide and encourage leadership: schools already time-burdened and resource-stretched so support from the DES and DH. Also need to meet health and well-being needs that arise in schools and requires a local area service response. Fine-tune manual? Build in time for inter-agency collaboration, what kinds of supports? Need leadership on this; schools already time-burdened and resource-stretched. Keep trying!

Conclusion Development of a health promoting school is recognised internationally as a challenging process that requires time, enthusiasm, and support; The HSP was an ambitious health promoting school’s initiative; With some adaptation and higher level support, it has the potential to become an evidenced-based national health promoting schools initiative (Comiskey et al, forthcoming). Evidence that this approach will work Trying to find the way to best do this – we do need to actively promote health in the schools (Coughlan’s work on this; GUI stats on obesity and health etc.) Existing policy and any new strategies being planned… Keep evaluating what is being used – need to find out what WORKS.

References Comiskey, O’Sullivan, Quirke, Wynne, Kelly and McGilloway (2012). The Healthy School’s Programme Evaluation. Dublin: Childhood Development Initiative (CDI) Lahiff, J. (2008). TWCDI Healthy School’s Manual. CDI Publication WHO (1997). Promoting Health through School’s. Report of a WHO Expert Committee on Comprehensive School Health Education and Promotion. WHO Technical Report Series 870, Geneva

Acknowledgments We would like to thank: All those who took part in the HSP and the evaluation; The research team from TCD; Our funders, DCYA and AP; The CDI team.