The Implementation and Institutionalization of a School-Based Youth Suicide Prevention Program

This paper describes the implementation and institutionalization of a comprehensive, county-wide, school-based youth suicide prevention program. Ten years after the program dissemination was begun, the extent of implementation and institutionalization was assessed utilizing a survey of the 46 public high schools in the county together with in depth interviews with informants from the first 11 schools that had adopted the program. All but one of the 31 survey respondents, and 9 of 11 interviewees had retained the student lessons that were the core of the program. Program retention was associated with a variety of factors suggested by the literature as supportive to the institutionalization of school-based innovations.     

The Shaping Healthy Choices Program: Design and Implementation Methodologies for a Multicomponent,School-Based Nutrition Education Intervention

ObjectiveTo provide a framework for implementation of multicomponent, school-based nutrition interventions. This article describes the research methods for the Shaping Healthy Choices Program, a model to improve nutrition and health-related knowledge and behaviors among school-aged children.DesignLongitudinal, pretest/posttest, randomized, controlled intervention.SettingFour elementary schools in California.ParticipantsFourth-grade students at intervention (n = 252) and control (n = 238) schools and their parents and teachers. Power analyses demonstrate that a minimum of 159 students per group will be needed to achieve sufficient power. The sample size was determined using the variables of nutrition knowledge, vegetable preference score, and body mass index percentile.InterventionA multicomponent school-based nutrition education intervention over 1 academic year, followed by activities to support sustainability of the program.Main Outcome MeasuresDietary and nutrition knowledge and behavior, critical thinking skills, healthy food preferences and consumption, and physical activity will be measured using a nutrition knowledge questionnaire, a food frequency questionnaire, a vegetable preferences assessment tool, the Test of Basic Science Process Skills, digital photography of plate waste, PolarActive accelerometers, anthropometrics, a parent questionnaire, and the School and Community Actions for Nutrition survey.AnalysisEvaluation will include quantitative and qualitative measures. Quantitative data will use paired t, chi-square, and Mann-Whitney U tests and regression modeling using P = .05 to determine statistical significance.     

Simplifying the Delivery of a Prevention Program with Web-Based Enhancements

The ease with which prevention programs can be delivered may impact whether or not they are implemented as designed. This paper presents a website with enhancements designed to make delivery of the All Stars substance use prevention program easier. Administrative tasks, such as completing paperwork associated with program delivery were automated using web technology. A pilot study of the web site was conducted with program instructors. There was a significant improvement in teachers’ perceived ease of program delivery. Modest correlation coefficients were found for the relationship between ease of delivery of specific program activities and adherence to these activities.     

Implementing and Evaluating a School-Based Program to Improve Childhood Vision*

BACKGROUND: Approximately 20% of the American schoolchildren have a vision problem. Children from low-income urban areas have been shown to have more than twice the normal rate of vision problems. This study evaluated the effectiveness of A Vision for Success, a school-based program designed to provide eyeglasses to children in a timely manner in selected New York City public elementary schools and to encourage their regular use at school. METHODS: An intervention-control group design with 265 first- and second-grade students across 8 New York City public schools was implemented. Participating students had failed a prior mandated vision screening. Students in A Vision for Success received (1) a school-based professional optometric screening, (2) provision of 2 pairs of eyeglasses (1 kept by the teacher for classroom use), and (3) teachers' encouragement of eyeglass use as prescribed in school. Mean rates of classroom eyeglass use were assessed between groups by direct observation prior to and after the optometric screening. RESULTS: Mean rates of eyeglass use for students in intervention and control groups at baseline were 22% and 19%, respectively (p > .10). At follow-up, eyeglass use rose to 47% in the intervention group, whereas the control group's rate remained consistent at 19% (p < .001). Significant differences persisted for boys and girls. CONCLUSIONS: Children disproportionately affected by visual dysfunction can receive glasses in a timely manner and wear them regularly in the classroom. Even more intensive efforts will be needed for some children to help ensure that they wear glasses in school.     

The Rural Dental Health Program: The Long-Range Effect of a School-Based Enriched Dental Health Program on Children's Oral Health*

ABSTRACT: In November 1985, 406 children ages 15 to 19 were clinically examined, answered survey questions covering dental attitudes and behaviors, and were tested to determine their dental knowledge. This group included 56 percent of the 725 first through third graders who participated in the Rural Dental Health Program beginning in the fall of 1975. The Rural Dental Health Program was a study designed, in part, to measure the effect of a school-based dental health program on the oral health of children in a rural, underserved Pennsylvania county. Measures taken on 406 children, six and one-half years after the educational program ended were used to test for its possible long-term impact on oral health. Evidence obtained from analysis of covariance supports the hypothesis that dental health education had a positive effect on children's oral health.     

School Predictors of the Intensity of Implementation of School-Based Prevention Programs: Results from a National Study

Research has indicated that the effectiveness of school-based prevention programs is affected by the implementation quality of these programs. As the importance of implementation has become clearer, researchers have begun to examine factors that appear to be related to implementation quality. Data from a nationally representative sample of 544 schools were used to examine structural equation models representing hypothesized relationships among school and program factors and implementation intensity, controlling for exogenous community factors. Significant relationships were found between implementation intensity and several school and program factors, including local program development process, integration into school operations, organizational capacity, principal support, and standardization. Implications of these findings are discussed.     

A Retrospective Examination of the Relationship Between Implementation Quality of the Coordinated School Health Program Model and School-Level Academic Indicators Over Time*

BACKGROUND: Although models such as the coordinated school health program (CSHP) are widely available to address student health needs, school professionals have been unconvinced that scarce resources should be allocated to improving student health. Concern that attention may be diverted from meeting academic accountability goals is often seen as a reason not to attend to student health. Despite continuing calls for the study of multicomponent health programs in relation to educational achievement, the understanding of the extent to which adherence to the characteristics of CSHP contributes to or compromises academic outcomes over time remains incomplete. METHODS: A retrospective study was conducted of CSHP implementation across 158 public schools in Delaware, serving grades K-12. Using a doubly multivariate design, this study examined 3 levels of CSHP implementation across 5 school-level academic indicators for 3 years. Indicators included school performance, school progress, and aggregated student performance in 3 content areas—reading, mathematics, and writing. Data for the years prior to, during, and following implementation of CSHP were analyzed. RESULTS: Multivariate main effects of year by implementation level were detected. CSHP schools with high levels of implementation had better school-level performance and progress ratings. CSHP implementation did not have an effect on reading, math, and writing indicators, though all groups showed significant improvements over time in these areas. CONCLUSIONS: Results of this study suggest that quality implementation of CSHP does not adversely impact school-level academic indicators over time. Moreover, findings suggest a better fit with school-wide accountability indicators than with specific content-based achievement indicators.     

Sugars and Dental Caries: Evidence for Setting a Recommended Threshold for Intake

Dental caries affects ≤80% of the world’s population with almost a quarter of US adults having untreated caries. Dental caries is costly to health care and negatively affects well-being. Dietary free sugars are the most important risk factor for dental caries. The WHO has issued guidelines that recommend intake of free sugars should provide ≤10% of energy intake and suggest further reductions to <5% of energy to protect dental health throughout life. These recommendations were informed by a systematic review of the evidence pertaining to amount of sugars and dental caries risk, which showed evidence of moderate quality from cohort studies that limiting free sugars to ≤10% of energy reduced, but did not eliminate, dental caries. Even low levels of dental caries in children are of concern because caries is a lifelong progressive and cumulative disease. The systematic review therefore explored if there were further benefits to dental health if the intake of free sugars was limited to <5% of energy. Available data were from ecologic studies and, although classified as being of low quality, showed lower dental caries when free sugar intake was <5% of energy compared with when it was >5% but ≤10% of energy. The WHO recommendations are intended for use by policy makers as a benchmark when assessing intake of sugars by populations and as a driving force for policy change. Multiple strategies encompassing both upstream and downstream preventive approaches are now required to translate the recommendations into policy and practice.     

关于促进基本公共卫生服务逐步均等化的意见

国家基本公共卫生服务项目作为2009年医改的主要任务之一,实施已近十年,基层服务水平和能力得以提升,健康效益逐渐显现,逐步实现服务“均等化”,区域、城乡、人群间差距逐渐缩小。随着社会经济发展,基本公共卫生服务在实施过程中面临新机遇与新挑战。适时总结评估,对于完善项目实施有重要意义。本文通过系统梳理数据、研究文献及政策报告等,分析国家基本公共卫生服务项目实施进展与成效,尝试探讨实施的主要问题,并提出相应的政策建议。     

Spreading a Warm Blanket of Prevention over All Children: Guidelines for Selecting Substance Abuse and Related Prevention Curricula for Use in the Schools

There is a need for a set of clear, practical, empirically and theoretically grounded guidelines to select substance abuse and related prevention and competence promotion programs based in schools. This report provides such a framework in the form of recommended key elements of effective school-based prevention programs derived from an extensive literature search. In addition, major programs are summarized and compared in relation to their coverage of these key elements.     

Co-Location of Health Care Services for Homeless Veterans: A Case Study of Innovation in Program Implementation

ABSTRACT

This case study examines how the Veterans Affairs Greater Los Angeles Healthcare System (GLA) improved homeless veteran service utilization through program innovation that addressed service fragmentation. The new program offered same-day co-located mental health, medical, and homeless services with a coordinated intake system. The program is analyzed using a framework proposed by Rosenheck (2001) Rosenheck, R. A. 2001. Stages in the implementation of innovative clinical programs in complex organizations. The Journal of Nervous and Mental Disease, 189(12): 812–821. [Crossref], [PubMed], [Web of Science ®] , [Google Scholar] that has four phases: the decision to implement, initial implementation, sustained maintenance, and termination or transformation. GLA was able to successfully implement a new program that remains in the sustained maintenance phase five years after the initial decision to implement. Key factors from the Rosenheck innovation model in the program's success included coalition building, linking the project to legitimate goals, program monitoring, and developing communities of practicing clinicians. The key lesson from the case study is the need for a coalition to persistently problem solve and act as advocates for the program, even after successful initial implementation. Social work leadership was critical in all phases of program implementation.     

Implementation of oral health initiatives by Australian rural communities: Factors for success

In this paper, we consider factors significant in the success of community participation in the implementation of new oral health services. Our analysis draws on data from the Rural Engaging Communities in Oral Health (Rural ECOH) study (2014–2016). We aimed to assess the Australian relevance of a Scottish community participation framework for health service development; Remote Service Futures. Internationally, community participation in planning of health initiatives is common, but less common in new service implementation. Health managers query the legitimacy of “lay” community members, whether they will persist, and whether they can act as change agents. Our data provide evidence that helps answer these queries. Six communities, located within regions covered by two large rural primary healthcare organisations (Medicare Locals), were selected in two Australian states. Two university‐based facilitators worked with a group of local residents (for each community) to monitor implementation of new oral health initiatives designed through participatory processes. Data about implementation were collected through interviews with 28 key stakeholders at the beginning of implementation and 12 months later. Data were coded, themed and analysed abductively. Five themes emerged; the inter‐relationship between community motivation to participate with the fortunes of the oral health initiatives, having the “right” people involved, continuing involvement of sponsors and/or significant people, trusting working relationships between participants and perceiving benefits from participation. Findings provide evidence of a role for community participation in implementing new community services if solid partnerships with relevant providers can be negotiated and services are seen to be relevant and useful to the community.     

The Relationship Between School-Based Health Centers,Rates of Early Dismissal From School,and Loss of Seat Time

BACKGROUND: This study sought to understand the relationship between school-based health centers (SBHCs) and academic outcomes such as early dismissal and loss of seat time (the time students are available in school to learn or to access support services). METHODS: A quasi-experimental research design was used to compare rates of early dismissal and loss of seat time between students who received SBHC and traditional school nursing services and students who received only traditional school nursing services. This study was a secondary data analysis of 764 “walk-in” visits during a 3-week period in 2 urban high schools in western New York state. Both schools provided school nursing services, and 1 of the 2 offered the option to enroll in an SBHC. RESULTS: SBHCs significantly reduced the number of early dismissals from school (p = .013) in a comparison with students who received school nursing services alone. Students not enrolled in an SBHC lost 3 times as much seat time as students enrolled in an SBHC. Race, gender, age, poverty status, and presence of a preexisting illness did not influence these findings. CONCLUSIONS: These findings suggest that SBHCs have a direct impact on educational outcomes such as attendance. Recommendations for further research include replication of this study to increase confidence in its findings and using early dismissal and loss of seat time as indicators of attendance to measure other health outcomes related to SBHCs and school nursing.     

The Development of a Master of Public Health Program with an Initial Focus on Urban and Immigrant Health at the State University of New York,Downstate Medical Center

The State University Downstate Medical Center initiated a Master of Public Health (MPH) degree program in July 2001 following planning efforts that began in 1995. Twelve Students entered the program in June 2002. Currently, eighty students are enrolled in the program and eighteen have graduated from it in 2004 and 2005. With an initial focus on urban and immigrant health, the program aims to train public health professionals who can assist in addressing through population-based interventions the health issues of Brooklyn’s 2,465,326 people, of whom 38.5% are immigrants to the United States. Starting with four courses in the summer 2002 semester, the program now offers twenty-four courses over the three semesters of the academic year. The program is housed in the Department of Preventive Medicine and Community Health of the College of Medicine and is part-time in nature for most students. In addition to completing required course work, students must also complete a 250-hour practicum experience in which they apply theoretical knowledge in a public health practice setting. Student practicum experiences play a vital role in linking the program to communities and serve as conduits for the initiation of further community based collaboratives. This article describes the challenges encountered in initiating an MPH program in an academic medical center, the importance of both intramural and community support to its success, and the vital role it plays in addressing the health issues of various communities. The program became a leading priority of the Strategic Plan of the Downstate Medical Center in 2000, and received the full support of Downstate’s then new president, Dr. John C. LaRosa. This prioritization and support proved essential to the rapid development of the program. The Downstate MPH program offers a concurrent degree to medical students who are able to complete both degrees in a four year period. The Alumni Fund of the College of Medicine provides each MD/MPH student with a one-time scholarship which covers a quarter of the MPH tuition. Concurrent MPH degrees are also offered for graduate students enrolled in occupational therapy, nursing, and several other health programs. The Council on Education for Public Health (CEPH) conducted an accreditation site visit of the Downstate MPH program in December 2004. On June 10, 2005, the CEPH Board accredited the program for 5 years. Pascal James Imperato, MD, MPH & TM is Distinguished Service Professor and Chair, Department of Preventive Medicine and Community Health and Director of the Master of Public Health Program, SUNY Downstate Medical Center; Judith H. LaRosa, PhD, RN is Professor of Preventive Medicine and Community Health and Deputy Director of the Master of Public Health Program, SUNY Downstate Medical Center; Leslie Schechter, MA is the Administrator for the Department of Preventive Medicine and Community Health and the Master of Public Health Program, SUNY Downstate Medical Center.