Implementing health-promoting activities in diverse primary school contexts in the Netherlands: practical lessons learnt

PurposeTo gain insight into factors enhancing or obstructing implementation in various school-settings, which is vital for widespread dissemination and sustainable integration of school-based health-promoting interventions.Design/methodology/approachA mixed methods multisite comparative case study to investigate (factors influencing) the implementation of health-promoting activities in twelve Dutch primary schools. Data were collected during three school years (2019-2022) through observations, questionnaires and interviews.FindingsThe project resulted in the implementation of small, incidental activities. Important reasons for the limited implementation were lack of commitment and bottom-up involvement. School directors and teachers were not involved early on in the project, which limited project support and commitment. On school level, directors largely carried project responsibility themselves, hindering project sustainability and integration. Coronavirus disease 2019 (COVID-19) made that schools had difficulties forming long-term visions and plans. Other observed barriers included limited perceived necessity to change, high workload and high staff turnover. Important facilitators were the presence of a process coordinator and sharing experiences from other schools.Originality/valueThis research provided valuable insights into (factors influencing) the implementation of health-promoting initiatives in diverse, real-world school contexts. More extensive support is needed to create commitment, bottom-up involvement and a project vision. Furthermore, empowering in-school champions and/or school-wide project groups is desirable to decrease schools' dependence on long-term external support. The findings can be used by various stakeholders throughout development, adoption and implementation and can facilitate widespread dissemination and sustainable integration of school-based health-promoting interventions.

"Why wasn't I doing this before?": Changed school social work practice in response to the COVID-19 pandemic

The American education system has been significantly disrupted by the COVID-19 pandemic, which led schools to shut down and convert to remote learning environments in spring 2020. However, long before these school closures, school social workers (SSWs) have faced significant practice dilemmas, as they have encountered obstacles to their engagement in best practices. While initial pandemic school closures presented SSWs with a range of uncertain situations, they also provided the possibility to respond to practice demands in different and dynamic ways. This article explores the pandemic's impact upon SSWs' practice, and how SSWs responded in turn as they quickly adapted their practice during this widespread, ongoing crisis. Informed by crisis theory, previous analyses of SSW practice trends and dilemmas, and a review of traditional social work values and ethics, we conducted three focus groups in July 2020 with SSWs during the pandemic's early months. From these interviews, we learned that participants' work was disrupted by dramatic shifts in school and community settings, as well as changes in support needs within their respective school communities. Those disruptions gave way to substantial shifts in practice, which reflect a more prominent role for systemic practice and for traditional social work values in SSW decision-making. These findings offer implications for post-pandemic practice, and practice in other host settings.

Formative Evaluation of a Student Symptom Decision Tree for COVID-19.

Objectives: In support of schools restarting during the COVID-19 pandemic, some schools partnered with local experts in academia, education, community, and public health to provide decision-support tools for determining what actions to take when presented with students at risk for spreading infection at school. Methods: The Student Symptom Decision Tree, developed in Orange County, California, is a flow chart consisting of branching logic and definitions to assist school personnel in making decisions regarding possible COVID-19 cases in schools which was repeatedly updated to reflect evolving evidence-based guidelines. A survey of 56 school personnel evaluated the frequency of use, acceptability, feasibility, appropriateness, usability, and helpfulness of the Decision Tree. Results: The tool was used at least 6 times a week by 66% of respondents. The Decision Tree was generally perceived as acceptable (91%), feasible (70%), appropriate (89%), usable (71%) and helpful (95%). Suggestions for improvement included reducing the complexity in content and formatting of the tool. Conclusions: The data suggest that school personnel found value in the Decision Tree, which was intended to assist them with making decisions in a challenging and rapidly evolving pandemic.

Comparisons of School-Day Glycemia in Different Settings for Children with Type 1 Diabetes Using Continuous Glucose Monitoring

Objective. Using continuous glucose monitoring (CGM), we examined patterns in glycemia during school hours for children with type 1 diabetes, exploring diferences between school and nonschool time. Methods. We conducted a retrospective analysis of CGM metrics in children 7-12 years (n = 217, diabetes duration 3.5 +/- 2.5 years, hemoglobin A1c 7.5 +/- 0.8%). Metrics were obtained for weekday school hours (8 AM to 3 PM) during four weeks in fall 2019. Two comparison settings included weekend (fall 2019) and weekday (spring 2020) data when children had transitioned to virtual school due to COVID-19. We used multilevel mixed models to examine factors associated with time in range (TIR) and compare glycemia between in-school, weekends, and virtual school. Results. Tough CGM metrics were clinically similar across settings, TIR was statistically higher, and time above range (TAR), mean glucose, and standard deviation (SD) were lower, for weekends and virtual school (p < 0.001). Hour and setting exhibited a signifcant interaction for several metrics (p < 0.001). TIR in-school improved from a mean of 40.9% at the start of the school day to 58.0% later in school, with a corresponding decrease in TAR. TIR decreased on weekends (60.8 to 50.7%) and virtual school (62.2 to 47.8%) during the same interval. Mean glucose exhibited a similar pattern, though there was little change in SD. Younger age (p = 0.006), lower hemoglobin A1c (p < 0.001), and insulin pump use (p = 0.02) were associated with higher TIR in-school. Conclusion. Although TIR was higher for weekends and virtual school, glycemic metrics improve while in-school, possibly related to benefcial school day routines.

Evaluating the feasibility of delivering a sleep education programme in secondary schools

Background: School-based sleep education programmes can promote the importance of sleep health and may improve adolescent sleep. To date, only limited research has examined the feasibility of integrating sleep programmes into the school curriculum. Objectives: This study evaluated the feasibility, acceptability and preliminary efficacy of the Strathclyde intervention to encourage good sleep health in teenagers (SIESTA). Methods: A total 171 students (12–15 years, 53% women) from secondary schools in Scotland participated in the study. Recruitment and retention, data collection and design procedures were assessed to establish feasibility. Qualitative feedback on acceptability was collected via focus group discussions. Outcome measures assessing insomnia symptoms, sleep hygiene, depression, anxiety and stress were completed at baseline and post-intervention to explore the preliminary effects of SIESTA. Results: All schools that were approached consented to participate, and most students completed assessments at both time points (171) with a dropout rate of 5%. Assessment measures provided sufficient data to compare baseline and post-intervention values. Training and delivery manuals ensured successful delivery of the programme. Qualitative feedback indicated SIESTA was acceptable, and students spoke favourably about the content, delivery and techniques. Students reported that SIESTA was age-appropriate, relevant and the techniques were beneficial. There were significant improvements in insomnia and stress, but no improvements were noted for sleep hygiene, depression or anxiety. Conclusion: The findings suggest that SIESTA is feasible and acceptable for delivery via the school curriculum. The results indicate that a controlled trial is required to further investigate the efficacy of SIESTA implemented in an educational context.

Reflection on the transdisciplinary approach involving students in educating communities about COVID-19

Introduction: The disruption brought about by the COVID-19 pandemic to higher education teaching and learning, as well as to the community engagement opportunities, has also brought about some new learning opportunities. The purpose of the research was to explore the views and to describe their thoughts of the School of Healthcare Sciences (SoHCS) and the Faculty of Engineering, Built Environment and Information Technology (EBIT) undergraduate students' on the use of robotics and technology in educating the communities about COVID-19. Method(s): Participatory Action Research (PAR) was used for this study since the students from SoHCS and EBIT were invited to be active participants as future professionals. A total of 27 students volunteered and participated in in-depth interviews. The responses were analysed using ATLAS.ti from nine data sets for qualitative content. Data reduction, coding, and decoding analytic processes were used to analyse and interpret each of these qualitative data forms. Ethical approval was obtained from the research ethics committees in the Faculty of Health Sciences as well as the Faculty of Engineering, Built Environment and Information Technology. Result(s): Five themes that emerged from this study are namely: COVID-19 and community challenges and behaviour;COVID-19 communication;COVID-19 knowledge and understanding;COVID-19 myths and COVID-19 robotics and technology education. Conclusion(s): COVID-19 has proven to be a driver of technology innovation and can create new high-touch and high-quality services. Using information technology and robotics in health sciences or in community engagement projects would minimizes the exposure of health care workers and members of the communities to possible infections. These findings also reflect on the importance of engaging the students when interventions are planned because they play an important role as members of the community within the university and outside the university.Copyright © 2022

Implementation of a Hardware-Assisted Bluetooth-Based COVID-19 Tracking Device in a High School: Mixed Methods Study.

BACKGROUND: Contact tracing is a vital public health tool used to prevent the spread of infectious diseases. However, traditional interview-format contact tracing (TCT) is labor-intensive and time-consuming and may be unsustainable for large-scale pandemics such as COVID-19. OBJECTIVE: In this study, we aimed to address the limitations of TCT. The Yale School of Engineering developed a Hardware-Assisted Bluetooth-based Infection Tracking (HABIT) device. Following the successful implementation of HABIT in a university setting, this study sought to evaluate the performance and implementation of HABIT in a high school setting using an embedded mixed methods design. METHODS: In this pilot implementation study, we first assessed the performance of HABIT using mock case simulations in which we compared contact tracing data collected from mock case interviews (TCT) versus Bluetooth devices (HABIT). For each method, we compared the number of close contacts identified and identification of unique contacts. We then conducted an embedded mixed methods evaluation of the implementation outcomes of HABIT devices using pre- and postimplementation quantitative surveys and qualitative focus group discussions with users and implementers according to the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. RESULTS: In total, 17 students and staff completed mock case simulations in which 161 close contact interactions were detected by interview or Bluetooth devices. We detected significant differences in the number of close contacts detected by interview versus Bluetooth devices (P<.001), with most (127/161, 78.9%) contacts being reported by interview only. However, a significant number (26/161, 16.1%; P<.001) of contacts were uniquely identified by Bluetooth devices. The interface, ease of use, coherence, and appropriateness were highly rated by both faculty and students. HABIT provided emotional security to users. However, the prototype design and technical difficulties presented barriers to the uptake and sustained use of HABIT. CONCLUSIONS: Implementation of HABIT in a high school was impeded by technical difficulties leading to decreased engagement and adherence. Nonetheless, HABIT identified a significant number of unique contacts not reported by interview, indicating that electronic technologies may augment traditional contact tracing once user preferences are accommodated and technical glitches are overcome. Participants indicated a high degree of acceptance, citing emotional reassurance and a sense of security with the device.

Piloting a clinical mental health process in the intermediate school setting

The COVID-19 pandemic has highlighted the need for increased adolescent mental health support in the school setting. This evidence-based quality improvement project aimed to determine if implementing a clinical mental health pathway increases the number of mental health screenings completed and increases school nurse practitioners' comfort and confidence in completing mental health screenings. A Mental Health Toolkit was developed to include program-specific management recommendations, a school collaboration flowsheet, and educational and community resources for the nurse practitioner, students, and school community. The 15-week pilot intervention was evaluated using quantitative pre-and post-survey and qualitative interviews. The intervention increased the number of depression screenings performed compared to the previous school year. In addition, the post-intervention interview provided clarity to the persistent system-level and clinic-level barriers and provided personal insights into performing mental health screenings within the school setting. This pilot project allowed the nurse practitioner to model the normalization of mental health discussions. It also provided an opportunity for increased collaboration between the nurse practitioner and school partners, which can substantially impact adolescent mental health outcomes. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Risks and opportunities for children's well-being in resource-constrained multigenerational households during COVID-19: Implications for school psychology interventions

The coronavirus disease (COVID-19) pandemic had a global impact on family social and economic well-being. Individuals and families sought alternative living arrangements as a result of the financial crisis, health implications, and housing insecurity, with many joining multigenerational households. However, it is unknown how multigenerational family life affects children's well-being. Therefore, this qualitative study explored risks and resilience-building opportunities for children's psychological and social well-being in resource-constrained multigenerational households during the COVID-19 pandemic in South Africa. Five multigenerational families were selected through snowball sampling and case design. The three generations of participants were grandparents (n = 5), parents (n = 7), and children (n = 4). Data were gathered through a questionnaire and interviews. The study received institutional ethics approval. After thematic analysis, two themes and six sub-themes were identified. Risks were related to interpersonal conflict, family collective fear of COVID-19, and children's multiple other fears. Opportunities were identified as academic support, shared responsibilities, life skills and values acquisition, and family cohesion. Results demonstrated the potential risks and resilience-building opportunities multigenerational households present for children's psychosocial well-being. Multisystemic influences in a multigenerational household contribute to children's adjustment. These outcomes necessitate systemic school psychology interventions. Longitudinal studies are recommended to explore child well-being trends in multigenerational households in varying socioeconomic contexts.

Towards best practice during COVID-19: A responsive and relational program with remote schools to enhance the wellbeing of Aboriginal and Torres Strait Islander students

Purpose: From 2018, the Schools Up North (SUN) programme worked with three remote Australian schools to enhance their capability and resilience to support the wellbeing and mental health of Aboriginal and Torres Strait Islander students and staff. This paper explores the implementation of SUN during the first two years of COVID-19 (2020–2021). Method: Using grounded theory methods, school staff, other service providers and SUN facilitators were interviewed, with transcripts and programme documents coded and interrelationships between codes identified. An implementation model was developed. Results: The SUN approach was place-based, locally informed and relational, fostering school resilience through staff reflection on and response to emerging contextual challenges. Challenges were the: community lockdowns and school closures;(un)availability of other services;community uncertainty and anxiety;school staff capability and wellbeing;and risk of educational slippage. SUN strategies were: enhancing teachers' capabilities and resources, facilitating public health discussions, and advocating at regional level. Outcomes were: enhanced capability of school staff;greater school-community engagement;student belonging and engagement;a voice for advocacy;and continuity of SUN's momentum. Conclusions: The resilience approach (rather than specific strategies) was critical for building schools' capabilities for promoting students and staff wellbeing and provides an exemplar for remote schools globally.

Refractive Errors Due To Online Classes Among School Children During The Covid-19 Pandemic

Aim: The current study aimed to assess the effect of refractive errors among school children due to online classes. Material(s) and Method(s): School-going children who were attending online classes between five and fifteen years were subjected to ophthalmic evaluation. A questionnaire including sections like demographics, gadget use, on-screen time, and physical complaints was administered to collect the required data. Result(s): The participants in our study had a mean age of 9 +/- 2 years (range 5-15 years) of whom 48.4% (n = 140) were males and 51.6% (n = 149) were females. There was a predominance of myopia (86.5%) in children where 44.6% of them have newly developed refractive errors. Around 70 (67.8%) children with a previous refractive error have been shown to have progression of refractive error. Conclusion(s): Our study reports that children were exposed to prolonged screen time which led to a rise in the number of myopia cases.Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.

The school nurse's experience of secondary exposure to trauma

The school nurse (SN) is often the sole health care expert in the school setting, providing for the physical and socio-emotional needs of others. SN may be exposed to reports of trauma, a widespread and costly public health issue. This study sought to explore the experience of the SN when exposed to reports of trauma from those in their care. Seven N.J. certified school nurses participated in two online interviews via Microsoft Teams, spaced one to two weeks apart between June 2021 and September 2021. Interviews were recorded & transcribed verbatim and thematic analysis applied. This study found that SN receive reports of trauma to varying degrees, with those in high-poverty urban settings relaying more frequent exposure than those in suburban settings. The SN identified the health office as a safe haven where students are welcome, accepted as they are, can share concerns, and seek comfort from their ailments. SN reported challenges working within the school model, and experienced obstacles to receiving reports of trauma including a lack of school-based collaboration, a lack of understanding of the SN role, and SN workload. In the eye of the storm, while receiving traumatic reports, SN focus on immediate needs. Later, while mitigating the aftermath, they process the experience and apply coping strategies, such as self-care and social support, to restore and replenish. While weathering the storm, they share concern and frustration, but acknowledge that they can only do so much. The SN in this study did not demonstrate secondary trauma but instead shared stories of resilience. Effects of the COVID-19 pandemic on the SN receipt of reports of trauma were explored. Further research is needed regarding the role of the SN, SN workload, and their experience in receiving reports of trauma. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

The Impact of COVID-19, Mental Health Distress, and School-Based Sociocultural Protective Factors among Elementary-Aged Children and their Caregivers

Given the individual and systemic stress endured by children and families during the COVID-19 pandemic, research examining culturally responsive school experiences and supports to enhance resilience is critical. This study examined the relationship between caregivers' perceptions of COVID-19 impact, mental health distress among children and caregivers, and school-based sociocultural protective factors, including culturally responsive practices in schools and the relationships between teachers and caregivers, concurrently and longitudinally. Data were collected from caregivers of elementary-aged children at two-time points from March to April 2020 (N = 174) and one year later in 2021 (N = 114). Regression analyses revealed that COVID-19 impact positively predicted and parent-teacher joining negatively predicted mental health concerns among children and families, concurrently and longitudinally. Furthermore, there was a positive relationship between caregivers' perceptions of teachers' social awareness and justice practices and mental health symptoms for children in 2020. Parent-teacher joining longitudinally moderated the relationship between COVID-19 impact and caregivers' mental health concerns. This study provides implications regarding sociocultural resilience factors that should be considered in schools amidst the COVID-19 pandemic.

Audit of council-level clean air policies for schools in England

Background: During the COVID Pandemic paediatric respiratory admissions in the UK fell to unprecedented levels. People questioned whether school air quality may be a risk factor for childhood respiratory disease and school health. There are existing recommendations around school air quality, but whether these have been implemented has not been audited. Aim(s): to evaluate whether district councils had policies around clean air in schools, and whether there was consistency across the country. Method(s): 3 reviewers examined the most recent council Air Quality Reports/Plans on the council websites of 181 district/borough councils in England. Based on existing standards, we evaluated important domains: air pollution monitoring;school travel plans;individual schools' asthma plans;education about air pollution;clean air zones around schools;building use to optimise air quality. Result(s): There was inconsistency across district councils. 143/181 (79%) of councils had an air quality action plan, but of these only 4/143 (3%) included policies specifically for schools. 119/181 (66%) recommended that schools should promote greener travel alternatives. Only 13/181 (7%) had specific plans to help manage children with respiratory illnesses. No councils had policies around building use, including ventilation. Conclusion(s): We found significant inconsistency in clean air policies for schools across district councils in England. Improving this is a priority for childhood respiratory health. Research must be undertaken alongside children suffering from respiratory illnesses, teachers, and healthcare professionals - in particular school nurses - to set high standards for air quality in schools.

Reducing Student Exposure to Digital Food and Beverage Marketing: Policy and Practice Recommendations.

Digital marketing of unhealthy foods and beverages to children and adolescents is pervasive, highly effective, undermines healthy eating, and contributes to health inequities. Expanded use of electronic devices and remote learning during the COVID-19 pandemic has increased the urgency for policy interventions to limit digital food marketing in schools and on school-issued devices. The US Department of Agriculture provides little guidance to schools for how to address digital food marketing. Federal and state privacy protections for children are inadequate. Considering these policy gaps, state and local education authorities can incorporate strategies to reduce digital food marketing into school policies for: content filtering on school networks and on school-issued devices; digital instructional materials; student-owned device use during lunch; and school use of social media to communicate with parents and students. Model policy language is provided. These policy approaches can leverage existing policy mechanisms to address digital food marketing from a variety of sources.

"It's hard for everyone" systemic barriers to home confinement to prevent community spread of COVID-19.

Rapid identification and isolation/quarantine of COVID-19 cases or close contacts, respectively, is a vital tool to support safe, in-person learning. However, safe isolation or quarantine for a young child also necessitates home confinement for at least one adult caregiver, as well as rapid learning material development by the teacher to minimize learning loss. The purpose of this study is to better understand barriers and supports to student home confinement. We conducted a mixed-methods study using focus group discussions and a self-administered online survey with parents and staff members from 12 elementary schools and childcare sites across San Diego County serving low-income and socially vulnerable families. Focus group participants reported that mental distress and loneliness, learning loss, childcare, food, income loss, and overcrowded housing were major barriers related to home confinement. The experiences described by FGD participants were prevalent in a concurrent community survey: 25% of participants reported that isolation would be extremely difficult for a household member who tested positive or was exposed to COVID-19, and 20% were extremely concerned about learning loss while in isolation or quarantine. Our findings suggest that there are serious structural impediments to safely completing the entire recommended course of isolation or quarantine, and that the potential for isolation or quarantine may also lead to increased hesitancy to access diagnostic testing.

BACKGROUND: During the COVID-19 pandemic, home confinement (isolation and quarantine) are important public health tools to keep children learning in-person at schools. However, isolation or quarantine for young children also means that often their caregivers must also go into home confinement, as well as forcing teachers to adapt their lessons to online teaching. PURPOSE: The purpose of this study is to better understand what makes home confinement comfortable or difficult for students and their families. METHODS: We did focus group discussions and shared an online survey with parents and staff members from 12 elementary schools and childcare centers across San Diego County vulnerable families. RESULTS: Focus group participants said that mental distress and loneliness, learning loss, childcare, food, income loss, and overcrowded housing made home confinement hard to do. Also 25% of survey participants said that isolation would be difficult for a household member who tested positive or was exposed to COVID-19, and 20% were really concerned about their child's learning loss if the family had to isolate or do quarantine. CONCLUSIONS: Our study's results suggest that there are serious structural issues for school families to safely go into isolation or quarantine, and because of this may make families more hesitant to get tested for COVID-19.

Challenges of COVID-19 Case Investigation and Contact Tracing in School Settings: An Initial Investigation.

BACKGROUND: Case investigation and contact tracing (CI/CT) are important public health tools to interrupt COVID-19 transmission. Our study aims to understand how parents and school staff perceive COVID-19 CI/CT. METHODS: Using a mixed methods approach, we distributed a community survey and conducted 15 focus group discussions (FGDs) in English and Spanish between December 2020 and March 2021 with 20 parents and 22 staff from schools in San Diego County ZIP Codes with COVID-19 rates in the top quintile as of August 2020. RESULTS: One in 4 survey respondents reported that they would be reluctant to participate in CI/CT. FGDs revealed themes of mistrust in government authorities, overburdened institutions, unfamiliarity with CI/CT, and uncertainty about its reliability. School community members emphasized that parents trust schools to be involved in CI/CT efforts, but schools are overwhelmed with this added responsibility. CONCLUSIONS: Investing in schools as community hubs is necessary so they can become important partners in prevention and mitigation in public health.

School-Based Sandtray Counseling on a Shoe String

The purpose of this article is to provide research evidence and a rationale for use of sandtray counseling in schools, as well as serve as a practical "how to" guide on conducting sandtray sessions inexpensively in a school setting, using case examples to illustrate. Especially now, in the midst of the COVID-19 epidemic and increased awareness of racial inequity, students (and teachers) will need interventions appropriate for trauma and grief. For school-based counselors, sandtray counseling is a developmentally appropriate intervention, particularly for preadolescents, who are old enough to feel uncomfortable with playroom toys and yet are not developmentally ready to use a primarily verbal intervention. Sandtray counseling can provide a culturally sensitive, safe, and soothing bridge between experience and expression, to facilitate integration and healing. With proper training, sandtray counseling can be a valuable addition to any practitioners' toolbox and is effectively conducted by practitioners working from various theoretical orientations.

COVID-19 Testing in Schools: Perspectives of School Administrators, Teachers, Parents, and Students in Southern California.

BACKGROUND: School-based COVID-19 testing is a potential strategy to facilitate the safe reopening of schools that have been closed due to the pandemic. This qualitative study assessed attitudes toward this strategy among four groups of stakeholders: school administrators, teachers, parents, and high school students. METHODS: Focus groups and interviews were conducted in Los Angeles from December 2020 to January 2021 when schools were closed due to the high level of COVID transmission in the community. RESULTS: Findings indicated similarities and differences in attitudes toward in-school COVID-19 testing. All groups agreed that frequent in-school COVID-19 testing could increase the actual safety and perceived safety of the school environment. School administrators expressed pessimism about the financial cost and logistics of implementing a testing program. Parents supported frequent testing but expressed concerns about physical discomfort and stigma for students who test positive. Teachers and parents noted that testing would prevent parents from sending sick children to school. Students were in favor of testing because it would allow them to return to in-person school after a difficult year of online learning. CONCLUSION: In-school COVID-19 testing could be a useful component of school reopening plans and will be accepted by stakeholders if logistical and financial barriers can be surmounted and stigma from positive results can be minimized.