Harnessing complexity: taking advantage of context and relationships in dissemination of school-based interventions.

Schools and school systems are increasingly asked to use evidence-based strategies to promote the health and well-being of students. The dissemination of school-based health promotion research, however, offers particular challenges to conventional approaches to dissemination. Schools and education systems are multifaceted organizations that sit within constantly shifting broader contexts. This article argues that health promotion dissemination needs to be rethought for school communities as complex systems and that this requires understanding and harnessing the dynamic ecology of the sociopolitical context. In developing this argument, the authors draw on their experience of the dissemination process of a multilevel school-based intervention in a complex educational context. Building on this experience, they argue for the need to move beyond conventional dissemination strategies to a focus on active partnerships between developers and users of school-based intervention research and offer a conceptual tool for planning dissemination.

Changing cultures: enhancing mental health and wellbeing of refugee young people through education and training.

Many refugee people and others entering Australia under the Humanitarian Program, have experienced extremely stressful and disrupted lives prior to arrival. A major difficulty experienced by a significant number of refugee young people is their lack of formal education before arrival. It directly affects their ability to start connecting to their new society and constructing a new life. The level of ease with which young people can move into the education and training system and begin to establish a meaningful career pathway has a huge impact on their successful settlement and stable mental health. This paper describes the Changing Cultures Project, a three-year project, which explored models of appropriate and accessible education and training for refugee and newly arrived young people that would enhance their mental health. The Changing Cultures Project was a partnership between the education, health and settlement sectors. This paper describes the program and system response to the health, settlement, education and vocational issues facing refugee young people using a mental health promotion framework and reflective practice. We discuss how the refugee youth programs met a broad range of needs as well as providing language, literacy and basic education to newly arrived young people. While working in an environment of changing policy and public opinion regarding refugee issues, the Project delivered successful outcomes at the program and organisational levels for refugee young people by addressing issues of program development and delivery, organisational development and capacity building and community development and evaluation.

Promoting social inclusion in schools: a group-randomized trial of effects on student health risk behavior and well-being.

OBJECTIVES: We sought to test the efficacy of an intervention that was designed to promote social inclusion and commitment to education, in reducing among students health risk behaviors and improving emotional well-being. METHODS: The design was a cluster-randomized trial in 25 secondary schools in Victoria, Australia. The subjects were 8th-grade students (aged 13 to 14 y) in 1997 (n=2545) and subsequent 8th-grade students in 1999 (n=2586) and 2001 (n=2463). The main outcomes were recent substance use, antisocial behavior, initiation of sexual intercourse, and depressive symptoms. RESULTS: At 4-year follow-up, the prevalence of marked health risk behaviors was approximately 20% in schools in the comparison group and 15% in schools in the intervention group, an overall reduction of 25%. In ordinal logistic regression models a protective effect of intervention was found for a composite measure of health risk behaviors in unadjusted models (odds ratio [OR]= 0.69; 95% confidence interval [CI]= 0.50, 0.95) and adjusted models (OR= 0.71; CI =0.52, 0.97) for potential confounders. There was no evidence of a reduction in depressive symptoms. CONCLUSION: The study provides support for prevention strategies in schools that move beyond health education to promoting positive social environments.

The Gatehouse Project: can a multilevel school intervention affect emotional wellbeing and health risk behaviours?

STUDY OBJECTIVE: The aim of this study was to determine the effect of a multilevel school based intervention on adolescents' emotional wellbeing and health risk behaviours. DESIGN: School based cluster randomised controlled trial. Students were surveyed using laptop computers, twice in the first year of intervention and annually thereafter for a further two years. SETTING: Secondary schools. PARTICIPANTS: 2678 year 8 students (74%) participated in the first wave of data collection. Attrition across the waves was less than 3%, 8%, and 10% respectively with no differential response rate between intervention and control groups at the subsequent waves (98% v 96%; 92% v 92%, and 90% v 89% respectively). MAIN RESULTS: A comparatively consistent 3% to 5% risk difference was found between intervention and control students for any drinking, any and regular smoking, and friends' alcohol and tobacco use across the three waves of follow up. The largest effect was a reduction in the reporting of regular smoking by those in the intervention group (OR 0.57, 0.62, and 0.72 at waves 2, 3, and 4 respectively). There was no significant effect of the intervention on depressive symptoms, and social and school relationships. CONCLUSIONS: While further research is required to determine fully the processes of change, this study shows that a focus on general cognitive skills and positive changes to the social environment of the school can have a substantial impact on important health risk behaviours.

Changing schools, changing health? Design and implementation of the Gatehouse Project.

PURPOSE: To describe the Gatehouse Project which addresses the social context of high school with an aim of changing students' sense of school connection and in turn, health risk behavior and well-being. METHODS: Distinguishing features of the project were its conceptual framework, implementation process, and evaluation design. The conceptual framework derived from attachment theory and focused on three aspects of the school social context: security, communication, and participation. Implementation was standardized around a survey of the school social environment, creation of a school-based action team, and the implementation of strategies matched to a school's profile of need. In addition, an early high school curriculum addressed the skills relevant to social functioning and emotional adjustment. The evaluation design was based on a cluster randomized trial involving 26 schools. It used follow-up of an individual cohort and repeat cross-sectional surveys to capture outcomes at an individual student and whole-school level. RESULTS AND CONCLUSIONS: The Gatehouse Project drew on both health and education research to develop and coordinate a broad-based school health promotion intervention. It represents a promising new direction for school-based preventive work.

Long-term impact of the Gatehouse Project on cannabis use of 16-year-olds in Australia.

This study examined the impact of a school-based preventive intervention on cannabis use in adolescence, using a cluster-randomized trial of a multilevel intervention aimed at improving social relationships within schools by promoting change in school environment. Four waves of data were collected at baseline (1997, Year 8: mean age 13 years) and six, 18, and 30 months later (1999, Year 10: mean age 16 years). Self-reported substance use, school engagement, and sociodemographic data were collected using computer-administered questionnaires. Some 2.678(74%) Year 8 students participated (wave 1) with minimal attrition (10% by wave 4). Adjusting for baseline use, weak evidence existed for an intervention effect on the prevalence of any use at Year 10 (OR 0.75, 95% CI 0.54, 1.05) and incident weekly use (OR 0.72, 95% CI 0.39, 1.33). These effects were reduced after adjusting for confounders. Moderate evidence suggested an interaction effect between intervention group and tobacco use (p = 0.04), suggesting the intervention was more effective for non-smokers at baseline (Adj. OR 0.50, 95% CI 0.26, 0.98). This study indicates that a multi-level school-based program may provide an innovative direction for sustainable school interventions with the potential to reduce substance use.

Social and school connectedness in early secondary school as predictors of late teenage substance use, mental health, and academic outcomes.

PURPOSE: To examine associations between social relationships and school engagement in early secondary school and mental health, substance use, and educational achievement 2-4 years later. METHODS: School-based longitudinal study of secondary school students, surveyed at school in Year 8 (13-14-years-old) and Year 10 (16-years-old), and 1-year post-secondary school. A total of 2678 Year 8 students (74%) participated in the first wave of data collection. For the school-based surveys, attrition was <10%. Seventy-one percent of the participating Year 8 students completed the post-secondary school survey. RESULTS: Having both good school and social connectedness in Year 8 was associated with the best outcomes in later years. In contrast, participants with low school connectedness but good social connectedness were at elevated risk of anxiety/depressive symptoms (odds ratio [OR]: 1.3; 95% confidence interval [CI]: 1.0, 1.76), regular smoking (OR: 2.0; 95% CI: 1.4, 2.9), drinking (OR: 1.7; 95% CI: 1.3, 2.2), and using marijuana (OR: 2.0; 95% CI: 1.6, 2.5) in later years. The likelihood of completing school was reduced for those with either poor social connectedness, low school connectedness, or both. CONCLUSIONS: Overall, young people's experiences of early secondary school and their relationships with others may continue to affect their moods, their substance use in later years, and their likelihood of completing secondary school. Having both good school connectedness and good social connectedness is associated with the best outcomes. The challenge is how to promote both school and social connectedness to best achieve these health and learning outcomes.

The beyondblue Schools Research Initiative: conceptual framework and intervention.

OBJECTIVE: To describe the rationale, conceptual framework and content of the intervention for the beyondblue Schools Research Initiative. CONCLUSIONS: The beyondblue Schools Research Initiative aims to prevent the development of depression in young people through increasing individual and environmental protective factors within the school context. The model draws on evidence that demonstrates the important role played by individual and environmental characteristics in buffering the impact of adversity. The school provides a forum in which both individual and environmental change may be produced in order to increase some of these key protective characteristics. The project also draws together health, education and other key services to provide more effective pathways to enable young people to receive professional help when required.