Thinking Positive - The Importance of Resilience and Listening to Children and Young People : The Importance of Resilience and Listening to Children and Young People 9781846636615, 9781846636608

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ISSN 0965-4283

Volume 107 Number 6 2007

Health Education Thinking positive: the importance of resilience and listening to children and young people Guest Editors: Professor Don Stewart and Dr Jenny McWhirter

www.emeraldinsight.com

Health Education

ISSN 0965-4283 Volume 107 Number 6 2007

Thinking positive: the importance of resilience and listening to children and young people Guest Editors Professor Don Stewart and Dr Jenny McWhirter

Access this journal online ______________________________

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Editorial advisory board ________________________________

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GUEST EDITORIAL Thinking positive: the importance of resilience and listening to children and young people Don Stewart and Jenny McWhirter ________________________________

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Health-promoting school indicators: schematic models from students Saoirse Nic Gabhainn, Jane Sixsmith, Ellen-Nora Delaney, Miriam Moore, Jo Inchley and Siobhan O’Higgins _________________________________

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Childrens’, parents’ and teachers’ perceptions of child wellbeing Jane Sixsmith, Saoirse Nic Gabhainn, Collette Fleming and Sioban O’Higgins ______________________________________________

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Promoting school connectedness through whole school approaches Fiona Rowe, Donald Stewart and Carla Patterson ____________________

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CONTENTS

CONTENTS

A resilience framework: perspectives for educators Cecily Knight __________________________________________________

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How effective is the health-promoting school approach in building social capital in primary schools? Jing Sun and Donald Stewart ____________________________________

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Development of population-based resilience measures in the primary school setting Jing Sun and Donald Stewart ____________________________________

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Internet review ___________________________________________

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Note from the publisher _________________________________

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EDITORIAL ADVISORY BOARD

Professor Peter Aggleton Director, Thomas Coram Research Unit, Institute of Education, University of London, UK Judith Aldridge Lecturer, School of Law, University of Manchester, UK Professor Neil Armstrong Children’s Health and Exercise Research Centre, University of Exeter, UK Sue Bowker Schools and Young People Specialist, Welsh Assembly Government, UK Val Box Health Promotion Consultant and Visiting Fellow, School of Education, University of Southampton, UK Professor Stephen Clift Faculty of Health, Canterbury and Christchurch University College, UK Julian de Meyrick Lecturer in Business (Marketing), Macquarie University, Australia Professor Hein de Vries Cancer Prevention and Health Promotion, Maastricht University, The Netherlands Dr Faith Hill Director, Division of Medical Education, School of Medicine, University of Southampton, UK Paul Fleming Academic Coordinator of Public Health, School of Nursing, University of Ulster, UK Professor Gerard Hastings Director, Centre for Social Marketing, University of Strathclyde, UK Dr Roger Ingham Reader in Health and Community Psychology, University of Southampton, UK Ruth Joyce, OBE Manager of Blueprint, Drug Strategy Directorate, London, UK Dr Ros Kane University of Lincoln, Lincoln, UK Professor Mike Kelly Director of Evidence and Guidance, The Health Development Agency, London, UK Dr Jackie Landman Registrar, The Nutrition Society, London, UK Professor Han Z. Li Psychology Program, University of Northern British Columbia, Canada Dr Jenny McWhirter Head of Education and Prevention, DrugScope, London, UK Dr Ray Marks Adjunct Associate Professor of Health Education, Columbia University, USA Bernie Marshall Senior Lecturer, School of Health and Social Development, Deakin University, Australia Health Education Vol. 107 No. 6, 2007 Professor Laurence Moore p. 488 # Emerald Group Publishing Limited Director, Cardiff Institute of Society, Health and Ethics, Cardiff University, UK 0965-4283

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Colin Noble Acting Head of Healthy Schools Programme, The Health Development Agency, London, UK Professor Don Nutbeam Pro-Vice-Chancellor and Head, College of Health Sciences, University of Sydney, Australia Professor Carl Parsons Department of Educational Research, Canterbury and Christchurch University College, Canterbury, UK Professor Dr Peter Paulus Professor of Psychology and Head of Institute of Psychology and Centre for Applied Health Sciences, University of Lu¨neburg, Germany Dr Carmen Perez-Rodrigo Coordinator, Community Nutrition Unit, Department of Public Health, Bilbao, Spain Vivian Barnekow Rasmussen Technical Adviser, Promotion of Young People’s Health, The World Health Organization, Copenhagen, Denmark David Rivett Technical Officer: Adolescent Health in Ukraine, The World Health Organization, Ukraine Dr Sally Robinson Principal Lecturer, Centre for Health Education Research, Canterbury and Christchurch University College, Canterbury, UK Professor Lawrence St Leger Associate Professor, School of Health and Social Development, Deakin University, Australia Mike Sleap Lecturer in Sport & Exercise Science, University of Hull, UK Katerina Sokou Institute of Child Health, Athens, Greece Professor Sarah Stewart-Brown Professor of Public Health, Warwick Medical School, University of Warwick, Coventry, UK Dr Catherine Swann Head of Underlying Determinants of Health (acting), The Health Development Agency, London, UK Professor Sylvia Tilford Visiting Professor in Health Promotion, Leeds Metropolitan University, UK Professor Keith Tones Emeritus Professor of Health Education, Leeds Metropolitan University, Leeds, UK Dr Graham Watkinson Assistant Director of Public Health, Western Sussex NHS Primary Care Trust, Chichester, UK Professor Patrick West Senior Scientist, MRC Social and Public Health Sciences Unit, Glasgow University, Glasgow, UK

The current issue and full text archive of this journal is available at www.emeraldinsight.com/0965-4283.htm

GUEST EDITORIAL

Guest editorial

Thinking positive The importance of resilience and listening to children and young people

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Don Stewart Griffith University, Meadowbrook, Australia, and

Jenny McWhirter RoSPA (Royal Society for the Prevention of Accidents), Birmingham, UK Abstract Purpose – The purpose of this paper is to introduce the papers in this special issue and outline the essential features of the resilient school approach, and the child-focused approach of Noreen Wetton in her work in health education on understanding children and young people. Design/methodology/approach – The paper shows distillation of the key principles used in the two complementary approaches. Findings – The paper finds that resilience is a life event phenomenon that buffers against circumstances that normally overwhelm a person’s coping capacity. It is linked with “coherence”, or the ability to handle stress-related problems, “connectedness” and the ecological model encompassing a lifespan approach, within key settings that influence the individual’s psychosocial development. Preventive population health practices that address the strengthening of human, social and organisational capital may well promise greater success in fostering population health, and particularly resilience, than traditional psycho-educational strategies. These become increasingly effective as the whole school approach is implemented as young people engage and participate fully in research and decision making – key principles of Noreen Wetton’s approach to health promotion. Practical implications – The paper shows the need to focus on seeking the positive in any educational opportunity, to listen to young people and find out what they believe and feel, and to address health problems through attempting to strengthen people’s capacity to cope rather than just shielding them from adversity. Originality/value – The paper, in showing this is the first time these two strands have been brought together in this way, has a wide value widely across health education and health promotion. Keywords Schools, Health education, Research Paper type Research paper

Two guest editors, to reflect their complementary interests, have put this special issue together. Four papers represent the growing body of work on resilience in schools – a focus on work on social and emotional aspects of education, which encourage children to be resilient and bounce back from adversity. Two further papers represent a complementary body of work closely identified with the late Noreen Wetton, which encourages us to listen to children and young people. Both strands recognise the importance of basing work on a positive, strengths based model, which recognise the enormous capacity people have to live positively, understand and make sense of their environments, and triumph over difficult circumstances. They also recognise the importance of supporting such positive capacities with a surrounding health school environment which starts where people are and helps them be all they can be.

Health Education Vol. 107 No. 6, 2007 pp. 489-493 q Emerald Group Publishing Limited 0965-4283 DOI 10.1108/09654280710827894

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This issue is therefore dedicated to the memory of Noreen, and her positive, life affirming, people centred view of the world. Salutogenic or positive models offer alternatives to the deficits-based explanatory models of environmental determinants of health that have dominated the literature (Lemerle and Stewart, 2007). Health Promoting Schools reflect this alternative vision and echo the contemporary paradigm shift from a focus on biomedical determinants of health, to one based on socio-ecological principles. The papers here by Rowe et al. and Knight et al., recognise resilience, perceived as adaptation in the context of adversity, as an outcome derived from circumstances in which intrinsic human resources converge with social and environmental capital to build capacity at multiple levels (individual through organisational and community). The concept of resilience is increasingly being understood as a life event phenomenon that buffers against circumstances that normally overwhelm a person’s coping capacity. It has developed out of research, in salutogenic terms, into “coherence”, or the ability to handle stress-related problems. It is also clearly related to the concept of “connectedness” discussed by Rowe et al. that explores the significance of “capital” or intangible resources within human systems, as a plausible explanation of the link between physical and mental health outcomes and factors within social environments (Yen and Syme, 1999). In this issue, both Rowe et al. and Knight et al. provide examples of how complex conceptual frameworks can have important practical implications for teachers in school settings and a strong rationale for resilience education. The articles by Sun and Stewart, using the Australian “Resilient Children and Communities” data, support the call for evidence-based practice. Using a prospective intervention study design, they found a statistically significant relationship between “health promoting school” indicators and social capital and that a health promoting school approach to building social capital is effective. They also provide one of the few papers available that provides a systematic evaluation of instruments to measure children’s resilience and associated protective factors in family, primary school and community contexts. The resilience papers reflect the growing support for an ecological model encompassing a lifespan approach, within key settings that influence the individual’s psychosocial development. They add to the evidence, now accruing, which demonstrates that the degree of access to these intangible resources such as social capital, plays a fundamental role in shaping individual and population health outcomes, that is, that health is determined by more than just exposure to physical or microbial risks in our environments. Preventative population health practices that address the strengthening of human, social and organisational capital may well promise greater success in fostering population health, and particularly resilience, than traditional psycho-educational strategies. These become increasingly effective as the whole school approach is implemented and, of course, as young people engage and participate fully in research and decision-making. Two papers in this journal have been selected to reflect the influence of one of the longest serving members of the editorial board of Health Education, Noreen Wetton. When Noreen died in February 2006, aged 80, she was still avidly promoting the importance of consulting young people about their education in health and well-being. Long before the UN Rights of the Child (UN, 1990) and Every Child Matters (Department for Education and Skills, 2004) she believed that children and young people should be at the centre of research intended to benefit them, that “starting where people are” is essential to curriculum development for young people, and that the key

to young people’s active participation in learning about health and health related issues is to ask them what they know, understand, feel and believe about being and staying healthy. The “draw and write” technique, which Noreen developed as part of the English Health Education Authority’s Primary School Project in the 1980s, was an embodiment of all those principles (Williams et al., 1989a, b). It was not only good, highly principled research but it led to the development of ground breaking curriculum materials for primary school pupils in health education: Health for Life (Williams et al., 1989c, d). In 2000 Health for Life was recommissioned, and based on new research, republished to include citizenship education (Wetton and Williams, 2000a, b). In the intervening years Noreen and close colleagues developed many different draw and write strategies, exploring all manner of important health issues, many of which were published in informal reports, others in highly respected journals – skin cancer (McWhirter et al., 2000) growing up (Wetton and Collins, 1996; McWhirter, 1993), alcohol (Smart et al., 1999). Based on this work Noreen wrote, or co-wrote, more than 20 books for teachers and other practitioners, the last posthumously published was written with another member of Health Education’s editorial board, Nick Boddington (Wetton and Boddington, 2007). She proudly claimed her books for teachers had no content, only the questions to ask and the kinds of answers to expect from young people. This, she believed, is what teachers need to build interesting, exciting and effective lessons and a far cry from information based textbooks. When Noreen began her research career in the 1980s she was already in her late 50s and all young people were “hard to reach” by the research community. The tools, which were available, were simplified versions of adult questionnaires administered like tests and hardly child centred. By contrast the draw and write technique looks and feels like a classroom activity (see Wetton and McWhirter, 1998). It offers children and young people the opportunity to share their views and perceptions of abstract concepts such as health, safety and relationships in their own words, not the words chosen by a researcher and, importantly, to have those views respected. Noreen was big on respect for young people; she thought it was the most important the three Rs, the others being Reflect and Research – each of which were at the heart of her approach to curriculum development in health education. Since its first publication the draw and write technique was quickly taken up by the research community, but also by thousands of practitioners. Teachers were empowered by her deceptively simple “invitations to participate” to find out what children in their classes knew, understood and felt about some very sensitive issues – and about some important developments affecting them, including the health promoting school (MacGregor et al., 1998). Noreen also believed fervently in having fun, whether that was in the classroom or doing (or disseminating) research. She often complained that the English national curriculum had taken all the fun out of education and encouraged teachers and researchers to put some of that back. So I am sure she would have been delighted to see how her work has been extended by Sixsmith et al. and Gabhainn et al. and how they have taken those lessons to their hearts. Using the draw and write as a starting point for their work, Sixsmith et al., have offered children the opportunity to use photography to represent their views. Both papers have extended the idea of children as participants in research to taking key roles as part of the action research team, analysing and constructing meaning from children’s own perceptions of well being and

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developing indicators for a healthy school. Both young participants and researchers found this approach useful and fun! One way to look at how things have changed since the early 1980s and the first draw and write research question for children “What makes me healthy and keeps me healthy?” is to reflect on Roger Hart’s ladder of participation (Hart, 1992). Prior to draw and write much research intended to develop services or resources for young people was based on “adultism” – children’s views were used for manipulation, decoration or were tokenistic. Hart (1992) describes these as the bottom three rungs of an eight step ladder. The draw and write technique – appropriately used – reaches beyond this to assigning, involving and informing young people about decisions which affect them – rungs 4 and 5. Noreen often said that the “Health for Life” books were written by 22,600 children aged four to 11years! When young people are active participants in the action research cycle, as described by Sixsmith et al. and Gabhainn et al., we can go beyond this to level 6 – adult initiated research where decision making is shared with young people. From where we stand today it is not difficult to see how young people can increasingly be part of the teams developing and carrying out research with other young people and even taking responsibility for initiation, sharing the decision making with adults, rather than the other way around. Noreen’s work showed us how to begin to climb this ladder and, has taken us past the point of no return, at least in health education. Onward and upward! References Department for Education and Skills (2004), Every Child Matters, HMSO, London. Hart, R.A. (1992), “Children’s participation: from tokenism to citizenship innocenti”, Essay, UNICEF, IDC, London, p. 4. Lemerle, K. and Stewart, D. (2007), “Promoting mental health and wellbeing: the emergence of a socio-ecological model for building children’s resilience within the school setting”, unpublished paper, School of Public Health, Griffith University, Meadowbrook. MacGregor, A.S.T., Currie, C.E. and Wetton, N. (1998), “Eliciting the views of children about health in schools through the use of the draw and write technique”, Health Promotion International, Vol. 13 No. 4, pp. 307-18. McWhirter, J.M. (1993), “A teenager’s view of puberty”, Health Education, May, pp. 9-11. McWhirter, J.M., Collins, M., Wetton, N.M., Bryant, I. and Newton-Bishop, J.A. (2000), “Evaluating ‘Safe in the sun’, a curriculum programme for primary schools”, Health Education Research – Theory and Practice, Vol. 15 No. 2, pp. 203-17. Smart, S., Wetton, N.M. and Collins, M. (1999), On the Brink: Growing up in an Alcohol Using World, Surrey County Council, Kingston upon Thames. Wetton, N.M. and Boddington, N. (2007), Health for Life 3, Nelson Thornes, Cheltenham. Wetton, N.M. and Collins, M. (1996), Growing and Growing Up, Health Education Unit, University of Southampton, Southampton. Wetton, N.M. and McWhirter, J.M. (1998), “Image based research and curriculum development in health education”, in Prosser, J. (Ed.), Image Based Research – A Source Book for Qualitative Researchers, Falmer Press, London. Wetton, N.M. and Williams, D.T. (2000a), Health for Life 1 Healthy Schools, Healthy Citizens, Nelson Thornes, Cheltenham. Wetton, N.M. and Williams, D.T. (2000b), Health for Life 2 Healthy Schools, Healthy Citizens, Nelson Thornes, Cheltenham.

Williams, D.T., Wetton, N.M. and Moon, A. (1989a), A Picture of Health, HEA, London. Williams, D.T., Wetton, N.M. and Moon, A. (1989b), A Way in: 5 Key Areas of Health Education, HEA, London. Williams, D.T., Wetton, N.M. and Moon, A. (1989c), Health for Life 1, Thomas Nelson, Tewkesbury. Williams, D.T., Wetton, N.M. and Moon, A. (1989d), Health for Life 2, Thomas Nelson, Tewkesbury. Yen, I.H. and Syme, S.L. (1999), “The social environment and health: a discussion of the epidemiologic literature”, Annual Review of Public Health, Vol. 20, pp. 287-308. Further reading Office of the High Commissioner on Human Rights (1990), Convention on the Rights of the Child, United Nations, New York, NY. Corresponding authors Don Stewart and Jenny McWhirter can be contacted, respectively, at: donald.stewart@ griffith.edu.au and [email protected]

To purchase reprints of this article please e-mail: [email protected] Or visit our web site for further details: www.emeraldinsight.com/reprints

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The current issue and full text archive of this journal is available at www.emeraldinsight.com/0965-4283.htm

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Health-promoting school indicators: schematic models from students

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Saoirse Nic Gabhainn, Jane Sixsmith, Ellen-Nora Delaney and Miriam Moore

Received 10 December 2006 Revised 30 May 2007 Accepted 16 June 2007

National University of Ireland, Galway, Republic of Ireland

Jo Inchley University of Edinburgh, Edinburgh, UK, and

Siobhan O’Higgins National University of Ireland, Galway, Republic of Ireland Abstract Purpose – The purpose of this paper is to outline a three-stage process for engaging with students to develop school level indicators of health; in sequential class groups students first generated, then categorised indicators and finally developed schematic representations of their analyses. There is a political and practical need to develop appropriate indicators for health-promoting schools. As key stakeholders in education, students have the right to be fully engaged in this process. Design/methodology/approach – The sample in this paper comprised 164 students aged 16-17 years in three medium-sized Dublin schools. In the first classroom, students answered the question “If you moved to a new school, what would it need to have to be a healthy place?” on individual flashcards. In the second classroom students classified the flashcards into groups using a variation of the card game “snap”. In the third classroom, students discussed the relationships between the developed categories and determined how the categories should be presented. These procedures were repeated twice in three schools, resulting in six developed schemata. Findings – The paper finds that the six sets of categories showed remarkable similarity – physical aspects of the school predominated but emotional and social health issues also emerged as potential indicators. The schema demonstrated the holistic perspectives of students. They illustrate the importance of relationships and the physical and psycho-social environment within schools. Originality/value – The paper illustrates that students can productively engage in the process of indicator development and have the potential to act as full stakeholders in health-promoting schools. The methods enabled student control over the data generation, analysis and presentation phases of the research, and provided a positive, fun experience for both students and researchers. Keywords Health education, Schools, Ireland, Scotland Paper type Research paper

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Introduction Schools have been identified as a key setting for health promotion, development and improvement. Dooris (2005) acknowledges the effectiveness of the settings approach on a number of levels; it encourages multi-stakeholder ownership, allows connections between people and enables interactions between different health issues. It also has the potential to provide “an efficient and effective framework for planning and

implementing health promotion initiatives and ultimately assessing their impact” (Goodstadt, 2001, p. 209). A series of workshops, the first held in 1998, looking at the fundamental difficulties inherent to evaluating the promotion of health in schools have been hosted by the World Health Organization (WHO) and the Swiss Federal Office of Public Health. At the “Fourth workshop on practice of evaluation of the Health Promotion School (HPS) – concepts, indicators and evidence” the focus was on issues relating to the development and selection of indicators. Representatives from 33 countries participated in workshops discussing indicators and one of the conclusions was that a set of, and framework for, basic common indicators is required (Rasmussen, 2005). Teams of researchers were encouraged to work on the development and measurement of indicators at the individual, school, regional, national or international level. The need for student participation when developing indicators was identified by some of the representatives. This paper is based on the Irish and Scottish team’s contribution to that process. Indicators have become important in understanding the objectives, processes and outcomes of both the health and education sectors, and their many components. In health promotion and health education these indicators provide us with information on which to base decisions and judgments about resource allocations, policy, awareness raising, as well as the efficiency, effectiveness and feasibility of particular interventions and programs, and about “best practice” (St Leger, 2000). Ranges of indicators or models for indicator development have been proposed (e.g. World Health Organization, 1996; Viljoen et al., 2005; St Leger, 2004). However, it is generally agreed that developing a set of indicators to guide the implementation of health promotion programmes in educational sectors should be done in consultation with all the stakeholders (Konu and Rimpela¨, 2002; Deschesnes et al., 2003) and may have greater potential to improve practice at the school rather than the national or international level (Young, 2005). Firmly rooted in articles 12 and 13 of the UN Convention of the Rights of the Child, the Irish National Children’s Strategy (Department of Health and Children, 2000, p. 16) asserts that “children are active participants in the world which continues to experience increasing change”. In line with this, the first goal of the strategy expresses a commitment to give children a voice in matters that affect them. Such empowerment is central to the ideology of health promotion. It represents a primary criterion for identifying health promotion initiatives (Raeburn and Rootman, 1998). Poland et al. (2000) argue that an initiative can be classified as a health promotion initiative if it exhibits the use of health promoting principles, such as the process of enabling or empowering individuals or communities, while Nilsson (2005) explains how empowerment in the classroom can develop the student’s confidence and ability, facilitating their holistic development within an academic environment. Consonant with the principle of empowerment, health promotion emphasises participation. Health promotion principles and strategies such as participation and empowerment could be employed at all stages of an intervention to improve health, including during needs assessment, planning and evaluation. A myriad methods have been developed in the search for appropriate ways to encourage student participation and to evaluate school health promotion. Indeed, Piette

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et al. (1995, 1999) presented an imaginative and influential toolbox of potentially appropriate methods as part of the EVA projects. Probably the most powerful approach designed to facilitate children to express their own opinions and perceptions is the “draw and write” technique, originally developed by Noreen Wetton and the HEA Primary Schools Project Team in Southampton (Williams et al., 1989; MacGregor et al., 1998; Nic Gabhainn and Kelleher, 1998; 2002). MacGregor et al. (1998) used this technique to elicit student’s ideas about health generally, and more specifically their views on the qualities schools need to promote health. This research contributed to the development of evaluation instruments for primary schools planning to develop the Health Promoting School concept in Scotland. In a classroom setting, students were read a scenario introducing a healthy school and then asked to draw a picture of the school, writing alongside the drawing what makes it healthy. They were also asked to write down what would make their own school healthy. Students identified a range of issues relating to health education, school ethos and the relationship between the school and its surroundings; all elements of the health promoting school concept. However, common to most of these methods is that researchers are employed to analyse, interpret and present research findings and outcomes. Thus the process becomes dependent not only on the skills and experiences of such “outsiders”, but also on their political and epistemological standpoints in relation to the voice of the child. Nic Gabhainn and Sixsmith (2005, 2006) and Sixsmith et al. (2007) present an alternative, where the research participants consciously retain the power inherent to the analysis and presentation phases of the research process. As in the draw and write technique, children are asked to respond to an initial question, however the raw data they generate, rather than being gathered up by researchers to be taken away, is brought to another group of children for analysis, and to a third group for organisation and presentation. In previous studies employing this method (Nic Gabhainn and Sixsmith, 2006; Sixsmith et al. (2007)) the data generated and analysed were in the form of photographs, a relatively expensive and time consuming approach, and the appropriateness of the procedures adopted for other types of data, for example text, is to date unknown. Thus this paper aims to explore the feasibility of employing participative methodologies, incorporating the analysis of textual data and data presentation by school students as a process for developing school level HPS indicators. Method Design This is a three-stage design, with each stage involving active student participation. Stage 1 involves the generation of data from a group of students, stage 2 comprises the categorisation of these data and stage 3 is the organisation and presentation of the developed categories. Each of the three stages in undertaken by a different group of the same age peers within a single school. Sample Students were accessed through three post-primary schools in Dublin. Schools were purposively selected and comprised one for boys only, one for girls only and one co-educational school, each with between 400-600 pupils aged 12-18, which would be

typical in Ireland. None of the schools described themselves as “health-promoting schools”, although all offered a curriculum in social, personal and health education (SPHE), as required by the national Department of Education and Science (circular M11/03). Three class groups were involved in each school, all drawn from the fourth year of post-primary education, which for most is the first year post-compulsory education. Consent was obtained in the first instance from school principals and management, and subsequently from parents and students. Passive consent forms were distributed to parents via students, and active consent was requested from all participating students at the beginning of the classroom sessions. Such consent was processual; all were free to withdraw, without censure, at any stage of the process. No parent withdrew their child and no student refused to participate or withdrew themselves. Procedures Following a brief introduction to the study and the collection of both parental and student consent, ground rules, including in all cases confidentiality, were agreed with each group. Students were briefed about the other sessions that had or were to take place. All sessions took place in classrooms, were facilitated by experienced schoolteachers and were audio-recorded. Each sequential stage involved a separate class group, and at the end of each session, students played a group game. Stage 1 The first stage involved gathering textual data based on individual students responses to two questions “What is it about school that affects your health?” and “If you moved to a new school, what would it need to have to be a healthy place?”. Both questions were placed on the black or white board in classrooms. Students wrote their responses on cards, using a separate card for each answer or new idea. Each student was initially given ten cards, and further cards were available throughout. One of the rationales for the first question was to facilitate answers to the second. Responses to both questions were treated separately, and this paper focuses on the analysis and reporting on replies to the second question. Stage 2 Stage two involved data categorisation with students from a second-class group, divided into two sub-groups. Each of the two sub-groups was given half of the cards generated at stage 1, and was invited to play the “snap” game: . The youngest person present dealt out the cards as equally as possible among group members. They were viewed face-up. . The student to their right called out the response on their first card and laid it on the table. . Other group members placed cards they perceived to be similar on top of the first card to form a category. . The game continued until all cards were used up and all categories had been formed.

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As a group they reviewed the constructed categories, and were free to add new cards. Each category of cards was stapled together and the group agreed a category title, which was secured with an elastic band. Stage 3 The third stage involved data presentation by the third class group, also divided into two sub-groups. The students were given the question, response cards and category titles developed during the two previous stages. The students were invited to consider how the categories could be arranged or organised into a pattern, on double A1 posters. They were not explicitly asked to order them in any way or place them in a hierarchy. In most cases, students read the stapled bundles to aid their understanding of the category titles, all participants had access to the response cards, but not all read each of them. Extra cards were given to each group so that new contributions were facilitated. In each group some of the original categories were removed and others added, and some category titles were amended. When the groups were satisfied with their category arrangement, they affixed the category title cards onto the posters with tape, some sub-groups also wrote their own comments on the posters, or linked the category titles with arrows. Findings In total, 164 students in nine class groups participated across the three schools. Table I presents the numbers, gender and age of the students by school, along with the number of responses volunteered by students in stage 1 and the number of categories developed in stage 2. During the schema development in stage 3, 16 (20.7 per cent) of the original 77 categories were removed and 15 new categories added. However, only three of these 16 were among the largest 30 categories. Two of the six sub-groups placed categories from stage 2 at the edge of their posters, indicating that they perceived them to be marginal to their schema. Five of the six sub-groups wrote on the poster. The content of their comments varied; some explained the layout, while others were explanatory of the schema content. Five sub-groups reworded category titles, though not more than three per sub-group; these new titles were less abstract and more reflective of the category content (see Figures 1-6).

School A B Table I. Characteristics and responses of students by school

C

Age in years

Mean (sd)

Group/ stage

16.18

(0.53)

1 2 3 1 2 3 1 2 3

16.29 16.29

(0.67) (0.65)

Male (n)

Female (n) 25 28 20

18 15 20 14 6 8

1 4 5

Responses 203 cards sub-group 1 sub-group 2 131 cards sub-group 1 sub-group 2 58 cards sub-group 1 sub-group 2

– 11 categories – 12 categories – 11 categories – 15 categories – 15 categories – 13 categories

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Figure 1. Schema school A, sub-group 1

During stage 3, students developed six independent schemata; based on the six sets of categories. These schemata have various structures. The two clearest hierarchical schemata are from the all-girls (A) and the all-boys (B) schools respectively. The boys’ schema (Figure 4) has a very distinct layout, it is numbered and structured to relate order of importance. The girls’ schema (Figure 2) is depicted in “level of importance”. These levels are internally related to sub levels. Sub-group 1 in the girl’s school developed a semi-hierarchical schema (Figure 1). It has two categories which are

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Figure 2. Schema school A, sub-group 2

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Figure 3. Schema school B, sub-group 1

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Figure 4. Schema school B, sub-group 2

central to the schema, one which was ranked “authority # 1” this leads into “respect” which in turn feeds into the outer circling categories, the outer arrows signifying continuity and movement of these categories. The second schema devised in the boy’s school is non-hierarchical (Figure 3), but does have a focal point, “good hygiene/mental health” to which all the other categories are linked by dual or single arrows. In the co-educational school (C), very clearly structured schemata were presented. In sub-group 1 (Figure 5) the structure is in three separate sections; each of which links what the students perceived to be related together. This block structure is also reflected

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Figure 5. Schema school C, sub-group 1

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Figure 6. Schema school C, sub-group 2

in the schema developed by sub-group 2 (Figure 6) where arrows link the related categories within two separate sections. Discussion All of the developed schemata are unique, both in terms of content and structure, as they were developed from exclusive sets of individual responses and categories, by separate groups of students. Nevertheless, there is substantial overlap in schema content, with an emphasis on the tangible; physical attributes of the school, school organisation and factors that contribute to physical health. This can be interpreted within the context of Irish post-primary education; schools are not supported, or in general expected to provide food of any kind for students, and many school buildings are in need of repair, renovation or replacement. Similar concerns have been expressed during previous studies of school health promotion in Ireland (e.g. Nic Gabhainn and Kelleher, 1998; Nic Gabhainn et al., 2000). The focus on the physical may also reflect the absence of a broader settings approach to health within these specific schools, which has also been previously identified (Nic Gabhainn and Kelleher, 2002). Nevertheless, the developed schemata reflect a broader understanding of the determinants of health and indicate a range of social and inter-personal factors that students highlight as relevant. These include the socio-emotional role of relationships with teachers and other students, and echo a body of findings that demonstrate the importance of relationships within the school for student health and wellbeing (Torsheim and Wold, 2001a, b). They also concur with previous Irish findings on primary (Nic Gabhainn and Kelleher, 2002) and post-primary (O’Higgins, 2002) students’ concept of health, which focused on health as an achievable resource for living; engaging with other people and being active. The structures of the schema illustrate how students perceive these aspects of the school to be inter-related and confirm the degree of sophistication of these students’ perspectives. That the schemata themselves are influenced by the preceding stages and student characteristics must be considered. While the sub-groups in stage 3 were generally faithful to the categories developed during stage 2, the extent to which they considered the physical size of the categories, in terms of the number of response cards in the category is unknown, although fieldworkers did report that this was noted in most sub-groups. “Contamination” of schema structure could also be an issue, given that in each of the three schools, the two sub-groups were working in the same room, albeit with independent sets of categories. Stage of the school career and gender are also possible influencing factors. All participating students in this study were senior students, at the end of their fourth year of post-primary education. As such they will have experienced group work communication processes, would be familiar with school structures and processes and were more likely to know each other well. Previous attempts at employing this approach found that, at least when investigating a topic with which students are familiar, such as their own well-being, the group components of this process were equally feasible with younger, primary school age students (e.g. Nic Gabhainn and Sixsmith, 2006). However, it is possible that young participants are more likely to have difficulty with this text-based approach, especially when playing the “snap” game in a group setting. Substantially more individual responses were produced in the girls-only school, reflecting previously identified gender differences in

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consultation processes (Edwards and Alldred, 1999; Stafford et al., 2003). However, during data reduction in stage 2, the girls produced an equivalent number of categories as the students in other schools, with no substantial variation in category titles. One of the objectives in this study was to develop indicators for a health promoting school and thus we need to question whether the schemata are appropriate for indicator development. It may be most straightforward to employ the categories as the indicators, with consideration of the individual response cards within the categories to help develop criteria for such indicators. This, however, does not negate the value of the schema, as they serve as a vehicle for conceptually linking the actions required for health promoting schools, and, equally importantly, as an aide to impressing on adult stakeholders the value of including students in the process. It is important to remember that students are not the only stakeholders in schools, and it is relevant to consider how these categories and schemata can contribute to a wider school level process of indicator development. It may be most coherent to adopt the process outlined here with all individual stakeholder groups and to subsequently facilitate an integration of developed schemata. Alternatively it would also be interesting to engage with representatives of all stakeholder groups together adopting a similar protocol. The extent to which the schemata developed here could appropriately be applied to other schools, or indeed to other groups of students within the participating schools is essentially unknown. The extent of the similarity between schemata supports their generalisability, but much further exploration is required. Even if the schemata presented here are generalisable, there are advantages to engaging in the process as outlined above. Whether employed as a needs assessment or evaluation exercise, involving students in this way has the potential to increase the engagement of students and may increase the likelihood of student’s involvement throughout the process of schools improving their health promoting status. Observation and informal feedback mechanisms indicated that all three stages of the process appeared to be positive and engaging experiences for participants. However, students were clear that they wanted their views to be taken on board, particularly by school management. It may be that student participation draws their collective attention to the issue of health in school, the impact of school life on their health and thus raises their awareness and interest in these issues. We cannot claim any long-term impact of this expressed desire by students to participate in decision-making and school improvement, or to fully commit to the implementation process if changes were to be introduced but it would be appropriate, if resources allowed, to follow-up students or classes in a case-study fashion in order to investigate this possible outcome. There are specific limitations of this approach to engaging with students. These include the necessity for literacy skills and the unknown extent of group influences on the outcomes. Fieldworkers must be prepared to allow students the freedom to say just what they want, refrain from directing them during the group-work process, and allow their final schema to be the final data representation. This can be a struggle for some researchers, particularly those who are already experienced classroom managers. It is also difficult to avoid the impetus to engage in further post-hoc “researcher-led” analysis of the responses, categories and schemata. While such analysis may be appropriate when investigating the appropriateness of the method, it is contradictory

to the underlying epistomological assumptions. The exact question employed as the intial trigger to data generation is also crucial. The wording of the question employed here, although similar to that of MacGregor et al. (1998) is the product of a number of pilots with groups of students, emphasising the contextually dependent nature of the language used. The exact phrasing of the question may heavily influence student responses. Thus questions need to be relevant and understandable to the individual student group. Those interested in replicating this work or employing these protocols must pay due attention to the language in the initial question. The methodology presented here was developed in the context of a research project, but the procedures outlined may also sit alongside participative approaches to health promotion, as the method is intended to be explicitly empowering. In an Irish context the process could easily be employed within either Social, Personal and Health Education or Civic, Social and Political Education, for example in gathering and organising ideas raised in the planning stages of work, an integral part of both of these curricula. Outside of the classroom, the process described may also be useful within the Student Representative Councils (SRC) now present in most Irish schools; it could be employed by SRC members with the student body for the purposes of planning, needs assessment or consultation. It is proposed that this approach complement rather than replace current participative practices and as with other methodologies, teachers and practioners must be very clear as to the rationale and appropriateness of its use in the setting and context that they are working. As this method is intended to empower children, the less adults try and influence or control the process, the better. In common with other methods of participation, it is important that there is follow-through from teachers and school management, and so it would be relevant to assess in advance whether this approach really is coherent with other aspects of the school or youth setting. The growing literature on children as researchers indicates that children are an underestimated and underused resource. Alderson (2000) suggests that children are more likely than adults to be interested in every phase of research pertaining to children. Their stage of the life-cycle means they are familiar with enquiring, accepting unexpected results, revising their ideas and assuming that their knowledge is incomplete and provisional; crucial skills for successful researchers. Nevertheless, it is necessary to debate whether there is any added value to this approach or whether it overcomes any of the limitations of other approaches to consulting with children (Coad and Lewis, 2004). Our experience is that the process is fun, with both fieldworkers and students giving very positive feedback on their involvement, but students do express concern that their views will be listened to. Given that the process is initiated and guided by adults, much will depend on how the schemata are subsequently employed. It is essential to allow the students as much freedom as possible at each stage, but the key to determining the extent to which this process faciltiates advanced levels of participation will be whether the adult stakeholders engage with children in relation to subsequent decision-making and the planning and execution of health promoting actions (Hart, 1997; Shier, 2001; Kirby et al., 2003). The degree to which this method facilitates the empowerment of students is similarly dependent on what happens next and deserves further investigation.

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The methods presented here involve strategies that are congruent with the principles of health promotion and produce useable indicators of the health promoting school at school level. The process applied to obtain these indicators can be employed successfully and efficiently within the school setting, although the context and participant characteristics must always be considered. The developed schemata demonstrate both the level of engagement achieved and the sophistication of students’ understanding of the factors that influence their health, and, their inter-relationships. References Alderson, P. (2000), “Children as researchers: the effects of participation rights on research methodology”, in Christensen, P. and James, A. (Eds), Research with Children: Perspectives and Practices, Routledge Falmer, London. Coad, J. and Lewis, A. (2004), Engaging Children and Young People in Research: Literature Review for the National Evaluation of The Children’s Fund (NECF), available at: www. ne-cf.org (accessed June 18, 2006). Department of Health and Children (2000), Our Children – Their Lives, Stationery Office, Dublin. Deschesnes, M., Martin, C. and Hill, A.J. (2003), “Comprehensive approaches to school health promotion: how to achieve broader implementation?”, Health Promotion International, Vol. 18 No. 4, pp. 387-96. Dooris, M. (2005), “Healthy setting: challenges to generating evidence of effectiveness”, Health Promotion International, Vol. 21 No. 1, pp. 55-65. Edwards, R. and Alldred, P. (1999), “Children and young peoples views of social research: the case of research on home-school relations”, Childhood, Vol. 6 No. 2, pp. 2281-612. Goodstadt, M. (2001), “Settings – Introduction”, in Rootman, I., Goodstadt, M., Hyndman, B., McQueen, D., Potvin, L., Springett, J. and Ziglio, E. (Eds), Evaluation in Health Promotion: Principles and Perspectives, WHO (Regional Office for Europe), Copenhagen. Hart, R. (1997), Children’s Participation: The Theory and Practice of Involving Young Citizens in Community Development and Environmental Care, Earthscan (UNICEF), London. Kirby, P., Lanyon, C., Cronin, K. and Sinclair, R. (2003), Building a Culture of Participation: Involving Children and Young People in Policy, Service Planning, Delivery and Evaluation, Department for Education and Skills Publications, Nottingham. Konu, A. and Rimpela¨, M. (2002), “Well-being in schools: a conceptual model”, Health Promotion International, Vol. 17 No. 1, pp. 79-87. MacGregor, A.S.T., Currie, C.E. and Wetton, N. (1998), “Eliciting the views of children about health in schools through the use of the draw and write technique”, Health Promotion International, Vol. 13 No. 4, pp. 307-18. Nic Gabhainn, S. and Kelleher, C. (1998), The Irish Network of Health Promoting Schools: A Collaborative Report, Department of Education, Dublin. Nic Gabhainn, S. and Kelleher, C. (2002), “The sensitivity of the draw and write activity as an evaluation tool”, Health Education, Vol. 102 No. 2, pp. 68-75. Nic Gabhainn, S. and Sixsmith, J. (2005), Children’s Understandings of Well-being. National Children’s Office, Department of Health and Children, Dublin. Nic Gabhainn, S. and Sixsmith, J. (2006), “Children photographing well-being: facilitating participation in research”, Children and Society, Vol. 20, pp. 249-59.

Nic Gabhainn, S., McCarthy, E. and Kelleher, C. (2000), Bı´ Follain: Review and Evaluation, Mid-Western Health Board, Dublin. Nilsson, L. (2005), “The roles of participation and dialogue in health promoting schools: cases from Sweden”, in Clift, S. and Jensen, B. (Eds), The Health Promoting School: International Advances in Theory, Evaluation and Practice, Danish University of Education Press, Copenhagen. O’Higgins, S. (2002), “Through the looking glass. Young people’s perceptions of the words health and happy”, MA dissertation, Department of Health Promotion, National University of Ireland, Galway. Piette, D., Roberts, C., Prevost, M., Tudor-Smith, C. and Tort i Bardolet, J. (1999), Tracking down ENHPS Successes for Sustainable Development and Dissemination, The EVA2 Project Final Report, Universite´ Libre de Bruxelles, Brussels. Piette, D., Tudor-Smith, C., Rivett, D., Rasmussen, V. and Ziglio, E. (1995), Towards an Evaluation of the European Network of Health Promoting Schools, The EVA Project, Brussels: Commission of the European Community, WHO Regional Office for Europe and the Council of Europe, Brussels. Poland, B.D., Green, L.W. and Rootman, R. (2000), Settings for Health Promotion: Linking Theory and Practice, Sage, London. Raeburn, J. and Rootman, I. (1998), People Centered Health Promotion, Wiley, Toronto. Rasmussen, V.B. (2005), 4th Workshop on Practice of Evaluation of the Health Promoting School – Concepts, Indicators and Evidence: Executive Summary, WHO (European Office), Copenhagen. St Leger, L. (2000), “Developing indicators to enhance school health”, Health Education Research, Vol. 15 No. 6, pp. 719-28. St Leger, L. (2004), “What’s the place of schools in promoting health? Are we too optimistic?”, Health Promotion International, Vol. 19 No. 4, pp. 405-8. Shier, H. (2001), “Pathways to participation: openings, opportunities and obligations”, A New Model for Enhancing Children’s Participation in Decision-making, in line with Article 12.1 of the United Nations Convention on the Rights of the Child, Children and Society, Vol. 15, pp. 107-17. Sixsmith, J., Nic Gabhainn, S., Fleming, C. and O’Higgins, S. (2007), “Childrens’, parents’ and teachers’ perceptions of child wellbeing”, Health Education, Vol. 107 No. 6, pp. 511-23. Stafford, A., Laybourn, A. and Hill, M. (2003), “‘Having a say’: children and young people talk about consultation”, Children and Society, Vol. 17, pp. 361-73. Torsheim, T. and Wold, B. (2001a), “School-related stress, support, and subjective health complaints among early adolescents: a multilevel approach”, Journal of Adolescence, Vol. 24 No. 6, pp. 701-13. Torsheim, T. and Wold, B. (2001b), “School-related stress, school support, and somatic complaints: a general population study”, Journal of Adolescent Research, Vol. 16 No. 3, pp. 293-303. Viljoen, C.T., Kirsten, T.G.J., Haglund, B. and Tillgren, P. (2005), “Towards the development of indicators for health promoting schools”, in Clift, S. and Jensen, B. (Eds), The Health Promoting School: International Advances in Theory, Evaluation and Practice, Danish University of Education Press, Copenhagen. Williams, T., Wetton, N. and Moon, A. (1989), A Picture of Health: What Do You Do That Makes You Healthy and Keeps You Healthy?, Health Education Authority, London.

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Further reading Lemerle, K. and Stewart, D. (2007), “Promoting mental health and wellbeing: the emergence of a socio-ecological model for building children’s resilience within the school setting”, unpublished paper, School of Public Health, Griffith University, Meadowbrook. Corresponding author Saoirse Nic Gabhainn can be contacted at: [email protected]

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Childrens’, parents’ and teachers’ perceptions of child wellbeing

Perceptions of child wellbeing

Jane Sixsmith and Saoirse Nic Gabhainn National University of Ireland, Galway, Ireland

511

Collette Fleming Scoil Phadraig Primary School, Westport, Ireland, and

Sioban O’Higgins

Received 10 December 2006 Revised 8 May 2007 Accepted 5 June 2007

Graduate of the University of Nottingham, Nottingham, UK, the Dublin Institute of Technology, Dublin, Ireland and the National University of Ireland, Galway, Ireland Abstract Purpose – The purpose of this paper is to present an exploration of parents’, teachers’ and childrens’ perspectives on children’s understanding of wellbeing with the aim of illuminating and comparing the conceptualisation of wellbeing from these three perspectives. Design/methodology/approach – The participatory method developed to undertake the study in this paper stems from the adoption of the “draw and write” technique, with children taking photographs rather than drawing and participating in data analysis. Children aged eight to 12 years took 723 photographs representing wellbeing, while a second set of children grouped the photographs into categories. A third set organised these categories, developing and illustrating through schemata the pattern of relationships between categories. This process was repeated for parent and teacher groups drawing on the photographs taken by the children. Findings – The findings in this paper show that differences emerged between parents and teachers and children and adults. Parents provided a more detailed conceptualisation than teachers. Children included pets where adults perceived school as being more important in children’s wellbeing. The identification of the differing perspectives between children and adults suggests that this approach has enabled children to illuminate their own unique perspective on wellbeing. The paper also demonstrates that children can express complex understandings of abstract concepts. Originality/value – In the paper the findings reinforce the need to gain children’s perspectives rather than relying on adult perceptions of children’s perspectives, in order to inform quality service, practice and policy developments. Keywords Teachers, Parents, Children (age groups), Perception Paper type Research paper

Introduction The centrality of wellbeing in the lives of children is epitomised in the United Nation (UN) Convention on the Rights of the Child (United Nations, 1989). Ireland ratified this convention in 1992 and the first National Children’s Strategy (Department of Health and Children, 2000) followed. The Irish strategy specifically recognised the The authors like to acknowledge the support of the Office of the Minister for Children, particularly from Dr Sinead Hanafin and Anne-Marie Brooks and the research input from Simon Comer, Ailish Houlihan, Michael Keogh and Thomas Gannon.

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development of indicators of children’s wellbeing as an action, putting the concept of wellbeing to the fore at a national level (Department of Health and Children, 2000). The strategy also identified three key goals: children will have a voice, children’s lives will be better understood and children will receive quality supports and services. That children’s lives be better understood is a necessary contributing step to the development of child centred quality supports, services and policies and it would appear logical that actively seeking out childrens’ voices would facilitate this endeavour. However, this has not always been the case and traditionally adults have provided information on children’s policy and service needs (Alderson, 2001) with parents often considered the most appropriate and primary voice of the child (Hayes, 2002). Adults, such as parents and teachers, it can be argued, have a unique perspective and hold key insights into the lives of children which could contribute to the development of child focused policy and practice. This paper presents an exploration of teachers’, parents’ and childrens’ perspectives on children’s understanding of wellbeing. The participatory method developed to undertake the study stems from our use of the “draw and write” technique but with children taking photographs rather than drawing and participants taking part in data analysis. The concept of child wellbeing is complex and multi-faceted (Helliwell, 2003). This results in many definitions being reported in the literature (Ben-Arieh et al., 2001), yet a single agreed understanding of wellbeing remains elusive (Hanafin and Brooks, 2005). Hanafin and Brooks (2005) identify the definition of Andrews et al. (2002) as a guide to the development of child wellbeing indicators in Ireland. The rationale given for this choice is that Andrews et al.’s (2002) conceptualisation is multi-dimensional, with the recognition of the importance of relationships within the context of a social ecological approach that is coherent with the reality of children’s lives. Interestingly, this definition also includes explicit reference to health. Definitions identified from the literature are usually conceptions by adults that mediate our understanding of children’s wellbeing, as opposed to children’s own constructions of wellbeing. This limitation would be ameliorated by children expressing their own perspective directly, unencumbered by an adult world view. Increasingly, children’s perceptions are being recognised as providing a unique view of the world, an insider’s view or emic perspective that can positively contribute to child centred policy and practice developments (Darbyshire et al., 2005). However, the research process through which this perspective is accessed can be problematic, as Harden et al. (2000) argue, it reinforces inequalities in power between adults and children. This can be negated to some extent by the active and meaningful participation of children throughout the research process (Darbyshire et al., 2005), including the analysis stage, where power differentials are particularly manifested (Mayall, 1994). Much of the focus today in research with children includes: seeking the emic perspective, fostering inclusion and participation, and striving towards equality and mirrors developments in health promotion research practice. Health promotion research is developing with the integration and application of the tenets of health promotion applied through the research process (Springett, 2001a, b; Tones and Tilford, 2001). In this way the active meaningful participation of people, not just children, is sought in a way that, at the very least, is not disempowering. The way children’s ideas are explored varies, with a vast range of approaches used. The “draw and write” technique is one such approach, often used in school

settings, as a vehicle to facilitate children’s expression of abstract concepts such as health (Williams et al., 1989; MacGregor et al., 1998). The technique, while ground-breaking in its time with its implicit recognition of the need to seek out the child’s perspective, has recognised limitations (Backett-Milburn and McKie, 1999; Kelleher et al., 2001; Nic Gabhainn and Kelleher, 2002). One of the constraints of the “draw and write” technique is the school setting, rather than the approach itself, with its organised physical and social boundary (Coad and Lewis, 2004), overseen at all times by adults (Harden et al., 2000) suggested to influence the participation of children in “draw and write” activities (Backett-Milburn and McKie, 1999; Nic Gabhainn and Kelleher, 2002). Children’s perception of their own abilities in drawing may also restrict their participation (Backett and Alexander, 1991). These limitations may be negated by the use of photography rather than drawing, as cameras can be taken out of the school setting and are dependant on a relatively straightforward skill that can be easily and quickly learnt. As disposable cameras have become more readily available and cheaper so their use in research has increased. Children as young as three to eight years of age have successfully used photographs to illustrate to adults what was important to them in their community (Miller, 1996). Photovoice, a participatory action research strategy, initially developed with adults (Wang and Burris, 1994, 1997), was employed by Darbyshire et al. (2005) with children, as one of many methods of data collection, to elicit children’s understandings and experiences of place, space and physical activity. Darbyshire et al. (2005) identified that the children’s rights agenda has created an environment of awareness in which children have the right to be consulted and heard. However, in an Irish context, Articles 41 and 42 of the Constitution directly refer to the life of the child and relate to family and education respectively (Government of Ireland, 1937). There is no specific clause that guarantees the rights of the child, although this was recommended in 1996 (Constitution Review Group, 1996). The inalienable rights of the family and parents in the Constitution have, in times of conflict, led to the subordination of child rights (Fahey, 1997). In circumstances of family breakdown, parents may agree issues of child custody and access and only in situations where agreement is not achieved is a court obliged to “take into account the child’s wishes” and then only “as it thinks appropriate and practicable” (All Party Oireachtas Committee on the Constitution, 1997, p. 25). In relation to school, children are accorded some consultative rights under the 1998 Education Act. However, Hayes (2002) has argued that this Act is circumspect with regard to the democratic participation of children, as students’ rights to information and consultation are conditional and dependant on the school Principal or board of management (Lynch, 1998). While the legislative context appears restrictive in regard to children’s rights the development of the National Children’s Office, which actively and meaningfully includes children in research, policy and practice developments, suggests an increasing commitment to a rights based approach in the Irish context. Due to the role of parents and teachers in the lives of children and their position in relation to power over children in Ireland, it would appear expedient to ascertain not only children’s perspectives but also that of parents and teachers in relation to children’s conceptions of wellbeing. This paper aims to illustrate teachers’, parents’ and childrens’ conceptualisations of wellbeing through a participatory method of research using photography.

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Methods This research was carried out in four rural school settings with each school outside the boundary of any city or town, yet geographically distinct from each other using a mixed gender team of researchers. One boys’ school, one girls’ school and two mixed gender schools were actively sought to participate. Written informed consent was obtained from parents/guardians of all child participants, as was consent from the school. At all research phases, following explanation of the study, children, whose parents had provided written consent, were given the option to withdraw with alternative activities provided. For all groups, ground rules, including observance of confidentiality, were agreed between the researchers and participants. The four phases of the research are delineated below. Phase 1 In classrooms, with teachers present, the research team introduced themselves and the study to class groups of eight to ten year olds. The purpose of the research was explained to the children and included a description of the concept of wellbeing taken from previous research in an Irish context as “feeling good, being happy, and able to live your life to the full” (O’Higgins, 2002). Children were asked to quietly reflect on what makes them well and keeps them well and then share their reflections with the rest of the class for which positive feedback was given. Disposable cameras were then distributed to each child and they were asked to label them with their name, sex and age. Instruction was given on their use and children were given the opportunity to take a test photograph, which the research team supervised, providing assistance when needed. Children were told that they could take as many photographs as they liked and of whatever they wanted. They were also told that if they did not want to participate they could return the camera unused. Finally, the children were informed of the day to return the used cameras to school and that the research team would return with their developed photographs. A letter to parents reiterating these procedural issues was sent home with each participating child. The children returned the cameras to the school, which were duly professionally processed, and two copies of each set of prints produced. One set of photographs was labeled, each label predominantly left blank except for coding of the child’s age, sex and school. The research team returned to the schools and the two sets of photographs were returned to the child that had taken them. One set was for the child to keep, and with the second set the children were asked to write on the labels what the pictures depicted. Researchers oversaw this process and with the teachers’ guidance provided assistance to children when required. The labeled and annotated photographs were collected by the research team. Each photograph was examined and those marked “test”, “practice”, “nothing”, “mistake”, “error” and “I didn’t mean to take this photograph/picture” and those left blank were removed as invalid. These procedures were repeated in two schools, one was boys only and the second girls only. In total 763 photographs were returned to the research team, 140 of which were invalid. The remaining 623 photographs were randomly assigned into sets of 50. Phase 2 A group of eight children aged ten to 12 years in a second school under took the second phase of the research. The research was described with the same explanation of

wellbeing given as at Phase 1. The children were introduced to the photographs 50 at a time, asked to view them and gather them into groups of pictures that went together, a process referred to as categorisation. The children themselves decided which photographs went into which category, how many categories and what they were called. As the process progressed, additional sets of 50 photographs were introduced until saturation – that is when no new categories were developed by the children. Finally, children decided on the title for the category and chose an example photograph. Phase 3 In this phase a new group of eight children from a third school were introduced to the study. The categories developed in Phase 2 were represented by a flashcard with the category name and previously chosen example photograph. The children were asked to arrange the categories into a pattern by fixing the flashcards onto a double sheet of A1 paper in any way they chose. The opportunity was also given for the addition of any perceived missing categories through the provision of blank flash cards, which could be used by labelling the cards and including them in the process. On conclusion of this activity the children were asked to indicate which categories, if any, were linked and to depict this by drawing a line joining the categories. This is referred to as schema development with the resulting depiction a schema. This division of data creation by children in Phase 1 from children’s analysis in Phases 2 and 3 ensured that people and scenes depicted in the photographs were not known to the children undertaking the analysis, limiting the potential for any pejorative comments. It also facilitated validation of the previous phase with the opportunity for participants to include further categories considered missing. Phase 4 Two purposively selected adult groups, one of parents and one of teachers participated in this final phase, at a fourth rural primary school. The research process mirrored that undertaken by the children at Phases 2 and 3 but were amalgamated. The study was explained in the same terms as that to the children, with the same definition of wellbeing. The parents’ and teachers’ groups independently used the photographs that had been taken by the children at Phase 1 and were introduced to them 50 at a time to categorise. They then went on to develop schema. Again, opportunity was given for the addition of any perceived missing categories. Phases 2, 3 and 4 engendered a large amount of discussion and negotiation in both child and adult groups, which was audiotaped with researchers taking contemporaneous notes. The researchers were also debriefed following the exercise. This information was used to inform the results. Results The results of this study take the form of the categories and schema developed by the three groups of children (n ¼ 8), parents (n ¼ 7) and teachers (n ¼ 6). Initially, the teachers’ construction will be presented followed by that of parents and finally that of the children. The depiction of the schemata is as faithful as possible to those produced by the groups themselves.

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Teachers The group of teachers used a total of 250 photographs to develop 14 categories. The categorisation process generated much discussion by teachers, particularly in relation to “freedom” and “pride”. One teacher interpreted the photograph “going home from school” as representing freedom and the other photographs in the group, according to the teachers, relate to the feelings a child would have, for example, when out in a boat. As there was only one photograph in the category “pride” it was suggested that this be subsumed into “possessions”, however, others felt that this should remain, the rationale given by the teachers that pride is an important component of children’s wellbeing. It was decided early on that “family” and “home” differed, with “family” equating to people and “home” a place. Teachers identified an emphasis in the photographs on solitary pastimes rather than group activities. They also identified nutritious food and visits to the doctor as missing from children’s representation of wellbeing. Teachers also highlighted a perceived lack of reference to spiritual wellbeing. Teachers’ schema The teachers constructed the schema around what they identified as the core categories of “home”, “family” and “friends” which were perceived as central to a child’s wellbeing and so placed them in the middle. Categories perceived as more important were placed in closer proximity to these three central features. The schema as developed is presented in Figure 1. The font size of the category label represents the number of photographs placed by the group of teachers into this category (see Table I for legend).

Figure 1. Teacher’s schema

Number of photographs

Table I. Legend for font size of schema category labels

,2 2-6 7-14 15-24 25-35 .35

Font size of category label 10 12 14 16 18 20

Parents Parents’ review of the photographs generated 28 categories from 300 photographs. In the development of the categories by parents, differentiation was made between “hobbies” and “play”, the rationale given by parents was that hobbies are specific, pre-meditated activities rather than spontaneous play. Similarly, distinction was made between “home” and “family” as home was considered a physical space and family were people. Parents separated sweets and food as they equated sweets with treats and food as a life necessity. A number of areas were identified as missing from the category development by parents. These missing components according to parents were emotional expression, areas of health, specifically mental health and ill health. Festivities, such as Christmas, were also identified as missing, as were holidays and money. These missing areas were perceived by parents as important to children’s wellbeing. Parent’s schema Parents positioned the categories in their schema in clusters of loosely grouped categories that they felt belonged together. For example, “family”, “home”, “support” and “friends” were all grouped together and are depicted as such in the schema. However, it was considered that the characteristics of each category, which had become to some extent a sub-section, were important to keep. All categories were depicted as linked and connected, as it was perceived that children need the totality for wellbeing and the schema as developed is presented in Figure 2 with the larger font size of the label indicating that more photographs were included in the category (see Table I). Children According to those constructing this schema it should be read from top to bottom in terms of importance, so that “family” (closely followed by “animals and pets” and “sports and soccer”) was considered the most important with flowers and clock the least important for wellbeing. As can be seen there are many connections with the most connected category that of fun, with nine connections, followed closely by “Things to do”. The schema constructed by children is presented in Figure 3. As before, the larger the font size of the category label, the greater the number of photographs placed in that category by the participating children in Phase 2. Discussion Differences and similarities emerge across all three groups of data analysts. Teachers took a broader approach to defining children’s wellbeing and consequently parents had exactly double the number of categories as teachers (28 to 14 respectively). There was consensus on the two main categories of “friends” and “family”. There was also general agreement on the categories “home” “nature” and “pets” although labelled “animals” by parents. The “school” category described by the teachers was more inclusive than that of parents which appears subdivided with “school” one category and the others being “teachers”, “academia” and “ability” which are presented in the parents’ schema in the same area of the chart but not explicitly linked. This broader conceptualisation by the teachers indicates the general salient features they perceive as important to children’s wellbeing as opposed to the more detailed construction by parents. However,

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Figure 2. Parent’s schema

as parents grouped sets of categories on the schema, it can be suggested that they recognise this broader conceptualisation also. The category and schema development indicate areas of consensus, which can also be observed between parent and teacher groups’ identification of what is missing from the constructions, which include holidays and ill health. However, differences can also be observed with teachers identifying of a lack of reference to spiritual wellbeing and parents suggesting that the expression of emotion is missing. Both these concepts, spirituality and emotion, are abstract and complex to express for both children and adults and it may be that this form of data collection is unable to capture this level of abstraction. However, it is important to recognise that these are adults’ interpretations of children’s photographs of wellbeing and children may have considered their photographs to be depicting emotions or spirituality and adults are not interpreting them in this way. A striking aspect of the children’s category and schema development is its complexity, with the 23 categories being presented in a hierarchy. The centrality of family is in concurrence with both parents and teachers and the importance of family to child wellbeing has been recognised (e.g. Carroll, 2002). The simplicity of the word “family” hides the complexity of what the term actually denotes. Costello (1999), when referring to the influence of the family on child wellbeing, considers definitions, structure, functioning and relationships within the family. However, family is not presented in this way through the category and schema development, rather simply as family members, which includes extended family. The category “friends” is given more

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Figure 3. Children’s schema

importance in the adults’ schema than would appear to be the case in the children’s even though the “friends” categories comprised large numbers of photographs. This is of note as Morrow (2001), in a study of young people’s perspectives on their environments, found that friends were photographed in at least half the pictures even though they had been asked to take pictures of places, not people. However, pets, while featuring in both adults’ schema, are accorded a much more significant position by the children. The primacy of pets to children’s perceptions of wellbeing was identified previously in the application of this approach (Nic Gabhainn and Sixsmith, 2006) but is often not included in considerations of child wellbeing (Ben-Arieh et al., 2001; Torsheim et al., 2001). The category “school” has more

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prominence in the adults’ conceptualisation of wellbeing than children’s, which is surprising when it is assumed that the primary productive activity of children is related to learning within school (Carroll, 2002). In a study of factors associated with school children’s general, subjective wellbeing, the strongest correlations were found with means of self-fulfilment and social relationships (Konu et al., 2002). The results of this research suggest that while adults recognise school as an important contributor to child wellbeing children themselves do not necessarily share this perception. The category “neighbours” is presented in both the teachers’ and children’s schema although in differing positions of importance. The children appear to place it higher in their hierarchy while teachers place it on the periphery of their construction linked to a category, labelled “locality”, which has been placed in a similar peripheral situation on the schema. The Children’s Strategy (Department of Health and Children, 2000) identifies the role of community to child wellbeing with recognition of the built and natural environment to support their physical and emotional wellbeing. Interestingly, teachers linked the category “neighbours” to that of “locality” but children did not link the category “neighbours” to “places” in their schema. Parents did recognise the role of environment for children’s wellbeing but in terms of “special places” and “nature”. The elements identified as missing by teachers, parents and children are also illuminating. Both parents and teachers identified a specifically biomedical component, ill health and visiting a doctor as missing. However, children appear to have constructed a very positive conceptualisation of wellbeing with no negative health connotations. Although the teachers identified spirituality as missing from the photographs it should be noted that children placed the category “church” high in their hierarchy. This category only had five photographs suggesting that few children took pictures of this topic area, which may explain why none appear to have emerged in the teacher’s category construction. This also highlights that the number of photographs in a category does not necessarily correlate with its placement on a hierarchal schema. The children depict the categories in the schema as highly connected, often with two way links and these contrasts with the adults’ constructions. The more connected categories could be interpreted as more important in that they have a perceived role in the other category areas, which would mean in this study that from the child’s perspective “fun” is a central feature of children’s wellbeing. However, this was not the way the children discussed the schema, although they did acknowledge that all categories are linked, in some way suggesting an integrated approach to wellbeing. The development of this approach to data collection and analysis has proved valuable in giving voice to children and demonstrating that their voice differs from that of adults and not as traditionally conceptualised, merely a simpler less developed world view. This supports the explicit participation of children in policy, practice and service developments that relate to their lives. Research informs these developments and researchers have an obligation to enable the voice of children to be heard beyond consultation and towards active participation. This can be achieved through child participation in the research process and supporting the use and development of participatory methodologies. The use of photography enabling children to reflect and record their insights outside the school setting has also proved useful and appears to have negated some of the restrictions encountered with the “draw and write” technique. Researchers working with children need to actively provide children with the opportunity to express themselves unfettered by restrictions imposed by adult

presumptions which are often reinforced by the setting in which research is undertaken. The inclusion of participants through data collection and analysis re enforces the importance and commitment of the research to the participant’s perspective. This would appear particularly important for children whose views have often been mediated through adults. This research approach is coherent with the principals of health promotion and would support the development of a health-promoting ethos within a school setting. Limitations As with all research this study has limitations. There are some documented differences in the procedures adopted with adults and children. Different groups of children were involved in the categorisation and the schema development phases, whereas single groups of both teachers and parents completed both sets of tasks, albeit independently. The involvement of one group of participants through all research phases may have provided more cohesion, facilitated greater reflection and resulted in more comprehensive conceptualisations of child wellbeing by parents, teachers and children. However, the division of the research in this way meant that no participant undertaking category and schema development knew those portrayed in the photographs, thus limiting the potential for any pejorative comment. However, this raises a further ethical issue; although informed consent was obtained from parents/guardians, teachers, parents and children, with participants proffered the opportunity to withdraw at all points of contact, consent was not obtained from those pictured in the photographs. Participation in analysis may be questioned as without academic analysts, research may produce nothing more than lay understandings (Harden et al., 2000). However, as in this case, if the aim is to give, children a voice and to gain their perspective in order to contribute to adults’ understanding of child wellbeing, it would appear necessary that children undertake the analysis to reduce the imposition of an adults’ view through the adult analyst’s interpretation of the data. Conclusion The childrens’ conceptions of wellbeing, illuminated through the participatory approach taken, are at least as detailed and complex as that of parents and teachers. As has been shown teachers’, parents’ and childrens’ perspectives of child wellbeing while having similarities also have discernable differences. This is particularly notable in relation to the role of pets in children’s lives which requires further exploration. This study demonstrates the value of the participation of children in research as active participants. Their contribution should not be under-estimated. References Alderson, P. (2001), “Research by children”, International Journal of Social Research Methodology, Vol. 4, pp. 139-53. All Party Oireachtas Committee on the Constitution (1997), First Progress Report, Stationery Office, Dublin. Andrews, A., Ben-Arieh, A., Carlson, M., Damon, W., Earls, F., Garcia, C., Gold, R., Halfon, N., Hart, N., Lerner, R.M., McEwen, B., Meaney, M., Offord, D., Patrick, D., Peck, M., Trickett, B., Weisner, T. and Zuckerman, B. (2002), Ecology of Child Well-being: Advancing the Science Practice Link, Centre for Child Well-being, Decatur, GA.

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Backett, K. and Alexander, H. (1991), “Talking to young children about health: methods and findings”, Health Education Journal, Vol. 50, pp. 34-8. Backett-Milburn, K. and McKie, L. (1999), “A critical appraisal of the draw and write technique”, Health Education Research, Vol. 102, pp. 68-75. Ben-Arieh, A., Hevener-Kaufman, N., Bowers-Andrews, A., Gearoge, R.M., Joo-Lee, B. and Aber, J.L. (2001), Measuring and Monitoring Children’s Well-being, Kluwer, Dordrecht. Carroll, E. (2002), The Well-being of Children: Four Papers Exploring Conceptual, Ethical and Measurement Issues, Irish Youth Foundation, Dublin. Coad, J. and Lewis, A. (2004), Engaging Children and Young People in Research, Literature Review for The National Evaluation of the Children’s Fund, available at: www.ne.cf.org (accessed 18 June 2006). Constitution Review Group (1996), Report of the Constitution Review Group, Stationery Office, Dublin. Costello, L. (1999), A Literature Review of Children’s Well-being, Combat Poverty Agency, Dublin. Darbyshire, P., Macdougall, C. and Schiller, W. (2005), “Multiple methods in qualitative research with children: more insight or just more?”, Qualitative Research, Vol. 5 No. 4, pp. 417-36. Department of Health and Children (2000), Our Children – Their Lives, Stationery Office, Dublin. Fahey, T. (1997), Family Policy in Ireland – A Strategic Overview: An Abstract of a Report on the Commission on the Family, Department of Social and Family Affairs, Dublin. Government of Ireland (1937), Bunreacht na hEireann, Stationery Office, Dublin. Hanafin, S. and Brooks, A.M. (2005), Report on the Development of a National Set of Child Well-being Indicators in Ireland, National Children’s Office, Dublin. Harden, J., Scott, S., Backett-Milburn, K. and Jackson, S. (2000), “Can’t talk won’t talk? Methodological issues in researching children”, Sociological Research Online, Vol. 5 No. 2, available at: www.socresonline.org.uk./harden.html (accessed 1 June 2005). Hayes, N. (2002), “Children’s rights: participation of children in policy making in Ireland”, in Crimmens, D. (Ed.), Having Their Say. Young People’s Participation: European Perspectives, University of Lincolnshire and Humberside, Lincoln. Helliwell, J. (2003), “How’s life? Combining individual and national variables to explain subjective wellbeing”, Economic Modelling, Vol. 20 No. 2, pp. 331-60. Kelleher, C., Hope, A., Barry, M.M. and Sixsmith, J. (2001), Health, Safety and Well-being in Rural Communities in the Republic of Ireland: Main Results from the Agriproject, Centre for Health Promotion Studies, National University of Ireland, Galway. Konu, A., Alanen, E., Lintonen, T. and Rimpela, M. (2002), “Factor structure of the school wellbeing model”, Health Education Research, Vol. 17 No. 6, pp. 732-42. Lynch, K. (1998), “The status of children and young persons: education and related issues”, in Healy, S. and Reynolds, B. (Eds), Social Policy in Ireland – Principles, Practices and Problems, Oak Tree Press, Dublin. MacGregor, A.S.T., Currie, C.E. and Wetton, N. (1998), “Eliciting the views of children about health in schools through the use of the draw and write technique”, Health Promotion International, Vol. 13 No. 4, pp. 307-18. Mayall, B. (1994), “Introduction”, in Mayall, B. (Ed.), Children’s Childhoods; Observed and Experienced, Falmer Press, London, pp. 1-12. Miller, J. (1996), Never Too Young – How Young Children Can Take Responsibility and Make Decisions. A Handbook for Early Years Workers, The National Early Years Network/Save the Children, London.

Morrow, V. (2001), “Using qualitative methods to elicit young people’s perspectives on their environments: some ideas for community health initiatives”, Health Education Research, Vol. 16 No. 3, pp. 255-68. Nic Gabhainn, S. and Kelleher, C. (2002), “The sensitivity of the draw and write technique”, Health Education, Vol. 102, pp. 68-75. Nic Gabhainn, S. and Sixsmith, J. (2006), “Children photographing wellbeing: facilitating participation in research”, Children and Society, Vol. 20, pp. 249-59. O’Higgins, S. (2002), “Through the looking glass: young people’s perceptions of the words health and happy”, unpublished MA thesis, Department of Health Promotion, National University of Ireland, Galway. Springett, J. (2001a), “Appropriate approaches to the evaluation of health promotion”, Critical Public Health, Vol. 11 No. 2, pp. 139-51. Springett, J. (2001b), “Participatory approaches to evaluation in health promotion”, in Rootman, I., Goodstadt, M., Hyndman, B., McQueen, D.V., Potvin, L., Springett, J. and Ziglio, E. (Eds), Evaluation in Health Promotion: Principles and Perspectives, WHO Regional Publications, Copenhagen. Tones, K. and Tilford, S. (2001), Health Promotion: Effectiveness, Efficiency and Equity, 3rd ed., Nelson Thornes, Cheltenham. Torsheim, T., Samdal, O., Danielson, M., Dur, W., Hetland, J., Kostarova, L. and Valimaa, R. (2001), “Positive health”, in Currie, C. (Ed.), HBSC Protocol for the 2001/2002 Survey, University of Edinburgh, Edinburgh. United Nations (1989), Convention on the Rights of the Child, United Nations, Geneva. Wang, C. and Burris, M. (1994), “Empowerment through photo novella; portraits of participation”, Health Education Quarterly, Vol. 21, pp. 171-86. Wang, C. and Burris, M. (1997), “Photovoice: concept methodology and use for participatory needs assessment”, Health Education and Behaviour, Vol. 24, pp. 369-87. Williams, T., Wetton, N. and Moon, A. (1989), A Picture of Health: What Do You Do That Makes You Healthy and Keeps You Healthy?, Health Education Authority, London. Corresponding author Jane Sixsmith can be contacted at: [email protected]

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Griffith University, Meadowbrook, Australia, and

Fiona Rowe and Donald Stewart Carla Patterson Queensland University of Technology, Brisbane, Australia

Received 15 October 2006 Revised 25 January 2007 Accepted 22 March 2007

Abstract Purpose – The purpose of this paper is to develop a framework to demonstrate the contribution of whole school approaches embodied by the health-promoting school approach, to the promotion of school connectedness, defined as the cohesiveness between diverse groups in the school community, including students, families, school staff and the wider community. Design/methodology/approach – A cross-disciplinary review of literature was conducted to identify strategies consistent with the health-promoting school approach and the values and principles that promote school connectedness. The review included peer-reviewed articles and published books and reports identified from the databases spanning the education, health, social science and science disciplines and used search terms encompassing health and mental health promotion, schools, social connectedness, belonging and attachment. The paper is also a framework of the contribution of the health-promoting school approach to promoting school connectedness and was developed drawing on health promotion strategies at the broader community level known to foster connectedness. Findings – The paper found that the framework developed illustrates how the health-promoting school approach has the potential to build school connectedness through two major mechanisms: inclusive processes that involve the diversity of members that make up a community; the active participation of community members and equal “power” relationships, or equal partnerships among community members; and supportive structures such as school policies, the way the school is organised and its physical environment, that reflect the values of participation, democracy and inclusiveness and/or that promote processes based on these values. Practical implications – In this paper the detailed mechanisms outlined in the framework provide practical strategies for health promotion practitioners and educators to use in the everyday school setting to promote school connectedness. Originality/value – This paper draws together substantial bodies of evidence and makes a persuasive case for the contribution of the health-promoting school approach to building school connectedness. Keywords Health education, Schools, United States of America Paper type Research paper

Health Education Vol. 107 No. 6, 2007 pp. 524-542 q Emerald Group Publishing Limited 0965-4283 DOI 10.1108/09654280710827920

Introduction Strong social relationships and a sense of connectedness in school communities have been shown to have a profound impact on the health of children and adolescents. Consistent evidence from controlled trials, longitudinal and cross-sectional research indicates that a sense of connectedness within the school environment is protective of mental and emotional well-being (Hawkins et al., 1999, 2005; Resnick et al., 1997; Rutter et al., 1979); healthy sexuality; and mitigates against health risk-taking behaviours related to substance use and violence (Lonczak et al., 2002; Nutbeam et al., 1993; Resnick et al., 1997). A sense of belonging and connectedness in the school community

is not only protective of health but is also identified as contributing to improved academic achievement and engagement (Croninger and Lee, 2001; Goodenow, 1993; Hargreaves et al., 1996) as well as to reducing crime (Catalano and Hawkins, 1996; Lonczak et al., 2002). As a significant protective factor for several health, academic and social outcomes, school connectedness has enormous potential to contribute to child and adolescent health and development into adulthood (Hertzman, 1999; Van der Gaag, 2002). Such evidence indicates that the challenge for policy makers, health practitioners and educationalists is to identify, develop and implement effective evidence-based strategies to increase school connectedness. The health promoting school (HPS) model which has its origins in the World Health Organization’s global initiative and under the label of comprehensive school health education in the USA, is increasingly being endorsed as an effective model to promote health in the school setting (Clift and Bruun Jensen, 2006; Lister-Sharp et al., 1999; Weare and Markham, 2005). The model has been applied and shaped in Europe (Parsons et al., 1996), most recently with the Egmond agenda (Clift and Bruun Jensen, 2006), the USA (Allensworth and Kolbe, 1987), Australia (St Leger, 1999) and the Asia-Pacific region (Rowling and Ritchie, 1996-1997). This model provides a clear process and framework for increasing school connectedness and thus also allows for the development of an approach or set of intervention strategies. Based on the principles of the Ottawa Charter for Health Promotion (World Health Organization, 1986), this model involves all groups in the school community, including students, families, school staff and the wider community, working together to promote the health and well-being of the whole school community. The model is based on a comprehensive framework, outlined in Figure 1 that considers curriculum, teaching and learning; school organisation, ethos and environment and partnerships and services (Clift and Bruun Jensen, 2006; NHMRC, 1996; St Leger, 2006; World Health Organization, 1996). There is little in the literature that reports on the contribution of the health promoting school approach to the promotion of school connectedness. During a literature review no articles were found that specifically investigated the influence of the health promoting school approach on school connectedness as an outcome in its own right. There are a number of studies and reports however on the use and

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Figure 1. The health promoting school

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contribution of the health promoting school approach to increasing school connectedness, or social relationships within the school, as a means to promote mental health and emotional well-being (Patton et al., 2000; Piette et al., 2001; Stewart-Brown, 2006; Wells et al., 2003; Wyn et al., 2000) and to lower rates of smoking among young people (West, 2006). The literature review showed more studies that identified the effectiveness of health promotion strategies in the broader community context in the development of social connectedness or cohesiveness at this broader community level (Baum, 1999; Hawe and Shiell, 2000; Lomas, 1998; Wakefield and Poland, 2005). Community collaboration processes characterised by the inclusiveness of diverse groups in the community; the active participation of community members and equal or democratic relationships promote, it is argued, the development of trust and strong social relationships which are the essential elements of social connectedness or cohesiveness in the broader community context (Baum, 1999; Hawe and Shiell, 2000; Labonte, 1999). It is also argued that structures in the community environment, such as representative committees and physical areas for social interaction, that promote inclusive, participatory and democratic processes and/or that reflect these values have also been shown to promote social connectedness (Baum, 2002; Lomas, 1998). Health promotion processes and structures that have been shown to promote connectedness can also be applied to the school setting. These processes and structures, combined with current evidence of strategies consistent with the values and principles of the health promoting school framework, provide a strong theoretical framework for using the health promoting school approach to build school connectedness. We argue that the HPS model has the potential to increase school connectedness through two major mechanisms: (1) Processes that are characterised by inclusiveness, involving the full range of members that make up a community; also the active participation of community members and equal or democratic partnerships among school community members. (2) Structures such as school policies, school organisational arrangements, the physical environment, teaching and learning approaches, and the extent to which these reflect the values of participation, democracy and inclusiveness and/or promote processes based on these values. We argue that processes and structures, located both in the general school environment and the immediate classroom environment, collectively have the potential to promote connectedness in the school setting. These processes and structures are summarised diagrammatically in Figure 2. What is school connectedness? School connectedness essentially describes the quality of the social relationships or social “bonds” within school communities. The concept of school connectedness has been predominantly defined and conceptualised from the perspective of the individual as the “bonds” that students develop with the school environment (Libbey, 2004; McBride et al., 1995; Patton et al., 2000; Resnick et al., 1997). Resnick et al. (1997) described the key elements of these social bonds as: attachment, or the quality of

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Figure 2. Health promoting school processes and structures that influence school connectedness

affective relationships that the adolescent has with members of the school community; commitment, or the degree to which adolescents aspire to pro-social goals; and involvement, or the degree to which the adolescent is integrated in conventional social activities. These elements are focussed on the perspective of the individual and relate to the degree to which individual students are embedded within the school social environment. They give little weight to, and do not adequately reflect school connectedness as an ecological concept, that is as a characteristic of the whole school environment, or as part of the school “culture”. Individualistic definitions, as conceptualised in Figure 3, also conceive of the school as a relatively insulated setting and focus largely on the quality of the social bonds or connectedness between those members residing within the geographical bounds of the

Figure 3. Individualistic conceptualisation of school connectedness

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school environment, for example between students and students, and between students and teachers. While these conceptualisations recognise connectedness to the school as having a social foundation, they ignore the importance of links to other social systems such as the family environment and the broader community context, including health services and community agencies, that have an enormous impact on the health of children and adolescents within the school (Bronfenbrenner, 1979) and on the effectiveness of the school as an educational institution (Gallimore and Goldenberg, 2001; Sanders, 2001; Taylor and Adelman, 2000). Schools as communities A clearer insight into the nature of school connectedness can be provided by conceiving it as an ecological concept. This allows a more complete recognition of the nature and associated processes of the school environment and recognises valuable social systems such as the family environment and the broader community. These systems impact on the health of children and adolescents and on the general effectiveness of the school. As illustrated in Figure 4, inherent in this view is the perspective of the school as a “community” that spans across the physical boundaries of the school fence into the social systems in the broader community. As a characteristic of the school environment, school connectedness can encompass the quality of the bonds in the school environment between the multiple social groups that impact on the school such as the students, school staff, families and the broader community. More specifically, school connectedness can be defined as the level of cohesiveness between diverse groups, such as students, families, school staff (teaching and non-teaching), and health and community agency representatives in the school community. It is characterised by strong social bonds, featuring high levels of interpersonal trust and norms of reciprocity – otherwise known as social capital (Kawachi and Berkmann, 2000).

Figure 4. Ecological conceptualisation of school connectedness

School connectedness and its relationship to social capital In the broader community context, the concept of social capital offers an important way of determining the level of connectedness or cohesion in communities from an ecological perspective (Kawachi and Berkmann, 2000; Kawachi and Kennedy, 1997). A cohesive society is formally defined as a society that has:

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Strong social bonds that are characterised by high levels of interpersonal trust, norms of reciprocity (Kawachi and Berkmann, 2000, p. 175).

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While typically traced to three prominent theorists (Bourdieu, 1986; Coleman, 1990; Putnam, 1993), the concept of social capital has received extensive attention in the literature, most recently over its conceptualisation and political implications of its meaning (Navarro, 2002; Portes, 1998; Szreter and Woolcock, 2004). It is the essence of the concept of social capital, described as “social relations of mutual benefit, which are characterised by norms of trust and reciprocity” (Winter, 2000), that is the building block of social cohesion or connectedness in communities (Kawachi and Berkmann, 2000; Kawachi et al., 1997; Lomas, 1998; Wilkinson, 1996). From an ecological perspective, individuals do not possess social capital; rather, social capital reflects the structural feature of social relationships surrounding the individual. In this case, social connections and the social capital lodged within those connections should be considered as a feature of the community to which the individual belongs (Kawachi and Berkmann, 2000). An ecological view of school connectedness Social connectedness, encompassing the concept of social capital in the broader community, can be reflected in the school community context. By investigating the characteristics of the bonds, such as levels of trust and norms of reciprocity between diverse groups such as students, families, school staff and health and community agencies in the school community, school connectedness can be conceptualised as an ecological concept that encompasses the links to the multiple social systems that influence child and adolescent health and school settings. In the broader community context, social cohesiveness or connectedness has also been considered to refer to the absence of social conflict, relating to such issues as income inequality or racial/ethnic tensions or other forms of polarisation; an abundance of associations that bridge social divisions; and the presence of systems of conflict management (Kawachi and Berkmann, 2000). At the school community level this implies an absence of harmful social conflict, such as bullying; an abundance of associations that bridge social divisions such as a tolerance of diverse cultures; and the presence of systems which promote conflict management, for example a fair and democratic process for resolving disputes. Promoting school connectedness Although there is a lack of research on the contribution of the health promoting school approach to increasing school connectedness in its own right, there is a plethora of evidence, for example from the fields of mental health promotion, psychology, sociology and education, of strategies to promote school connectedness that is consistent with the values and principles of the health promoting school model (Battistich et al., 2004; Hawkins et al., 2005; Rowling, 2002; Weare, 2000). This evidence

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fits within the broad areas of curriculum, teaching and learning; school organisation, ethos and environment; and partnerships and services and is reviewed below under these components of the health promoting school approach. Curriculum, teaching and learning The curriculum, teaching and learning component of the health promoting school framework is concerned not only with the content of the school health curriculum but also the action and participatory teaching and learning styles used and promoted in the delivery of the curriculum (Bruun Jensen and Jensen, 2006; Simovska, 2006). Student-centered learning activities which encourage student participation and enhance students’ roles in decision-making in the classroom are highlighted as an effective teaching strategy in the health promoting school model (NHMRC, 1996). Such an approach has been shown to promote school connectedness (Barker et al., 1997; Bateman, 1998; Battistich and Schaps, 1996; Schaps, 1998). Student participation and involvement in their learning builds upon the strengths of young people and has been shown to enhance the value of their contributions as partners in the learning process (Holdsworth, 1996; Wilson, 2000). Also learning approaches such as co-operative and democratic rule setting in the classroom environment have been used to promote a sense of school connectedness (Barker et al., 1997; Battistich and Schaps, 1996). Approaches involving students in decisions about what they will learn in the curriculum through negotiated curriculum teaching strategies (Bateman, 1998; Battistich and Schaps, 1996) have produced similar results. Student participation in the classroom arena can also encompass specific “student participation” projects including community development and research as well as community action projects (Holdsworth, 1996; Wilson, 2000). Other teaching and learning approaches that have been shown to build social relationships and connectedness in the classroom include small group work, class discussions, co-operative learning activities, shared tasks and peer-tutoring (Barker et al., 1997; Hunt et al., 2000; Korinek et al., 1999; Patton et al., 2000; Schaps and Soloman, 1990, Smith and Sandhu, 2004). These approaches enable students to interact with members of the class and build stronger relationships between them. In particular, co-operative learning strategies that involve small, heterogeneous groups of students of differing abilities and backgrounds working together as learning partners (Bateman, 1998; Hendrix, 1996; Slavin, 1995), have been shown to foster positive attitudes towards teachers and other students; improve race relations (Slavin and Oickle, 1981); support relationships of students with disabilities (Korinek et al., 1999; Salend, 1999) and students with emotional and behavioral disorders (Farmer et al., 1999; Searcy, 1996). The curriculum, teaching and learning component of the health promoting school framework also highlights the importance of implementing well-planned, comprehensive health promotion curricula, based on a holistic view of health that considers the social, cultural and economic environments in which students live (Hancock and Perkins, 1985; Kickbush, 1989). Evidence indicates that by linking the classroom curricula to everyday life activities, such as “experiential learning” activities (NHMRC, 1996), learning is embedded within the environmental contexts in which students live and so addresses these influences on health (Lister-Sharp et al., 1999; NHMRC, 1996; St Leger, 1999; World Health Organization, 1996). Experiential learning

has been advocated by several authors as a classroom teaching strategy to build school connectedness (Barker et al., 1997; Battistich and Schaps, 1996; Glover et al., 1998; Malloy and Malloy, 1997; McCarthey, 1999). This type of learning involves students in practical learning experiences that embed their learning in a real and relevant social context (Glover et al., 1998) and encourages the formation of social relationships, which develop naturally in everyday social contexts and situations. A comprehensive health curriculum that addresses the environmental determinants of health also has implications for integrating health issues across the entire school curriculum so that students see school life and daily life in the broader health perspective (Jensen, 1991; Lavin et al., 1992). A health curriculum that spans different subject areas has also been thought to contribute to the development of social relationships central to school connectedness. For example, Markham and Aveyard (2003) argue that health related activities and themes that span the entire school curriculum encourage students to develop insights into the social construction of knowledge and how knowledge is informed by multiple perspectives or contexts. The authors theorise how such an understanding encourages students to develop insights into the multiple realities of social contexts and therefore the likelihood that they will associate with others different to them. School organisation, ethos and environment This component of the health promoting school framework utilises formal and informal school structures such as the school organisation, policies, procedures and environment, including the physical and social environment to promote health. The social environment, termed variously as the “ethos” or as the psychosocial environment (World Health Organization, 1995; Young and Williams, 1989) or the “hidden curriculum” (Lister-Sharp et al., 1999), identifies the underlying values of school structures and functions as major contributors to the relationships between staff, students and parents (Parsons et al., 1996). We argue that it is this component of the health promoting school framework that has the most potential to promote school connectedness. The school social environment, or ethos, is shaped by underlying norms and values that are reflected in school policies and procedures, such as codes of discipline and standards of behaviour and attitudes adopted by staff towards students and parents (Lister-Sharp et al., 1999; McNeely et al., 2002; Smith and Sandhu, 2004). Based on the values of social justice, respect for diversity and the collaboration of the whole school community in identifying and developing strategies to address health, the health promoting school framework promotes a supportive social environment that values all members of the school community. The values of the health promoting school model can help shape the ethos and connectedness of the school community. For example, schools that value and support strong, positive personal relationships (Konu et al., 2002; Limato, 1998; Smith and Sandhu, 2004) and that are oriented around a shared set of values and goals, have a strong sense of community and connectedness (Barker et al., 1997; Carrington, 1999; Lieber et al., 2000; Limato, 1998; Salisbury et al., 1993). Other values that contribute to school connectedness are those that emphasise collectivity and the common good of school members and organise around values that promote the mutual rights and obligations of the community (Barker et al., 1997; Carrington, 1999). Holdsworth (1996)

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argues that underpinning the concepts of mutual rights and obligations, and indeed the issue of school connectedness, is the issue of “agency” which refers to: People having access to open and democratic structures and processes; being listened to and treated with dignity, respect and mutuality; and living in a non-authoritarian environment (Holdsworth, 1996, p. 101).

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Views of agency in the school context call for developing genuinely inclusive and democratic systems of school governance and approaches which value the contributions of students, their experiences, their knowledge and their present situations (Holdsworth, 1996). At the school level, the influence of student participation on school connectedness is well documented. Involving students in school organisational structures such as school council committees, or curriculum committees (Babiuk, 1999; Glover et al., 1998; Holdsworth, 1996; Konu et al., 2002; Korinek et al., 1999; Markham and Aveyard, 2003) and through student-run organisations such as student representative councils (Holdsworth, 1996) can promote school connectedness. Increasing student involvement in the school’s decision making process can also enhance student-teacher relationships through promoting greater insights and understanding of each others’ values and personalities (Markham and Aveyard, 2003). A variety of other strategies under the school organisational component of the health promoting school framework, such as re-organising school policies and procedures, have been shown to build social relationships and connectedness within the school environment. To facilitate social interactions, schools have restructured timetables and recess periods (Konu et al., 2002; Korinek et al., 1999). Also, multi-age grouping, block scheduling or other methods such as “school within a school” or “house” concepts have been identified as increasing student-teacher contact and building the relational quality of teacher-student interactions (Barker et al., 1997; Malloy and Malloy, 1997; Smith and Sandhu, 2004; Weller, 2000). Building on this concept, team teaching efforts have also been shown to develop strong relationships between teachers, parents and students (Babiuk, 1999; Hunt et al., 2000; Kugelmass, 2001; Weller, 2000). Creative scheduling of co-curricular activities has also been identified as a means to shape the social patterns of adolescents (Bearman and Burns, 1998). Provision and participation in extra-curricular community-based, or leisure activities provides opportunities for students to develop friendships, which usually begin in non-academic activities and settings (Booker, 2004; Konu et al., 2002; Korinek et al., 1999; McNeely et al., 2002; Salend, 1999). The implementation of “peer buddy” or peer tutoring programs has also been shown to improve relationships between diverse students and improve the social environment (Korinek et al., 1999; Salend, 1999; Searcy, 1996; Thomas and Smith, 2004). Under the “environmental” aspect of this component of the health promoting school model, teachers, as role models in the school environment, contribute greatly to school connectedness by playing a critical role in developing a caring and accepting school environment and a healthy rapport with students. Teachers who feel good about each other and their work, and who are committed to students and the welfare of students, contribute greatly to the school climate (Ma, 2003; Smith and Sandhu, 2004). Students who experience positive, caring interactions and relationships with teachers, where

they feel supported and respected indicate a greater degree of school connectedness (Baker et al., 2003; Booker, 2004; Ma, 2003; McNeely et al., 2002; Ridge et al., 2003). Professional development for teachers to enhance their skills and competence in developing positive relationships with students has been identified as an important strategy for the development of school connectedness (Thomas and Smith, 2004; Voisin et al., 2005). The other “environmental” aspect of this component of the health promoting school model that contributes to school connectedness is the school physical environment. This refers, for example to the playground layout and structures, building and classroom layout and appearance including classroom lighting, space and use of colour (Hebert, 1998; NHMRC, 1996; St Leger, 1999; World Health Organization, 1996). The school and classroom physical environment can also promote and support social interactions among school community members that are central to the development of school connectedness. A pleasant, clean and welcoming physical environment with passive recreation areas and spaces for social interaction has been found to support opportunities for the development of school connectedness (Konu et al., 2002; Smith and Sandhu, 2004). Monitoring and supervision of known problem areas by school staff also helps to reduce opportunities for behavioural problems (Smith and Sandhu, 2004). At the classroom level, open-space areas have enabled the use of small group, large group and entire-team instruction strategies (Limato, 1998). Classroom learning centres have been shown to promote interaction (Salend, 1999; Searcy, 1996) as well as variation of classroom seating plans so that students sit near a variety of, or in a group of classmates (Salend, 1999). Partnerships and services The partnerships and services aspect of the framework has been argued to be the most essential component of the health promoting school approach (Goltz et al., 1997; Lister-Sharp et al., 1999; World Health Organization, 1996) with significant potential to promote school connectedness through the multiple groups in the whole school community. Working collaboratively to identify and address health issues through the health promoting school framework, the wide range of groups in the school community enables the community to draw upon its diverse and unique strengths and ensures that the identified health needs and strategies to address health are relevant to, and owned by, the community. The importance of the home-school-community link in the creation of connectedness in school communities is strongly supported (Coleman and Hoffer, 1987; Driscoll and Kerchner, 1999; Hunt et al., 2000; Markham and Aveyard, 2003; Musial, 1999; Wehlage, 1993). According to Musial (1999, p. 119): In the development of social-capital networks we must move to a new structure that encompasses the household, neighbourhood and school, a structure uniting all three agencies into a comprehensive web made by developing interagency programs within the framework of the school.

Markham and Aveyard (2003) propose that weakening the boundaries between the school and the wider community results in the convergence of the values, beliefs and interests of the school and the wider community. Reducing the boundaries or creating links to outsider communities allows those “alienated or detached” to share in the

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values and beliefs of the school and feel connected to the school community. This theory has been supported in recent literature by findings that the discontinuities between home and school cultures, for example, in language, values and behavioural expectations, contribute to the low achievement of students from diverse cultural backgrounds (Gallimore and Goldenberg, 2001; McCarthey, 1999). Studies by Coleman (1990), Hunt et al. (2000) and Limato (1998) have demonstrated that collaborative school community efforts have created the interdependence necessary for social capital and connectedness to exist. The greater a collaborative effort, the greater the possibility exists to create the relationships of support, and the development of trust and mutual obligations, otherwise known as social capital, which remain the building block of connectedness in the school community. The role of health services and community agencies in the partnerships and services component of the health promoting school framework is to support the process of health promotion in schools. The relationship between health and community agencies and school communities should be characterised by an equal partnership, whereby health services support school-based health activities through provision of resources and expertise (St Leger, 1999; World Health Organization, 1996). The development of links to health and community agencies in the broader school community as a means of addressing health issues has received much attention in the literature (Driscoll and Kerchner, 1999; Sanders, 2001; Taylor and Adelman, 2000). Strong connections between the school environment and health and community agencies not only provide crucial support for school community health activities but also link those most “at-risk” with important sources of support (Patton et al., 2000). Strengthened partnerships between health and community agencies in the broader community and the school environment are important for the development of networks and a sense of “support” for the school community (Sanders, 2001; Taylor and Adelman, 2000). A conceptual framework for promoting school connectedness – building on the health-promoting school model By transposing health promotion processes and structures, from the broader community into the school community setting and combining them with strategies consistent with the components of the health promoting school model currently providing evidence to influence school connectedness, a framework of how this model can increase school connectedness has been developed and shown in Figure 5. The “health promoting school processes” and “health promoting school structures” characterised by inclusiveness, democracy and participation, have the potential to influence school connectedness. These processes and structures are present both in the classroom environment and in the broad school environment. In the classroom environment, processes based on the values of participation, inclusiveness and democratic partnerships include student-centred learning activities that encourage student participation and enhance students’ roles in decision-making in the classroom. These activities include the negotiation of class rules and negotiated curriculum teaching approaches, as well as experiential learning activities and activities that promote partnerships and relationships between students, school staff and the wider community. In this environment, structures based on the values of participation, inclusiveness and democratic partnerships include classroom policies

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Figure 5. Conceptual framework of health promoting school structures and processes that influence school connectedness

that reflect these values and classroom organisation structures, such as the adoption of a student-centred curriculum and activities such as co-operative learning that support inclusion and participation in the classroom. Other classroom-based structures include the classroom physical environment such as grouped desks and the re-organisation of study space to encourage the development of social relationships. In the broad school community environment, health promoting school processes include participatory, inclusive and democratic processes that involve students, school staff, families and the broader community working together to guide the development of school policy and organisation. Included in these broad health promoting school processes are other opportunities for all members of the school community to work or participate in an activity together, for example, in the development of a school mural. Health promoting school structures in the broad school environment similarly include policies that reflect values of participation, inclusiveness and democratic partnerships; school organisation strategies such as time-table restructures and extra-curricular activities; and areas for social interaction in the school physical environment to promote social interactions. Other structures that promote and support these values are school committees that are representative of the diverse groups that make up the school community, such as students, families, school staff and the broader

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community. In this sense, the role of health and community agencies is the role of an “equal partner” in the health promotion activities within the school. This framework, at a broader systems level, further recognises the impact of factors such as economic, social, cultural and political factors in the broader community context, on the development of school connectedness. Conclusion School connectedness has been recognised as a fundamental protective factor relating to child and adolescent health and development, school and academic achievement and involvement in crime. At the same time, the health promoting school model offers a clear process and framework for increasing school connectedness through processes and structures based on values of participation, inclusiveness and democracy, in the classroom and the broader school environment. The conceptual framework presented here draws together two significant bodies of evidence, effective school health promotion and school connectedness, which is a major protective factor for child and adolescent health and development into adulthood. The framework presented remodels this evidence to provide in-depth understanding of the relationship between the health promoting school model and school connectedness. This framework further contributes to broader understanding of these concepts through explicating the mechanisms by which the health promoting school model can build connectedness in the school setting. Understanding these mechanisms provides a strong theoretical foundation to guide further empirical investigation in the school setting, where in-depth qualitative research is necessary to refine the nature of these mechanisms. The detailed mechanisms of this framework also provide practical strategies for health practitioners and educators to use in the everyday school setting to promote school connectedness. The development of this framework supports the argument for the use of the health promoting school model as an effective model to build school connectedness. This will make a significant contribution to the evidence base of effective strategies to promote the health and well-being of children and adolescents and support their development into adulthood. References Allensworth, D. and Kolbe, L. (1987), “The comprehensive school health program: exploring an expanded concept”, Journal of School Health, Vol. 57, pp. 409-12. Babiuk, G. (1999), “Making holistic changes to the school structure”, Education Canada, Vol. 39 No. 1, pp. 20-1. Baker, J.A., Dilly, L.J., Aupperlee, J.L. and Patil, S.A. (2003), “The developmental context of school satisfaction: schools as psychologically healthy environments”, School Psychology Quarterly, Vol. 18 No. 2, pp. 206-21. Barker, J.A., Terry, T., Bridger, R. and Winsor, A. (1997), “Schools as caring communities: a relational approach to school reform”, School Psychology Review, Vol. 26 No. 4, pp. 586-603. Bateman, H. (1998), “Psychological sense of community in the classroom: relationships to students’ social and academic skills and social behaviour”, PhD dissertation, Vanderbilt University, Nashville, TN.

Battistich, V. and Schaps, E. (1996), “Prevention effects of the child development project: early findings from an ongoing multisite demonstration trial”, Journal of Adolescent Research, Vol. 1 No. 1, pp. 12-36. Battistich, V., Schaps, E. and Wilson, N. (2004), “Effects of an elementary school intervention on students’ ‘connectedness’ to school and social adjustment during middle school”, Journal of Primary Prevention, Vol. 24 No. 3, pp. 243-62. Baum, F. (1999), “The role of social capital in health promotion”, Health Promotion Journal of Australia, Vol. 9 No. 3, pp. 171-8. Baum, F. (2002), “‘Opportunity structures’: urban landscape, social capital and health promotion in Australia”, Health Promotion International, Vol. 17 No. 4, pp. 351-61. Bearman, P. and Burns, L. (1998), “Adolescents, health and school: early analyses from the national longitudinal study of adolescent health”, National Association of Secondary School Principals Bulletin, Vol. 82 No. 601, pp. 1-12. Booker, K. (2004), “Exploring school belonging and academic achievement in African American adolescents”, Curriculum and Teaching Dialogue, Vol. 6 No. 2, pp. 131-43. Bourdieu, P. (1986), “The forms of capital”, in Richardson, J. (Ed.), The Handbook of Theory: Research for the Sociology of Education, Greenwood Press, New York, NY. Bronfenbrenner, U. (1979), The Ecology of Human Development: Experiments by Nature and Design, Harvard University Press, Cambridge, MA. Bruun Jensen, B. and Jensen, B. (2006), “Inequality, health and action for health: do children and young people in Denmark have an opinion?”, in Clift, S. and Bruun Jensen, B. (Eds), The Health Promoting School – International Advances in Theory, Evaluation and Practice, Danish University of Education Press, Copenhagen. Carrington, S. (1999), “Inclusion needs a different school culture”, International Journal of Inclusive Education, Vol. 3 No. 3, pp. 257-68. Catalano, R. and Hawkins, J.D. (1996), “The social development model: a theory of antisocial behaviour”, in Hawkins, J.D. (Ed.), Delinquency and Crime: Current Theories, Cambridge University Press, New York, NY. Clift, S. and Bruun Jensen, B. (2006), The Health Promoting School – International Advances in Theory, Evaluation and Practice, Danish University of Education Press, Copenhagen. Coleman, J. (1990), Foundations of Social Theory, Harvard University Press, Cambridge, MA. Coleman, J. and Hoffer, T. (1987), Public and Private Schools: The Impact of Communities, Basic Books, New York, NY. Croninger, R.G. and Lee, V.E. (2001), “Social capital and dropping out of high schools: benefits to at-risk students of teachers’ support and guidance”, Teachers College Record, Vol. 103 No. 4, pp. 548-81. Driscoll, M. and Kerchner, C. (1999), “The implications of social capital for schools, communities and cities: educational administration as if a sense of place mattered”, in Murphy, J. and Seashore, L.K. (Eds), Handbook of Research on Educational Administration, 2nd ed., Jossey-Bass Publishers, San Francisco, CA. Farmer, T., Farmer, E. and Gut, D. (1999), “Implications of social development research for school-based interventions for aggressive youth with EBD”, Journal of Emotional and Behavioural Disorders, Vol. 7 No. 3, pp. 130-9. Gallimore, R. and Goldenberg, C. (2001), “Analysing cultural models and settings to connect minority achievement and school improvement research”, Educational Psychologist, Vol. 36 No. 1, pp. 45-56.

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A resilience framework: perspectives for educators

A resilience framework

Cecily Knight Central Queensland University, Mackay, Australia Abstract Purpose – The purpose of this paper is to present a framework for resilience education that can be used by teachers in schools. The paper seeks to identify a common language for exploring the concept of resilience. Design/methodology/approach – The paper presents an overview of the construct of resilience as it appears in the literature. It provides a rationale for resilience education by examining the changing circumstances that impact on the work of educators. It also provides an overview of current Australian programs that promote resilience. Findings – After an extensive examination of the literature, it is suggested that resilience is discussed in the literature as a state, a condition and a practice. Consequently, a three-dimensional framework has been developed from this to help teachers understand resilience and to provide practical ways in which they can promote the resilience of their learners. Practical implications – This conceptual paper suggests that the three-dimensional framework for resilience has implications for supporting the mental health and wellbeing of children and young people. The paper highlights the important role of the school in enhancing resilience for children and young people. Originality/value – The original work of this paper is the presentation of a three-dimensional framework for resilience: as a state, a condition and a practice. This framework is useful for preservice teacher education programs and for the professional development of practising teachers.

543 Received 5 April 2007 Revised 14 July 2007 Accepted 20 July 2007

Keywords Education, Schools, Teachers, Australia Paper type Research paper

This position paper has three fundamental perspectives. First, it outlines the rationale for resilience education in the school curriculum. Second, it presents an original three-dimensional framework for resilience: as a state, a condition and as a practice. Third, it explores some current Australian programs designed to enhance resilience for children and young people. This paper asserts that knowledge of resilience is important for teachers in view of the changing circumstances that have an impact on their work as educators. The framework for resilience proposes a way forward in supporting children and families by fostering coping skills that empower them and become protective resources as they deal with contemporary issues. Resilience is associated with optimism and suggests we can encounter change and adversity but still find hope. The three-dimensional framework for resilience offers a framework for action. The focus of both this framework and this paper are on being proactive. It is about “what can be done” rather than just “what is needed”. It is proposed that teachers who are equipped with knowledge of “resilience” are better able to cater for children and young people’s emotional and social needs. Recent neuroscience and brain research in the educational sciences is supporting the importance of the relationships between the emotions and learning and suggests

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learners who can manage their emotional state will be better able to manage the stresses associated with learning (Greenberg, 2006). Teachers need to develop what Thomsen (2002, p. 11) calls a “resiliency attitude” so that they see children and young people as competent and focus on their strengths rather than deficits. Teachers themselves also require resilience education to cope with the stresses of teaching. If teachers are to create motivating learning environments they need to be motivated and supported themselves. The construct of resilience There is no universal definition of resilience. I explored accounts of the concept and identified similarities and differences in an attempt to have a common language with which to work. After examining the literature, I consider that resilience is discussed in the literature as: a state; a condition; and as a practice. I believe the advantage of using the three-dimensional construct of resilience I have developed is that it is all encompassing. It can be used as a meta-resilience framework that can be applied in different contexts once understood. There are a number of cognate terms found in resilience literature that are effectively talking about aspects of what I understand to be resilience. The terms include mental health promotion, emotional intelligence, social-emotional competence and emotional literacy. There is considerable overlap and the whole area of work on social and emotional issues has been described as something of a “linguistic minefield” (Weare, 2004, p. 1). The term “mental health” is often confused with mental illness so education professionals prefer to talk about emotional wellbeing instead of mental health and the term “emotional wellbeing” is common in mental health literature (Raphael, 2000). Goleman (1995) describes resilience in terms of “emotional intelligence”. Goleman (2002), considers emotional intelligence an essential life skill with application during school life and into working lives. Emotional intelligence supports effective teamwork, problem solving, risk taking and the ability to cope with change. The term “social-emotional competence” refers to understanding, managing and expressing the social and emotional aspects of one’s life (Elias et al., 1997). It is often used in education literature from the USA and is largely associated with the major US network CASEL (the Collaborative for Academic, Social and Emotional Learning). CASEL (2002) networks academics, educators and professionals engaged in promoting academic, social and emotional learning in schools. Their web site (www.casel.org) details a vast number of projects worldwide. In the UK, Weare (2004) uses the term “emotional literacy” to suggest ways that schools can develop resilience. Weare highlights the central place of the emotions in learning and thinking and the important roles schools can play in enhancing emotional literacy. An emotional literate person is one who has self-understanding, can understand and manage their own emotions and can understand social situations to develop effective relationships. In the most recent educational literature being disseminated to schools in Australia the preferred term is “resilience”. An example of this is the information kits released in 2004 for Australian schools regarding drug education. The kit is titled “Resilience Education and Drug Information” (REDI). REDI is a Commonwealth Government initiative that is promoted as “a resilience approach to drug education”. The REDI resources focus on

building resilient young people in order to prevent and reduce harm from drug use. This is achieved by focusing on building strong relationships with family, friends, school and community so that support networks exist when problems arise. Though the notion of resilience has received renewed interest in education circles, it is not a new construct. During the 1970s, instead of the focus on individual deficit and research which focused on finding effective ways to “fix/find solutions”, the new research focused on strengths and asked questions about what made some children and young people seemingly immune to their negative situations. The concept of resilience emerged from the psychological literature. Questions were asked about why these children and young people appeared to be immune to the negative factors to which others succumbed. Garmezy (1971), Werner and Smith (1989, 1992), Garmezy and Rutter (1983), Masten et al. (1990, 1995) all made significant contributions to this research. A consistent finding was that, in most cases, children and young people developed coping mechanisms and achieved successful life outcomes. This research refuted the proposition that risk factors were predictors of negative life outcomes. Empirical research on resilience has burgeoned in recent years (Benard, 1995; Doll and Lyon, 1998; Grotberg, 2001; Howard and Johnson, 2000; Luthar, 2000; Masten and Coatsworth, 1998). Most recently, a study of 11-15 year olds who had survived the tsunami in Aceh, Indonesia, shows that internal and external protective factors appear to have mitigated the risk factors for some children (Ratrin Hestyanti, 2006). In relation to the three-dimensional construct of resilience, two key points have been acknowledged from this research: that protective factors have more importance than risk factors; and that resilience is not a quality that some possess and others do not. If it is possible to enhance the protective factors as the research suggests, then it is proposed there is a role for classroom teachers in enhancing resilience for all children and young people in schools independent of risk. In this paper, resilience is construed within this universal perspective and is concerned with promoting the positive development of all children and young people. Perspective 1: Rationale for resilience education in the school curriculum Changing circumstances that impact on the work of educators Not all children and young people grow through childhood and adolescence without difficulty. A number of research reports indicate that many children and young people require extra support (Australian Institute of Health and Welfare, 2002; Fuller, 2001; Raphael, 2000; Sawyer, 2004). Depression has become a recognised illness prevalent among our young people (Sawyer, 2004). Seligman (1995) described it as the common cold of mental illness. This illness has an adverse effect on young people’s school life, relationships with family and peers as well as their personal wellbeing (Sawyer et al., 2000). Depression has been associated with more frequent health-risk behaviours such as substance abuse and suicide. As families become more diverse, children and young people as family members face many dilemmas relating to their change situation. Educators are challenged to investigate the effects on children and young people. These effects can be quite devastating if they are not given the necessary support (Raveis et al., 1999). Research has documented the effects on children and young people as a result of change (Howe, 1999; Osterweis et al., 1984; Siegel et al., 1996). Some of the changes that children and

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young people can face include: the death of a parent, grandparent or significant other; divorce of parents; children and young people/parents living with life-threatening illnesses or drug abuse; the relocation of families; loss of employment for a parent or significant other. Current social practices challenge traditional concepts of “family”. It is not surprising that revisions of discourse about family are emerging in Western industrialised nations. A plethora of family alternatives is emerging, each with its own benefits and difficulties. Evidence is accumulating that instability of family structure puts children and young people at risk of poor outcomes. Consistent outcomes have been found in studies undertaken in New Zealand, the USA and the UK (Cockett and Tripp, 1994; Fergusson et al., 1994; Kurdek et al., 1995; Najman et al., 1997). As well as family forms, traditional gender identities are also changing. Women are commonly in the paid workforce which impacts of the domestic division of labour. Immediate family changes have a direct impact on the lives of children and young people. Changes in family structures have meant changes in the parenting of children and young people today. Michael Carr-Gregg, an Australian psychologist specialising in adolescent mental health, suggests there is a current crisis in parenting that is adversely impacting upon the normal psychological growth and development of young people. He suggests there is a distinct theme emerging that the burden of setting boundaries for young people usually set by parents is increasingly falling to schools. He sites some of the evidence that there are difficulties with young people as: increased teenage alcohol consumption; increase in sexual diseases and abortion among young people; increase in suicide rates; obesity; bullying; increased medication used for depressive illness. He suggests that affluence is no protective factor. He claims parents are time-poor and often not available to their children and young people. This means they engage in quick-fix solutions ranging from providing fast food on demand to expecting teachers to sort out bullying problems (Carr-Gregg, 2004). Perspective 2: The three-dimensional framework for resilience Having reviewed some of the evidence that there is a place for resilience education, the next issue is to explore ways this can be integrated into school curricula, considering teachers already struggle with a crowded curriculum. I suggest the three-dimensional framework simplifies the process for teachers by providing answers to some basic questions: “what is resilience and what does a resilient student look like?” (resilience as a state); “what can I do about it as a teacher?” (resilience as a condition); and “how will I go about it?” (resilience as a practice). This paper will outline each of these dimensions and the research evidence for each. The three-dimensional framework for resilience: resilience as a state Resilience as a state indicates a set of personal characteristics associated with healthy development. Based on my knowledge of the research I have outlined key concepts that underpin resilience as a state. In a sense, this is what resilience “looks like”. I have labelled these “Manifestations of Resilience”. Drawing on the work of Benard (1991) and Wolin and Wolin (1993), I propose the following categories of manifestations of resilience:

. .

. .

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emotional competence; social competence; and futures oriented.

In Table I the attributes that encompass each group are identified. Emotional competence Research has identified a number of qualities required to develop emotional competence including: having a positive self-concept and an internal locus of control, being autonomous and possessing a sense of humour. Being autonomous means having a well-developed sense of identity. The results of the longitudinal study by Masten et al. (1995) showed that children and young people who succeeded in spite of adversity had more internal resources. They were good problem solvers and had high self-esteem. Those who were less resilient lacked these internal resources. The results also showed that these children and young people had more external resources in addition to the internal resources. The study reported that success in later life had roots in earlier competence and that the more emotionally competent a person was, the more likely they were to cope with adversity. Young adults who were more emotionally competent were more likely to turn their life around if things did not go so well. For example, a successful strategy reported in the study is adolescents who relocated in order to break ties with deviant peer groups. Pulkkinen’s (2004) ongoing Jyvaskyla Longitudinal Study of Personality and Social Development reports similar findings that having an internal locus of control was a key determinant of resilience. Pulkkinen (2004, p. 127) reports, “If a child learns self-control or emotion regulation at an early age, the likelihood for developing adaptive social functioning in adulthood is higher than if the child’s socioemotional behaviour is dysregulated”.

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Social competence Research supports the notion that being able to form stable relationships is an important component of social competence. The Masten et al. study (1995) indicated that where children and young people had supportive relationships with people in their lives, they were more resilient when faced with adversity. A supportive relationship with an adult is a commonly identified protective factor in the literature on resilience (Benard, 1991; Doll and Lyon, 1998). Parents and teachers are noted as significant resources for enhancing children and young people’s resilience.

Emotional competence

Social competence

Futures-oriented

Positive self-concept Internal locus of control Autonomous Sense of humour

Communication Relationships Empathy Benevolence

Optimism Problem solving Spiritual Sense of purpose Critical thinking Flexible and adaptive Proactive

Table I. Manifestations of resilience

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The research consistently reports the need for relationships that encourage connectedness, belonging and empathy with others. Children and young people who have these connections are less likely to engage in risk taking behaviours (Fuller, 2001; Pulkkinen, 2004). Research shows however, that connectedness to peers, family and school can minimise these risks (Henderson and Milstein, 1996; McGinty, 1999). Fostering this type of curriculum will help build resilient students. Developing a capacity for resilience enhances children and young people’s mental health and wellbeing (Raphael, 2000). In order to build resilient students, it is equally important that the teachers themselves have a highly developed sense of optimism, and understand and exhibit social and emotional competence. Futures-oriented I suggest being futures-oriented means having a clear sense of purpose and feeling that one’s life has meaning; a sense of optimism; being able to engage in problem solving and critical reflection; and having the ability to be flexible and adaptive in new situations. Benard (2004), p. 28) states that resilience research (Werner and Smith, 1989, 1992) consistently demonstrates that having a “deep belief that one’s life has meaning and that one has a place in the universe . . . is probably the most powerful [strength] in propelling young people to healthy outcomes despite adversity”. Studies of resilience (Brissette et al., 2002; Werner and Smith, 1992; Seligman, 1995) have found that a sense of optimism about the future was a protective factor. Brissette et al. (2002) found that there was a definite association between greater optimism and better adjustment to stressful life events for young people of both genders. Seligman’s (1995) studies add to the body of research that demonstrates that optimism and hope are associated with holistic health (Seligman, 2002). Seligman reports that children and young people who are able to problem solve (demonstrate metacognition) are more likely to consider alternatives and be flexible and adaptive to change, as they can see beyond the current situation. As well as having positive dispositional characteristics, resilient children and young people have positive beliefs about self-efficacy. Teaching problem solving and critical thinking skills is an important aspect of resilience education. Teachers are required to empower their students to believe in themselves and in their ability to influence their future. Students need to develop a sense of empowerment in terms of their capacity to be innovative and to cope with uncertainty and change. Teachers are encouraged to teach children and young people a range of problem solving strategies. The three-dimensional framework for resilience: resilience as a condition Resilience as “a condition” is based around the notion of focussing on opportunities to minimise risk factors and enhance protective factors. Building on the protective factors

has the potential to mitigate the risk factors. “Families, schools or communities may provide these protective factors. I believe that manifestations of resilience (resilience as a ‘state’) indicate an individuals’ potential for resilience but agree with Rutter (1993) and Henderson and Milstein (1996) that the level of resilience is determined by both internal/personal and environmental factors” (Knight, 2007, p. 70). It is important to note that these risk factors may stem from life events or personal circumstances. Rutter (1993) and Henderson and Milstein (1996) both emphasise the role of family and social contexts over personal attributes and perceive family and community resilience as more important than individual resilience. Resilience as “a condition” suggests by recognising the risk factors, educators can help protect children and young people from adversity through appropriate intervention that builds their resilience. Research that supports resilience as a condition Garmezy (1971), Werner and Smith (1989, 1992), Garmezy and Rutter (1983) and Masten et al. (1990) all made significant contributions to early research into resilience in the category I term a “condition”. These were very comprehensive studies of children and young people at risk from which informed conclusions could be drawn. These studies indicate that children and young people can do well in spite of high risk factors, if protective factors (such as positive relationships with significant others) are present. The studies also show that resilience is not a discrete quality that children and young people possess or do not possess, but rather an interplay between the individual and the environment. Resilience research has been undertaken with children and young people in various categories of risk with similar results (Martin and Jackson, 2002; Masten et al., 1995; Rodgers and Rose, 2002; Wyle et al., 2004). The consistent results of these studies indicated that no matter what the risk factors, internal and external protective factors could mitigate the risk factors. The studies show the source of protective factors could be the family, school or community. Howard and Johnson (2000) report on an Australian study that looked at how “resilient” and “non-resilient” adolescents dealt with life events. They found that “resilient” and “non-resilient” young people spoke very differently about their lives. “Resilient” students had a greater sense of belonging, a sense of autonomy and had a more positive attitude to their future than “non-resilient” students. Howard and Johnson (2000, p. 11) suggest that the indicators of risk have changed very little over the years but “What is new is the concept of ‘resilience’ and its utility in understanding how ‘risk’ may be minimised or avoided”. They found that “connectedness” to at least one adult was a vital ingredient in developing resilient behaviour. This “connectedness” was equally valuable whether it occurred in family, school or community contexts. Their research highlights the importance of giving all children and young people access to protective factors. Research into the resilience of children and young people in adverse circumstances appears to suggest that we can learn from these children and young people by identifying the characteristics that promote resilience (Rowling et al., 2002). The studies show that resilience-enhancing factors can be encouraged and promoted in children and young people who currently lack them. A resilience approach builds on children and young people’s strengths and finds ways to strengthen their support networks (Benard, 1991, 1997; Fuller et al., 2002; Luthar, 2000; Murray, 2004; Thomsen,

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2002). Programs that promote resilience appear to be effective preventative interventions for students facing adversity (Doll and Lyon, 1998). The three-dimensional framework for resilience: resilience as a practice Resilience as a practice is concerned with what families, schools and communities can do to promote resilience. In particular, it focuses on the role of the school and teachers and includes practical ways for fostering resilience in schools. Resilience as “a practice” broadens the construct of resilience as other researchers and educators generally see it. It is about the practical application of resilience knowledge to achieve better outcomes for all children and young people by placing more focus on protective factors that enhance resilience. Australian researcher, Professor Fiona Stanley (2003, p. 6) recommends that if social issues are having a negative impact on our children, we need to work out new alliances to support families through problems. This can be achieved using such frameworks as the Health Promoting Schools framework. Cefai (2004) joins Stanley and a number of other researchers (Battistich, 2001; Fuller, 2001; Levine, 2003; Martin, 2002) who call for the broadening of the resilience construct as an effective way of promoting the wellbeing of all children. She claims that whole school programs, irrespective of risk, have the potential to benefit all children and young people. According to Cefai (2004, p. 152) “Resilience is a dynamic process related to changes taking place within the individual’s life and it is context and culture specific. It is a process that can be promoted and enhanced, and social systems such as schools, have a significant role to play in resilience enhancement”. In Australia, a number of programs that focus on resilience as a practice have been developed. These programs include MindMatters, Resilience Education and Drug Information, Bounce Back, ResponseAbility, Seasons for Growth and Literature for Life. Research into the effectiveness of each program is on-going but each makes a positive contribution to resilience education in Australian schools. I would like to briefly outline each and suggest that further information can be found on the web sites for each program. MindMatters MindMatters is a mental health promotion program for secondary schools (MindMatters Consortium, 2000). The program provides comprehensive resources that include teaching strategies and teacher professional development designed to promote and protect the mental health of school communities. A national team provides on-going training ad professional development for teachers. Resources were distributed to every secondary school in Australia in 2000. The Hunter Institute of Mental Health was appointed as the external evaluator of the program in 2001 and the report can be found at: www.aare.edu.au/05pap/haz05475. pdf The Australian Council for Educational Research conducted a national survey of Health and Well-being Promotion Policies and Practices in Secondary Schools in 2006 (Ainley et al., 2006). The report found that MindMatters has had a significant impact on school ethos and culture and had a greater effect in schools that used MindMatters as a key resource than in other schools. The report states that MindMatters is a key resource for just under one secondary school in five in Australia. These schools

appeared to have more effective policies and programs that foster resilience. The MindMatters web site is http://cms.curriculum.edu.au/mindmatters/ Resilience education and drug information Resilience Education and Drug Information (REDI), is a set of resources designed to support the implementation of a resilience approach to drug education in Australian schools, as part of promoting the health and wellbeing of students and school communities (Department of Education, Science and Training, 2003). REDI is a national initiative of the Commonwealth Department of Education, Science and Training. Resources were distributed to every school in Australia in 2003. It includes teacher resources and multi-media resources for the classroom that is age-appropriate. The resources include evaluation tools such as student attitudinal surveys, the health promoting schools monitoring tool and the monitoring school performance in drug education rating scale. Examples of these can be found on the web site: www.redi.gov.au Bounce back The Bounce Back! Classroom Resiliency Program is an Australian classroom resource designed to enhance students’ resilience and wellbeing (McGrath and Noble, 2003). The resource is written by Dr Helen McGrath and Dr Toni Noble and comprises a teachers’ handbook and three teachers’ resource books: junior primary; middle primary; upper primary to junior secondary. Each resource book contains detailed curriculum units and activities for the classroom. Including topics such as managing emotions, dealing with bullying, and developing optimism. Bounce Back uses wellbeing as a unifying concept in a practical program that develops social skills and resilience skills that develop coping mechanisms for children facing adversity. Further information can be found at www.bounceback.com.au ResponseAbility This national multimedia resource for teacher education has been developed by the Australia Government Department of Health and Aging in conjunction with the Hunter Institute of Mental Health and tertiary educators. The Response Ability resources for Teacher Education won The Australian Award for Excellence in Educational Publishing (2003) for a tertiary teaching and learning package. The resource is designed to support teacher education faculties and provide preservice teachers with an opportunity to explore adolescent mental health issues in depth, including such topics as promoting positive mental health, identifying and responding to troubled young people, working with parents and the broader community and creating a supportive school environment (Hunter Institute of Mental Health, 2001). Specific issues such as adolescent depression and youth suicide are also being addressed. This resource highlights the role of schools and teachers in mental health promotion. Available at: www.responseability.org Good grief: seasons for growth and literature for life Good Grief is an international organisation established by the MacKillop Foundation in Australia with the intention of developing resources and services for assisting children and young people to manage change, loss and grief. It supports two key programs: Seasons for Growth and Literature for Life (available at: www.goodgrief.org.au).

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Seasons for Growth is a peer support program for children and young people who have experienced change, loss and grief. Students work through a program in small groups led by a facilitator called a Companion. There are three levels of resources in the primary school and two levels for secondary school. It was developed by Dr Anne Graham of Southern Cross University (Graham, 1996). The success of Seasons for Growth confirmed a need for a universal program that dealt with issues of change, loss and grief. Consequently, Literature for Life was commissioned by Good Grief International and developed by Helen Cahill of the Youth Research Centre, University of Melbourne, as a universal program designed to enhance resilience and social competence in primary and secondary school settings. Students develop reading, writing, listening and speaking skills while exploring emotional or behavioral reaction to change, loss and challenge. The Seasons for Growth Program has been successfully evaluated on three separate occasions in 1999, 2004 and 2005. Most recently, Good Grief commissioned the Evaluation of the Seasons for Growth Program in Secondary Schools across Australia (2005) by The University of Melbourne. This evaluation found that the among other benefits, the Seasons for Growth Program assisted participants to connect to their communities by improving communication, teaching them to problem solve, and to seek assistance when faced with problems. It also helped participants reduce their sense of isolation by normalising their experiences. The full evaluation report can be found at: www.goodgrief.org.au/news/05evaluation.pdf Concluding remarks Twenty-first century society requires that schools and teachers play a significant role in enhancing resilience and mental heath promotion for young people. The three-dimensional framework outlined in this paper suggest a way forward for teachers. It is a useful framework for preservice teacher education and requires minimal professional development to empower practising teachers to build on the valuable work they already do. The curriculum resources already exist to support mental health promotion for children and young people. Further research into the use of the framework to implement whole schools approaches is needed to test the efficacy of the framework. It encourages educators to consider resilience as a practice and to accept the challenge of implementing programs designed to enhance resilience for children and young people References Ainley, J., Withers, G., Underwood, C. and Frigo, T. (2006), MindMatters National Survey of Health and Wellbeing Promotion, Policies and Practices in Secondary Schools, Australian Council for Educational Research, Melbourne, available at: http://cms.curriculum.edu.au/ mindmatters/resources/pdf/evaluation/summary_dec06.pdf (accessed April 28, 2007). Australian Institute of Health and Welfare (2002), Australia’s Children: Their Health and Wellbeing 2002: The First Report on Children’s Health by The Australian Institute of Health and Welfare, available at: www.aihw.gov.au/publications/phe/ac02/index.html (accessed March 6, 2004). Battistich, V. (2001), “Effects of elementary school intervention on students’ connectedness to school and social adjustment during middle school”, in Brown, J. (Ed.), Resilience Education: Theoretical, Interactive and Empirical Applications, Symposium Conducted at the Annual Meeting of the American Educational Research Association, Seattle, April.

Benard, B. (1991), Fostering Resilience in Kids: Protective Factors in Family, School and Community, Western Center Drug-Free Schools and Communities, Portland, OR. Benard, B. (1995), Fostering Resilience in Children and Young People, ERIC/EECE Digest, EDO-PS-99. Benard, B. (1997), Turning it All around for All Youth: From Risk to Resilience, Educational Resources Information Centre (ERIC), Digest, ED412309. Benard, B. (2004), Resiliency: What We Have Learned, WestEd, San Francisco, CA. Brissette, I., Scheier, M. and Carver, C. (2002), “The role of optimism and social network development, coping and psychological adjustment during a life transition”, Journal of Personality and Social Psychology, Vol. 82, pp. 102-11. Carr-Gregg, M. (2004), “Rotten kids or clueless adults: Australian parenting on trial – what’s happened to a developmental perspective?”, paper presented at Research Conference 2004: Supporting Student Wellbeing, ACER, Adelaide. CASEL (2002), The Collaborative Centre for the Advancement of Social and Emotional Learning, University of Illinois in Chicago, Chicago, IL, available at: www.cfapress.org/casel/casel. html (accessed June 10, 2005). Cefai, C. (2004), “Pupil resilience in the classroom: a teacher’s framework”, Emotional and Behavioural Difficulties, Vol. 9 No. 3, pp. 149-70. Cockett, M. and Tripp, J. (1994), Exeter Family Study, Exeter University Press, Exeter. Department of Education, Science and Training (2003), REDI for the Classroom: A Resilience Approach to Drug Education, Commonwealth Department of Education, Science and Training, Canberra. Doll, B. and Lyon, M. (1998), “Risk and resilience: implications for the delivery of educational and mental health services in schools”, School Psychology Review, Vol. 27 No. 3, pp. 348-63. Elias, M., Zins, J., Weissberg, R., Frey, K., Greenberg, M., Haynes, N., Kessler, R., Schwabstone, M. and Shriver, T. (1997), Promoting Social and Emotional Learning, ASCD, Alexandria. Fergusson, D., Horwood, L. and Lynskey, M. (1994), “Parental separation, adolescent psychopathology, and problem behaviours”, Journal of the American Academy of Child and Adolescent Psychiatry, Vol. 33 No. 8, pp. 80-93. Fuller, A. (2001), “A blueprint for building social competencies in children and young people and adolescents”, Australian Journal of Middle Schooling, Vol. 1 No. 1, pp. 40-8. Fuller, A., McGraw, K. and Goodyear, M. (2002), “Bungy jumping through life: a framework for the promotion of resilience”, in Rowling, L., Martin, G.L. and Walker, L. (Eds), Mental Health Promotion and Young People, McGraw-Hill, Roseville, CA. Garmezy, N. (1971), “Vulnerability research and the issue of primary prevention”, Journal of Orthopsychiatry, Vol. 41, pp. 101-16. Garmezy, N. and Rutter, M. (1983), Stress, Coping and Development in Children, McGraw-Hill, New York, NY. Goleman, D. (1995), Emotional Intelligence, Bloomsbury, London. Goleman, D. (2002), “Emotional intelligence: five years later”, New Horizons for Learning, available at: www.newhorizons.org (accessed August 10, 2004). Graham, A. (1996), Seasons for Growth Companion’s Manual: Primary Program, Extreme Visions, Sydney. Greenberg, M. (2006), “Promoting resilience in children and youth: preventive interventions and their interface with neuroscience”, Annals of the New York Academy of Sciences, Vol. 1094 No. 1, pp. 139-50. Grotberg, E. (2001), “Resilience programs for children and young people in disaster”, Ambulatory Child Health, Vol. 7, pp. 75-83.

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Henderson, N. and Milstein, M. (1996), Resiliency in Schools. Making it Happen for Students and Educators, Corwin Press, Thousand Oaks, CA. Howard, S. and Johnson, B. (2000), “What makes the difference? Children and young people and teachers talk about resilient outcomes for students at risk”, Educational Studies, Vol. 26 No. 3, pp. 321-7. Howe, J. (1999), Early Childhood, Family and Society in Australia: A Reassessment, Social Science Press, Katoomba. Hunter Institute of Mental Health (2001), Risk and Resiliency: Teachers Guide to Mental Health, on the ResponseAbility CD-ROM Resources, Hunter Institute of Mental Health, Newcastle. Knight, C. (2007), “Building resilient learning managers”, in Smith, R., Lynch, D. and Knight, B.A. (Eds), Learning Management: Transitioning Teachers for National and International Change, Pearson Education Australia, Frenchs Forest, pp. 66-74. Kurdek, L., Fine, M. and Sinclair, R. (1995), “School adjustment in sixth graders: parenting transitions, family climate, and peer norm effects”, Child Development, Vol. 66 No. 2. Levine, D. (2003), Building Classroom Communities, National Educational Service, Bloomington, IN. Luthar, S. (2000), “The construct of resilience: a critical evaluation for future work”, Child Development, Vol. 71 No. 3, pp. 543-62. McGinty, S. (1999), Resilience, Gender and Success at School, Peter Lang, New York, NY. McGrath, H. and Noble, T. (2003), Bounce Back! Teacher’s Handbook: A Classroom Resiliency Program, Pearson, Frenchs Forest. Martin, A. (2002), “Motivation and academic resilience: developing a model for student enhancement”, Australian Journal of Education, Vol. 46 No. 1, pp. 34-49. Martin, P. and Jackson, S. (2002), “Educational success for children and young people in public care: advice from a group of high achievers”, Child and Family Social Work, Vol. 7, pp. 121-30. Masten, A.S. and Coatsworth, J.D. (1998), “The development of competence in favorable and unfavourable environments: lessons from research on successful children and young people”, American Psychologist, Vol. 53, pp. 205-20. Masten, A.S., Best, K.M. and Garmezy, N. (1990), “Resilience and development: contributions from the study of children and young people who overcome adversity”, Development and Psychopathology, Vol. 2, pp. 425-44. Masten, A.S., Coatsworth, D.A., Neemann, J., Gest, S.D., Tellegen, A. and Garmezy, N. (1995), “The structure and coherence of competence from childhood to adolescence”, Child Development, Vol. 66, pp. 1635-59. MindMatters Consortium (2000), Mindmatters: A Whole School Approach Promoting Mental Health and Well-being, Youth Research Centre, Melbourne. Murray, J. (2004), “Making sense of resilience: a useful step on the road to creating and maintaining resilient students and school communities”, Australian Journal of Guidance and Counselling, Vol. 14 No. 1, pp. 1-15. Najman, J., Behrens, B., Andersen, M., O’Callaghan, M. and Williams, G. (1997), “Impact of family type and family quality on child behavior problems: a longitudinal study”, Journal of the American Academy of Child and Adolescent Psychiatry, Vol. 36 No. 10, pp. 1357-65. Osterweis, M., Solomon, F. and Green, M. (1984), Bereavement: Reactions, Consequences and Care, National Academy Press, Washington, DC. Pulkkinen, L. (2004), “A longitudinal study on social development as an impetus for school reform toward an integrated school day”, European Psychologist, Vol. 9 No. 3, pp. 125-41.

Raphael, B. (2000), “Promoting the mental health and wellbeing of children and young people”, discussion paper: Key principles and Directions. National Mental Health Working group, Commonwealth Department of Health and Aged Care, Canberra, available at: www. muhealth.org/,news.MMRTRAUMA.shtml (accessed June 28, 2002). Ratrin Hestyanti, Y. (2006), “Children survivors of the 2004 Tsunami in Aceh, Indonesia: a study of resiliency”, Annals of the New York Academy of Sciences, Vol. 1094 No. 1, pp. 303-7. Raveis, V., Siegel, K. and Karus, D. (1999), “Children’s psychological distress following the death of a parent”, Journal of Youth and Adolescence, Vol. 28 No. 2, pp. 165-80. Rodgers, K. and Rose, H. (2002), “Risk and resiliency factors among adolescents who experience marital transitions”, Journal of Marriage and Family, Vol. 64 No. 4, pp. 1024-38. Rowling, L., Martin, G. and Walker, L. (2002), Mental Health Promotion and Young People: Concepts and Practice, McGraw-Hill, Sydney. Rutter, M. (1993), “Resilience: some conceptual considerations”, Journal of Adolescent Health, Vol. 14, pp. 598-611. Sawyer, M. (2004), “The mental health and wellbeing of young people in Australia”, paper presented at Research Conference 2004: Supporting Student Wellbeing, Australian Council for Educational Research, Adelaide. Sawyer, M., Arney, F., Baghurst, P., Clark, J., Graetz, B., Kosky, R., Nurcombe, B., Patton, G., Prior, M., Raphael, B., Whaites, L. and Zubrick, S. (2000), The Mental Health of Young People in Australia: The Child and Adolescent Component of the National Survey of Mental Health and Wellbeing, AusInfo, Canberra. Seligman, M. (1995), The Optimistic Child, Random House, New York, NY. Seligman, M. (2002), Authentic Happiness: Using the New Positive Psychology to Realise Your Potential for Lasting Fulfilment, The Free Press, New York, NY. Siegel, K., Karus, D. and Raveis, V. (1996), “Adjustment of children facing death of a parent due to cancer”, Child Adolescent Psychiatry, Vol. 35 No. 4, pp. 442-50. Stanley, F. (2003), The Real Brain Drain: Why Putting Children First Is so Important for Australia, Press Club Address, 6 August, available at: www.aracy.org.au/pdf/media/ 20030806_pressClubAddress.pdf (accessed June 16, 2004). Thomsen, K. (2002), Building Resilient Students, Corwin Press, Thousand Oaks, CA. Weare, K. (2004), Developing the Emotionally Literate School, Sage Publications, London. Werner, E. and Smith, R. (1989), Vulnerable but Invincible: A Longitudinal Study of Resilient Children and Youth, McGraw-Hill, New York, NY. Werner, E. and Smith, R. (1992), Overcoming the Odds: High Risk Children from Birth to Adulthood, Adams, Bannister and Cox, New York, NY. Wolin, S. and Wolin, S. (1993), The Resilient Self: How Survivors of Troubled Families Rise above Adversity, Villard, New York, NY. Wyle, C., Thompson, J., Hodgen, E., Ferral, H., Lythe, C. and Fijn, T. (2004), Competent Children at 12, New Zealand Council for Educational Research, Wellington. Corresponding author Cecily Knight can be contacted at: [email protected]

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How effective is the health-promoting school approach in building social capital in primary schools? Jing Sun and Donald Stewart

Received 20 January 2007 Revised 1 June 2007 Accepted 15 July 2007

Griffith University, Meadowbrook, Australia Abstract Purpose – The purpose of this paper is to describe a study which investigated the relationship between the “health-promoting school” (HPS) approach and social capital and tested the proposition that the implementation of an HPS intervention leads to a significant improvement in HPS features and social capital. Design/methodology/approach – In this paper a prospective intervention study design was used and involved the comparison of an intervention population group and a comparison population group matched for school size, urban location, school type and socio-economic status. The paper shows that the intervention group used the holistic HPS approach to promote resilience, whereas the comparison group did not use the HPS approach. In the intervention schools, 262 staff in the pre-intervention phase, and 288 staff in the post-intervention phase responded to the survey. In the control schools, 156 staff in the pre-intervention phase, and 261 in the post-intervention phase responded. The HPS Scale derived from the Ottawa Charter and the Social Capital Scale derived from the Social Capital Index were used at the school community level. Findings – The findings of this paper show that there was a statistically significant relationship between HPS indicators and social capital. The evidence indicates that an HPS approach to build social capital is effective. Practical implications – The results in this paper indicate that social capital embedded in the HPS structure has the capacity to substantially affect relationships that people have with one another and the school psychosocial environment. Originality/value – This paper provides health educators with resource strategies to promote social capital within the HPS program framework. Keywords Social capital, Primary schools, Health education Paper type Research paper

Health Education Vol. 107 No. 6, 2007 pp. 556-574 q Emerald Group Publishing Limited 0965-4283 DOI 10.1108/09654280710827948

Introduction Since the last decade, the role of social capital in school health has been an area of research interest. A selection of studies, have considered the link of social capital to child wellbeing (Woolcock, 2001), child mental and physical health (Caught et al., 2003) and the ability of children to resist social stress (Resnick, 1997). School social capital is a fundamental factor in the positive health outcome in the school environment (Sampson et al., 1999) and academic achievement (Coleman, 1988). It has been found that key social capital components, such as supportive school climates (caring and supportive relationships) and school bonding (trust and sense of school community), The authors gratefully acknowledge funding support for this project from Queensland Health.

when combined, can facilitate a broad range of children’s positive outcomes. Social capital components are considered to function as protective factors in the individual, or in the environment, enhancing an individual’s ability to resist adverse outcomes, such as adolescent pregnancy, delinquency, drug use, academic failure and child maltreatment (Coleman and Hoffer, 1987; Furstenberg and Hughes, 1995; Putnam, 2000; Teachman et al., 1996). The individual’s health outcomes depend on whether he or she resides in a school environment that is rich or poor in social capital (Portes, 1998). Social capital embedded in social structure has been characterised as a resource that resides in the relationships that people have with each other, and that individuals within a social structure can draw upon to achieve certain actions (Kawachi and Berkmann, 2000; Veenstra, 2005). It has been described as “features of social organisation, such as networks, norms, and trust, that facilitate coordination and cooperation for mutual benefit” (Putnam, 1993, p. 35), enabling people to act collectively (Woolcock, 2001). For children, schools are characterised as social organisations that are uniquely suited to the wide range of interventions needed to promote positive health outcome through enhancing social capital (World Bank Group, 2007). The building blocks of social capital in most models include: trust, engagement and connection, collaborative action, shared identity, shared values and aspirations (Onyx and Bullen, 2000). Social capital and health-promoting school The role of the school in promoting health in children is recognised worldwide through the “health promoting school” (HPS) approach (Anderson, 2004; Lynagh et al., 2002; Stewart et al., 2004). This approach was developed over more than a decade ago using the World Health Organization (WHO) Global School Health Initiative (WHO, 1986). Evaluations of the HPS model consistently demonstrate its effectiveness in providing positive outcomes for children’s health (Roeser et al., 2000; Rogers et al., 1998; Schaps and Soloman, 1990; Scriven and Stiddard, 2003; St Leger and Nutbeam, 1999; Stewart et al., 2004). Implicit in HPS approach is the idea that the school community’s health can be fostered and promoted by establishing health promotion actions at an organisational level. As a model, the HPS encompasses change in three broad areas: (1) Formal curriculum in health education with a specific time allocation for topics. (2) Subjects and cross curricular themes that emphasise connectedness and caring relationships between school members, and between home and school. (3) Recognition of the important role that the school has to promote health in the community in which it exists, and development of appropriate links with the wider community to support this role. A key strategy that facilitates collaborative school-community relations, caring relationships between school staff, student-teacher and student-parents, is one that is characterised by the key elements of social capital such as trust, effective communication, and a collective action towards problem solving. However, few studies in published literature have examined the relationship between HPS and social capital, and the involvement of health promotion embedded in HPS model in building social capital at the primary school community settings.

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The hypotheses laid out below will test the proposition that HPS may be a key variable influencing the social capital. By focusing on and improving school organization using HPS approach, schools may begin making a contribution to developing the entire school community’s capacity to build social capital. This study focuses on the relationship between factors associated with the HPS approach and social capital at the primary school level. HPS factors include such features (WHO, 1995) as: . the school is concerned with health promotion relating to the physical environment, social environment, and overall “climate” having regard to the relations between staff and family, and staff and students; . the school health services are accessible to all school members; . the school provides personal skills building; and . the school promotes school and community partnerships. This study aims to investigate the relationship between the HPS and social capital. It explores two general hypotheses: there is a significant association between HPS and social capital; and that the implementation of a HPS intervention leads to a significant improvement in HPS features and social capital. Methods Research design The study used a prospective intervention design involving the comparison of an intervention population group (ten urban primary schools in a region north of Brisbane, Australia) to a control population group (ten urban primary schools in a region south of Brisbane) matched for school size, urban location, type (State or Catholic) and socio-economic status. The intervention group used the holistic HPS approach to promote social capital, and the comparison group did not use the HPS approach designed for the current study. A comparison has been made between intervention and control schools over the two and a half year time period of the project. Participants This paper is concerned with the all school staff (e.g. teaching and non-teaching) in the 20 schools. The data were collected at two levels: school staff sampled at level 1 clustered within schools at level 2. Data collection was carried out in November and December in 2003 in the pre-intervention phase, and October 2006 for the post-intervention phase. Data collection for the staff sample was carried out by two project officers through the distribution of a questionnaire at staff meetings organised by the school principals. Specific written instructions were issued to staff describing the administrative procedures to be followed. Participants were clearly informed about the study and asked to provide their consent to participate. Participation was voluntary and a guarantee of anonymity was given. Ethics approval was obtained in October, 2003, from the University’s Human Research Ethics Committee, Education Queensland Ethics Committee, and Catholic Education Ethics Committee (ethic approval number: QUT Ref No 3058H). The school characteristics are shown in Table I.

Schools Size Small (n) Medium (n) Large (n) Type State (n) Catholic (n) SES High Medium Low

Intervention schools

Control schools

5 3 2

5 3 2

8 2

8 2

3 2 5

3 2 5

Five of the intervention schools and five control schools were small in size. Three intervention schools were of medium size and these were matched with three control schools of medium size, and two large intervention schools were matched with two large control schools. Eight State Schools were matched with eight control State Schools, and two Catholic Schools were matched with two Catholic Schools. Characteristics of school staff are shown in Table II. Staff in the intervention schools, 262 staff (response rate of 49.5 per cent) responded to the survey in the pre-intervention phase, and 288 staff (response rate of 59.5 per cent) responded in the post-intervention phase. In the control schools, 156 staff (response rate of 36.2 per cent) responded in the pre-intervention phase, and 261 responded (response rate of 58.4 per cent) in the post-intervention phase. Most staff were female (86 per cent) and 68 per cent were classroom teachers. Most staff had working experience of three years or more. This proportion was similar to both intervention and control schools at both pre- and post-intervention phase. Chi-square tests showed that there was no significant (p . 0:05) differences between intervention and control schools in the proportion of staff with respect of staff role, gender and years of working experience. Intervention strategies and activities The intervention was implemented in ten intervention schools from August 2004 to August 2006. The intervention schools were required to use a HPS approach (WHO, 1995) to develop intervention activities. Such an approach focuses on the organisational change processes within a school. Strategies that promote a healthy school climate, or environment, were identified as those encouraging personal skill building in students, staff and parents; fostering positive relationships within school and family social networks; and endorsing supportive environments within the school. The intervention activities were developed around the issues identified by each school community: resilience, anti-bullying, healthy physical and social environment building, professional development in staff and parents in HPS principles, communication skills, health behaviours, extra curriculum development in music, drama, sport and peer relationship. The intervention strategies using health promoting school principles in ten intervention schools emphasised the following themes, summarised in Table III.

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Table I. School characteristics

n 15 168 74 257 42 217 259 35 28 78 64 52 257

Main role Principal Teachers Admin Total

Staff gender Male Female Total

Years of work ,1 1-2 3-5 6-10 . 10 Total

Table II. Staff characteristics

Demographic variables

Pre-

13.6 10.9 30.4 24.9 20.2

16.2 83.8

5.8 65.4 28.8

(%)

44 30 69 78 58 279

41 238 279

15 197 67 279

15.8 10.8 24.7 28.0 20.8

14.7 85.3

5.4 70.6 24.0

Intervention schools Postn (%)

27 26 62 45 36 196

26 175 201

10 119 65 194

13.8 13.3 31.6 23.0 18.4

12.9 87.1

5.2 61.3 33.5

Control schools Pren (%)

41 38 60 73 45 257

29 229 258

12 186 59 257

n

Post-

16.0 14.8 23.4 28.4 17.5

11.2 88.8

4.7 72.4 23.0

(%)

147 122 269 260 191 989

138 859 997

52 670 265 987

n

13.8 86.2

5.3 67.9 26.9

(%)

14.9 (12.3) 27.2 26.3 (19.3)

Total

10.03

2.90

8.70

x2

0.59

0.39

0.19

p

HE 107,6

560

Intervention strategies

Actions

Constant communication Principals and project committees communicated regularly, sharing a and shared visions common vision/mission of the school’s health problems and ways in which they could be improved The committee members constantly sought feedback from agencies and organizations, that are partners with the school, on changes that are needed Student needs assessments were conducted to determine suitable health promotion activities Principals and project committees informed school members of project progress at school staff meetings and school assembly Develop staff’s sense of Empower staff: The intervention was implemented through two leadership ownership teams for the project. One leadership team included school staff, the principal, parents and students. Additionally, there was a parent association, comprising community members and parents, which was the supporting body of the school Both teams worked together closely in developing school plans and monitoring the implementation of stated objectives/outcomes for the HPS project to provide staff with collegial interaction and opportunities to talk with parents Teachers were provided with school-based professional development opportunities to develop their expertise in HPS principles Teachers were encouraged to participate in university training program with the aim of providing leadership training to implement school-based HPS activities Providing a structure Resources and structures were provided to support a health promotion that supports a culture of culture. Project funding was provided to each intervention school, a project HPS committee in each intervention school was established, and an action plan was developed to implement the HPS activities Health-promoting school culture was developed through articulation of school policy, refocusing curriculum on health promotion, student skills development in coping, problem solving, seeking help and support from family, school and community and parent workshop in HPS These schools adopted various health promotion curricula such as “You can do it” and “Virtues”, that were aligned with the HPS principles Project team from our university provided quarterly training workshop on HPS principles to school project team University project team provided guidance and monitoring activities to school HPS project on a weekly basis Support for school The university project working team collaborated closely with school partnerships project committee to facilitate the implementation of the HPS program and has provided continuous support on a weekly basis Schools were associated with various organizations (local city council, local departments of Education and Health, museum, community agencies, and youth groups) that provided the school with a range of support services and resources on a periodic or weekly basis depending on school’s circumstances More specifically, these partnerships focused their efforts in building partnerships between school and families and school and communities These partnerships provided schools with resources to promote student peer relationship and healthy physical environment, social interaction opportunities, and professional development for staff and parents

The healthpromoting school 561

Table III. Intervention strategies and actions

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Measures A number of scales were adopted, modified or developed. They included: (1) Health Promoting School (HPS) scale: the structure of the HPS scale was based on factors identified in the Ottawa Charter (WHO, 1986) and items for the Staff Survey were based on a review of the literature in relation to the key features of the HPS that best described these factors (Deschesnes et al., 2003; Loureiro, 2004; Lynagh et al., 2002; Rogers et al., 1998; Scriven and Stiddard, 2003). This scale was initially developed and tested in a study by Lemerle (2005) involving 797 teachers in 39 schools in Queensland, Australia. Reliability of this scale is high, with alpha levels of 0.80 for the whole scale and levels ranging from 0.77 to 0.82 for the six subscales. The total variance explained by this scale is 60 per cent, indicating reasonable level of validity. There are a total of 32 items for the HPS scale. Items of the HPS scale, designed to assess aspects of the school that helped to promote health included: health policy, physical environment, social environment, school-community relations, personal skill building, and health services provision. For example, a question from the HPS scale included: “To what extent is your school actively putting into place the following policies . . .?”, was followed by a series of options such as “ . . . preventing the use of alcohol, tobacco and illicit drugs” and “ . . . accident and injury risk reduction”. A five-point Likert scale format was kept as in the original Lemerle HPS scale, wherein 1 indicated “not at all” and 5 indicated “a great deal”. (2) Social Capital Scale: The most common existing instrument to measure social capital in the general community context consists of the Social Capital Index, which was developed and empirically tested by Onyx and Bullen (2000). This instrument encompasses the following factors, which are related to social capital in the school community: . participation in the local community (participation in formal community structure); . proactivity in a social context (sense of personal and collective efficacy); . feelings of trust and safety (feelings that most people in the community can be trusted); . tolerance of diversity (views of multiculturalism in community); and . work connections (feelings of team at work). There were 36 items in the original scale. A total of 20 items pertinent to social capital in school were selected (see the Appendix). The subscales for the social capital included: feelings of trust and safety, pro-activity in a social context, tolerance of diversity and work connection. Questions selected included items such as: “Do you feel valued by this school?” and “Is this school regarded as a safe place?”. The format of the social capital was changed from the Onyx and Bullen (2000) original four-point Likert scale to a five-point Likert scale in which 1 indicated “never” and 5 indicated “always”. The reliability and validity had been checked for the scale. Reliability of this scale was high, with alpha levels of 0.87 for the whole scale and levels ranging from 0.61 to 0.79 for the four subscales. The total variance explained by the scale is 58 per cent, indicating a reasonable level of validity.

The underlying assumption for both the HPS measure and the social capital measure was that at the school, as a setting in which not only children but also many adults spend a very substantial part of their day, is the best place to promote all school members’ health and well-being. Factors that may contribute to resilience at the school community level are contextual and include factors such as school ethos, social environment and physical environment. Furthermore, opportunities for all school members to access health services and resources, opportunities for personal development and co-curricular participation contributed to HSP environment. The development of an atmosphere of mutual support and trust, with high collective expectations of success in meeting challenges, combined with the capacity to cope with a crisis, were qualities considered to strengthen the school community. Data analysis The association between HPS and social capital was analysed by multilevel analysis controlled for confounding factors at the individual level. Controlled factors included gender, years of working experience, and position of staff, and type and size of school. The intervention effect on HPS and social capital was examined by using the multilevel approach. This analysis considered the interaction of time (time 1 and time 2) and group (intervention and control groups), while the potentially confounding factors at an individual level (e.g. staff role in the school, years of work experience, and gender) and at the school level (e.g. school size and school type) were adjusted in the model. The multilevel models took into account the two-level hierarchical structure of the data for staff (level 1), sampled within schools (level 2). Multilevel modelling was preferred for staff sampled within schools because it was likely that there was some standardisation in workplace environmental factors. Thus, the clustering effect of staff within schools, which may generate improper estimates of standard errors, was adjusted. A two-level hierarchical linear regression model was employed using MlWiN version 2.1: Y ¼ b0 b1j group þ b2j þ vi þ uj where Y is the outcome variable for the ith staff and in the jth school. The b represents parameter to be estimated, v and u denote random effects that are assumed to be independently normally distributed with means equal to 1 and variances s2v and s2u respectively. Results The demographic variables for staff (role in the school and years of working experience) were found to have significant relationships with both HPS and social capital scales. Table IV presents the relationship between staff demographic characteristics and health promoting school and Table V presents the relationship between staff demographic characteristics and social capital for this study. Table IV indicates that teaching staff tended to score lower on HPS characteristics than did principals, administrative staff, and other non-teaching staff. These differences reached statistical significance (Parameter ¼ 0:08, p , 0:05) in terms of the physical environment. Staff with less than one to two years working experience had lower scores on the overall health promoting school, than did staff who had more than two years of working experience. These differences reached statistical significance in

The healthpromoting school 563

0.19 0.11 1.64 0.51 0.11 4.55 * * * 0.18 0.09 1.86 0.08 0.10 0.86 0.32 0.09 3.64 * * * 0.34 0.08 4.38 * * * 0.25 0.08 3.06 * *

School type 2 0.01 0.05 2 0.26 0.08 0.04 2.05 * 2 0.04 0.04 2 1.13 0.01 0.04 0.17 0.05 0.04 1.18 0.05 0.04 1.14 0.03 0.03 0.79

Main role 0.05 0.02 2.65 * * 0.00 0.02 0.13 0.01 0.02 0.47 2 0.04 0.02 2 2.56 * * 0.01 0.02 0.75 0.02 0.02 1.06 0.01 0.01 0.64

Years work 0.02 0.01 2.00 * 0.06 0.02 3.53 * * * 0.04 0.01 3.17 * * * 0.04 0.01 3.08 * * * 0.03 0.01 2.73 * * 0.01 0.01 1.75 0.03 0.01 2.89 * * 9.10

2.95

7.30

8.70

9.70

13.80

6.98

Variance explained School level (%)

0.24 0.02 15.00 * * * 0.38 0.02 20.89 * * * 0.35 0.02 20.76 * * * 0.42 0.02 21.00 * * * 0.38 0.02 21.28 * * * 0.46 0.02 20.95 * * * 0.26 0.01 19.92 * * *

90.00

97.10

92.70

91.30

90.30

86.30

93.08

Variance explained Staff individual level (%)

Notes: Significance level: * p , 0:05, * * p , 0:01, * * * p , 0:001. Intervention effect (time £ group interaction) was controlled in the analysis. Parameter refers to parameter estimate, SE refers to standard error, and t-value refers to the ratio of the parameter estimate to its standard error. t-value greater than 1.96 indicates significant effect

HPS total

Access to health services

Personal skills building

School-community relations

Social environment

Physical environment

20.05 0.05 21.06 20.13 0.05 22.66 * * 20.04 0.04 20.98 20.08 0.04 21.80 20.04 0.04 20.90 0.01 0.03 0.35 20.07 0.04 21.89

Parameter SE t-value Parameter SE t-value Parameter SE t-value Parameter SE t-value Parameter SE t-value Parameter SE t-value Parameter SE t-value

Health policy

Table IV. Staff characteristics and health-promoting school indicators School size

564

Response variables

HE 107,6

Parameter SE t-value Parameter SE t-value Parameter SE t-value Parameter SE t-value Parameter SE t-value 20.16 0.06 22.47 * * 20.06 0.03 22.19 * 20.01 0.06 20.13 20.04 0.04 21.03 20.07 0.03 22.00 *

0.39 0.14 2.73 * * 0.16 0.06 2.76 * 0.19 0.13 1.41 0.23 0.09 2.61 * * 0.22 0.08 2.93 * * 20.01 0.04 20.16 20.03 0.03 20.83 0.04 0.04 0.95 20.03 0.04 20.67 20.03 0.03 20.84

0.02 0.02 1.60 0.04 0.01 2.92 * * 0.02 0.02 1.17 0.07 0.02 4.67 * * * 0.04 0.01 3.25 * * *

0.11 0.03 3.79 * * * 0.01 0.01 2* 0.09 0.03 3.6 * * * 0.03 0.01 2.73 * * 0.02 0.01 3** 10.20

7.30

15.80

4.20

24.10

0.35 0.02 20.41 * * * 0.23 0.01 20.64 * * * 0.48 0.02 21.82 * * * 0.38 0.02 21.11 * * * 0.21 0.01 21.20 * * *

89.80

92.70

84.20

95.80

79.93

Variance explained Variance explained School size School type Main role Year’s work School level (%) Staff individual level (%)

Notes: Significance level: * p , 0:05, * * p , 0:01, * * * p , 0:001. Intervention effect (time £ group interaction) was controlled in the analysis. Parameter refers to parameter estimate, SE refers to standard error, and t-value refers to the ratio of the parameter estimate to its standard error. t-value greater than 1.96 indicates significant effect

Social capital total

Social capital 4: Work connection

Social capital 3: Tolerance of diversity

Social capital 2: Proactivity in a social context

Social capital 1: Feeling of trust and safety

Response variables

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Table V. Staff characteristics and social capital indicators

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the health promoting school factors relating to school-community relations (Parameter¼ 20:04, p , 0:01). Large schools tended to have lower scores on the overall HPS than did medium size and small schools. These differences reached statistical significance in the health promoting school factors relating to physical environment (Parameter ¼ 20:13, p , 0:001). State schools tended to have lower scores on the overall HPS than did Catholic schools. These differences reached statistical significance in the HPS factors of physical environment (Parameter ¼ 0:51, p , 0:001), personal skills building (parameter ¼ 0:32, p , 0:001), and access to health services (Parameter ¼ 0:34, p , 0:001. It is evident (Table V) that there is no significant difference between the teaching and non-teaching staff in social capital indicators. School size, school type, staff working experience, however, had a significant relationship with social capital. For instance, staff with less than one to two years working experience had lower scores on the overall social capital indicators, than did staff who had more than two years of working experience. These differences reached statistical significance in factors relating to “proactivity in a social context” (Parameter ¼ 0:04; p , 0:05) and “work connections” (parameter ¼ 0:07, p , 0:05). Large schools tended to have lower scores on the overall social capital indicators, than did medium size and small schools. These differences reached statistical significance in the social capital factors of trust and safety (Parameter ¼ 2; 0:16; p , 0:01), and proactivity in a social context (Parameter ¼ 20:06, p , 0:01). State schools tended to have lower scores on the overall social capital indicators than did Catholic schools. These differences reached statistical significance in feelings of trust and safety (Parameter ¼ 0:39, p , 0:01), proactivity in a social context (Parameter ¼ 0:16, p , 0:01) and work connection (Parameter ¼ 0:23, p , 0:01). Table VI shows the relationship between the HPS approach and social capital. Significant relationships were found between HPS and staff perceptions of social capital. This indicates that HPS is significantly related to social capital factors of trust among staff, staff proactivity in school life, and staff working relationship. Tables VII and VIII show the intervention effect on the HPS approach and social capital indicators. For the intervention schools, all of the HPS and social capital indicators improved at the post-intervention phase. These improvements reached statistical significance in three out of six HPS indicators, and three out of four social capital indicators. The three HPS indicators are: (1) Social environment (Parameter ¼ 0.23, p , 0.01). (2) Improved school-community relations (Parameter ¼ 0:33, p , 0:001). (3) Increased access to personal skill building activities (Parameter ¼ 0:25, p , 0:001). Statistically significant improvements occurred in social capital indicators of trust and safety (Parameter ¼ 0:39, p , 0:01), social proactivity (Parameter ¼ 0:13, p , 0:01), and work connection (Parameter ¼ 0:20, p , 0:01). These differences reached a statistically significance level regardless of staff individual characteristics (e.g. role, duration of teaching experiences and gender), school characteristics (State versus Catholic Schools) and school size were adjusted in the analyses.

HPS Feelings of trust and safety

Parameter SE t-value Proactivity in a Parameter social context SE t-value Tolerance of Parameter diversity SE t-value Work connection Parameter SE t-value

20.10 0.02 24.25 * * 20.01 0.01 21.00 0.59 0.02 27.09 * * 0.09 0.01 6.70 * *

0.01 0

6.71

0 0

8.57

0.01 37.5 0 0 0

4.17

Variance explained Variance explained at at school level individual staff level (%) (%) 0.14 0.06 2.24 * 0.03 0.01 2.29 * 0.02 0.01 2.14 * 0.07 0.03 2.23 *

93.29

567

91.43 62.50

Table VI. Relationship between the health-promoting school approach and social capital

95.83

Notes: Significance level: * p , 0:05, * * p , 0:01. SE refers to standard error

Intervention effect

Response variables Health policy Physical environment Social environment School-community relations Personal skills building Access to health services HPS total

Parameter SE t-value Parameter SE t-value Parameter SE t-value Parameter SE t-value Parameter SE t-value Parameter SE t-value Parameter SE t-value

0.12 0.07 1.75 0.19 0.10 1.88 0.23 0.85 2.72 * 0.33 0.09 3.67 * * 0.25 0.08 3.18 * * 0.10 0.08 1.35 0.22 0.07 3.06 * *

Variance explained School level effect (%) 0.02 0.01 2.38 * 0.06 0.02 3.53 * * 0.04 0.01 3.25 * * 0.04 0.01 3.14 * * 0.03 0.01 2.82 * 0.03 0.01 2.50 * 0.03 0.01 2.89 *

The healthpromoting school

5.32 13.76 9.95 9.48 7.49 5.14 9.12

Notes: Significance level: * p , 0:01, * * p , 0:001. SE refers to standard errors

Variance explained Individual level effect (%) 0.34 0.02 21.13 * * 0.38 0.02 20.89 * * 0.35 0.02 20.76 * * 0.42 0.02 21.00 * * 0.38 0.02 21.28 * * 0.46 0.02 20.95 * * 0.26 0.01 19.92 * *

94.68 86.24 90.05 90.52 92.51 94.86 90.88

Table VII. Intervention effect on the health-promoting school environment

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Intervention effect

Response variables Feeling of trust and safety

568

Proactivity in a social context Tolerance of diversity Work connection Social capital

Table VIII. Intervention effect on social capital

Parameter SE t-value Parameter SE t-value Parameter SE t-value Parameter SE t-value Parameter SE t-value

0.39 0.13 2.98 * 0.13 0.05 2.35 * 0.19 0.12 1.53 0.02 0.08 2.50 * 0.20 0.07 2.93 *

Variance explained School level effect (%) 0.11 0.03 3.83 * * 0.01 0.01 2.40 * 0.09 0.03 3.54 * * 0.03 0.01 2.91 * 0.03 0.01 3.25 * *

24.24 5.02 16.08 7.77 10.92

Variance explained Individual level effect (%) 0.35 0.02 20.41 * * 0.23 0.01 20.64 * * 0.48 0.02 21.82 * * 0.38 0.02 21.11 * * 0.21 0.01 21.20 * *

75.76 94.98 83.92 92.33 89.08

Notes: Significance level: *p , 0:01, * * p , 0:001. SE refers to standard error

Tables VII and VIII indicated that there were statistically significant differences between schools in all of the HPS and social capital indicators. This suggested that there were statistically significant differences in staff perception of these indicators between schools, in terms of improvements at post-intervention measurement time. These differences were explained by school level variables such as school type and school size. State schools had lower scores than Catholic schools in all HPS and social capital indicators and large schools had lower scores than medium and small schools in HPS and social capital indicators. The differences between schools may also be due to the variety of intervention approaches applied in the schools. Tables VII and VIII also show that there are significant differences between staff in all of the HPS and social capital indicators. These differences are largely explained by individual staff demographic characteristics such as staff roles in the schools, and years of working experience. Generally, staff with less than 1 year of working experience had lower scores than staff who had more years of work experience, and staff who had teaching roles had lower scores than staff who were principals, administrative and support staff.

Discussion This HPS project involved a strong multidisciplinary and collaborative partnership between health and education organisations, a constant communication between staff, parents and students within intervention schools, and participation and engagement of staff, students and parents. Such approaches have the potential to maximise health promotion activities and outcomes at the community level, and have been strongly endorsed by a wide range of peak health bodies (NHMRC Health Advancement Standing Committee, 1996; WHO, 1995).

The purpose of this paper was to examine the relationship between HPS and social capital; and that the implementation of a HPS intervention leads to a significant improvement in HPS features and social capital. We found HPS is significantly related to overall social capital scores, with specific regard to staff’s feelings of trust and safety, tolerance of diversity, and work relationship with other staff members. The relationship between HPS and social capital was found from this study using population based approach indicating that HPS has capacity to substantially affect the relationship that people have with each other with respect to staff’s sense of trust and safety and work connection with other school members. HPS also significantly affected the collective action that staff had as measured by proactivity in school context. According to Colquhoun (2000), this may be due to HPS and social capital, as both involve: Demographic ideals and processes; voluntary participation; notions or visions of the common good; collective involvement or action to achieve this ideal; “prerequisite” skills and knowledge; and potential for use in both environmental and health education within schools as organisations; realistic understandings of social processes and contexts; perhaps a raised ecological awareness; community involvement in decision making (p. 9).

The empirical evidence derived from this study suggests that there is link between HPS action and social capital in the school context. Staff role, staff working experience, school type and school size might be confounders of the intervention effect on intervention schools as the demographic factors were significantly associated with HPS and social capital. The study design for this study takes clustering effect into account for community based research, the intra-class correlation coefficient are significant for the multilevel analysis on intervention effect, suggesting cluster effect, and this was controlled in the analysis on intervention effect on both HPS and social capital. When these factors were adjusted in the data analysis, the implementation of HPS approach led to significant improvement in HPS features in intervention schools in the post-intervention phase. The intervention using the HPS framework at the school level may lead to changes in school organisational structure, school policy, health service provision, curriculum, and school-community relationship as suggested in previous studies (Colquhoun et al., 1997; St Leger and Nutbeam, 2000). The empowerment and democracy in the HPS model applied in this study may also contribute to the staff’s commitment and participation that lead to significant changes in school environment (Scriven and Stiddard, 2003). The involvement of the whole school community indicated that using democratic processes of HPS approach led to significant improvement in social capital with respect to staff’s perception of trust and safety, proactivity in health promotion activities and work connections with other school members. According to Putnam (1993), social capital at the ecological level encompasses groups such as neighbourhood, communities, census tracts and others. For the purpose of this study, social capital links to the school community. The HPS actions at school level may have influenced: . health related behaviours by promoting diffusion of health-related information with increased likelihood that healthy norms of behaviour are adopted; and . the extent that people volunteer, involve themselves in school activities, and are willing to help out the school communities.

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Our evidence indicates that HPS approach in building social capital in primary school is effective. Conclusion The multi-strategy and multidimensional approaches inherent in the HPS model have allowed the targeting of multiple risk and protective factors across multiple contexts in the school community. The programs to address various health needs have allowed all school members to develop commitment to HPS related activities. The HPS model is ideally placed to support ongoing initiatives in a successful and sustainable framework. It is dynamic allowing for new circumstances to be addressed and it is also inclusive in providing opportunities for identifying and celebrating success (St Leger and Nutbeam, 2000). An intervention activity that targets the development of partnerships and social relationships among school members fosters the development of norms, proactivity and collective actions in the school community (Sampson et al., 1999). As suggested by Rowling and Jeffreys (2000), intervention that focused on shared vision and constant communication among school members significantly promoted trusting relationships among staff. Staff play the main role in creating a supportive school ethos and climate. Staff acceptance of the intervention is clearly a critical variable for the success of the intervention and where there were high levels of acceptance and involvement, positive changes took place. This could be seen across the HPS areas with significant improvements observed in the school social environment, school-community relations, and staff personal skill building activities. Although not statistically significant, there were improvements in the areas of school health policy, physical environment and access to health services. Improvements were also seen in the promotion of a caring and supportive environment. Teachers indicated that they considered that the intervention had been of benefit to their school and students and that it had been the means whereby increased school involvement was gained from students, parents and the general community. An HPS approach, that links schools with relevant agencies and groups, embeds protective factors into the curriculum and encourages school members’ participation, is effective in creating social capital within the school environment. There is strong evidence in this study to show that HPS approach is closely linked to the improvement in social capital in a primary school context. This is evidenced by the large extent to which the intervention schools promoted a healthy environment. School environment indicators (such as school social environment, school-community relations and personal skill building), with immediate effects in intervention schools compared with schools that were not using a holistic approach. The improvement was also shown in overall social capital score, and indicators of sense of trust and safety, proactivity in school context, and working relationship between staff. More broadly, there is good evidence to show that social capital is a strong protective factor for a wide variety of health issues (Wilkinson, 1996). Our intervention schools showed a significant improvement in terms of supportive psycho-social indicators. Such indicators include a sense of trust and safety in the school, a desire to take a proactive role as a participant in school development and the development of positive relationships between staff in the working environment. The improvements shown by these indicators demonstrate that the HPS approach used by the schools significantly enhanced social capital in the schools.

There is also good evidence indicating that interventions which augment the social capital available in a person’s environment can help protect against the adverse effects of psychosocial stressors (Phongsavan et al., 2006). The effect of the intervention activities in the current project indicates that schools are the ideal place to promote social capital for school community. Therefore it could be that with further sustained effort in implementing the program within schools, a higher level of behavioural change could result. There are number of limitations that may have mitigated against a greater intervention effect; for instance the time frame of the pre-post evaluation (Mitchell et al., 2000). The time frame employed was considered moderate in terms of influencing school organisational change. Given the positive findings indicating change in school social environment, personal skill building and school-community relations, it may be possible that a later follow-up may reveal a longer-term effect. Despite time constraints for the study period, this work is important as it provides a baseline evaluation of the relationships between HPS and social capital in HPS program in Australian primary schools. In light of the current, and an on-going, debate over which outcomes should be used to evaluate HPS interventions (Carlsson, 2005; Clauss-Ehlers, 2003; Rowling and Jeffreys, 2000), this study provides additional and alternative directions. One of the focus of this study was to examine the extent to which school’s improvement in HPS and social capital in post-intervention phase can be explained by the characteristics of staff in those schools, for example, staff gender, position and working experience, as compared with effects attributable to the schools. This study adds substantial value to the field with the focus on statistical issues using a large scale population based approach that differences between the sampling units (schools) as a substantive area of interest was examined. To distinguish the effects of individual staff characteristics and school itself on HPS and social capital the study design in this study allowed the effects of staff characteristics (staff gender, working experience, position) on HPS and social capital outcome to be separated from that of the school (school type and size). A longitudinal study design was also used to exclude the possibility that school differences are not attributable to characteristics staff have before working the school (prior intervention). It is envisioned that future studies will focus on changes to school context as the main outcome. Given the positive relationship of social capital with HPS, we recommend that social capital is promoted in schools to foster the wellbeing and health of children. References Anderson, A. (2004), “Health promoting schools: a community effort”, Physical and Health Education Journal, Vol. 70 No. 2, pp. 4-9. Carlsson, D. (2005), School Health Services, Health Promotion and Health Outcomes: An Investigation of the Health Promoting Schools Approach as Supported by School Nurses, School of Public Health, Queensland University of Technology, Brisbane. Caught, M.O., O’Campo, P.J. and Muntaner, C. (2003), “When being alone might be better: neighborhood poverty, social capital, and child mental health”, Social Science and Medicine, Vol. 57, pp. 227-37. Clauss-Ehlers, C.C.C. (2003), “Promoting ecologic health resilience for minority youth: enhancing health care access through the school health center”, Psychology in the Schools, Vol. 40 No. 3, pp. 265-78.

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Coleman, J. (1988), “Social capital in the creation of human capital”, in Dasgupta, P. and Serageldin, I. (Eds), Social Capital: A Multifaceted Perspective, World Bank, Washington, DC. Coleman, J.S. and Hoffer, T.B. (1987), Public and Private Schools: The Impact of Communities, Basic Books, New York, NY. Colquhoun, D. (2000), “Action competence, social capital and the health promoting school”, in Jensen, B.B., Schnack, K. and Simovska, V. (Eds), Critical Environmental and Health Education Research Issues and Challenges, Research Centre for Environment and Health Education, The Danish University of Education, Copenhagen. Colquhoun, D., Goltz, K. and Sheehan, M. (1997), The Health Promoting School: Policy, Programmes and Practice in Australia, Harcourt Brace, Sydney. Deschesnes, M., Martin, C. and Hill, A.J. (2003), “Comprehensive approaches to school health promotion: how to achieve broader implementation?”, Health Promotion International, Vol. 18 No. 4, pp. 387-96. Furstenberg, F.F. and Hughes, M.E. (1995), “Social capital and successful development among at-risk youth”, Journal of Marriage and Family, Vol. 57, pp. 580-92. Kawachi, I. and Berkmann, L. (2000), “Social cohesion, social capital and health”, in Berkmann, L. and Kawachi, I. (Eds), Social Epidemiology, Oxford University Press, New York, NY. Lemerle, K. (2005), Evaluating the Impact of the School Environment on Teachers’ Health and Job Commitment: is the Health Promoting School a Healthier Workplace?, School of Public Health, Queensland University of Technology, Brisbane. Loureiro, M.I. (2004), “A study about effectiveness of the health promoting schools network in Portugal”, Promotion and Education, Vol. 11 No. 2, pp. 85-92. Lynagh, M., Perkins, J. and Schofield, M. (2002), “An evidence-based approach to health promoting schools”, The Journal of School Health, Vol. 72 No. 7, pp. 300-2. Mitchell, J., Palmer, S., Booth, M.L. and Davies, G.P. (2000), “A randomised trial of an intervention to develop health promoting schools in Australia: the south western Sydney study”, Australian and New Zealand Journal of Public Health, Vol. 24, pp. 242-6. NHMRC Health Advancement Standing Committee (1996), Effective School Health Promotion, National Health and Medical Research Council, Canberra. Onyx, J. and Bullen, P. (2000), “Measuring social capital in five communities”, The Journal of Applied Behavioral Science, Vol. 36 No. 1, pp. 23-42. Phongsavan, P., Chey, T., Bauman, A., Brooks, R. and Silove, D. (2006), “Social capital, socio-economic status and psychological distress among Australian adults”, Social Science and Medicine, Vol. 63, pp. 2546-61. Portes, A. (1998), “Social capital: its origins and applications in modern sociology”, Annual Review of Sociology, Vol. 24, pp. 1-24. Putnam, R. (1993), Making Democracy Work: Civic Traditions in Modern Italy, Princeton University Press, Princeton, NJ. Putnam, R. (2000), Bowling Alone: The Collapse and Revival of American Community, Simon & Schuster, New York, NY. Resnick, M. (1997), “Protecting adolescents from harm: findings from the national longitudinal study on adolescent health”, Journal of the American Medical Association, Vol. 278 No. 10, pp. 823-32. Roeser, R.W., Eccles, J.S. and Sameroff, A.J. (2000), “School as a context of early adolescents’ academic and social-emotional development: a summary of research findings”, The Elementary School Journal, Vol. 100 No. 5, pp. 443-549.

Rogers, E., Moon, A.M., Mullee, M.A., Speller, V.M. and Roderick, P.J. (1998), “Developing the ‘health-promoting school’: a national survey of healthy school awards”, Public Health, Vol. 112, pp. 37-40. Rowling, L. and Jeffreys, V. (2000), “Challenges in the development and monitoring of health promoting schools”, Health Education, Vol. 100 No. 3, p. 117. St Leger, L. and Nutbeam, D. (1999), “Evidence of effective health promotion in schools”, in Boddy, D. (Ed.), The Evidence of Health Promotion Effectiveness: Shaping Public Health in a New Europe, European Union, Brussels. St Leger, L. and Nutbeam, D. (2000), “A model for mapping linkage between health and education agencies to improve school health”, The Journal of School Health, Vol. 70 No. 2, pp. 45-50. Sampson, R.J., Morenoff, J.D. and Earls, F. (1999), “Beyond social capital: spatial dynamics of collective efficacy for children”, American Sociological Review, Vol. 64 No. 5, pp. 633-60. Schaps, E. and Soloman, D. (1990), “Schools and classrooms as caring communities”, Educational Leadership, Vol. 48 No. 3, pp. 38-43. Scriven, A. and Stiddard, L. (2003), “Empowering schools: translating health promotion principles into practice”, Health Education, Vol. 103 No. 2, pp. 110-18. Stewart, D., Sun, J., Patterson, C., Lemerle, K. and Hardie, M. (2004), “Promoting and building resilience in primary school communities: evidence from a comprehensive ‘health promoting school’ approach”, International Journal of Mental Health Promotion, Vol. 6 No. 3, pp. 26-33. Teachman, J.D., Paasch, K. and Carver, K. (1996), “Social capital and dropping out of school early”, Journal of Marriage and Family, Vol. 58, pp. 773-83. Veenstra, G. (2005), “Location, location, location: contextual and compositional health effects of social capital in British Columbia, Canada”, Social Science and Medicine, Vol. 60 No. 9, pp. 2059-71. WHO (1986), Charter Adopted at an International Conference on Health Promotion – The Move towards a New Public Health, WHO, Ottawa. WHO (1995), School Health Promotion – Series 5: Regional Guidelines: Development of Health Promoting Schools: A Framework For Action, World Health Organization, Manila. Wilkinson, R. (1996), Unhealthy Societies: The Afflictions of Inequality, Routledge, London. Woolcock, M. (2001), “The place of social capital in understanding social and economic outcomes”, ISUMA, Vol. 2 No. 1. World Bank Group (2007), Social Capital: Conceptual Frameworks and Empirical Evidence, available at: www.worldbank.org/poverty/scapital/whatsc.htm (accessed 29 June 2007). Appendix. Social capital scale (1) Do you feel valued by this school? (2) Are you satisfied with your participation in this school? (3) How often do you help with cleaning up communal areas in the school, e.g. playground, tuckshop, corridor? (4) Do you feel safe walking around this school after dark? (5) Do people in this school feel trusted? (6) How often would a stranger needing help be invited into this school and offered assistance?

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(7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) (20)

Is this school regarded as a safe place? Does this school community feel like “home”? How often do people in this school go to visit other schools? Can you find important information in this school? If you disagreed with people in this school about an important issue, would you feel free to speak out? Would you ever seek mediation if you had a dispute with a staff member at this school? Life in this school is richer because of the variety of cultures represented within the school community? Are people of different lifestyles valued in this school? If someone a bit “different” joins your school, would the school community accept them? How often do you take the initiative to do what needs to be done even if no one asks you to do it at this school? How often in the past week, have you helped another staff member in this school? Do you feel part of the local community (neighbourhood) where you work? Do you regard your colleagues at this school also as friends? Do you feel part of a team at work?

Corresponding author Jing Sun can be contacted at: [email protected], or jingsun@ optusnet.com.au

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Development of population-based resilience measures in the primary school setting Jing Sun and Donald Stewart Griffith University, Meadowbrook, Australia

Population-based resilience

575 Received 20 February 2007 Revised 30 June 2007 Accepted 18 July 2007

Abstract Purpose – The purpose of the population-based study in the paper is to report on progress in formulating instruments to measure children’s resilience and associated protective factors in family, primary school and community contexts. Design/methodology/approach – In this paper a total of 2,794 students, 1,558 parents/caregivers, and 465 staff were surveyed in October 2003. A cross-sectional research method was used for the data collection. Three surveys (student survey, parent/caregiver survey, and staff survey) were developed and modified to measure student resilience and associated protective factors. Exploratory factor analysis with Oblimin rotation and confirmatory factor analysis were used to analyse the reliability and validity of the scales of the three surveys. Findings – The surveys in this paper find good construct validity and internal consistency for the social support scale of parent/caregiver survey, which had been modified from previous studies. Confirmatory factor analysis indicated a goodness of fit for the following scales: student resilience scale of the student survey; the school organisation and climate scale and family functioning scale of the parent/caregiver survey; and the health-promoting school scale and social capital scale of the staff survey. Practical implications – The paper specifies aspects of the resilience concept within a holistic or socio-ecological setting. Measures of validity and reliability indicate that these instruments have the sensitivity to elucidate the complexity of both the resilience concept and the intricacy of working within the multi-layered world of the school environment. Originality/value – This paper provides health educators and researchers with reliable and valid resilience measures, which can be used as guidelines in implementing evaluation programmes for the health-promoting school project and the prevention of mental health problems in children. Keywords Surveys, Primary schools, Research methods Paper type Research paper

Introduction The concept of resilience Originally described in the 1950s, research regarding concepts of vulnerability, coping and stress resistance have been carried out in the fields of psychopathology, developmental and abnormal psychology. This research has contributed to development of the construct of resilience. An early attempt to study resilience was published in the early 1980s with Werner and Smith’s (1982) 30 year ethnographic study of high-risk children on the Hawaiin Island of Kauai. Resilience has been used to characterise individuals who overcome difficult and challenging life circumstances and risk factors (Garmezy et al., 1984; Rutter, 1984; Werner, 1992). This perspective has The authors gratefully acknowledge funding support for this project from Queensland Health.

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conceptualised resilience as successful adaptation despite risk. Risk factors have been defined as hazards relating to the individual, or to the individual’s environment, that increase the likelihood of a problem occurring (Rutter, 1987). Resilience has been described as the interaction between risk and protective factors, specifically a process that results from individual reaction to risk factors, or vulnerabilities, that are present in the environment (Luthar, 2003; Luthar and Cicchetti, 2000). Studies on resilience in terms of adaptation despite risk often cite protective factors to explain why only the minority of children living in adverse conditions manifest problem behaviours and symptoms of psychopathology (Rutter, 1987). Protective factors have been referred to as those factors in the individual, or the environment, that enhance an individual’s ability to resist problems and deal with life’s stresses. Thus, protective factors exert their effect only when a risk is present (Rutter, 1987). Protective factors have been considered to either compensate the risk, or buffer the effect of risk on child development. Recently there has been a change in the direction of research focus away from the negative outcomes and damage caused by risk factors. Current research directions tend towards an emphasis on the socio-ecological context in which people experience risk factors and the identification of resources used for coping. These concepts have been captured in relation to resilience in Antonovsky’s salutogenic model (Antonovsky, 1987, 1996) and Bronfenbrenner’s ecological model (1979). Solutogenic perspective on resilience A salutogenic model side-steps the whole notion of risk exposure as a prerequisite for being labelled “resilient” and places the emphasis on factors that contribute to health and wellbeing. The salutogenic model focuses on factors that help identify coping resources of children, which may contribute to resilience and effective adjustment, notwithstanding adversity and risk. The concepts implicit in the salutogenic model have relevance in health promotion and practice. Whilst a salutogenic model emphasizes competence and healthy children functioning in multiple domains (e.g. social, emotional and academic), it emphasises enhancing protective factors in the lives of all children, irrespective of the risk present. Implicit in this approach is the idea that resilience in children can be fostered and promoted by establishing protective factors in the environment (Benard, 2005). Ecological perspective on resilience The emphasis on resilience toward an ecological approach takes into account the influences of social context, both proximal and distal, to children (McLoyd, 1998). This advance is formalized in Bronfenbrenner’s ecological model (1979, 1989). It specifies that wellbeing is affected substantially by the social contexts in which children are embedded and is a function of the quality of relationships among individual, family and institutional systems. The factors reside within the individual include a variety of coping skills; for example self-efficacy. Also to be considered are positive factors external to the individual. External protective factors include parental support, adult mentoring, or organizations that promote positive youth development. The term external emphasizes the social environmental influences on child health and development, helps place resilience in a more ecological context, and moves away from conceptualization of resilience as a static, individual trait.

Although there is not a single consensus regarding the definition of the resilience paradigm, there is a general agreement regarding its construct and components. These include individual characteristics of the child, family structures and the external environment (Werner, 1989). Werner argues that resilient children have the following characteristics: a high level of autonomy, empathy, better problem solving skills and supportive peer relationships. He also found that variables relating to resilience are protective factors embedded in the family, the school and the community (Werner, 1992). Protective factors modify, ameliorate, or alter a person’s response to the negative effects of risk (Smith and Carlson, 1997). Family protective factors are those that shape the family’s ability to endure in the face of adversity and risk. Key characteristics of family protective factors include: warmth, affection, cohesion, commitment and emotional support for one another (McCubbin et al., 1987b) These factors have also been found to be associated with resilience in children (Smith, 1999; Werner, 1995). School experiences that include a safe and supportive environment, positive peer relationships, positive teacher influences, and opportunities for success, have also been found to be positively related to children’s resilience (Rutter, 1987; Werner, 1995). Such variables may have a decisive impact on a child’s ability to cope with stress or challenge and may be crucial in determining the extent to which a stressful situation will escalate into harm or resolve itself into adjustment and resilience. Thus, the presence of protective factors may determine a child’s ability to adjust and cope with adversity in the family, school or community. Researchers have commonly assigned resilience related factors into two broad categories: (1) Those falling within the domains of individual personality attributes or dispositions (Rutter, 1990; Werner, 1992) such as social competence, problem solving, autonomy, and sense of future and purpose. (2) Those relating to environmental influences such as peers, family, school and local community (Rutter, 1987; Werner, 1995). Components of resilience This discussion considers resilience in a broad context and comprised of the individual characteristics; family, school and community. It maintains that resilience is affected substantially by social relationships and is a function of the quality of those relationships. Individuals are interconnected within and across multiple contextual systems that engage in ongoing transactions, thereby mutually influencing each other. This paper attempts to apply both an ecological and a salutogenic approach in developing indicators of resilience at the population level in primary school settings. Within this framework, we aim to identify and test instruments that measure resilience at the individual, family, school and community levels and to develop instruments to reflect the perceptions of all school members. Student-level variables in relation to the personal characteristics examined in this study are drawn from the relevant literature. They include self-esteem, self-efficacy, capacity to solve problems, willingness to cooperate and communicate, sense of purpose in life, autonomy, and perceptions of family, peers, school and community (Rutter, 1990; Werner, 1992). Family-level variables examined, centre on family functioning, family coherence, and how the family as a unit copes with the stresses of life. Family coherence pertains mainly to the elements of coping, problem solving,

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support, communication and understanding (Rutter, 1990; Werner, 1992). Resilient families generally have the resources to access support from the community, friends, and kinship network. School-level variables examined include parents’ perceptions of the school organisational environment, its capacity to provide good structure, clear rules and regulation, and the extent to which a supportive psychosocial environment is present in the school. Numerous studies have indicated that social support has the ability to moderate the effects of family stress (DuBois et al., 1994; Murata, 1994; Spilman, 2006); hence, community level variables in the study examine social support as perceived by parents/caregivers. The family stress and coping literature is replete with emphasis on the importance of social support both as a protective factor and as a recovery factor. Such community, friend and kinship networks can help to give meaning to a situation, help to develop coping strategies, and, more importantly, foster the family’s ability to face challenge and change situations (McCubbin et al., 1987a). A number of school factors have been identified as being able to influence children’s mental health. Specifically noted are the school environment, it’s climate or ethos, the curriculum, the rules and discipline regarding management of student behaviour, expectations of the staff and parents, and opportunity for positive relationships with adult models in the school (Baker et al., 2003). In this paper the school-level variables examined also included staff perceptions of the school’s health promoting nature and social capital. Other researchers have identified similar health promoting school factors including school policy, school physical environment, and school social environment but have also identified personal skill building, access to health service, and school-community relations (Booth and Samdal, 1997; Deschesnes et al., 2003; Loureiro, 2004; Lynagh et al., 2002; Rogers et al., 1998; Scriven and Stiddard, 2003) to be important aspects of the health promoting school environment.

Method Study design and population Data were collected from 2,794 students, 1,558 parents/caregivers, and 465 teaching and non-teaching staff attending 20 primary schools in Brisbane’s northern urban corridor and southern urban corridor, in the state of Queensland, Australia. The schools comprised 16 state schools and four Catholic schools. Data collection for students, parents/caregivers and staff was carried out in November and December in 2003. Data from the student sample were collected in the school classrooms by teachers. Parents/caregivers completed the questionnaire at home and returned the survey to school. Data collection for the primary school staff sample was carried out through distribution of the questionnaire at staff meetings organised by the school principals. Specific written instructions were issued to teachers describing the administrative procedures to be followed. Students, parents/caregivers and school staff were asked to give written informed consent, participation was voluntary and a guarantee of anonymity was given. Ethics approval was obtained from the Queensland University of Technology’s Human Research Ethics Committee, Education Queensland Ethics Committee, and Catholic Education Ethics Committee in October 2003 (ethics approval number: QUT Ref No 3058H).

Selection of instruments After review, a selection of instruments that drew on ecological and health promotion perspectives from previous studies was made. A synthesis of the various scales and subscales considered is presented in Table I. After comparing independent listings by the researchers, Three surveys (Student Survey, Parent/Caregiver Survey, and Staff Survey) were derived from the instruments presented in Table I. The Resilience Scale of the Student Survey, the School Organisation and Climate Scale, the Family Functioning Scale, and the Social Support Scale of the Parent/Caregiver Survey, the Health Promoting School Scale, and the Social Capital Scale of the Staff Survey reflect the perceptions of all members of the school community including staff, parents/caregivers and students. The scales focused on student individual characteristics, protective resources from family, school and community, and health promoting initiatives and characteristics within a school, which may promote these protective resources. The proposed measures were designed to investigate student resilience including student perceptions of their individual characteristics, protective resources from family, peer, school and community; parent/caregiver perceptions of the school environment, family functioning, and social support; and staff perceptions of the school as a health promoting setting and overall school climate (school social capital). The proposed measures were designed to investigate student resilience using the following three surveys: (1) Student Survey: student perceptions of their individual characteristics, protective resources from family, peer, school and community. (2) Parent/Caregiver Survey: parent/caregiver perceptions of the school environment, family functioning, and social support. (3) Staff Survey: staff perceptions of the school as a health promoting setting and overall school climate (school social capital). Student Survey Student Survey comprised one scale only: Resilience Scale. Resilience scale. The Resilience scale was completed by students. There is some variation in the definition of resilience across studies and not all surveys include the same array of protective factor components for each group. The California Healthy Kids Survey (California Department of Education, 2004) for example, identifies adult support and pro-social peer and group as important protective factors for student resilience. Not explicitly specified in this scale, however, is peer support at school. As this factor was considered an important protective factor by us, the Peer Support Scale derived from the Perception of Peer Support Scale (Ladd et al., 1996) was incorporated in the Student Survey as a school protective resource indicator relating to peer support for students. Items for the Student Survey were tested in a pilot study in four primary schools for 189 students in Years 3, 5 and 7 to ensure they satisfied the primary school children’s comprehension and literacy level. High reliability was achieved for the scales (a ¼ 0:92). The items with low levels of item-correlation were deleted from the questionnaire. This resulted in two items being either reworded or deleted. A final pool of 47 items was determined.

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Student survey

Authors

Scales

Subscales

California Healthy Kids Survey (2004)

California Department of Education (2004)

Resilience scale

Communication and cooperation

580 Protective factor scale

Perceptions of peer support scale Parent/Caregiver Survey Indicators of social and family functioning Family hardiness index School Organisation Questionnaire

Social support index Staff survey Measuring social capital in five communities in NSW

Health-promoting school scale

Table I. Selection of resilience measures

Ladd et al. (1996)

Perception of peer support Authors Scales Zubrick et al. (2000) Family coherence

McCubbin et al. (1987a) Hart et al. (2000)

McCubbin et al. (1987a) Authors Onyx and Bullen (2000)

Family hardiness

Self-esteem Self-empathy Effective help-seeking Goals and aspirations Family connection School connection Community connection Autonomy experience Pro-social peers Pro-social group Family connection Peer support Subscales Coping and problem solving Family coherence and support Communication and understanding Hardiness

School organisation School morale and climate Appraisal and recognition Curriculum coordination Effective discipline policy Excessive work demands Goal congruence Participative decision making Professional growth Professional interaction Role clarity Student orientation Supportive leadership School morale Social support index No constructs have been identified Scales Social capital

Health-promoting Deschesnes et al. school audit (2003); Loureiro (2004); Lynagh et al. (2002); Rogers et al. (1998); Scriven and Stiddard (2003)

Subscales Feelings of trust and safety Proactivity in a social context Tolerance and diversity Work connection Feelings of trust and safety Health policies

School physical environment School social environment School-community relations Personal skills building Access to health service

Parent/Caregiver Survey The Parent/Caregiver Survey comprised three scales: the Family Functioning Scale, the School Organisation and Climate Scale, and the Social Support Scale. The family functioning scale. This scale was completed by parents/caregivers and assessed family and community quality of life and resilience. Twelve items selected from Zubrick et al. (2000) “Indicators of Social and Family Functioning” scale as well as 4 items from the “Family Hardiness Index” (McCubbin et al., 1987b) comprised this scale. The Family Functioning questionnaire (Zubrick et al., 2000) provides limited information about the characteristics of hardiness as a stress resistance and adaptation resource in the family. This has been identified as an important protective factor to cope with stress at family level (McCubbin et al., 1987b); we therefore added four items from the Family Hardiness Index, to the Family Functioning Scale. The School Organisation and Climate Scale. This scale was also addressed to parents/caregivers. In its development, items were selected from the School Organisational Health Questionnaire (Hart et al., 2000). This questionnaire had 54 items. The goodness-of-fit statistics using confirmation factor analysis approach showed the questionnaire had satisfactory reliability and validity, with the root-mean-square errors of approximation being 0.08 or less, the root-mean-square residuals being 0.05 or less, and the relative noncentrality indices being 0.98 or better. This questionnaire was originally designed to reflect teacher morale and school climate from a school staff point of view. The items chosen from the School Organisational Health Questionnaire were modified to reflect the perceptions of parents/caregivers. Examples of typical modifications made were: “I am able to approach the school’s manager to discuss concerns and grievances” from the staff perspective; to: “I am able to meet the school staff to discuss concerns and grievances” from the parent/caregiver’s perspective. Moreover, “I have the opportunity to be involved in cooperative work with other members of staff”, became, “I have the opportunity to help teachers with classroom activities”. Items for each scale were examined for clarity and conceptual overlap and this resulted in a number of items being added, reworded or discarded. A final pool of 36 items was determined. The Social Support Scale. The Social Support Scale was addressed to parents/caregivers to assess the degree to which families are integrated into the community, view the community as a source of support, and feel that the local community can provide emotional, self-esteem and networking support. This scale consisted of 17 items from the Social Support Index (McCubbin et al., 1987a) and showed a high level of reliability (p. 839). Staff Survey Staff Survey comprised two scales: Health Promoting School Scale and Social Capital Scale. Health Promoting School Scale. the structure of Health Promoting School Scale was based on indicators identified in a number of studies (Booth and Samdal, 1997; Deschesnes et al., 2003; Loureiro, 2004; Lynagh et al., 2002; Rogers et al., 1998; Scriven and Stiddard, 2003). Items for the Staff Survey were based on a review of the literature to find the key features of a health promoting school that best describe Ottawa Charter factors (WHO, 1986). This scale was initially tested in a study of 797 teachers in 39 schools in Queensland, Australia by Lemerle (2005). It shows a high level of reliability

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with alpha levels of .80 for the whole scale and levels ranging from 0.77 to 0.82 for the six subscales. Social Capital Scale. The Social Capital Scale also addressed to school staff was developed by Onyx and Bullen (2000). This scale measures feelings of trust and safety, proactivity in a social context, tolerance of diversity, and work connection. The reliability of the Social Capital Scale was high with alpha levels of 0.84 for the whole scale. Structural equation model indicates the good model fit with RMSEA index of 0.05, AGFI of 0.90 and NNFI of 0.82. For the purpose of this paper to develop school based Social Capital Scale, one new item relating to tolerance of diversity was added to the subscale. Two new items in relation to work connection were also added. Identification of issues recognized in the literature as related to both school health promotion and social capital were then oriented to the school unit level. Final questionnaires After a pilot study and reviewing all the selected scales and subscale, the final items and constructs (with exception of the Social Support Scale) were determined for each scale. The Student Survey was developed based on the resilience concept that used for this study. The survey consisted of individual characteristics of the child family, school support, and community connection and peer support. The underlying assumption for the Parent/Caregiver Survey was that the family provides a protective environment that fosters the resilience of its individual members, including the children, and promotes the role of the family as a unit to help, cope with and overcome, stress, adversity and risk situations. Resilience in the family unit is fostered by: . cohesiveness, communication and understanding among family members and joint development of strategies to cope with problems; . accessible support such as social and community resources and social networks; and . good relations between the family and school community in which parents perceive their child’s school as a healthy and safe environment. The underlying assumption for the Staff Survey is that the school, as a setting in which not only children but also many adults spend a very substantial part of their day, is the best place to promote all school members’ health and well-being. Factors that may contribute to resilience at the school community level are structural, such as explicit health policies, the physical and social environment, and access to health services and resources, personal skill development opportunities for school members and school-community partnerships. They also include the social climate, opportunities for personal development, and levels of participation of school members, mutual support and trust. Furthermore, high collective expectations of success in meeting challenges, and the capacity to cope with a crisis or significant adversity in a way that strengthens the community are factors that contribute to resilience at the school community level. The final measures were incorporated into three questionnaires: Student Survey, Parents/Caregiver Survey, and Staff Survey. The details of each survey are presented in Table II.

Measures

Scales

Subscales

Student Survey

Resilience Scale

Communication and cooperation Self-esteem Empathy Problem solving Goals and aspirations Family connection School connection Community connection Autonomy experience Pro-social peers Meaningful participation in community activity Peer support Family coherence Family coping School morale Supportive leadership Parental participation in decision making Professional interaction Appraisal and recognition of students Professional growth Goal congruence Curriculum coordination Effective discipline policy School orientation towards students Less school pressure Student behaviour Excessive work demands Others To be confirmed by Exploratory Factor Analysis (see Table III) Feelings of trust and safety Proactivity in a social context Tolerance and diversity Work connection Health policies School physical environment School social environment School-community relations Personal skills building Access to health service

Parent/Caregiver Survey Family Functioning Scale School Organisation and Climate Scale

Social Support Scale Staff Survey

Social Capital Scale

Health Promoting School Scale

Student Survey: In total, 34 of the total 47 items were from California Healthy Kids Survey (2004), while the remaining 13 items were developed from Perceptions of Peer Support Scale by Ladd et al. (1996). The items from the California Healthy Kids Survey were modified to make them more accessible to Australian primary school students, for example, “Outside of my home and school, I do these things: I am part of clubs, sports teams, church/temple, or other group activities”, became “Away from school, I am a member of a club, sports team, church group, or other group.”

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Table II. Final questionnaires

Table III. Exploratory factor analysis for Social Support Scale of Parents/Caregiver Survey

Factor 4: Family affection and commitment

Factor 3: Family-community connection

Factor 2: Emotional, esteem and friendship network support

55. The things I do for members of my family and they do for me make me feel part of this very important group 54. I feel good about myself when I sacrifice and give time and energy to members of my family 64. The members of my family make an effort to show their love and affection for me

69. Members of my family do not seem to understand me, I feel taken for granted 59. Members of my family seldom listen to my problems or concerns, I usually feel criticized. 62. I need to be very careful how much I do for my friends because they take advantage of me 66. This is not a very good community to bring children up in 61. There are times when family members do things that make other members unhappy

68. I have some very close friends outside the family who I know really care for me and love me 67. I feel secure that I am as important to my friends as they are to me 57. I have friends who let me know they value who I am and what I can do 60. My friends in this community are a part of my everyday activities

58. People can depend on one another in this community 56. People here know they can get help from the community if they are in trouble 53. If I had an emergency, even people I do not know in this community would be willing to help 63. Living in this community gives me a secure feeling 65. There is a feeling in this community that people should not get too friendly with one another

Social Support Scale

0.61

0.75

0.77

0.55 0.46

0.66

0.67

0.75

0.45

0.77 0.72

0.84

0.72 0.55

0.76

0.79 0.77

Factor loading

2.12

2.44

2.46

3.29

Eigen value

12.46

14.34

14.49

60.65 19.36

Percent variance

584

Factor 1: Community as a source of support

Items no in questionnaire

0.73

0.67

0.80

0.87 0.84

Alpha coefficient

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The format of the Student Survey was different from both the California Healthy Kids Survey and the Perceptions of Peer Support Scale. The California Healthy Kids Survey asked students to rank each question on a four-point Likert scale from “Not at all true” to “very much true”. The Perceptions of Peer Support Scale asked students to rank each question on three-point Likert scale from “lots of times” to “never”. To make the format consistent throughout the survey and to avoid the ceiling effect of the questions, a five-point Likert scale format was used for the Student Survey. Thus, students were asked to respond to the items using a rating continuum of 1-5 in which 1 indicated “never”, 5 indicated “always”, or “lots of times”, or “all the time”. Students were asked to read each statement and circle the number that best suited what they thought. Examples of items regarding individual characteristics in the Resilience Scale included, “I can do most things if I try” and “There are many things I do well.” Items regarding adult support included examples such as, “Adults at home (or school or community) are interested in my (the student’s) school work, believe that I will be a success.” Items in relation to peer support included the examples, “Are there students at your school who would; choose you on their team at school?” or “. . .your friends tell you you’re good at doing things?” Parent/Caregiver Survey. The Parent/Caregiver Survey consisted of three scales: the School Organisation and Climate Scale, the Family Functioning Scale, and the Social Support Scale. The School Organisation and Climate Scale consisted of 36 items derived from Hart et al. School Organisational Health Questionnaire (2000). The Family Functioning scale consisted of 16 items. The content of the items from the Family and Social Functioning Scale were not changed and kept as original, however, to be consistent with other scales, the format of the Family Hardiness Index was changed from a four-point Likert Scale to a five-point Likert scale in which 1 indicates “strongly disagree” and 5 indicates “strongly agree”. The Social Support Scale consisted of 17 items from the Social Support Index (McCubbin et al., 1987a) to assess the degree to which families were integrated into the community, viewed the community as a source of support and felt that the local community could provide emotional, self-esteem and network support. The content of the items and five-point Likert Scale format for the Social Support Index were not changed and were kept as in the original scale. Parents/caregivers were presented with each of the 65 items and asked to circle the number that best matched their level of agreement with each statement. Staff Survey. This survey comprised a Health Promoting School Scale and Social Capital Scale at school scale. All items of the Health Promoting School Scale were designed to assess school health promoting characteristics, such as health policy, physical environment, social environment, school-community relations, personal skill building, and access to health services. The question, “To what extent is your school actively putting into place the following policies . . .?”, followed by a series of options, such as: “. . . preventing the use of alcohol, tobacco and illicit drugs”, “. . . accident and injury risk reduction” is typical of items in the Health Promoting School Scale. A five-point Likert scale format was kept as in the original Health Promoting School Scale, in which 1 indicated “not at all” and 5 indicated “a great deal”. The Social Capital Scale consisted of 20 items selected from the original 36-item Social Capital Index (Onyx and Bullen, 2000). Subscales selected included, feelings of trust and safety, pro-activity in a social context, tolerance of diversity, and work

Population-based resilience

585

HE 107,6

connection. Questions selected included items such as, “Do you feel valued by this school?” and “Is this school regarded as a safe place?” The format of the Social Capital Scale was changed from Onyx and Bullen’s original social capital measure (a four-point Likert scale) to five-point Likert scale in which 1 indicated “never” and 5 indicated “always”.

586

Analytical approach Exploratory and confirmatory factor analyses (EFA and CFA) were used for analysis of the data. Exploratory factor analysis was used to identify the constructs of the questionnaire. In the current study, the constructs for the Social Support Scale of the Parent/Caregiver Survey were not identified in the previous studies (McCubbin et al., 1987a, p. 389), so exploratory factor analysis was used in the first instance to identify the constructs for the scale. In exploratory factor analysis, eigenvalues greater than 1.0, and Cattell’s Scree test were used to determine the number of subscales extracted. Subsequently, alpha factoring with oblimin rotation was used to determine the items of the subscales. Internal reliability of the subscales derived from the factor analysis was assessed using Cronbach’s alpha coefficient. Confirmatory factor analysis was used to examine whether the constructs of measurement identified by the previous studies fit to the current sample data. It could also be used to examine whether the theories proposed for the scales fitted to the sample in the current study. Structures of the School Organisation and Climate Scale, Family Functioning Scale, and Social Support Scale of the Parent/Caregiver Survey, and Social Capital Scale of the Staff Survey were developed by previous studies. Additionally, the structure of the Health Promoting School Scale of the Staff Survey was theoretically well-articulated in the WHO documents. Thus, a confirmatory factor analysis was conducted to test the fit of these scales to the current sample data using LISREL version 8.71 for the five scales. In structural equation modelling, a variance-covariance matrix of the raw data is analysed using a full-information maximum likelihood estimation procedure. In the CFA framework, the model can be tested, and the LISREL software provides goodness-of-fit indices to assess the adequacy of the models in matching the data. Goodness-of-fit indexes used in the present study included the following: x2 likelihood ratio statistic, root mean square error of approximation (RMSEA), comparative fit index (CFI), normed fit index (NFI), non-normed fit index (NNFI), Standardized Root Mean Square Residual (SMSR), and Goodness of Fit index (GFI). The x2 likelihood ratio statistic is often used to measure fit and for model comparisons. This absolute fit statistic evaluates the discrepancy between the implied covariance matrix and the sample covariance matrix. A p-value more than 0.05 generally indicates a good fit of the model. One limitation of this statistic is its tendency to reject the true model too frequently when variables follow slightly non-normal distributions, and the simultaneous use of other indexes is suggested. Comparative fit indexes (Bentler, 1980) are less susceptible to bias caused by non-normality. The NFI, NNFI, CFI, and GFI as indices of fit, vary between 0 and 1; values greater than 0.95 are indicative of a good fit. RMSEA compares the model optimal parameter values with the population covariance matrix. Values less than 0.05 indicate good fit, and values between 0.05 and 0.08 indicate reasonable fit. RMSR (Joreskog and Sorbom, 2004) were also used, because these are commonly reported in the literature.

Results Participation and sample characteristics The mean age of this student sample was 8.09 years (SD ¼ 0.55) for Year 3 students, 10.05 years (SD ¼ 0.04) for Year 5 students, and 12.02 years (SD ¼ 0.04) for Year 7 students. There were no differences in mean ages of boys and girls, or in the response rates across the school years (Year 3: 32.7 per cent, Year 5: 32.7 per cent, Year 7: 34.5 per cent). Most of the students (86.3 per cent) were born in Australia. Most of the parent/caregiver sample was female (88.5 per cent). Over 43 per cent (43.2 per cent) had education level to year 12, over a third were engaged in full-time home duties, and 29.2 per cent had a family annual income of less than AUD 30 000. Dual-parent families were the most common, comprising 74.1 per cent of the sample. The staff sample was predominantly female (85.2 per cent) and most were teaching staff (63.5 per cent). The distribution of teaching staff across the school years was similar (Year 3: 12.9 per cent, Year 5: 12.7 per cent, Year 7: 15.4 per cent). Most of the staff had worked in the same school for between three to ten years. Exploratory factor analysis results for social support scale of the Parent/Caregiver Survey Table III shows the items, loadings, and alpha coefficients of the subscales for the Social Support Scale. Salient structure loadings (. 0:40) are included. Factor analysis on the Social Support Scale resulted in four factors. Factor 1, “community as a source of support”, reflects that the community has resources that can provide support when people need help or have an emergency; as well, it reflects that people feel secure living in the community. Factor 2, “emotional, esteem and friendship network support”, includes friends in the community who can provide emotional support and support for self-esteem. Factor 3, “family-community connection”, indicates the understanding and mutual support between community members and family members. Factor 4, “family affection and commitment”, represents how family members show affection and help each other. The internal consistency analysis for factors 1 to 4 indicates Cronbach’s alpha coefficients ranging from 0.67 to 0.84. The correlation between subscales indicates modest inter-correlations between subscales (absolute mean, r ¼ 0:45). Evaluation of model fit using confirmatory factor analysis The results of the CFA for five scales including Resilience Scale from student survey, School Organisation and Climate Scale, Family Functioning Scale from the parent/caregiver survey, and Health Promoting School Scale and Social Capital Scale from the staff survey are provided in Table IV. Tables V-IX as indicated in factor loadings and measurement errors confirm the structure of 12 factors for the Resilience Scale from the Student Survey, 14 factors for the School Organisation and Climate Scale, and two factors for the Family Functioning Scale from the Parent/Caregiver Survey, six factors for the Health Promoting School Scale, and four factors for the Social Capital Scale from the Staff Survey. The item reliabilities shown in the figures suggest that each item for each subscale for each scale was adequately defined. The item reliabilities were all significant at the 0.001 level, and 94 per cent were equal to, or greater than .55 (M ¼ 0:63; SD ¼ 0:10). This indicates that, in the vast majority of cases, there was at least 30% shared variance between each item and its underlying factor.

Population-based resilience

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Table IV. Summary of fit indices for confirmatory factor analyses for the five scales 12 14 2 6 4

923 503 76 458 164

Df

2.79 4.28 5.84 2.68 3.89

x2 =df

0.03 0.05 0.06 0.06 0.08

RMSEA

0.99 0.99 0.99 0.98 0.94

CFI

0.99 0.99 0.98 0.96 0.92

NFI

0.99 0.99 0.98 0.98 0.93

NNFI

0.04 0.04 0.05 0.06 0.08

SRMSR

0.89 0.87 0.88 0.86 0.99

GFI

Note: RMSEA ¼ Root Mean Square Error of Approximation. CFI ¼ Comparative Fit Index. NFI ¼ Normed Fit Index; NNFI ¼ Non-Normed Fit Index; SRMSR ¼ Standardized Root Mean Square Residual. GFI ¼ Goodness of Fit Index

Staff Survey

Resilience Scale School Organisation and Climate Scale Family Functioning Scale Health Promoting School Scale Social Capital Scale

Number of factors

588

Student Survey Parent/Caregiver Survey

Scale

HE 107,6

Subscales

Items no in questionnaire

Family connection

At home, there is an adult who: Is interested in my school work Believes that I will be a success Wants me to do my best Listens to me when I have something to say At school, there is an adult who: Really cares about me Tells me when I do a good job Listens to me when I have something to say Believes that I will be a success Away from school, there is an adult who: Really cares about me Tells me when I do a good job Believes that I will be a success I trust Home and school, I do things at home that make a difference (i.e. make things better)

School connection

Community connection

Participation in home and school life

Peer relationship Participation in community life Peer support

Communication Self-esteem

I help my family make decisions At school, I help decide things like class activities or rules I do things at my school that make a difference (i.e. make things better) My friends: Try and do what is right Do well in school Away from school I am a member of a club, sports team, church group, or other group I take lessons in music, art, sports, or have a hobby Are there students at your school who would: Choose you on their team at school Tell you you’re good at doing things Explain the rules of a game if you didn’t understand them Invite you to play at their home Share things like stickers, toys and games with you Help you if you hurt yourself in the playground Miss you if you weren’t at school Make you feel better if something is bothering you Pick you for a partner Help you if other students are being mean to you Tell you you’re their friend Ask you to play when you are all alone Tell you secrets? About me. I help other people I enjoy working with other students I stand up for myself I can work out my problems I can do most things if I try There are many things that I do well

Factor loading

Measurement error

0.66

0.57

0.75 0.60 0.70 0.76

0.44 0.64 0.51 0.43

0.75 0.73 0.79 0.78

0.44 0.47 0.38 0.40

0.81 0.83 0.71 0.67

0.34 0.30 0.49 0.55

0.62 0.65

0.61 0.58

0.73

0.46

0.77 0.71 0.67

0.41 0.50 0.54

0.83 0.66

0.31 0.56

0.73 0.67

0.47 0.56

0.71 0.75 0.78 0.74 0.78 0.78 0.79 0.81 0.80 0.66 0.71 0.63 0.40 0.63 0.77 0.74

0.50 0.43 0.39 0.46 0.39 0.40 0.38 0.35 0.36 0.56 0.49 0.60 0.84 0.60 0.41 0.45 (continued)

Population-based resilience

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Table V. Factor loading for confirmatory factor model of Resilience Scale of Student Survey

HE 107,6

Subscales

Items no in questionnaire

Empathy

I feel bad when someone gets their feelings hurt I try to understand what other people feel When I need help, I find someone to talk to I know where to go for help when I have a problem I try to work out problems by talking about them I have goals and plans for the future I think I will be successful when I grow up

Problem solving

590 Table V.

Goals and aspiration

Factor loading

Measurement error

0.66 0.82 0.77 0.69 0.79 0.63 0.74

0.56 0.33 0.41 0.52 0.38 0.60 0.45

Table IV depicts all five scales as having RMSEA values less than 0.08, and CFI values of more than 0.94. As can be seen by the chi-squares and the different fit statistics (RMSEA, CFI, NFI, NNFI, RMSR), the hypothesised 12 factors for the Student Survey, 14 factors for the School Organisation and Climate Scale, two factors for the Family Functioning Scale, six factors for the Health Promoting School scale, and four factors for the Social Capital Scale, fit the model. The findings from the CFA confirm that the structure of the Resilience Scale of the Student Survey, the School Organisation and Climate Scale, the Family Functioning Scale of the Parent/Caregiver Survey, the Health Promoting School Scale and Social Capital Scale of the Staff Survey is optimal for the sample of students, parents/caregivers, and staff in the current study. Discussion The findings of both the exploratory and confirmatory factor analyses reported above, indicate that the measures represented in the Student Survey, the Parent/Caregiver Survey, and the Staff Survey are valid instruments for measuring resilience and associated protective factors. Such a approach reflects not only the perceptions of the student sample, but also those of the broader school community, including parents/caregivers and school staff. Exploratory factor analysis: structure of the Social Support Scale of the Parent/Caregiver Survey EFA revealed a four-factor structure in the Social Support Scale of the Parent/Caregiver Survey. The internal reliability analysis shows a high level of internal consistency of the items for the whole scale (0.87) and the four subscales (0.84, 0.80, 0.67, and 0.73 respectively from factor 1 to 4), indicating each of the subscales represents the concept, or construct, of social support for families. Confirmatory factor analysis: evaluation of model fit for five scales In terms of the Resilience Scale of the Student Survey, the CFA shows a good model fit for the 12-subscale construct. This confirms that the construct identified in previous studies (Waring and Hazell, 2002) fits in the student sample in the current study. This also confirms the hypothesis for the California Healthy Kids Questionnaire (California Department of Education, 2004) that resilience consists not only of individual characteristics, such as communication, cooperation, self-esteem, empathy, problem solving, and goals and aspirations; but also includes protective factors embedded in the

Subscales

Items in questionnaire

School morale

There is a good team spirit in this school There is a lot of energy in this school Staff go about their work with enthusiasm The staff and students take pride in this school I am able to meet the school’s staff to discuss concerns and grievances The school staff really understand the problems faced by parents and families There is good communication between staff and parents in this school There are opportunities provided for me to give my views and opinions about the school I am happy with the opportunities for input into decision making at this school I have the opportunity to help teachers with classroom activities Teachers frequently discuss and share teaching activities with parents Children are encouraged in their work by praise, thanks or other recognition I am happy with the quality of feedback I receive on my child’s performance Staff in the school take an active interest in the children’s development and personal growth The planning for children’s personal development in this school takes account of their individual needs and interests There are opportunities in this school for children to develop new skills The goals of this school are easily understood The school has written objectives and goals available to everyone The curriculum in this school is well planned There are structures and processes in this school which enable parents to be involved in curriculum planning There is an agreed approach to discipline in this school My own expectations about discipline are the same as the staff in this school The rules and regulations about discipline in this school are well understood by staff, parents and students The rules and regulations relating to discipline are enforced evenly and consistently in this school Students in this school are encouraged to be successful The school promotes the idea of students being individuals

Supportive leadership

Parental participation in decision making Professional development Student appraisal and recognition Professional growth

Goal congruence Curriculum coordination Effective discipline policy

School orientation towards students

Factor loading

Measurement error

0.79 0.80 0.81 0.88 0.63

0.38 0.35 0.35 0.22 0.61

0.77

0.41

0.84

0.29

0.82

0.33

0.89

0.21

0.39

0.85

0.78

0.40

0.71

0.49

0.78

0.38

0.82

0.33

0.80

0.36

0.78

0.40

0.81 0.72

0.34 0.48

0.80 0.61

0.37 0.62

0.81

0.34

0.84

0.29

0.83

0.32

0.84

0.29

0.79

0.37

0.80

0.37 (continued)

Population-based resilience

591

Table VI. Factor loading and measurement error for confirmatory factor analysis of School Organisation and Climate Scale: Parent Survey

HE 107,6

592

Subscales

Less school pressure Student behaviour Excessive work demand Others

Table VI.

Table VII. Factor loading and measurement error for confirmatory factor analysis of Family Functioning Scale: Parent Survey

Items in questionnaire Students are treated as responsible people in this school There is a lot of tension in this school Staff in this school seem to be under a lot of stress Students who do not want to learn are a problem in this school Students are generally well behaved in this school Children do not have enough time to relax in this school Too much is expected of children in this school Schools support one another when dealing with student misbehaviour There is enough support in this school to deal with students with behavioural problems Students at this school have adequate access to support services and counselling

Subscales

Items in questionnaire

Family coherence

Planning family activities is difficult because we misunderstand one another In times of crisis we can turn to one another for support We cannot talk to one another about sadness we feel Individuals (in the family) are accepted, for what they are We express feelings to one another There are lots of bad feelings in our family We feel accepted for what we are We are able to make decisions about how to solve problems We don’t get on well together We confide in each other It is not wise to plan ahead and hope because things do not turn out anyway Our work and efforts are not appreciated no matter how hard we try and work We do not feel we can survive if another problem hits us Life seems dull and meaningless

Family coping

Factor loading

Measurement error

0.82

0.33

0.53 0.83 0.45

0.72 0.30 0.80

0.82 0.61

0.33 0.62

0.67 0.74

0.55 0.45

0.76

0.43

0.71

0.50

Factor loading

Measurement error

0.60

0.64

0.69

0.52

0.65 0.68

0.57 0.54

0.69 0.73 0.76 0.68

0.53 0.47 0.42 0.54

0.78 0.72 0.68

0.43 0.48 0.54

0.76

0.43

0.84

0.30

0.84

0.30

environment, including adult support at school, adult support at home, adult support in the community, autonomy experience, prosocial peers, and meaningful participation in community activities, and peer support. In the Health Promoting School Scale of the Staff Survey, the CFA indicates a good model fit for the six-subscale construct. This confirms that the construct articulated by

Subscales

Items in questionnaire

Health policy

Promotion of healthy food and eating habits Preventing the use of alcohol, tobacco and illicit drugs Sun protection Management of student medications First aid, emergency or critical incident response management (including regular rehearsals) Control and safe management of HIV/AIDS, Hep C and other blood-borne diseases Accident and injury risk reduction Behaviour management (including truancy and bullying) Promotion of road safety in school grounds and immediate surroundings, e.g. by supporting police in local traffic speed-reducing measures Minimisation of injury hazards to students and staff in playground, classrooms and offices, e.g. ergonomic seating, safe play equipment, training for use of sports resources Recycling and waste reduction practices Caring for and improving the school facilities and grounds, e.g. painting murals, planting and caring for gardens Provision of adequate ventilation, lighting, heating/cooling, and noise reduction strategies Discipline practices that promote moral and ethical consciousness Programs and activities to develop and support positive interpersonal communication skills Student involvement in school decision making Support, resources or programs for students with special needs (e.g. economic disadvantage, behavioural problems, or special talents) Recognition of cultural, religious and ethnic diversity (e.g. availability of appropriate food, exhibitions, cultural festivals) Provision of programs for parents and caregivers (e.g. literacy, parenting skills, drug education) Involvement of local community organisations, including health and non-health services, in delivery of programs or services to the school Development of curriculum activities that encourage children’s active involvement in the local community Participation by students’ parents, caregivers or extended families in all school activities (e.g. policy development, program planning, school cultural activities) Raising local community awareness about school-based health promotion initiatives (e.g. through the local media, school open days, newsletters)

Physical environment

Social environment

School-community relations

Factor loading

Measurement error

0.55 0.66

0.70 0.56

0.69 0.62 0.68

0.53 0.61 0.54

0.67

0.56

0.81 0.67

0.34 0.55

0.78

0.39

0.80

0.37

0.60 0.62

0.64 0.61

0.65

0.58

0.73

0.46

0.79

0.38

0.67 0.65

0.55 0.57

0.74

0.45

0.62

0.62

0.80

0.35

0.85

0.27

0.75

0.44

0.74

0.45

(continued)

Population-based resilience

593

Table VIII. Factor loading and measurement errors for Health Promoting School Scale: Staff Survey

HE 107,6

Subscales

Items in questionnaire

Skill building

Development of a comprehensive school-based health curriculum Integration of relevant health curriculum across key learning areas Provision of sufficient time each week for health enhancing activities (e.g. physical activity, social skills) Teachers have access to adequate professional development specifically relevant to their roles in health education and promotion (e.g. in-service courses) Provision of information, resources and services to support the personal health, welfare and lifestyle needs of staff (e.g. access to quit smoking programs; staff sporting competitions) Regular access by students to school-based preventive health services (e.g. immunisation programs, health screenings, and oral health care) Access to counselling and support services for children with acute social, emotional or behavioural problems Access to counselling and support services for children with chronic medical conditions (e.g. asthma, diabetes, and epilepsy) Access to basic health promotion and counselling services for staff (e.g. employee assistance programs, health benefit schemes)

594

Access to health service

Table VIII.

Factor loading

Measurement error

0.87

0.25

0.86

0.26

0.69

0.53

0.65

0.58

0.56

0.68

0.67

0.55

0.83

0.32

0.81

0.34

0.78

0.39

WHO (1986) fits the staff sample in the current study. The six subscales which are derived from health policy, physical environment, social environment, school community relations, personal skill building, and access to health services are consistent with the five areas of the Ottawa Charter proposed by WHO (1986). Healthy school policies, a supportive school environment, school community action, development of personal skills, and reorienting services were all emphasized. Such healthy school policies as sun protection, student medication management, and injury prevention are reflected in subscale 1. A supportive school environment in terms of strategies which focus on the improvement of a school’s social and physical environment is reflected in subscales 2 and 3. School community action in terms of enabling equitable participation and empowerment of all sectors of the school community in decision making and implementation of health programs, is reflected in subscale 4. Development of personal skills including strategies for the improvement of knowledge and attitudes; skills which promote healthy lifestyles, interpersonal skills, and opportunities for staff to attend training and/or courses on health issues, are reflected in subscale 5. Finally, the reorientation of health services which includes strategies to provide health promotion and counselling services for staff and students is reflected in subscale 6.

Subscales Trust and safety

Items in questionnaire

Do you feel safe walking around this school after dark? Do people in this school feel trusted? How often would a stranger needing help be invited into this school and offered assistance? Is this school regarded as a safe place? Does this school community feel like “home”? Proactivity How often do you help with cleaning up communal areas in the school, e.g. playground, tuckshop, corridor? How often do people in this school go to visit other schools? Can you find important information in this school? If you disagreed with people in this school about an important issue, would you feel free to speak out? Would you ever seek mediation if you had a dispute with a staff member at this school? How often do you take the initiative to do what needs to be done even if no one asks you to do it at this school? How often in the past week have you helped another staff member in this school? Tolerance of diversity Is life in this school richer because of the variety of cultures represented within the school community? Are people of different lifestyles valued in this school? If someone a bit “different” joins your school, would the school community accept them? Work connection Do you feel valued by this school? Are you satisfied with your participation in this school? Do you feel part of the local community (neighbourhood) where you work? Do you regard your colleagues at this school also as friends? Do you feel part of a team at work?

Factor Measurement loading error 0.45

0.80

0.75 0.32

0.43 0.89

0.73 0.83 0.27

0.47 0.31 0.93

0.44

0.80

0.68 0.69

0.54 0.52

0.34

0.89

0.37

0.87

0.37

0.86

0.62

0.62

0.89

0.21

0.71

0.49

0.63 0.57

0.60 0.67

0.77

0.41

0.68

0.54

0.84

0.30

Theoretical structure The theoretical structure of the scales derived from the EFA and CFA for resilience measure development, fit well with a socio-ecological approach. Not only are individual student traits such as empathy, communication and cooperation, self-efficacy and problem solving emphasised, but also, an equal focus is placed on assets, resources, and contextual elements as protective factors in the family, school and community context (Fergus and Zimmerman, 2005; Luthar and Cicchetti, 2000). This reflects the socio-ecological framework of the resilience measure. The three surveys were constructed on Antonovsky’s (1996) principle of a positive or “salutogenic” notion of health which sees health as created, rather than a concept

Population-based resilience

595

Table IX. Factor loading and measurement errors for Social Capital Scale: Staff Survey

HE 107,6

596

which is measured by reduction in risk factors alone. Based on this positive health concept, the measures include assessing the extent to which the primary school setting is healthy and supportive, with family and community similarly supportive and collaborative through partnerships. Key school contextual factors are identified in the School Organisation and Climate Scale of the Parent/Caregiver Survey, the Health Promoting School Scale and the Social Capital Scale of the Staff Survey. These school contextual factors reflect not only the school organization and structure, curriculum content, school rules and regulations and physical environment, but also the school climate including school-family relationships, staff and student relations, teacher and peer support for students, school networks, norms, trust, coordination and cooperation, that are of benefit to all concerned. Understanding of family and community contexts may enable schools to make learning and health more relevant and sensitive to family and community circumstances. Parents, on the other hand, will be more likely to reinforce such activities in the home if the family environment is more supportive and family members understand each other. The measures of the family and community context factor are identified in the Family Functioning Scale and Social Support of the Parents/Caregiver Survey. This focus on the family climate and community social support includes emotional, and self-esteem support for each family member. Limitations and future directions The three surveys with six scales in relation to resilience capture protective factors from students, parent/caregivers and staff perspectives. These surveys, however, were tested in Australia and there may be additional, culture-specific questions that would better assess migrant children. As these surveys are philosophically based in salutogenic theory, they do not contain questions that would enable responders to address risk factors in their individual circumstances and environments. For example, achievement-oriented questions such as learning specific and culture adjustment questions were not included in the surveys. Additionally, the surveys were not tested against populations who have mental health problems. Thus, an association between these protective factors and prevalence of mental health problems, such as depression or behavioural problems, has not been tested. Future research could address whether these surveys could be utilised in populations of varying cultures for early identification of children who may be pre-disposed to, or be at high risk, for mental health problems. Conclusion The instruments discussed above provide a significant addition to the tools available to measure the critical mental health construct of resilience. Increasing numbers of policy statements and mental health promotion plans identify this construct as central to reform initiatives (Veenstra et al., 2005), but few specify the components of the concept and even fewer locate it within a holistic, or ecological setting. An attempt has been made here to provide validated and reliable instruments that have the sensitivity to recognise the complexity both of the concept of “resilience” and also of the intricacy of working within the multi-layered world of the school environment. The Resilience Scale of the Student Survey provides a validated tool for collecting data regarding the perception of students about resilience factors. The Parent/Caregiver Survey provides

a tool both for measurement and to engage them in a dialogue about their perceptions of the school environment, family functioning, and social support for the family. These elements have been widely recognised as critical protective and contextual factors for student and family resilience. The Staff Survey provides an appropriate tool to evaluate organisational social capital and the extent to which staff perceive their school to be a health promoting school.

Population-based resilience

597 References Antonovsky, A. (1987), Unravelling the Mystery of Health, Jossey-Bass, San Francisco, CA. Antonovsky, A. (1996), “The salutogenic model as a theory to guide health promotion”, Health Promotion International, Vol. 11, pp. 11-18. Baker, J.A., Dilly, L.J., Aupperlee, J.L. and Patil, S.A. (2003), “The developmental context of school satisfaction: school as a psychologically healthy environment”, School Psychology Quarterly, Vol. 18 No. 2, pp. 206-21. Benard, B. (2005), Resiliency: What We Have Learned, WestEd, San Francisco, CA. Bentler, P.M. (1980), “Multivariate analysis with latent variables: causal modelling”, Annual Review of Psychology, Vol. 31, pp. 419-56. Booth, M.L. and Samdal, O. (1997), “Health-promoting schools in Australia: models and measurement”, Australian and New Zealand Journal of Public Health, Vol. 21 No. 4, pp. 365-70. Bronfenbrenner, U. (1979), The Ecology of Human Development: Experiments by Nature and Design, Harvard University Press, Cambridge, MA. Bronfenbrenner, U. (1989), “Ecological systems theory”, Annals of Child Development, Vol. 6, pp. 187-249. California Department of Education (2004), California Healthy Kids Survey, California Safe and Healthy Kids Program Office, Sacramento, CA. Deschesnes, M., Martin, C. and Hill, J.A. (2003), “Comprehensive approaches to school health promotion: how to achieve broader implementation?”, Health Promotion International, Vol. 18 No. 4, pp. 387-96. DuBois, D.L., Felner, R.D., Meares, H. and Krier, M. (1994), “Prospective investigation of the effects of socioeconomic disadvantage, life stress, and social support on early adolescent adjustment”, Journal of Abnormal Psychology, Vol. 103, pp. 511-22. Fergus, S. and Zimmerman, M.A. (2005), “Adolescent resilience: a framework for understanding healthy development in the face of risk”, Annual Review of Public Health, Vol. 26, pp. 399-419. Garmezy, N., Masten, A.S. and Tellegen, A. (1984), “The study of stress and competence in children: a building block for developmental psychopathology”, Child Development, Vol. 55, pp. 97-111. Hart, P.M., Wearing, A.J., Conn, M., Carter, N.L. and Dingle, R.K. (2000), “Development of the school organisational health questionnaire: a measure for assessing teacher morale and school organisational climate”, British Journal of Educational Psychology, Vol. 70 No. 2, pp. 211-28. Joreskog, K. and Sorbom, D. (2004), LISREL 8: Structural Equation Modelling with the SIMPLIS Command Language, Scientific Software International, Lincolnwood, IL. Ladd, G.W., Kochenderfer, B.J. and Coleman, C.C. (1996), “Friendship quality as a predictor of young children’s early school adjustment”, Child Development, Vol. 67, pp. 1103-18.

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Lemerle, K. (2005), Evaluating the Impact of the School Environment on Teachers’ Health and Job Commitment: Is the Health Promoting School a Healthier Workplace?, School of Public Health, Queensland University of Technology, Brisbane. Loureiro, M.I. (2004), “A study about effectiveness of the health promoting schools network in Portugal”, Promotion and Education, Vol. 11 No. 2, pp. 85-92. Luthar, S.S. (2003), Resilience and Vulnerability: Adaptation in the Context of Childhood Adversities, Cambridge University Press, New York, NY. Luthar, S.S. and Cicchetti, D. (2000), “The construct of resilience: implications for interventions and social policies”, Development and Psychopathology, Vol. 12, pp. 857-85. Lynagh, M., Perkins, J. and Schofield, M. (2002), “An evidence-based approach to health promoting schools”, The Journal of School Health, Vol. 72 No. 7, pp. 300-2. McCubbin, H.I., Paterson, J. and Glynn, T. (1987a), “Social support index”, in McCubbin, H.I., Thompson, A.I. and McCubbin, M.A. (Eds), Family Assessment: Resiliency, Coping and Adaptation: Inventories of Research and Practice, University of Wisconsin Publishers, Madison, WI. McCubbin, M.A., McCubbin, H.I. and Thompson, A.I. (1987b), “Family hardiness index”, in McCubbin, H.I., Thompson, A.I. and McCubbin, M.A. (Eds), Family Assessment: Resiliency, Coping and Adaptation: Inventories of Research and Practice, University of Wisconsin Publishers, Madison, WI. McLoyd, V.C. (1998), “Socioeconomic disadvantage and child development”, American Psychologist, Vol. 53, pp. 185-204. Murata, J. (1994), “Family stress, social support, violence, and sons’ behaviour”, Western Journal of Nursing Research, Vol. 16 No. 2, pp. 154-68. Onyx, J. and Bullen, P. (2000), “Measuring social capital in five communities”, The Journal of Applied Behavioral Science, Vol. 36 No. 1, pp. 23-42. Rogers, E., Moon, A.M., Mullee, M.A., Speller, V.M. and Roderick, P.J. (1998), “Developing the ‘health-promoting school’: a national survey of healthy school awards”, Public Health, Vol. 112, pp. 37-40. Rutter, M. (1984), “Resilient children. Why some disadvantaged children overcome their environments, and how we can help”, Psychology Today, March, pp. 57-65. Rutter, M. (1987), “Psychosocial resilience and protective mechanisms”, American Journal of Orthopsychiatry, Vol. 57, pp. 316-31. Rutter, M. (1990), “Psychosocial resilience and protective mechanisms”, in Rolf, J., Masten, A., Cicchetti, D., Nuechterlein, K. and Weintraub, S. (Eds), Risk and Protective Factors in the Development of Psychopathology, Cambridge University Press, New York, NY. Scriven, A. and Stiddard, L. (2003), “Empowering schools: translating health promotion principles into practice”, Health Education, Vol. 103 No. 2, pp. 110-18. Smith, C. and Carlson, B.E. (1997), “Stress, coping, and resilience in children and youth”, The Social Science Review, Vol. 71 No. 2, pp. 231-56. Smith, G. (1999), “Resilience concept and findings: implications for family therapy”, Journal of Family Therapy, Vol. 21, pp. 154-8. Spilman, S.K. (2006), “Child abduction, parents’ distress, and social support”, Violence and Victims, Vol. 21 No. 2, pp. 149-65. Veenstra, G., Luginaah, I., Wakefield, S., Birch, S., Eyles, J. and Elliott, S. (2005), “Who you know, where you live: social capital, neighbourhood and health”, Social Science and Medicine, Vol. 60 No. 12, pp. 2799-818.

Waring, T. and Hazell, T. (2002), Evaluation of Mindmatters, Hunter Institute of Mental Health, Newcastle. Werner, E.E. (1989), “High-risk children in young adulthood: a longitudinal study from birth to 32 years”, American Journal of Orthopsychiatry, Vol. 59, pp. 72-81. Werner, E.E. (1992), “The children of Kauai: resiliency and recovery in adolescence and adulthood”, Journal of Adolescent Health, Vol. 13, pp. 262-8. Werner, E.E. (1995), “Resilience in development”, Current Directions in Psychological Sciences, Vol. 4, pp. 81-5. WHO (1986), Charter Adopted at an International Conference on Health Promotion – The Move towards a New Public Health, WHO, Ottawa. Zubrick, S.R., Williams, A.A., Silburn, S.R. and Vimpani, G. (2000), Indicators of Social and Family Functioning (ISAFF Reference Instrument), Department of Family and Community Services, Canberra. Corresponding author Jing Sun can be contacted at: [email protected]

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Internet review Healthy schools in the UK Children are geting fatter, the school canteen, if there is one, is serving nothing but junk food, the school playing fields were sold off a long time ago, and health and safety have banned most of what would have been sports day. If only a small portion of this media hype was true, then our children are spending a significant proportion of their childhood in institutions that seem to be promoting ill health. How much of this is true, and what are our schools doing to promote healthy behaviours in young people? In this review we look at the web sites that are aimed at promoting and supporting the “healthy schools” ethos in the UK. Healthy schools www.healthyschools.gov.uk/ This government sponsored web site describes the healthy schools initiative as one in which schools are helped to support the health and well-being of all those who are involved with schools, i.e. pupils, parents and staff. The UK government has set a target of all schools participating in the scheme by 2009, and by then 75 per cent of these should have achieved National Healthy School Status. This national web site is quite well designed and attractive to look at, though some of the text is litle on the small size. It should be emphasised that this web site does not provide any materials or learning resources that a teacher might want to use if involved with a healthy schools project. What it does provide is guidance on the measures required to achieve healthy school status. All the relevent targets and associated documentation can be found here. For the user who wants more practical information there are a number of useful links provided that will give access to the resources that may be wanted. The main part of this web site is under the heading of themes. The healthy schools programme is based on a whole-school approach which focuses on four main themes, Personal, Social and Health Education (PSHE), Healthy Eating, Physical Activity, and Emotional Health and Well-Being. For each of these themes the web site describes what is required of a school that wishes to achieve healthy school status. For example under PHSE the web site sets out the guidelines for developing a PHSE programme. The importance of monitoring and evaluation are emphasised as is the need for a named member of staff. Alongside each guidance note is the minimum evidence equired by the Office for Standards in Education (OFSTED) in order to achieve healthy school status. It should be emphasisd that the information provided by this web site is largely administrative, rather than practical. It tells the user what hoops they will have to jump through in order to achieve healthy school status, but it does not tell them how to jump though those hoops.

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Healthy schools http://www3.hants.gov.uk/education/hias/healthyschools This web site has been produced by Hampshire County Council as part of their Hantsweb initiative. In many ways it is quite similar to the government web site

described above. The content is very similar and is even presented in a similar way. However it does differ from the government web site in a number of important ways. First, the content is much more accessible via the simplified menu. Starting with a brief account of the healthy schools initiative, the content moves on rapidly to the practical matters dealing with how to set up a healthy school. This includes details of necessary audits required and how to undertake them. How to set up a healthy school team, it even includes information on the awards ceremony that is available for those who achieve healthy school status. Associated with the four themes are a number of resources in the form of links to relevant web sites as well as documents and information leaflets that can be freely downloaded. Web sites such as this must illustrate what they are trying to achieve, preferably with case studies from which other schools might learn. The Healthy Schools in Action link provided here does this, though the casual user might not appreciate it from the link information provided. The link gives the user access to two newsletters that are in pdf format an can be read online. It may not sound very exciting, but these newsletters are really a collection of case studies from Hampshire schools. It is a pity this information was not made available as a sub section of the main web site, presented in html format, allowing links to the different topic areas. There is a lot of useful information in these newsletters and newcomers to healthy schools could learn a great deal, but it does need to be made more accessible. Finally, for school staff who do not know where to start with their own healthy schools scheme, there is a particularly useful frequently asked questions (FAQ) section that should be able to answer most queries.

Leeds Healthy Schools www.educationleeds.co.uk/HealthySchools/index.aspx This is another local authority web site but it has a number of features that mark it out from the Hampshire web site and are therefore worth a look at, but first a criticism. The font used for this web site is very small, and in an era of disability awareness and equal access, it needs to be changed. The designers of this web site have gone to the trouble of providing the content in Bengali, Chinese, Punjabi and Urdu so they are obviously aware of equality issues, but they do need to focus on the visual design to make it more accessible. The first aspect of the content that users will find most useful is the “Leeds Healthy Schools Toolkit”. This is a set of six documents that can be downloaded and will provide users with all the formal documentation they will require if they wish to adopt the healthy schools initiative. Although aimed at schools in Leeds they could be easily adapted by schools from other authorities. The web site also provides some “Good Practice Case Studies” that are very good. These are documents that have been submitted by local schools who are striving for healthy schools status. They include a statement of the problem faced, what was done to overcome the problem, how the solution was evaluated, and in some cases, even how the solution was funded. These are very readable and most users will find something of interest and perhaps even learn something that could be applied to their own school.

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Healthy Schools Nottingham www.nottinghamhealthyschools.org.uk/ This web site starts by celebrating the 24 schools in Nottingham that have achieved he Gold Standard for Healthy Schools. As with the previous web sites the main menu has links to the four main themes of the healthy school programme. Where this web site scores over others is in the list of downloads that are available for each of the themes. The standards for each of the four themes are clearly explained and the requirements to meet these standards are set out in language that lay people, as well as teachers, will easily understand. A novel feature in this web site that others might want to emulate is the Resource Review section. Here users will find a list of resources that may be used with each of the four themes of healthy schools. Some of these resources are freely available and appropriate web site addresses are provided. Others are published commercially and details of the publisher and costs can be found. What is most useful though is that each of these resources has been reviewed and given a star rating (up to five) by people who are actively involved in healthy schools projects. It is also possible for users to add their own comments if they are familiar with a particular resource. It should be added that although there are a large number of resource reviews available, at the time of writing, they were mainly focused on the PHSE theme. Health Promoting Schools www.healthpromotingschools.co.uk/ This web site is run by the Health Promoting Schools unit in Scotland. The organisation and design of this web site reflects the key stakeholders in the healthy schools initiative, i.e. the practitioners, family and community, young people, and children. Clicking on the appropriate link will take the user to the resources available for that particular stakeholder group. The section for children is aimed at primary school level and contains masses of interactive games, screen savers, pictures and other resources appropriate for this age group. The part of the web site aimed at young people is very similar, but with the games and other resources designed for slightly older children. For parents and carers the family and community section explains the healthy school initiative and suggests ways in which they might want to get involved. There are no games in this section but there are other downloadable resources that parents will find of interest. The practitioners section is aimed at teachers, catering staff, health educators, school nurses, in fact any professional who may have a role within a healthy schools project. As might be expected, this is a rather more formal part of the web site, it emphasises, standards to be met, required documentation, and strategy papers to help with the implementation of a healthy schools programme. This excellent web site has been well thought out and can be used by everyone involved in healthy schools projects. Whether the user be a director of education, a teacher, a parent, or a child, they will all find something of interest within this web site. Highly recommended.

Note from the publisher The Editor would like to thank the following for their valuable help with reviewing papers during 2007 for Health Education: . Peter Aggleton . Judith Aldridge . Yvonne Anderson . Neil Armstrong . Helen Austerberry . Michael Baker . Shane Blackman . Nick Boddington . Per Boge . Val Box . Ian Bryant . Chris Chappell . Gill Clarke . Stephen Clift . Julian de Meyrick . Hein de Vries . Diane Debell . Sharon Doherty . Alan Geller . Christine Goodair . Sue Hacking . Katri Hameen-Anttila . Marion Henderson . Faith Hill . Pauline Hobbs . Iben Holter . Roger Ingham . Ros Kane . Han Li . Donna McCann . Jim McKenna . Lisako McKyer . Jenny McWhirter

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Bernie Marshall Owen Metcalfe Michael Murray Colin Noble Don Nutbeam Sabu Padmadas Elizabeth Parker Martin Polley Emily Power Lillian Range David Rivett Louise Rowling Terhi Saaranen Lawrence St Leger Glen Schmidt Mike Sleap Katerina Sokou Viv Speller Donald Stewart Keith Tones Kerttu Tossavainen Hannele Turunen Graham Watkinson Mark Weist Jennifer White and Ekua Yankah.

Erratum “Childhood obesity prevention and physical activity in schools”, Fiona Davidson, HE, Vol. 107 No. 4, pp. 377-95 Owing to an error when processing the above paper, a digit was accidentally omitted from a one-line quotation on page 390. The quotation should be: To halt, by 2010, the year on year rise in obesity among children under 11.

The correct version of the full paper is available on the Emerald web site. The Production Department sincerely apologises to the author and readers for this processing error.