School Readiness - Community & School Health (CSH) Approach-Explained

5.1 Community & School Health (CSH) Approach-Explained

In Canada , several national organizations have defined a comprehensive approach that integrates such school, family, agency, and community efforts. (CASH 1991) This school-related approach is defined as Comprehensive School Health (CSH) which is described as " a broad spectrum of programs, policies, services and activities that take place in schools and their surrounding communities." The goals of this comprehensive approach are:

* · to promote the conditions and behaviors that favour health development of children and adults

* · to prevent speech problems or risky behaviours leading to disease , disorder, injuries or dysfunction.

* · to assist children and youth who are at greater risks

* · to help to rehabilitate or reintegrate those that have experienced difficulties.

This CSH approach was four means to achieve those goals:

* · instruction to develop knowledge, skills, attitudes, and behaviour.

* · support services such as health, social, guidance, recreation, and employment services.

* · social support from families, peers, school staff, media, the community, and local policy-makers.

* · healthy physical environments on school, homes and neighbourhoods.

This framework is consistent with later research and development about health determinants. (Health Canada, 1994) It is based on the understanding that a variety of environmental, family, individual, and school factors contribute to the development of the child. Consequently, this Internet Essay uses the CSH framework to organize our review of the specific actions that school can take in cooperation with parents, other agencies and the community.

The Rationale for the CSH Approach

There is considerable evidence of the positive impact of community & school-based health promotion (Comprehensive School Health). Comprehensive School Health is based on well-founded and multiple investigations into behaviour change. Parcel (1984) has reviewed several theories about behavioral change, such as psycho-social influences, social learning and reasoned actions, that form the basis for a comprehensive approach to school-related health promotion.

Several models of health education and health promotion have been developed from that understanding of behavioural change, including the Health Belief Model (Janz & Becker, 1984), the Risk Reduction Model (Catania, 1991) and the PRECEDE model (Green & Kreuter, 1991). These models explain how individual health behaviours and environmental influences are linked in maintaining or reducing health status.

These behavioural theories and health promotion models have been applied to the school setting. Allensworth (1993) has described the "state of the art" in a review of school-related health promotion research. The Institute of Medicine in the US(Allensworth et al, 1997) has presented a rationale and criteria for successful CSH approaches. Lavin et al (1992), of the Harvard School of Public Health, have reviewed 25 major reports and reviews that support a CSH approach. Other researchers have described how the CSH approach and theory relate to specific issues such as tobacco (Glynn, 1989), sexuality (Fisher, 1990) and AIDS (Allensworth & Symons, 1989).

The beneficial impact of school health instructional programs has been demonstrated through large scale studies in the United States. Connell et al (1985) reported that 50 hours of well-delivered health instruction can improve student health behaviours, attitudes and knowledge. A later study undertaken by the Metropolitan Life Foundation (1988) found similar results.

Studies on single health issues, such as sexuality, show that linking classroom instruction with accessible health services (Fisher, 1990) increases the positive impact on behaviours such as teen pregnancies and STD's. Similarly, Parcel (1996) reported that a school-community approach to promoting cardiovascular health resulted in significant health gains. This Swedish study combined classroom instruction, community support and public policy on tobacco use.

Canadian (Stephens et al, 1997) and American studies (Centers for Disease Control, 1995) have estimated that the economic benefits of introducing such programs are enormous, with 15$ saved in health care and other costs for every dollar invested in school-based education.

The emphasis in the CSH approach is on community collaboration. Indeed, for school readiness, it is a prerequisite for success. It usually takes a person or an individual agency to begin the process.

However, individuals cannot successfully maintain the collaboration alone. There are implications for policy and practice that need to be addressed. Funding must be allocated, first for the services and programs and then for the process of collaboration. Policy must support flexible program delivery and administrative structures.

For more on community-school cooperation to support readiness, go to:

5. More about Community/ Agency Roles

5.2 Support Services for Children

For more on the actions that schools can take to be ready, go back to the Introduction.