Canadian Success Stories

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Canadian Success Stories

• Laura M. Ghali, Ph.D.
• CIHR Centre for the Study of
• Social and Physical Environments and Health
• The University of Calgary
• November 4, 2004

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Definition of Health

• a state of complete physical, mental and social
  well-being and not merely the absence of disease
  or infirmity
• (WHO 2001, p.1)
• Mental health is an integral part of health
• Mental health is more than just the absence of
  illness
• Complex interactions between the determinants of
  health, mental health and health behaviours

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Definition of Mental Health

• a state of well-being in which the individual
  realizes his or her own abilities, can cope with
  the normal stresses of life, can work
  productively and fruitfully, and is able to make
  a contribution to his or her community (WHO
  2001a, p.1)

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The Bad News

• In contrast to overall health gains of the
  worlds populations, the burden of mental illness
  has grown
• (1990) mental and behavioural disorders
  represented 11 of global disease burden (2020
  15)
• (1990) depression was the 4th largest contributor
  to disease burden (2020 2nd after heart
  disease)
• Big gap between burden of mental health problems
  and resources for treatment (14.4 billion
  annually in Canada)
• HBSC survey (2002) Self-reported depression in
  Grade 10 students (25 males, 35 females)
• Stigma and confusion around Mental Health and
  Mental Illness

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The Good News

• Growing body of evidence suggests that mental
  health and/or its determinants can be improved
• Can learn from health promotion successes in
  other areas (tobacco, heart health)
• Possible to intervene at several levels
  (individuals, schools, communities)
• Improving mental health is likely to have
  multiple benefits (academic, health, economic)
• Mental health promotion is a natural fit with
  comprehensive approaches in schools

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Mental Health Promotion in Schools

• Evidence from a successful program
• Replication and transfer to new contexts
• Supports
• Challenges
• Data Collection Evaluation
• Early Outcomes Sustainability

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The Gatehouse Project

• Cluster randomised controlled trial
• 12 intervention,14 comparison schools (Aus)
• Baseline survey of 2,678 grade 8 students in 1997
• Yearly follow-up surveys of original cohort up to
  2002
• Reduction in smoking, binge drinking, cannabis
  use
• Multi-level intervention
• Classroom and Curriculum Strategies focused on
  exploring feelings, understanding how thoughts
  influence how we feel and act
• Whole-School Strategies focused on improving
  schools environment to enhance security,
  connectedness, positive regard
• School-community partnerships focused on engaging
  families and service providers
• Focus was on mental health promotion not risk
  behaviours

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Gatehouse Project (RCT) 1997-2002
Dissemination Further Research Adolescent
Health Social Environments Program (Melbourne,
Australia)
Beyondblue Schools Research Initiative Australian
RCT 2003 onwards
CORE Connections (pilot) Canadian Context
Alberta RCT (2006) 40 schools
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Building on the EvidenceThe CORE Connections
Project

• Creating
• Opportunities that promote
• Resiliency and
• Engagement
• Pilot project supported by
• AHFMR
• AADAC
• SACYHN
• Centre for Adolescent Health

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What are we trying to replicate/transfer?

• CORE Connections is not a program but rather a
  systematic, facilitated process building capacity
  for change
• Key Features
• Based on individual school profiles and is
  tailored specifically to current context
• School Action/Health Team Facilitator
• Intervention strategies at the classroom,
  whole-school, and community levels (i.e., not
  just curriculum)
• Targets all school stakeholders
• Improvement strategies locally derived

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Stakeholders
Students
Community Members Organizations
Parents
Support Staff
Teachers
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Challenges of working with schools to promote
Mental Health

• Stigma (cultural differences between Canada
  Australia)
• Not providing treatment services
• Multiple agendas health not top priority
  (school academic rankings)
• Programs with little or no evidence being
  implemented in schools programitis
• Need to tie into mission/philosophy of the school

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The goal of BCHS is to develop the following
attributes within each student critical
thinking and decision-making skills, sound
academic and/or vocational learning, a feeling of
self-worth and confidence, attainable educational
and vocational goals, an optimistic attitude
toward the present and the future, the ability to
adapt to change, and an intrinsic desire for
lifelong learning.
In summary, the goal of BCHS is to offer each
student the possibility of becoming a positively
contributing member of society.
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Data Collection Evaluation

• Qualitative interviews with school staff
• Focus groups with students and community members
• Quantitative measures of school environment
  (staff students)
• Health/Mental Health and risk behaviour surveys
  (students)
• Telephone interviews with parents
• Process monitoring of team meetings, professional
  development, school activities and policy changes
• Social network analysis

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Early outcomes Sustainability

• ??? - Time 2 data collection (2005)
• Paid external internal facilitator
• Professional development (reorganized, inclusive,
  project-focused)
• New mission statement
• 3-year education plan includes project goals
  (feeling safe, connected, valued)
• CORE committee added to Site-Based Management

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Site-Based Management
CORE
Curriculum
Budget
Policy
Extra- Curricular
CORE Committee has a staff liaison for each
stakeholder group. Its function is to monitor and
improve the social environment of the school.
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Contacts

• CIHR International Collaborative Centre for the
  Study of Social and Physical Environments and
  Health
• The University of Calgary, Faculty of Medicine
• Penny Hawe phawe_at_ucalgary.ca
• Laura Ghali ghali_at_ucalgary.ca
• David Casey dcasey_at_ucalgary.ca