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

doi:10.1016/S1054-139X(03)00204-0

Journal of Adolescent Health

Volume 33, Issue 4, October 2003, Pages 231-239

Presented in part at the International Session, “Effective preventive interventions in the school and community setting: An international perspective,” at the Annual Meeting of the Society for Adolescent Medicine, Boston, Massachusetts, March 2002.

https://doi.org/10.1016/S1054-139X(03)00204-0 Get rights and content

Abstract

Purpose

To describe the Gatehouse Project which addresses the social context of high school with an aim of changing students' sense of school connection and in turn, health risk behavior and well-being.

Methods

Distinguishing features of the project were its conceptual framework, implementation process, and evaluation design. The conceptual framework derived from attachment theory and focused on three aspects of the school social context: security, communication, and participation. Implementation was standardized around a survey of the school social environment, creation of a school-based action team, and the implementation of strategies matched to a school's profile of need. In addition, an early high school curriculum addressed the skills relevant to social functioning and emotional adjustment. The evaluation design was based on a cluster randomized trial involving 26 schools. It used follow-up of an individual cohort and repeat cross-sectional surveys to capture outcomes at an individual student and whole-school level.

Results and conclusions

The Gatehouse Project drew on both health and education research to develop and coordinate a broad-based school health promotion intervention. It represents a promising new direction for school-based preventive work.

Section snippets

Conceptual framework

The utility of a conceptual framework should influence the choice for a particular setting. Ideally, it will communicate the idea behind the program simply and plausibly with workers in that context.

School-based health education has drawn heavily on the social learning paradigm in recent decades. More diverse theoretical frameworks used in other settings, whether focused on individual behavior (e.g., theory of reasoned action, health locus of control) or dealing with the broad social and

Implementation process

A health-promoting schools approach points to using strategies at multiple levels within a school. Thus, the promotion of interpersonal skills may, in part, take place within the formal curriculum. In contrast, reorientation of service provision takes place at a level of the school within its local neighborhood. The promotion of the social environment of a school can take place in multiple settings, ranging from the classroom to the schoolyard and sporting field. What is an appropriate strategy

A whole-school evaluation design

The Gatehouse Project stands out from most earlier school interventions in targeting the school group as opposed to individual students. As a consequence, the evaluation differs from that used in earlier health education work. The limitations of many earlier evaluations of health education in schools have been well-documented. They include samples sizes being too small to account for clustering, high attrition rates, absence of randomization, contamination of intervention effects, and failure

Summary

Health interventions have increasingly been developed to address settings rather than individuals. School-based interventions have lagged in this respect. With a few notable exceptions (e.g., The Comer Project 34, 35 and The Seattle Social Development Project [36]), the focus for school-based programs has remained health education of the individual. In contrast, the Gatehouse Project focused on the school social environment and the individual student within that context with benefits across a

Acknowledgements

This study was supported by grants from the Victorian Health Promotion Foundation, the Foundation for Young Australians, and the National Health and Medical Research Council.

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International symposiumChanging schools, changing health? design and implementation of the Gatehouse Project

Abstract

Purpose

Methods

Results and conclusions

Section snippets

Conceptual framework

Implementation process

A whole-school evaluation design

Summary

Acknowledgements

Fifteen Thousand HoursSecondary Schools and Their Effects on Children

Promoting school connectednessEvidence from the National Longitudinal Study of Adolescent Health

J School Health

Protecting adolescents from harmFindings from the National Longitudinal Study on Adolescent Health

JAMA

School health promotion programs over the past decadeA review of the smoking, alcohol and solar protection literature

Health Promot Internation

Structural and management changes that encourage schools to adopt comprehensive health promotion programs

Health Promot J Aust

Smoking Prevention ProjectLong-term randomized trial in school-based tobacco use prevention—Results on smoking

J Natl Cancer Inst

Linking Theory, Research and Practice