The costs of a community-based intervention to promote maternal health

The costs of community-level interventions are rarely reported, although such insights are needed if intervention research is to be useful to practitioners seeking to understand what might be involved in replicating interventions in different contexts. We report the costs of a 2-year community-based intervention to promote the health of recent mothers in Victoria, Australia. Program of Resources, Information and Support for Mothers was an integrated programme of primary care and community-based strategies. It had health care professional training, health education and community development components as well as an emphasis on creating ‘mother-friendly’ environments. Costs included the programme costs [primarily the salaries of the community development officers (CDO) in the field] and also ‘induced’ costs that relate to the CDOs' successes in attracting additional resources to the intervention from the local community. The total cost averaged A$272 490 per rural community and A$313 900 per urban community, equivalent to A$172.40 and A$128.70 per mother, respectively. For every A$10 of public funds initially invested in the project, the CDOs were able to attract a further A$1–2 worth of local resources, predominantly in the form of volunteer time or donated services.

Continuous professional learning through school based strategic planning

There is ample evidence that in many countries school science is in difficulty, with declining student attitudes and uptake of science. This presentation argues that a key to addressing the problem lies in transforming teachers’ classroom practice, and that pedagogical innovation is best supported within a school context. Evidence for effective change will draw on the School Innovation in Science (SIS) initiative in Victoria, which has developed and evaluated a model to improve science teaching and learning across a school system. The model involves a framework for describing effective teaching and learning, and a strategy that allows schools flexibility to develop their practice to suit local conditions and to maintain ownership of the change process. SIS has proved successful in improving science teaching and learning in primary and secondary schools. Experience from SIS and related projects, from a national Australian science and literacy project, and from system wide science initiatives in Europe, will be used to explore the factors that affect the success and the path of innovation in schools.

A comparison of self-reported puberty using the pubertal development scale and the sexual maturation scale in a school-based epidemiologic survey

Purpose: To examine concordance between two self-reported measures of puberty: Sexual Maturatiom Scale (SMS) and Pubertal Developl1!ent Scale (PDS) and their acceptability to adolescents. Methods: Participants of a school-based study in grades 5, 7 and 9 were classified into one of 5 pubertal stages using each method. Results: 2864 students (age 9-16 years) participated. Agreement was moderate for males (K 0.42, 95% CI 0.39,0.45) and females (K 0.57, 95% CI 0.53, 0.61). Concordance within one stage was excellent (females 97%, males 89%), with discrepancies due to females being classified one stage later on the PDS (26%) and males one stage earlier (32%). There were more missing data for the SMS (13%) than the PDS (4%).

Combating homophobia : preliminary results of a school-based program to reduce discrimination against same-sex attracted youth

Two key determinants of mental health are (a) freedom from discrimination and (b) social connectedness. Same-sex attracted youth who are subjected to violence and discrimination, or who experience homophobia in their everyday lives are at greater risk of mental health problems, including suicidal thoughts and behaviours. As one of the most significant sites of homophobia is the school, a 6-week school-based program designed to help students explore their attitudes to gays and lesbians was developed, called “Pride & Prejudice”. In order to evaluate the usefulness of the program, students’ attitudes were measured before and after their participation. Variables assessed were: beliefs about gender roles, social desirability, attitudes to gay men and lesbians, social connectedness, self-esteem, and attitudes to race. Attitudes towards gay men held by students were significantly more positive after the program, and the level of attendance during the program significantly predicted > this change. A significant positive change also occurred in attitudes towards lesbians. Process evaluation showed that students generally viewed the program positively. From this preliminary data, it can be concluded that school-based programs delivered to individual classes in which students are given the opportunity to explore their attitudes towards lesbians and gay men are likely to lead to a significant reduction in homophobia. Health-promoting schools now have available to them an effective tool for promoting opportunities for students to reflect on their attitudes towards gay men and lesbians, and other aspects of “social diversity”. It is hoped that school-wide implementation of such a program will eventually lead to a reduction in the discrimination same-sex attracted youth often experience (either directly, or indirectly), and improve the social-connectedness of all students.

School based partnerships : an Orff approach experiencing, exploring and engaging in music education

This article considers the role school-based partnerships can offer pre-service music education students. It is a reflection on what my students and I experienced, explored and engaged in music teaching and learning at a local primary school in Melbourne where the teacher is an Orff practitioner. As Wiggins says, 'Excellent teacher education programs provide students with experiences from which they can construct their own understandings of music, education, and music education' (Wiggins, 2007, p.36). Although both students and I kept reflective journals over our fiveweek visit during the first semester of 2008, this article selectively reports on some of my observation notes regarding music teaching and learning using the Orff approach. Such interaction paves the way for ongoing professional growth for all concerned (preservice students, music teacher and lecturer). It may be argued that school based partnerships offer students 'hands on' opportunities to 'develop an initial repertoire of teaching competencies, comprehend the various dimensions of music experience and understand student learning' (Campbell & Brummett, 2007. p.52). Although this article draws on the principal of linking theory to practice where the emphasis is on school and university partnerships (Henry, 2001) it makes pertinent links to the Orff approach to music teaching and learning.

The effect of an area-based intervention on breastfeeding rates in Victoria, Australia

Objectives
Best Start is an area-based early childhood intervention where projects are developed and implemented through a community partnership. A core tenet of the initiative is that implementing projects through a partnership generates greater value than would be expected if projects were undertaken independently by partner members. In this study we examine whether: (1) Best Start is effective in increasing the proportion of infants being fully breastfed at 3 months and 6 months. (2) The quality of community partnerships is a potential mechanism for change.

Methods
Best Start was implemented in Victoria, Australia. The study examined breastfeeding rates before and after Best Start in sites with Best Start breastfeeding projects compared to the rest of state. The relationship between partnership quality scores and breastfeeding percentages was also examined. Both analyses controlled for socioeconomic and demographic differences and clustering by area.

Results
Best Start targeted some of the most socially disadvantaged communities in Victoria. In the 3 years of its operation, the rates of fully breastfeeding at 3 months (OR 1.30, 95% CI 1.14–1.47) and 6 months (OR 1.33, 95% CI 1.1–1.61) increased in Best Start sites compared to the rest of the state. Quality of partnership scores was positively associated with increased percentages of fully breastfeeding (3 months = OR 1.03, 95% CI 1.01–1.06; 6 months = OR 1.03, 95% CI 0.98–1.08).

Conclusions
These results suggest that area-based interventions are effective in increasing percentages of fully breastfeeding. The study also supported the idea that developing quality community partnerships had a positive influence on their success.

Weighing it up : thinking about the implications of school based obesity prevention initiatives

In this paper we explore the tensions that exist between two health promotion discourses prevalent in school based Health Education. We use one example from a widely used curriculum resource and one classroom episode to explore discourses related to obesity prevention, often described as an obesity epidemic by media and health professionals alike. Our argument is that these discourses work to produce the 'unhealthy other' that everyone is then in danger of becoming and in the process produce moral judgements and reinforce stereotypes about overweight and obese people. In so doing they run counter to health education and other discourses that seek to promote self-esteem and body acceptance in students no matter what their shape and size.

What's the difference and where is the evidence? Investigating student teachers learning about literacy in a school based vs university based experience

This paper is in response to increasing national and international interest in the role of university teacher education programs in preparing pre-service  teachers in the area of early years literacy. The most effective manner to  facilitate this learning in teacher education is however not known and much debate exists about the merits of university-based versus school-based  approaches. It is within this context that the authors of this paper conducted a study that investigated student teachers learning about literacy through two different approaches both with distinctive design features. The first approach offered student teachers a school based experience, adopting a two hour micro-teaching model in a preparatory classroom; the other, a mainstream university based approach where students attended a tutorial for two hours. These two approaches were then compared for factors that student teachers articulated through a written survey. In analysing the data, two main findings emerged; firstly from the student teachers’ perspective, choice of approach resulted in improved learning and secondly, from the researchers’ perspective that student teachers placed in the school based approach emerged with a deeper understanding of the complexity of literacy teaching in general.

The effects of an area-based intervention on the uptake of maternal and child health assessments in Australia : a community trial

Background
Recognition of the importance of the early years in determining health and educational attainment and promotion of the World Health Organization Health for All (HFA) principles has led to an international trend towards community-based initiatives to improve developmental outcomes among socio-economically disadvantaged children. In this study we examine whether, Best Start, an Australian area-based initiative to improve child health was effective in improving access to Maternal and Child Health (MCH) services.

Methods
The study compares access to information, parental confidence and annual 3.5 year Ages and Stages visiting rates before (2001/02) and after (2004/05) the introduction of Best Start. Access to information and parental confidence were measured in surveys of parents with 3 year old children. There were 1666 surveys in the first wave and 1838 surveys in the second wave. The analysis of visiting rates for the 3.5 year Ages and Stages visit included all eligible Victorian children. Best Start sites included 1,739 eligible children in 2001/02 and 1437 eligible children in 2004/05. The comparable figures in the rest of the state were and 45, 497 and 45, 953 respectively.

Results
There was a significant increase in attendance at the 3.5 year Ages and Stages visit in 2004/05 compared to 2001/02 in all areas. However the increase in attendance was significantly greater at Best Start sites than the rest of the state. Access to information and parental confidence improved over the course of the intervention in Best Start sites with MCH projects compared to other Best Start sites.

Conclusion
These results suggest that community-based initiatives in disadvantaged areas may improve parents' access to child health information, improve their confidence and increase MCH service use. These outcomes suggest such programmes could potentially contribute to strategies to reduce child health inequalities.