WHO INFORMATION SERIES ON SCHOOL HEALTH
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WHO INFORMATION
SERIES ON
SCHOOL HEALTH DOCUMENT THREE
Violence
Prevention:
An Important
Element of a
HealthPromoting
School
WHO gratefully acknowledges the generous financial contributions
to support the printing of this document from: the Division of
Adolescent and School Health, National Center for Chronic Disease
Prevention and Health Promotion, Centers for Disease Control and
Prevention, Atlanta, Georgia, USA; and the Johann Jacobs
Foundation, Zurich, Switzerland.
This document is published jointly with Education International
(Brussels, Belgium) which is working with WHO to promote health
through schools worldwide.
World Health Organization
Geneva, 1998
The development of this document is a joint effort by the following WHO programmes:
Health Education and Health Promotion Unit, Division of Health Promotion, Education, and
Communication (HPR/HEP) and the Division of Emergency and Humanitarian Action/Violence
and Injury Prevention (EHA/PVI) in collaboration with the Education Development Center,
Inc. (a WHO Collaborating Centre to Promote Health through Schools and Communities). '
This document has been prepared on behalf of the WHO Task
Force on Violence and Health as part of the WHO Plan ofAction
on Violence and Health -which -was endorsed by the WHO World
Health Assembly WHA49.25 (1996) and the WHO Global School
Health Initiative.
A copy of this document may be downloaded from the WHO
Internet Site at: http://www.who.ch/hpr
*
© World Health Organization, 1998
This document is not a formal publication of the World Health Organization (WHO), and all rights are reserved by
the Organization. The document may, however, be freely reviewed, abstracted, reproduced and translated, in part or
in whole, but not for sale or for use in conjunction with commercial purposes.
The views expressed in documents by named authors are solely the responsibility of those authors,
/of
86793
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A
1
A
Violence Prevention: An Important Element of a Health-Promoting School was written for
WHO by Isolde Birdthistle of Education Development Center, Inc., U.S.A. (EDC). Edward
De Vos, Cynthia Lang, Daphne Northrop, Ron Slaby, and Cheryl Vince-Whitman provided
considerable guidance and expertise to the preparation of this document. Other EDC
colleagues reviewed drafts and offered advice including Rebkha Atnafou, Larry Cohen, Joan
Vas Serra Hoffman, Dieter Koch-Weser, and Karen McLaughlin.
WHO would like to thank the following individuals for the time, scrutiny, and wisdom they
contributed to the preparation of this document:
Maria Carolina Buitrago
Harvard University Graduate
School of Education
Bogota, Colombia
Jesus Enrique Chaux
Harvard University Graduate
School of Education
Cali, Colombia
Lisa Cohen
Division of Adolescent
School Health
Centers for Disease Control and Prevention
Atlanta, Georgia USA
Jack T. Jones
Health Education and Health Promotion Unit
World Health Organization
Geneva, Switzerland
Dinesh Mohan
Transportation Research and Injury
Prevention Program
New Delhi, India
I'- .'.-7
- ■
Claude Romer
Violence and Injury Prevention
World Health Organization
Geneva, Switzerland
Louise Rowling
The University of Sydney
New South Wales, Australia
Matthew Fumer
Health Education/Health Promotion Unit
World Health Organization
Geneva, Switzerland
WHO would also like to thank the following individuals who provided comments and
suggestions on this document during its discussion at the Fourth International Conference on
Health Promotion in Jakarta, Indonesia, in July 1997:
Dr Mohammed Al Khateeb, WHO/EMRO, Egypt; Masamine Jimba, JICA School &
Community Health Project, Nepal; Professor Dr Peter Paulus, Fachhochschuule Magdeburg,
Germany; David Rivett, WHO, Copenhagen; Dr Louise Rowling, University of Sydney,
Australia; Prapapen Suwan, PhD, Mahidol University, Thailand; Rachmi Untoro, Ministry of
Health, Indonesia.
*
CONTENTS
1. INTRODUCTION
1
Why did WHO prepare this document?
1
Who should read this document?
1
What is meant by “violence”?
2
What are the causes of violence?,
3
Why focus efforts through schools?
3
How should this document be used?,
4
2. CONVINCING OTHERS THAT VIOLENCE PREVENTION THROUGH
SCHOOLS IS IMPORTANT
4
Rationale: Violence affects the well-being and learning potential of millions of
children around the world
4
Rationale: Violence is a social and economic problem for all nations
5
Rationale: Violence is learned and therefore capable of being unlearned
6
Rationale: Schools offer an efficient, practical, and timely means to prevent and
reduce violence
6
Rationale: Evaluations of school-based violence prevention efforts show
promising results
6
3. PLANNING THE INTERVENTIONS
7
Who is going to make this happen?
7
The School Health Team
8
Community Advisors
8
Where should we start?.
9
Situation Analysis
9
Needs assessment
10
Resource assessment
10
Data collection
10
Commitment needed
13
Political acceptability
13
Community and family commitment
14
Teachers and school staff
14
Youth involvement
15
What should we do?
15
Goals
15
Objectives
15
Activities .
16
How will we know how well we are doing?
16
Evaluation design and monitoring
.........
4. INTEGRATING VIOLENCE PREVENTION INTO A HEALTH
PROMOTING SCHOOL
............................... .
School health education...
Timing
16
16
17
■
19
Teaching methods.
20
Youth involvement
21
Parent education
21
Building the capacity of administrators, teachers, and other school staff....
22
Pre-service training
22
In-service training
22
School health services
23
Screening/Diagnosis/Treatment
24
Training for health service providers
25
Referral
25
A healthy school environment
26
Overall school climate
26
Supportive school policies and practises
26
Physical environment
27
Safety and security
28
Youth development activities
28
School/community projects and outreach ..
30
1
Coordinating mutually reinforcing components
5. EVALUATION
Types of evaluation
31
31
32
Formative evaluation
32
Process evaluation
32
Outcome evaluation
32
6. ENSURING CONTINUITY IN THE SCHOOL & COMMUNITY
Tool 1
Violence Prevention Action Plan
Annex 1 Ottawa Charter for Health Promotion
Annex 2 Examples of violence prevention curricula
Annex 3 Examples of grade-specific objectives for violence prevention
skills
Annex 4 Resources to help you in your health promotion and violence
prevention efforts
References
34
FOREWORD
Investments in schools are intended to yield benefits to communities, nations and
individuals. Such benefits include improved social and economic development, increased
productivity, and enhanced quality of life. In many parts of the world, such investments are
not achieving their full potential, despite increased enrolments and hard work by committed
teachers and administrators. This document describes how educational investments can be
enhanced, by increasing the capacity of schools to promote health as they do learning.
The "rising waves" of conflict and violence described in this document take a
tremendous toll on the health, and subsequently the learning potential, of people everywhere.
Young people are often exposed to violence, as witnesses, victims and perpetrators, in all
settings of their everyday life. Because children need to be healthy to take advantage of every
opportunity to learn, reducing and preventing violence is necessary to help schools achieve
their full potential. Schools must be places where children feel and are safe if they are to
successfully increase the health and learning potential of its students, staff and community
members.
This document is part of a technical series on school health promotion prepared for
WHO’s Global School Health Initiative. WHO's Global School Health Initiative is a concerted
effort by international organizations to help schools improve the health of students, staff*,
parents, and community members. Education and health agencies are encouraged to use this
document to strengthen violence prevention interventions as part of the Global School Health
Initiative's goal: to help all schools become Health-Promoting Schools.
Although definitions will vary, depending on need and circumstance, a HealthPromoting School can be characterized as a school constantly strengthening its capacity as a
healthy settingfor living, learning, and working (see box on following page).
The extent to which each nation's schools become Health-Promoting Schools will play a
significant role in determining whether the next generation is educated and healthy. Education
and health support and enhance each other. Neither is possible
Dr Ilona Kickbusch, Director
Division of Health Promotion,
Education and Communication, WHO
Dr C. Rome!, Chief
Safety Promotion and Injury Control
WHO
HEALTH-PROMOTING SCHOOL
A Health-Promoting School:
•
fosters health and learning with all the measures at its disposal.
•
engages health and education officials, teachers, students, parents, health provider^ and
community leaders in efforts to promote health.
•
strives to provide a healthy environment, school health education, and school health services
along with schooVcommunity projects and outreach, health promotion programmes for staff,
nutrition and food safety programmes, opportunities for physical education and recreation,
and programmes for counselling, social support, and mental health promotion.
•
implements policies, practices, and other measures that respect an individual's well-being^
and dignity, provide multiple opportunities for success, and advance good efforts and:
intentions as well as personal achievements.
•
strives to improve the health of school personnel, families and community members as well
as students; and works with community leaders to help them facilitate community
contributions to health and education.
f
WHO INFORMATION SERIES ON SCHOOL HEALTH
VIOLENCE PREVENTION: AN IMPORTANT ELEMENT OF A HEALTH
PROMOTING SCHOOL
1.
INTRODUCTION
This document introduces health promotion strategies through a Health-Promoting School to
improve the health, education, and development of children, families, and community members. It is
based on the recommendations of the Ottawa Charter for Health Promotion1 (see Annex 1) and will
help people to apply a new approach to public health, one that creates on-going conditions
conducive to health, as well as reductions in prevailing health concerns.
The concepts and strategies introduced in this document apply to all countries; however, some of the
examples provided may be more relevant to some countries than to others.
Why did WHO prepare this document?
“Together, we must build and develop for the future a culture of peace based on non-violence,
dialogue, and mutual respect, and social justice. This is neither easy nor a quick task.
Nevertheless, it is possible and at a time of rising waves of new forms of conflict and violence,
it is absolutely necessary.”
—The Dalai Lama, January 1995
Violence affects everyone. It undermines the health, learning potential, and economic well-being of
people everywhere. As Carlyle Guerra de Macedo, Director of the Pan American Health
Organization, notes, “Terrorism, genocide, political assassination, bloody crimes, abuse, assault,
torture, harassment, and other modes of force, in violation of the most basic human rights, have
become part of our daily existence.”2
It is time for us to go beyohd treating and trying to manage the health consequences of violence; we
must prevent it. It is time to change the social, behavioural, and environmental factors that lead to
violence. The World Health Organization (WHO) has prepared this document to help people
understand the nature of a Health-Promoting School and how efforts to promote health and prevent
violence might be planned, implemented, and evaluated as part of the development of a HealthPromoting School. It will focus on simple, concrete steps that schools can take without major
investments of resources. It is designed as a “starting point,” to be modified and enriched as more
knowledge and experience is gained in the prevention of violence through schools.
Who should read this document?
This document can be used by:
a)
Members of the school community, including teachers and their representative organizations,
students, staff, volunteers, parent groups, coaches, and school-based health workers.
1
b)
Officials and members of institutions responsible for planning and implementing the
interventions described in this document, especially those from the ministries of health and
education.
c)
Community leaders, local residents, health care providers, and members of organised groups
(e.g. community groups interested in improving health, education, and well-being in the school
and community).
d)
Policy- and decision-makers, programme planners and coordinators at local, district
(provincial), and national levels.
e)
Programme staff and consultants of international health, education, and development
programmes who are interested in working with schools to promote health.
What is meant by “violence”?
Violence takes many forms and is understood differently in different countries and among different
cultures. While there is no universally accepted definition of violence, the following is a working
definition of violence that encompasses the broad range of understanding:
“Violence is the intentional use of physical force or power, threatened or actual, against
oneself, another person, or against a group or community, that either results in or has a high
likelihood of resulting in injury, death, psychological harm, maldevelopment, or
deprivation.”3
Three main categories of violence can be identified:4
Self-inflicted violence refers to intentional and harmful behaviours directed at oneself, for which
suicide represents the fatal outcome. Other types include attempts to commit suicide and behaviours
where the intent is self destructive, but not lethal (e.g. self mutilation).
Interpersonal violence is violent behaviour between individuals and can best be classified by the
victim-offender relationship. Examples include domestic violence (in the nuclear or extended family,
where women and children are the main victims), violence among acquaintances, and violence
among persons who are not acquainted. Interpersonal violence may also be specified according to
the age or sex of the victim (e.g., child abuse or rape). Types of interpersonal violence include
bullying, harassment, and criminally-linked violence including assault and homicide.
Organised violence is violent behaviour of social or political groups motivated by specific political,
economic, or social objectives. Armed conflict and war may be considered the most highly
organised types of violence. Other examples include racial or religious conflicts occurring among
groups and gang or mob violence.
2
What are the causes of violence?
The causes of violence are complicated and varied.5 Factors that are thought to contribute to the
development of violent behaviour include individual characteristics such as:
•
•
•
•
knowledge, attitudes, thoughts about violence, and skill deficits, such as poorly developed
communication skills
drug and alcohol use
having witnessed or been victimised by interpersonal violence
access to firearms and other weapons
There are also many contributing forces at the family level, including:
•
•
•
•
lack of parental affection and support
exposure to violence in the home
physical punitiveness and child abuse
having parents or siblings involved in criminal behaviour
In addition, environmental factors such as the following can contribute to violence:6
•
•
•
•
•
socio-economic inequality, urbanization, and overcrowding
rapid economic development with high levels of unemployment among young people
media influences
social norms supporting violent behaviour
availability of weapons
Why focus efforts through schools?
Violence prevention efforts that address factors at all levels will be the most successful. Schools
certainly cannot control many factors that contribute to violence — defense budgets, military
spending, arms sales, unemployment, corrupt members of governments and police forces. However,
they can address a broad range of behaviours, skills, communication patterns, and attitudes that
support and perpetuate violence. They can also prevent violence from occurring within their walls
or on school grounds, thus providing a safe place in which students and staff can work and learn.
This document suggests ways that schools can:
a) Create public policy that promotes health: This document provides information and
“arguments” that can be used to persuade others of the importance of violence prevention and to
advocate for increased local, district, and national support for violence prevention and health
promotion through schools.
b) Develop skills: This document identifies the skills that young people need to learn and practise in
order to resolve conflict through peaceful, nonviolent, and socially constructive means,
preferably before they face high-risk situations and before many drop out of school. It also
identifies ways others can create school conditions conducive to violence prevention and health.
c) Reorient health services: This document describes how schools can enhance access to
screening, diagnostic, treatment, and counselling services either within the school or through
3
referrals to community services for those suffering physical or psychological trauma from
violence.
d) Develop supportive environments: This document describes simple, low-cost changes that
schools can make to improve their physical and psychosocial environments and create an
atmosphere that supports violence prevention.
e) Mobilise community action: This document identifies ways the school can interact with
community members, parents, and local services to reinforce violence prevention initiatives, and
to support and guide young people in all realms of their lives.
In implementing these suggestions, schools can take an essential step toward becoming a HealthPromoting School.
How should this document be used?
The arguments in Section 2 can be used to advocate for violence prevention interventions in schools.
Section 3 helps create a strong basis for local action and for planning interventions that are relevant
to the needs and circumstances of the school and community. Section 4 details how to integrate
violence prevention efforts into various components of a Health-Promoting School. Section 5
assists in evaluating efforts to make violence prevention an essential part of a Health-Promoting
School. Section 6 provides recommendations for ensuring continuity and sustainability in the school
and community.
2.
CONVINCING OTHERS THAT VIOLENCE PREVENTION THROUGH
SCHOOLS IS IMPORTANT
This section provides information that can be used to convince others of the importance of reducing
and preventing violence through schools. It presents reasons why communities and schools both
need and will benefit from violence prevention and health promotion.
Rationale: Violence affects the well-being and learning potential of millions of children around
the world
“You know, there are no children here. They’ve seen too much to be children.”
—LaJoe, United States7
Children and adolescents are becoming as likely as adults to suffer rape, torture, and brutal death in
armed conflicts, as displaced persons and/or refugees and as soldiers. Even where armed conflict is
not present, young people are exposed to violence on the streets, in their home, on television and in
movies. In addition, children all over the world experience violence at school, through corporal
punishment, fights, bullying, or harassment from teachers and other students.
For every assault, there is a victim and countless witnesses who may experience physical injury,
psychological effects, and social-emotional and behavioural problems. Consequences are serious,
especially among children growing up in chronically violent homes or neighbourhoods. While many
4
children show a high level of resilience to such trauma, others will suffer serious and lasting effects
including post-traumatic stress disorder (PTSD), distress, and impairment of attachment, making it
difficult for them to form strong relationships. Their self-esteem may suffer and they may fail to
acquire competence in peer relations. Children exposed to violence may also adopt highly
sexualized or highly aggressive behaviour, use psychoactive substances, incur dissociation,
intentionally injure themselves, or show other dysfunctional ways of dealing with anxiety at higher
rates.8 Victims of intimate partner violence and rape have been found to be at risk for depression,
thoughts of suicide, and suicide attempts.9
The Trauma of War
Almost one out of every four children in Sarajevo was wounded in the conflict. In a survey
of 1,505 Sarajevan children conducted by UNICEF in the summer of 1993, it was found that
97 percent had experienced shelling nearby, 29 percent felt ‘unbearable sorrow’, and 20
percent had terrifying dreams. Following interviews with children, the UN Commission on
Human Rights’ Special Rapporteur on former Yugoslavia reported: “Memories of the event
remain with them, causing., .daily intrusive flashbacks of the traumatic events, fear,
insecurity, and bitterness.” Adolescents are also particularly vulnerable to the effects of war.
Aid workers in Bosnia and Herzegovina have been encountering adolescents who have
‘weeping crises’, who attempt suicide, who are in a state of depression and who have
increased levels of aggression and delinquency.
From “Children in War^ in The State of the World 's Children, 1996, UNICEF
Children need to be healthy to take full advantage of every opportunity to learn. The effects of
violence — physical injury, psychological effects, and behavioural problems — reduce attendance at
school, impair concentration, and detrimentally affect cognitive development. In addition, fear of
violence or abuse at school or en route to school, or displacement that results from violence and
war, can all prevent or reduce attendance and diminish children’s ability to learn.
Rationale: Violence is a social and economic problem for all nations.
“The old law of an eye for an eye leaves everybody blind... Violence is immoral because it
thrives on hatred rather than love. It destroys community and makes brotherhood
impossible.”
—Martin Luther King, Jr.
Violence undermines the social and economic conditions of communities and nations. It endangers
healthy and sustainable development by causing community decay, destabilizing national labour and
industry, discouraging investment and tourism, threatening the quality of life, and contributing to the
emigration of skilled citizens.10 Governments spend a significant proportion of public funds
responding to violence, often at the expense of other services, including criminal justice, police,
education, and health services. Violence also disrupts the provision of basic social services and the
delivery of curative and preventative health care.10 Finally, as an expression of power, violence
increases gender and social inequity. Preventing youth violence is not only a sound investment for
5
the future of individuals, but also a prerequisite for the development and maintenance of a healthy
societal development.11
Rationale: Violence is learned and therefore capable of being unlearned
Violence is a behaviour learned at an early age.12,13 Often through early experiences with family
members, schools, media, peers, and communities, children learn that violence, rather than
communication or negotiation, is an appropriate way to solve interpersonal problems. Because it is
learned at an early age, many researchers assert that it “may be unlearned — or conditions may be
changed so that it is not learned in the first place.”14 True prevention should take place before
violent behaviour becomes ingrained.
Rationale: Schools offer an efficient, practical, and timely means to prevent and reduce
violence.
In all countries, the school system can be the most efficient and organised way to reach large
portions of the population, including young people, school personnel, family members, and local
residents. More children than ever are attending school. In just the past five years, the number of
children enrolled in primary school has jumped by some 50 million; the percentage of girls enrolled
rose from 39 percent in 1960 to 72 percent in 1996. 15’16
In many developing countries, the school is an ideal setting for health promotion activities. In the
school, much of the structure, resources, and staff that can contribute to violence prevention efforts
are already in place. Health services of some form or another are provided for students in almost
every country and many countries have some elements of a school health programme that could
become the starting point for a more integrated approach that includes violence prevention.17
Schools also have the benefit of a staff equipped with tools of teaching and learning. Furthermore,
among most students and communities, teachers and school staff are highly regarded, positive role
models. The almost 43 million teachers at the primary and secondary school levels around the world
can have a significant impact on the healthy behaviour of adolescents.18
Another advantage of school-based interventions is that they can reach children when they are
young, in their early stages of developing attitudes, values, and communication patterns, and before
many drop out. When we reach children at this early point, it is possible to encourage the formation
of healthy attitudes and practises instead of changing well-established unhealthy habits.
Developmental research has shown that early aggression “will commonly escalate into later violence
and broaden into other antisocial behaviour.”19 Early intervention can thus be less expensive and
more effective than trying to change established patterns of violence among older children.
Rationale. Evaluations of school-based violence prevention efforts show promising results.
Though relatively few school-based violence prevention efforts have been evaluated, the results of
published studies are encouraging.
•
In a report of 12 case studies describing promising violence-prevention programmes across the
United States, Education Development Center, Inc. (EDC) found positive effects (as indicated
by preliminary programme evaluations) on student knowledge, attitudes and behaviour; teacher
6
attitudes and competence in violence-prevention skills; school climate; school statistics in
violence/behaviour; programme implementation; and general response to/support of
programmes.20
•
To assess the Norwegian Ministry of Education’s national programme to reduce bullying in
elementary schools, Olweus21 followed four cohorts of 600-700 pupils each and found that
frequency of bullying decreased by 50 percent or more during the two years following the
campaign. The project also reduced rates in antisocial behaviour such as theft, vandalism, and
truancy. Findings were consistent among boys and girls and across all grades. The effects of the
intervention were more significant after two years than after one year.22
•
In a recent evaluation of Second Step: A Violence Prevention Curriculum, which is used in over
10,000 elementary schools in the United States and Canada,23 observations of 588 students in the
classroom and playground/cafeteria settings indicated that the curriculum led to a moderate
decrease in physically aggressive behaviour and an increase in pro-social behaviour in school.
•
In a review of programmes designed to reduce adolescent violence, Tolan and Guerra (1994)24
found that there is support for programmes that combine generic problem-solving skills with
other specific cognitive skills and programmes that are based on real-life skills and situations.
They also found clear evidence that family-targeted interventions focusing on improving parent
behaviour, management skills, promoting emotional cohesion within the family, and assisting
family problem solving are effective in reducing adolescent violence. Regarding school-based
interventions, the authors noted that parental access to teachers, parental support for school
efforts, and more opportunities for parents to have valued roles in schools seem beneficial. Also
effective was to motivate high-risk youth to attend and perform in school and engage in pro
social community activities, and to provide youth with opportunities to have more pro-social
roles in schools and communities.
3.
PLANNING THE INTERVENTIONS
Violence prevention can ba an entry point for increasing a school’s capacity to plan and implement
health promotion strategies and interventions that will respond to needs and contribute to both
health and education. Once the importance and feasibility of providing violence prevention
interventions through schools become understood by citizens, school officials, and policy- and
decision-makers, the next step is to plan the interventions. This can be done by determining which
strategies will have the most significant influence on health, education, and development and how
such interventions can be integrated with other health promotion efforts. Interventions should
enable students, parents, teachers, and community members to make healthy decisions, practise
healthy behaviours, and create conditions conducive to health.
This section describes the steps to consider in planning violence prevention as an essential element of
a Health-Promoting School.
Who is going to make this happen?
*
Health-Promoting Schools involve members of the school and community in planning interventions
that respond to their needs and that can be maintained with available resources and commitments.
7
An important group that should be involved in the process of planning health interventions is a
School Health Team that includes community advisors.
The School Health Team
A Health-Promoting School should have a designated team to coordinate and monitor health
promotion policies and activities. If your school is a Health-Promoting School and a School
Health Team already exists, violence prevention can be one of the health areas to address.
You might consider establishing a Violence Prevention Task Force to focus on integrating
violence prevention efforts into the overall health programme.
If your school does not have a team, committee, or group organised to address health
promotion, the violence prevention effort could provide the opportunity to form one. A
School Health Team can lead and oversee health promotion efforts in the school, including
violence prevention. A Violence Prevention Task Force within that group can be responsible
for designing, planning, and evaluating violence prevention interventions; clearly defining
roles and responsibilities; and facilitating communication about plans, progress, and
problems. Aim to find a balance of both men and women/boys and girls who are committed
to the idea of nonviolence, believe that violence prevention can work, can work well in a
team, and, ideally, can make a commitment over several years.
Potential members of the School Health Team:
• Administrators
• Teachers
• Students
• School security
• Support staff
• School-based health service providers
• Coaches
• School volunteers
• Representatives of the local teacher/school employee union
Community Advisors
It is important to include the participation of groups and individuals outside of the school
who have an impact on students’ knowledge, attitudes, and skills related to violence. Some
Health-Promoting Schools are closely linked with community advisors for this purpose.
Through representation on the School Health Team, community representatives can help to
determine local needs and resources, disseminate information about the violence prevention
efforts, build support across the community, encourage community involvement, help to
obtain resources and funding for the programme, and reinforce messages and skills built in
school. Look for men and women who are influential, interested in violence prevention, able
to mobilize support, can contribute a diversity of skills and connections (e.g., writing,
interviewing, organising groups, speaking in public), and represent the community’s
geographic areas, and economic, social, ethnic and religious makeup. In some settings, it
8
may be useful to collaborate with an existing community group, e.g. councils, youth groups,
women’s groups.
Potential partners from outside the school include:
• Community residents
• Parents/Caregivers
• Law enforcement and criminal justice officials
• Local government officials
• Religious leaders
• Businesses
• Vendors
• Media representatives
• Community youth agencies
• Representatives of non-governmental organisations
• Social services providers
• Health service providers
• Mental health service providers
• Sports figures and other celebrities
Where should we start?
Once a School Health Team is established, its members can start the planning process by conducting
a situation analysis.
Situation Analysis
Conducting a “situation analysis” will help individuals to better understand the school
community’s strengths, problems, perceptions, and needs that are relevant to planning
violence prevention interventions.
9
'•■we
>
The necessity for an adequate situation analysis on the national, district, and/or
local level(s) is justified by several reasons:25
1.
2.
2
Policy- and decision-makers will need a strong basis for their support,
especially when their policies and decisions involve the allocation of
resources.
Accurate and up-to-date information provide a basis for discussion, for
justification, for setting priorities for action, and for identifying groups in
special need of interventions.
Data obtained through the situation analysis are essential for planning and
evaluating interventions. Data can help ensure that efforts focus on the
actual health needs, experience, motivation, and strengths of the target
population so that interventions increase physical, social, and mental wellbeing of students, staff, families, and community members.
This analysis consists of three steps: needs and resource assessments and data collection.
Needs assessment. This step will assist you in gaining an understanding of the nature of
violence and its causes in your community. Start by using the definition and types of
violence described in the introduction as a guide. Engage members of the School Health
Team and Violence Prevention Task Force in discussions and activities that help identify the
different types of violence that occur within your school and surrounding community. By
participating in brainstorming and word-association exercises, people will be able to identify
behaviours that are harmful to individual or groups of children, including many that may be
regarded as socially acceptable (e.g., corporal punishment by teachers and principals, verbal
abuse, gender discrimination).
Resource assessment. Another key step is to assess the school and community’s capacity to
provide violence prevention services. Determine what the school is currently doing that is
conducive to violence prevention. Also determine which specific resources and services are
available, either through the school or community, that will help as you implement violence
prevention interventions. Knowing this will allow you to draw on available personnel and
financial resources. The amount of resources will affect the scope and amount of services
provided, the availability of trained staff, and the capacity to plan and evaluate efforts.
Data collection. In this step, information about the extent of local violence and its
consequences is gathered. Accurate and up-to-date data and information can help ensure
that efforts focus on the real health needs, experience, motivation, and strengths of the target
population, rather than problems that are perceived by others.26 Policy- and decision-makers
will be more likely to support activities that are based on documented problems (especially
when they are being asked to allot or reallocate funds). Information gained through the
needs assessment can also serve as a useful baseline to which changes can be compared later.
10
Exploring the local situation*
Answering questions such as these can help you determine local needs and strengths:
. .: •
• How safe is the school?
How prevalent is violence among students? What types of violence occur in the school?
Where and at what time of day does it typically happen? Are weapons involved? If so,
what kind? Who is involved in violent events? What seems to put some students at risk
for engaging in violence? What seems to protect other students from engaging in
violence? Do students feel safe at school? What is the school currently doing to reduce
violence? What more can be done? How is violence affecting students’ well-being and
learning potential? Can outside individuals easily enter the school and threaten staff and
students?
• What perceptions of school safety are held by the teachers, administrators, and
students?
• What is the nature of the school environment?
Are children treated with respect and dignity? Is there respect and understanding for
different cultures and religions represented in the school? Is there equal respect for boys
and girls? What are some common positive, pro-social behaviours seen at school that can
be enhanced and rewarded? Are firm, fair, and consistently applied conduct standards
enforced? Does the school have a protocol for dealing with traumatic events or
emergencies? Are faculty, school staff, and parents treated with respect?
• How safe are students when they are not at school?
What types of violence occur to students outside of school (i.e., in the home or the
community)? Where else are students witnessing or engaging in violence? Who is involved
in it? What do parents seem to be doing to reduce, prevent, or perpetuate violence? What ;
is being done in the community to reduce or prevent violence?
■
• How safe is the route to school?
Do students and staff feel safe coming to and from school? Are parents or other caring
adults visible along the major routes between homes and school?
• Adapted from Peacing it Together: A Violence Prevention Resource for Illinois
Schools. Illinois Council for the Prevention of Violence, 1996.
11
:
i
• What resources are available to provide violence prevention interventions in
your school?
What resources exist to foster healthy youth development and resiliency (human and
material resources, curricula, training, health services, and connections with community
members and agencies)? Has any money been allocated to provide teacher training in
violence prevention? Are teachers required to study health topics in order to obtain or
maintain their certification? Have any universities or teacher training colleges developed
courses in violence prevention? What already exists in the school that addresses violence
prevention and life skills development? Can parents potentially volunteer to help violence
prevention and safety efforts? What resources exist at schools or centres for younger
children before they enter your school?
■
• Are there any current health promotion efforts in your school that can be the foundation
for new efforts? For example, what efforts are helping students and staff:
• Care for themselves and others?
• Make decisions and have control over their lives?
• Foster societal conditions that allow the attainment of health by all?
• Improve students’ understanding of health concepts and how to apply them?.27
• Examples of indicators that can help describe a local situation .
• Number of fights occurring during a typical month
• The nature, time, and place of conflict/fights
• Descriptions of the assailant and victim
• The number and types of weapons confiscated
• Arrests
• Absences/truancy rate
• Alcohol, tobacco and other drug use among students
• Student perceptions of alcohol, tobacco and other drugs and
weapon availability
• Supervision of students during free time at school
• Existence of school-wide policies and procedures for handling
violence and conflict
• Consistent enforcement of disciplinary methods
• Use of nonviolent and effective ways of disciplining and educating students, e g.,
school policy on paddling/corporal punishment
• Provision of violence prevention skills education in the school curriculum
• Provision of life skills education in the curriculum
• Availability of counselling services and mental health promotion
• Availability of health services
• The level of parental and community involvement in school activities
12
.
Sources of the previous information include:
• School records documenting student achievement, dropouts, absenteeism,
discipline problems, and suspensions and expulsions, especially those related to
fights
• School-based records from school clinics, nurse’s office, or existing school health
services regarding injuries, etc.
• Surveys or interviews assessing knowledge, attitudes, and practises of the students
• Assessment of teacher, student, and staff attitudes and skills regarding violence
• Surveys or interviews assessing perceptions of concerns and problems as well as
possible solutions
• Group activities where students list the types of violence in their school and the
frequency of the violence (daily, weekly, once or twice a month, every few months,
once 6r twice a year)
• Group activities in which students and staff place pins on a map to mark the
location of assaults and bullying incidents at school or en route to school
• Group discussions or activities in which students and school staff discuss the types
of violence prevention efforts taking place in the school and outside the school
• Classroom observation
• Interviews with community leaders, youth, parents, youth counsellors, community
health doctors, religious leaders, and parent/teacher association representatives
• Careful observations of the surrounding neighbourhood and community
• Crime reports from the police, juvenile, or criminal justice system
• Local clinic or hospital records
Commitment Needed
The success of efforts to create a Health-Promoting School relies also on the extent to which people
in the community are aware and willing to support health promotion efforts. Efforts to prevent
violence are most successful when a core group of people support and become involved in their
development and implementation. It is important in the early stages to gamer the acceptance and
support of politicians, educators, parents, community leaders, the community in general, public
health professionals, religious groups, business leaders, and students.
Political acceptability
National policies, guidelines, and support from ministries of education and health can be of
immense help to local schools. The will, commitment, attention, support, and action of these
authorities can help acquire time, money, and public support. Collaborative relationships
with other sectors, such as ministries ofjustice (for legal commitment/measures to combat
conditions favouring violence), social welfare, transportation, trade and development, as well
as local government and community-based organisations, will also prove very valuable.
13
j§
Political commitment is evidenced in many ways:
•
•
•
•
•
Favourable policies
Designation of someone with responsibility and authority
Provision of financial support
Provision of technical equipment, services, and materials
Public acknowledgment by ministries of the importance of the problem and efforts to
reduce violence
Community and family commitment
The success of efforts to create a Health-Promoting School relies also on the extent to which
people in the community are aware and willing to support health promotion efforts. Schools
need to receive input from families and community members regarding the design, delivery,
and assessment of the interventions, so as to respond to their concerns and gain their
commitment.28 They should play an integral part in discussions and sensitization about these
topics. Parent-teacher associations, adult-education activities, formal presentations, open
houses, civic clubs, religious centres and community-group meetings are appropriate forums
for the School Health Team and community advisors to communicate with families and
community members.29
Not everyone will immediately understand or support violence prevention efforts.
WHO/UNESCO (1992)30 suggest the following strategies for embracing differences and
improving acceptance:
•
•
•
Identifying and addressing the concerns of people or groups that may have difficulty in
accepting the interventions
Creating opportunities for extensive communication about violence and its consequences
Creating a process for welcoming feedback
Teachers and school staff
Teachers and school staff play a key role in carrying out violence prevention efforts. To
respect what they know and what they can do, it is important to involve them early in the
planning stages. A staff meeting is one useful forum for developing teachers’ interest.
Important ideas to discuss include:
•
•
•
•
•
•
How violence prevention programmes can help teachers achieve teaching/leaming
objectives
Information and data that support the need for violence prevention
The roles teachers play (whether or not they are trained in violence prevention) as role
models, facilitators, and partners of parents
How the involvement of staff and administrators is crucial for success
Plans for teacher training
How teachers and staff members will be affected by violence prevention efforts
14
Teacher interest and participation can be stimulated and attendance may be facilitated by
paying for release time, conducting a needs assessment to determine teachers’ concerns and
needs, offering continuing education units or recertification credit, or offering incentives
such as free materials, free manuals, or reimbursement.31
Youth involvement
It is also important to engage the energy and creativity of young people in the planning and
design stages. When young people are involved from the very beginning of a new idea, they
can help develop and plan interventions that respond to their specific needs and concerns, in
a culturally appropriate manner. Their participation can also build their sense of ownership,
which will enhance sustainability. Numerous ways in which young people can be involved in
the implementation of violence prevention activities are discussed later in this report.
What should we do?
Use the information regarding the nature and extent of local problems and strengths that you have
gathered in the situation analysis to develop a vision for change and an action plan. Tool 1 can help
you decide what your goals are and what strategies you will use to reach your goals.
Goals
The goals should describe in broad terms what you hope to achieve with violence prevention
efforts. Organise brainstorming activities for the School Health Team to decide on overall
goals for your violence prevention efforts. To help form your goals, try first to envision your
school and community as violence-free.32 Examples of overall goals may be:
•
•
•
•
To provide a safe learning environment for students and a safe workplace for staff
To minimize violence and bullying within the school
To build violence prevention skills for the future
To involve and empower youth to become leaders in violence prevention
Objectives
Objectives are the necessary steps for reaching the overall goals. Break the goals down into
specific short-term and long-term objectives or steps so that everyone understands clearly
what needs to be done and when. Describe outcomes that will help you determine how
successfully you are reaching your goal. Those responsible for designing policies and
programmes, instructional activities, services, changes in the school environment, and
evaluation should be able to refer to the objectives for clear guidance. The clearer and more
specific the objectives, the easier it will be to select appropriate activities to achieve them.
List objectives you plan to accomplish within specific timeframes. They should be specific,
measurable, and achievable. They should tell what measurable change is expected, who is
going to do what, when, where, and how it will be measured. They follow from statements
such as “To increase,” “To decrease,” “To reduce,” “To change,” etc.
15
Activities
Develop a strategy or, preferably, a combination of strategies that is most feasible for your
school to begin. All activities and curriculum content that are part of this strategy should
reflect the objectives. Actions that will be taken follow from statements such as “To
provide,” “To establish,” “To create,” etc. Sample actions that could be taken include:
•
•
•
To provide a violence prevention curriculum to students in grades 4-6
To invite police officers, former victims, or former perpetrators of violence to speak to
students about safety, crime, negative consequences of violence, and preventive measures
To establish disciplinary procedures for violence on school grounds
The next section describes numerous actions that schools can take to prevent violence.
Many schools do not have the resources to initiate a large, comprehensive investment in
violence prevention. However, this need not discourage any school from addressing the
issue; even small steps can make a difference. You may need to choose one or two activities
that are the most important and most feasible for your school, such as a staff training,
introducing peer mediation, or offering parent education. Try not to be discouraged if your
efforts do not immediately reduce the level of violence in your school or community.
Remember that violence is pervasive and cannot be changed easily or quickly.
How will yve know how well we are doing?
Evaluation design and monitoring
Evaluation — a review of what you have been doing and how well it has worked — is
important for many reasons and should be considered from the outset. An evaluation plan
and mechanisms for monitoring should be established at the start, so you can track your
school’s progress in accomplishing your goals and objectives. The groundwork for
evaluation is laid at the very beginning of the implementation process when needs are
assessed, objectives set, and activities planned.33 Specific recommendations for process and
outcome evaluation are discussed below.
4.
INTEGRATING VIOLENCE PREVENTION INTO A HEALTH-PROMOTING
SCHOOL
A Health-Promoting School strives not only to improve health education, but also to improve health
services, make changes in the school environment and school policies and practises, and mobilize
community action — all to create a culture of peace.
The effectiveness of these efforts will depend on the extent to which the interventions are supported
by the policies of the school and the training and capacity of the teachers and staff.
16
School health education
“To educate the child of today is to prevent the criminal or the violent abuser of tomorrow.”
—Carlyle Guerra de Macedo34
This section describes ways in which students can receive accurate information about violence and
its consequences, explore their own values and attitudes, and acquire personal skills needed to avoid
conflict through peaceful and nonviolent ways. It is usually not enough to deal with violence as a
single, isolated subject. Violence prevention education should be integrated into other core areas of
the school’s curriculum, such as social studies, language arts, history, or science. Messages about
violence prevention become stronger when they are repeated in a variety of contexts.
Children and adolescents need access to accurate information in order to make informed choices.
For this, students need to understand violence and its serious consequences. Teachers can help
children recognise the following:
• Different types of violence (e.g., self-inflicted, domestic/intrafamilial violence, sexual assault and
abuse, neglect, gang violence, organised and/or political violence, or hate crimes against people
of a particular ethnicity, religion, sexual orientation, mental or physical ability)
• The different contexts in which violence takes place (e.g., the home, the school, the immediate
community, between friends)
• The consequences of violence
• That violence is preventable
• What puts1 some young people at risk for violent behaviour (e.g., the role of alcohol and other
psychoactive substances, exposure to violence, access to weapons, social class, ethnicity, sexism)
• The role of media messages and societal norms in promoting violence (e.g., sex role socialization
and violence portrayed through television, movies, music, comic books, and video games)
• What protects some young people from violence (e.g., the ability to use alternative solutions to
problems, the ability to predict consequences of various approaches to problems, the ability to
practice life skills and negotiation skills, exposure to nonviolent adult role models)
Learning cognitive skills can help to prevent violence. While studying language, social studies, math
and science, children develop cognitive skills that help them reason their way through stressful and
dangerous situations.35 For example, those with superior language skills and analytic abilities are
less likely to use force to persuade and more likely to use creative and intellectual exercises to
imagine and respect different points of view. They are also able to more clearly envision the
consequences of certain actions and possess a greater repertoire of alternatives to violent
behaviours.36
One way to reduce violence is to alter the patterns of thought that support an individual’s
involvement with violence, whether in the role of the aggressor, victim, or bystander. There are
“habits of thought” that cause some children to act aggressively, cause others to put themselves at
risk for involvement with violence, or cause others still to support violence through passive
acceptance, instigation or active encouragement.37
It is not enough, however, for students to be aware of violence and its consequences and to adopt
healthy attitudes and “habits of thought.” They also need opportunities to acquire and practise a
17
wide range of life skills. Although not developed specifically as an approach to violence prevention,
life skills training can be an important part of successful conflict resolution.38 Life skills education
can help students acquire practical skills to prevent violence, such as peacefully resolving conflict,
evading dangerous situations, relieving stress, dealing with death, reducing prejudice, critically
evaluating violence depicted in the media, and resisting pressure from peers and adults.39 Annex 2
provides descriptions of some specific curricula designed to promote skills to prevent violence.
Which curricula you should use depends on local concerns and specific objectives agreed upon in the
planning stage. It is possible to select from existing curricula and make adaptations with caution to
meet local needs. The description of Sri Lanka’s “Education for Conflict Resolution” programme
below provides a good example of this.
18
Educating for Peace in Sri Lanka
The effects of 11 years of civil war have permeated all aspects of life in Sri Lanka,
including the education system: most schools are now segregated along language lines.
The Government, with assistance from UNICEF, launched a school-based programme
called “Education for Conflict Resolution” (ECR) to help children learn non-violent ways
of resolving disputes. A core group of resource persons, initially trained at the National
Institute of Education in different forms of conflict resolution, soon adapted these and
developed their own methods appropriate to Sri Lanka. They produced 10 different
training manuals aimed at principals, teacher trainers, teachers, and pupils.
The ideas of conflict resolution were consistent with many aspects of Sri Lankan culture.
For example, just as conflict resolution promotes assertiveness over aggression and
passivity, Buddhism, one of the major religions in Sri Lanka, emphasises the importance of
taking the middle path. Just as conflict resolution is based on cooperative behaviour, Sri
Lankan village life has traditionally operated on cooperative principles. In addition.
Buddhism and Hinduism emphasise harmony with the natural environment and make
extensive use of meditation. ECR incorporates meditation to calm and concentrate the
mind to create a sense of inner peace. A typical ECR lesson for primary schoolchildren
starts with meditation, and then covers issues such as decision-making and conflict
resolution. Role-playing is an important part of the approach and children are encouraged
to express emotions through stories, songs, and poetry.
ECR is not Unuted to particular lessons on 'conflict resolution’; rather, it is integrated into
the entire curriculum. At the Nilwala College of Education, student teachers learn to
integrate ideas and methods of conflict resolution into all subjects areas. For example, a
social studies lesson might focus on how different groups need to work together for a
community to function. Within that lesson, students would be encouraged to act out a
traditional story with a theme of peace and cooperation. Teachers learn to discuss the
messages of stories with their students and help them to draw parallels between them and
their own lives.
Between 1992 and 1994, ECR trained 3,500 principals, 400 master teachers, 3,000
teachers, and 7,500 student leaders, who, as of 1996, had reached approximately 420,000
of Sri Lanka s 4.5 million schoolchildren. ECR has also begun a media campaign to
extend these ideas to parents and to the community as a whole.
Adapted from How Sri Lanka educates children for peace,” in The State of the World's
Children, 1996, UNICEF.
Timing
To be most effective, principles of violence prevention should be taught to students before
they are likely to encounter violent situations, not after. Also, violence prevention should be
taught to each student in a series of developmentally appropriate building blocks of specific
skills and knowledge integrated in curricula from pre-school through the final year of
secondary education. Annex 3 provides examples of grade-specific objectives for skills of
19
violence prevention as developed by the West Virginia Department of Education Office of
Healthy Schools in the United States.
Though it may not be possible to create an educational series for each grade-level, a module
taught in one year is unlikely to be enough to provide long- term change in youth attitudes
and behaviour. Even in your first efforts, try to include a sequential plan that will expose
students to violence prevention education more than once in their school careers. Also, try
to choose teaching methods that are developmentally appropriate for your students. For
example, debates, discussions, and peer mediation may be too complex for younger students,
but essential for older ones.
Teaching methods
A lecture can be an effective way to increase students’ knowledge, but there are other
methods that are more effective in influencing beliefs and building skills. Active, informal,
personalized and participatory learning methods that are culturally appropriate are the most
effective in changing health-related behaviour. Try to use teaching methods that are
activities-based and encourage students to participate more actively. Methods which actively
engage students in their own learning are more likely to change what they know and what
they do.
Examples include:
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Role-plays and rehearsal of life skills including refusal skills, negotiation, and conflict
resolution
Interviewing
Small and large group discussions about violence in the school or community, what
causes it and what could prevent it
Discussions based on “cases” or stories with a problem of violence that encourage
students to find a solution
Journals/story writing
Activities oriented by peer leaders or community speakers
Interactive radio
Community involvement activities
Analysis of broadcast and print media to identify positive and negative messages about
violence, conflict resolution, and gender roles
Suggestion boxes to collect questions and opinions of adolescents
Radio programmes with brief, upbeat messages on prevention
Word murals, posters, flyers, bulletin boards and pamphlets to share your work
Games
Brainstorming
Visual and performing art projects can also instill principles of nonviolence. Artistic
activities that allow students to explore alternatives to violence and spread messages of
peace include: music and songs emphasising tolerance of differences; and drawing, painting,
collages, puppetry, and theatre that explore violence-related issues.
20
I
Emphasise collaboration — encourage students to achieve academic success by working
together in teams and being accountable to one another. For example, assign teams of
students to study, work on projects, and learn together. Students in some cultures will be
accustomed to cooperating in most aspects of life. For other students, however, competition
may be more the norm than cooperation. Collaborative learning will help such students
experience the benefits of cooperation in their lives. Collaboration and team projects can
also be good methods to use when training teachers and staff, and adults and community
members outside of the school.
Finally, it is important to utilise teaching methods and curricula that are culturally sensitive
and free from gender bias. Specifically, be sensitive to gender and cultural differences in
your examples and assumptions. Ask: can students from different cultural and ethnic
backgrounds learn from the curriculum? Similarly, can both boys and girls learn from it? Do
materials and lessons avoid the use or promotion of gender-based stereotypes and biased
language?
Youth involvement
Students themselves can be major actors in school-based efforts to prevent violence. For
example, they can act as peer educators and peer counsellors. They can act as agents of
change in their families and communities if your school focuses on youth empowerment,
youth leadership, and peer mediation. In some places, student health educators have
conducted special school programmes, such as peace days and violence-prevention weeks
and months during which they have written and produced plays and videos with violence
prevention themes.
It is important to value the contribution of peer educators. Some schools have done this
through public recognition, a certificate and by providing incentives such as programme Tshirts, food and money stipends or scholarships.
Parent education
Parents and other caregivers play an important role in violence prevention, including roles as
nurturer, teacher, disciplinarian, role model, and supervisor. Far too often, however, parents
and other caregivers do not have the resources, skills, or community support to carry out
these roles as effectively as possible.40 As a result, the messages students receive in the
classroom may be irrelevant once they go home.
r
21
■ '-'M ■
A Health-Promoting School can provide caregivers with information, resources,
and skills to enhance and extend efforts to the students’ own homes. Parent
education or training can inform caregivers of some important ways to prevent
violence among their own children and other children in the community:41
•
•
•
•
•
•
•
•
•
•
Setting firm, consistent limits on aggressive and coercive behaviour
Teaching young children healthy, non-violent patterns of behaviour
Learning and applying effective, nonviolent means of disciplining and
consistently correcting children when they misbehave (using physical discipline
teaches children that aggression can be an acceptable form of control)
Presenting themselves and others as effective role models for resolving conflict
nonviolently
Improving communication with their child (e g., being available to listen)
Supervising children’s involvement with media, schools, peer groups, and
community organisations
Establishing appropriate expectations for their children
Encouraging and praising children for helping others and solving problems
nonviolently
Identifying alcohol/psychoactive substance problems in themselves or their
children
Coping with crises
Gaining help from professionals
Teaching their children assertiveness
Leading community efforts to develop, coordinate, and effectively implement
community-based support services
Providing opportunities for children to practise life skills
If possible, offer parent education courses at the primary/elementary school level, and
provide transportation and child care to allow more parents to attend. During the sessions,
encourage parents to become more involved in Health-Promoting School activities. Allow
parents an opportunity to meet and talk with other parents who may share their particular
concerns. These meetings offer a good opportunity to encourage parent communication.
Building the capacity of administrators, teachers, and other school staff
Pre-service training. A valuable means of preparing teachers for violence prevention
education is through programmes in teacher education/training institutes and universities.
This way, teachers can receive time-intensive and specialised training in violence prevention
methods. Some efforts are being made in developing countries to provide academic courses
or programmes in schools of higher education.
In-service training. In order to learn about, teach, support, and reinforce violence
prevention methods, the School Health Team and teachers need to receive training.42 Team
training helps to ensure consistent application of violence prevention efforts in different
classrooms and throughout the school. Many teachers have a limited background in teaching
not only facts about violence, but also skills to help students reduce risks. In addition.
22
teachers need to examine their own attitudes about customs and practises which prevent or
encourage violence. School staff need to model the skills of peaceful coexistence in the
classroom and in the community.
Staff training/development should:
•
•
•
•
•
•
•
•
•j
Instill an understanding of the nature and type of local violence
Develop staff skills in conflict resolution, intergroup relations skills, and
classroom management
Demonstrate the teaching methods to be learned and provide a chance to
practise these methods and receive feedback/coaching
Provide the knowledge and skills to respond to student disclosure of all types of
violence, whether as victims, offenders, or bystanders of violence
Encourage and empower teachers to shape the instructional processes within
their own schools and classrooms, and provide adequate opportunities for
teachers to share in decision-making
Demonstrate strategies for integrating these concepts and skills into social
studies, language arts, and other core academic subjects
Train teachers how to recognise symptoms associated with abuse and trauma
(e.g., symptoms of post-traumatic stress disorder)
Link school teachers and staff to external resources that can assist children who
have been victims of violence, have witnessed violence, or who are behaving
violently
To be effective, in-service training should be of sufficient duration, periodically reinforced,
and should provide time for coaching and sharing of strategies. It should also consider the
support that teachers need as they begin using a new curriculum. A staff developer can
provide demonstration lessons, help the teacher prepare, observe classes, give feedback, and
sustain the teacher’s motivation. Follow-up training sessions should allow teachers to share
their experiences, discuss concerns, and plan school-wide events.
Where can you look for good training? Training and learning materials may be available
through government and non-governmental agencies, international organisations,
universities, or teachers’ unions in your country. Annex 4 lists WHO Regional Offices that
you can contact for help and information. Education Development Center, Inc., and the U.S.
Centres for
Disease Control and Prevention are WHO Collaborating Centres and serve as
sources of technical assistance and information. Supplemental training materials can also be
generated by teachers and students themselves—a strategy which has proven successful in
some countries.
■7
School health services
>■
Children who have been victims of violence or who are showing aggressive or disruptive behaviour
at school have a particular need for support and intervention. It is important to identify these
children in order to provide them with services, evaluate their progress, and conduct follow-up.
Schools have a role to play in this process, even where resources are scarce. In a Health-Promoting
School, health services work in partnership with and are provided for students, school personnel,
23
families, and community members.43 They should be coordinated with other services and activities
at school and in the community to utilise the potential of specialist resources to provide advice and
support for health promotion and violence prevention.44 Schools and communities need to consider
what preventive and treatment services are best provided at school sites and avoid duplicating
services available in the community that would easily be accessible for students and school
personnel.
Screening/Diagnosis/Treatment
Children who show behavioural and learning problems, or who you believe are at high risk
for involvement in violence, should be screened for victimisation and exposure to violence.
Where children have been caught in war or other strife and hardship, it is recommended that
school health providers routinely take the family’s history of violence when providing
medical services to children.
“Creating a safe environment for children to express themselves with a trusted adult is the
most important intervention to alleviate the long-term psychosocial effects of war-related
violence on children.”
—Dr. Leila Gupta, Afghanistan45
In some communities, children identified with needs related to exposure to violence can be
referred to specialists for treatment. In most communities, however, specialists are scarce.
In such cases, school staff can be trained by health professionals to recognise physical and
emotional symptoms of trauma and to deal with child trauma victims, at least in a preliminary
way.46 With the support and guidance of an empathetic and informed adult, a child, or
groups of children, can be helped to express suffering and to confront bad memories.
Talking or writing about, or even acting out, traumatic events is a way for a child to begin
healing. Children who have witnessed, perpetrated, or been victimised by violence or neglect
can benefit from art and re-enactment “play” therapy. Art and expressive therapies can
elucidate the child’s problems and help the caregiver and child start to explore new, healthier
symbols of expression which can replace previously conditioned responses and beliefs.
Counselling may provide children and adolescents with their first opportunity to discuss the
violence in their lives as well as ways to prevent, stop, or avoid it.47 Through individual and
group counselling or peer support groups, children can talk about life, death, grief, safety,
their fears, and feelings in a supportive environment. In addition, volunteer “special friends”
can act as companions and confidants to troubled children.
All schools should have a plan for dealing with emergencies and crises. Do not wait for a
major emergency or act of violence to occur. Try to designate a crisis coordinator and
ensure that at least some staff members are certified in First Aid and Cardio-Pulmonary
Resuscitation. Regularly rehearse the plan so that if there is an emergency, your school can
respond rapidly.
Reintegrating traumatized children to their schools after a violent event can be coordinated
between mental health professionals, parents, and the school. Mental health professionals
24
can assess when a child is ready to go back to school and advise teachers and parents on how
to monitor the child’s progress.
Training for health service providers
The Health-Promoting School does not exist in a vacuum. To be most effective, it must
collaborate with formal and informal, public and private individuals, organisations, and
disciplines. In the area of violence, health service providers play an especially important role.
Professional training and continuing education for health professionals should include a focus
on how to address different kinds of violence affecting children and adolescents. Health care
professionals need skills in the diagnosis and management of child and adolescent behaviour
disorders. They need to know how to recognise symptoms associated with abuse and
trauma.
Rather than only learning to treat the consequences of violence, however, health
professionals need to know how to prevent or at least reduce its frequency and severity.
They can benefit from training in many of the violence prevention skills. They should also be
trained to work in partnership with teachers, communities, parents, young people, and
volunteers. For example, health care professionals can provide prevention education to
students and counselling to those who have witnessed or are victims of violence. They can
also help inform parents by advising them about appropriate disciplining, effective parent
child communication, dangers, availability and safe storage of firearms, and role modelling of
appropriate behaviour. These lessons can be built into children’s early and on-going routine
visits.
Institutes of higher education that train professionals and paraprofessionals in public health,
nursing, medicine, social work, and education may provide training on violence prevention
and interventions. In war-tom countries, mental health workers from non-governmental
organisations, mental health institutes, and the ministry of public health may be trained in
ways to help children deal with their trauma and grief Continuing education should be
offered to practising professionals so that practitioners can acquire the skills they need to
intervene early.
Referral
Many schools around the world have very few, if any, resources for directly providing
treatment services. It is necessary for these schools to explore ways to establish or
strengthen linkages with sources of health services in the community. An array of services
may be available to students through formal referral systems for diagnostic and treatment
services. These may include community health clinics, private doctors, professional
counsellors, social workers, and mental health, social service, and legal service providers in
the community. Schools should also follow-up on all referrals made to ensure that students
and families are connecting and benefiting from health services. This is also a way for the
school to support the efforts of outside providers.
25
Your initial assessment of school resources, which included a simple summary of existing
programmes and services, provides information that can be used to formulate ideas for
possible linkages with existing community agencies.
A healthy school environment
One of the ten recommendations of WHO’s Expert Committee on Comprehensive School Health
Education and Promotion (September 1995) is that “Every school must provide a safe learning
environment for students and a safe workplace for staff.” Too often the school environment itself
can threaten physical and emotional health* The school environment must protect from
discrimination, harassment, abuse, and violence. In a Health-Promoting School, both the physical
and psychosocial environment should be consistent with and reinforce other health promotion
efforts.48
Overall school climate
Students’ quality of education is affected by the psychosocial environment of the school and
the surrounding community. Discrimination, harassment, double standards, or violence and
abuse between students and between staff and students are barriers to school participation,
even to school attendance. One reason some parents refuse to send their daughters to school
is their concern about the risks their daughters will face at school; girls are sexually harassed,
sometimes raped, by their fellow students, their teachers and sometimes by strangers as they
walk to school.49 Surveys of high school students in the United States also reveal high
numbers ofboys who report sexual harassment or abuse by other boys. The following
section outlines policies and practises that can be implemented to create a caring school
community that is characterized by cooperation, effective communication, appreciation of
differences, and shared decision-making.50
Supportive school policies and practises
School policies and practises should promote a clear set of school norms regarding violence,
beginning with mutual respect between administrators and teachers and among teachers. A
Health-Promoting School can create student and staff conduct and discipline codes regarding
violence and aggression. Teachers, for example, should know how to respond effectively
when facing routine incidents of conflict and aggression, as well as with those children who
show repeated and severe problems with aggressive behaviour. School policies and practises
should advance relations between students that are respectful, nondiscriminatory, and
nonabusive. They should also enhance teacher-student respect and communication.
Instances of discrimination or abuse between students, between staff, and between staff and
students should be condemned openly to promote appropriate social norms.51
Discipline does not only derive from rules, punishment, and external control. It is also
learned from reinforcement, and by consequences which are fair, firm and clearly
communicated. Disciplinary measures, such as suspending or expelling students, do not
provide students with the opportunity to improve their behaviour. These strategies have not
been shown to prevent violent or disruptive behaviour in school. In-school or after-school
suspensions, on the other hand, allow schools to remove disruptive students from the
26
classroom and provide them with counselling and individual or small-group academic
tutoring.52
In general, try not to view discipline in terms of punishment, but rather as a means of
upholding expectations for a code of decent conduct. Provide recognition, rewards and
reinforcement for newly learned skills and behaviour.53 Hold appropriate expectations for all
students, beginning in early childhood, and help provide students with the opportunity,
support, and encouragement to meet those expectations.
School Policies and Practises Promote Peace in New South Wales, Australia
The state education system in New South Wales, consisting of about 750,000 students and
60,000 employees in 2,200 schools, has mandated that all government schools have a
policy to handle critical incidents (natural disasters, traumatic incidents, and deaths/injuries
to students or staff); that teachers must report instances of suspected child abuse; and that
schools develop student welfare policies, programmes, and structures. The New South
Wales Department of School Education employs psychologists who are based in secondary
or primary schools. Pastoral care is also provided through peer support programmes.
In the Kair High School in Sydney, relationships among students, between teachers and
students, among teachers, and between teachers and parents have been enhanced through
the school’s “critical incident management plan.” Teachers act as advocates for students,
spending time with students, sharing information and personal experiences, and intervening
early through perceptive problem solving.54
Adapted from WHO, The Status of School Health. Geneva, 1996.:
Physical environment
The school’s physical environment plays a crucial role in either facilitating or discouraging
violence. Some strategies to ensure that the school’s appearance, layout, and facilities are
working to discourage rather than increase violence include the following:
•
•
•
•
•
School clean-ups and “painting parties”
Lighting policies to reduce crime (i.e., total darkness discouraging youth from
congregating in the area or increased lighting to discourage violent activity from
happening in a highly visible area)
Making emergency exits visible
Murals and posters with nonviolent messages
Public announcements supporting nonviolence
27
Safety and security
Some measures that schools have taken to provide a climate of safety among students and
staff include:
•
•
•
•
•
•
School safety plans, with parent and community input
Providing safe passages for students on their way to and from school
Providing student identification cards to restrict outsiders from entering school grounds
Structuring lunch and recess time with group activities supervised by adults
Classroom telephones
Weapon detection systems
Youth development activities
To avoid involvement in violence, students need more opportunities for healthy, productive activities
and less opportunities for engaging in negative behaviour. Some examples are:
• Mentors/RoIe-models
Positive adults acting as teachers, role models, and mentors can instill in students a higher value on
staying in school and avoiding violence. Mentors and role models can be local business owners,
community residents, university students, senior citizens, secondary school students, student
athletes, and teachers.55 Mentoring interventions include activities such as tutoring, counselling,
cultural enrichment, social skills development, life experience sharing, summer jobs, and sporting
events.
• Service learning
Service learning, or using service to the community as a "hands-on" approach to learning, can be
linked to anti-violence courses to promote youth leadership, help young people care for others, and
to heighten awareness of how poverty, substance abuse, and other social ills cause violence.
Students can do anything, such as cleaning up neighbourhood streets, building a playground,
tutoring young and old members of the community, assisting sick, elderly or handicapped
community members with housecleaning and chores, providing childcare, or volunteering their time
and talents, such as singing or dancing in hospital settings.
Service learning projects can also aim to counter violence more directly. For example, the principal
of an elementary school located in a high-crime area of the United States instituted the "Peaceful
Playground" project to reduce violence. As “playground monitors,” students selected and trained in
peer mediation and conflict resolution became well-versed in "Rules of Peace," and not only stopped
physical altercations, but instituted ground rules for peaceful conversation as well. In serving their
school as role models and problem-solvers, the students became increasingly more aware of
alternatives to the violence around them.56
• Art programmes
Art programmes can nurture resiliency and social skills and provide a safe place where young people
can practise respect for differences, listening skills, and cooperative learning.57 They can also
provide youth with excitement, challenge, and relief from boredom, as well as the opportunity to
develop characteristics, like discipline and creative problem-solving, that help to prevent violence.
28
Art programmes can also create positive changes in the environment, helping to revitalize
communities that have been affected by crime and poverty. Examples of art activities include
drama, dance, painting, photography, music, sculpture, film, video, computer graphics, puppetry,
writing, oral history, storytelling, architecture, design, and toymaking. The larger community’s
cultural resources can be used: museums, theatres, music groups, singing groups, local artists and
performers, and dance and literary organisations.
• After-school activities
Try to organise recreational, physical, and sports activities for students after school. One example is
to form clubs that meet the interests of students. As a means of counteracting student involvement
in gang violence, one school in New York City formed over 50 clubs, including Yoga, Floral
Design, Sports, International Pen Pal, Ceramics, Science, Movies, Drama, Reading, Math Counts,
We Make a Difference (visiting senior citizens homes). Singing, Poetry and Walking.58
• Career exploration
Counselling in career opportunities, training in job skills, and work experience
placements/apprenticeships can provide students with technical, entrepreneurial, and vocational skills
and help improve the economic futures of young people, combat poverty and joblessness, and
contribute to violence prevention efforts.59
Buddies Try to Counter Violence in South Africa
The urban environment of South Africa, like other urban areas around the world, is often
marked by large scale violence that has been called a “low-intensity war.” The “PsychoSocial Enrichment of Children” project is run by the University of Witwatersrand’s
Department of Psychology to foster the development of both young primary school
children and of unemployed youths in Eldorado Park, near Johannesburg. The project
helps youths become positive role models for younger children. As ‘Big Buddies’,, male
and female adolescents who have up to now failed to find a role in their communities
become dependable and supportive friends and role models for groups of young children.
As a result, the project gives the Big Buddies the opportunity to become a respected
community resource; this increases their sense of their own worth while also teaching them
parenting skills which will assist them in their roles in later life. Big'Buddies are also able
to channel their energies into positive activities for and with young children. They are
trained in problem solving, leadership skills, managing anger and frustration, and mediation
skills, and are encouraged to use games, drama, and creative toys to work with themes that
boost the confidence and self-esteem of the children.
At the same time, the project provides the ‘Little Buddies’ with a safe development
environment in which they have many opportunities for growth. Parents have reported
happier children who enjoy better relationships with others, have a growing ability to share
and a diminishing need to fight, who show increased self-confidence and self-awareness,
and have developed an enhanced ability to discern between right and wrong.
Adapted from South Africa: Countering violence through psycho-social enrichment. In
Bernard van Leer Foundation Newsletter, 84, October 1996.
29
School/comtnunity projects and outreach
Schools cannot take on the problems of violence alone. Violence prevention activities should be a
responsibility of the whole community. Key community leaders and groups need to be included in
violence prevention training so that the messages young people receive regarding violence
prevention are consistent, whether they hear the messages from teachers, peers, parents, or
community members. Involving the community can also help to affect those young people who have
dropped out, are chronically truant, and who are at high risk for becoming perpetrators or victims of
violence. Schools around the world have found creative ways to include the wider community, as
described in Youth Development Activities above. Peer education projects can be organised where
trained students act as peer leaders in church or other community organisations. Word and picture
murals, posters, flyers, bulletin boards, and pamphlets can also be used to create awareness within
the community. These efforts can be coordinated by the School Health Team with help from the
community advisors.
Schools can benefit greatly from partnerships with local business and representatives from agencies
and organisations, such as health departments, juvenile courts, probation departments, youth-serving
agencies, and parks and recreation. Together, partners can discuss common problems, develop joint
interventions, and integrate services. Specific opportunities for collaboration include the following:
•
•
•
•
•
Family and other community members can serve as volunteers to help ensure peace both in
school and during after-school activities. They can provide additional security in school and
around school grounds.
Volunteers can tutor students, act as mentors, or simply share their time.
Caregivers can transport or accompany students to school to ensure safety and improve
attendance.
Through donations, businesses can provide the funding for teacher training, sponsor events,
contribute funds for increased street and schoolground lights and pay for school uniforms.
Local businesses can collaborate with schools in the following ways:
— Help ensure safe passage to school. For example, in a large urban area in the United
States, businesses posted identification stickers on their windows indicating to students
that they are free to enter the business any time if they feel they are in danger.
— Provide work experience to students, particularly during summer and/or school break
periods.
30
Police in New Zealand Play an Important Role in Violence Prevention
The Youth Education Service (YES) of the New Zealand Police works successfully with
young people, teachers, and school communities to promote individual safety and safer
communities. One hundred and thirty Police Education Officers of YES have been selected
and trained to help deliver health curricula to students in primary and secondary schools
through social studies or health curricula. In addition to curricula focusing on drug abuse
resistance, road safety, and social responsibility development, YES promotes nonviolence i
through age-appropriate resources and the following violence prevention interventions:
Keeping Ourselves Safe — a series of units for the primary, intermediate, and secondary
schools teaching skills to take responsibility for keeping oneself and others safe in a range
of situations appropriate to the age of the student — and Kia Kaha, social skills
development for bullies and victims of bullies.
The Police Education Officers come from a range of backgrounds and represent all types
of policing duties. Though YES forms a relatively small section within the police, it
delivers the major component of community contact and liaison through its relationship
with school communities. Police Education Officers have become valuable resources for
teachers, sometimes assisting teachers in the planning, preparation, delivery, and evaluation
of the educational programmes. A growing body of research and overwhelming demand
from schools and teachers for YES programmes are indicative of their positive impact on
the behaviour of children and the safety of schools.
Coordinating mutually reinforcing components
In a Health-Promoting School, the School Health Team will want to find ways to coordinate all
these different education, health services, environmental, and community components, so that all
aspects work together to promote health and prevent violence. Success is most likely to occur when
schools deliver education and services in an environment where there is respect, tolerance, and
gender equity, and where social norms favour nonviolence. Educational approaches to violence
prevention need to be complemented by policy and consistent enforcement of rules. Personnel
providing education, health services, or counselling related to violence need to collaborate and
increasingly work toward integrated activity. In addition, health promotion efforts are strengthened
when schools forge trusting and ongoing relationships with parents and community organisations.60
Messages to young people need to be consistent, reinforced, and acceptable within the community
and family cultures.
Coordination will require commitment of the School Health Team to coordinate a multidimensional
effort. Leaders will need to identify points of intersection among the components that are related to
violence prevention. One suggestion is for the leadership team to identify key people involved in
promoting violence prevention through different aspects of the school:
5.
EVALUATION
Evaluation is a powerful tool that can be used to inform and strengthen Health-Promoting School
activities at both local and global levels. Data collected through carefully designed evaluations
31
‘
06793
I
provide essential information to national, state, and local programmes as they set goals and
objectives for current and future efforts. Unfortunately, the vast majority of violence prevention
interventions have not been evaluated. Strengthening evaluation efforts has the potential to provide
solid evidence of effectiveness and inform individual programmes and planners with information on
which interventions work best, which do not, and how to advance efforts in the future.
Evaluation is necessary to answer such questions as:
•
•
•
•
•
•
•
Are our interventions reaching the right individuals at the right time in their lives- children and
adolescents, their parents, teachers, counsellors, community members, etc.?
Are classroom materials, media presentations, parent outreach, community meetings, and other
activities being implemented the way we had intended?
Are they accomplishing what we expected?
Which specific interventions or components of our efforts work best? With whom? Under what
circumstances?
What components did not work? What went wrong?
Where should we place more of our efforts in the future?'>61
What can be improved?
Types of evaluation
Formative evaluation
Formative evaluation has the primary purpose of helping to design and modify a new
programme. It refers to the process of gathering information to advise the planning and
design stages and decisions about implementation.62 Formative evaluation relies extensively
on qualitative methods such as observation, individual and group interviews, and focus
groups, to gather feedback from students, teachers, or professionals that can improve the
violence prevention interventions during planning and initial implementation.
Process evaluation
Process evaluation documents what has been done and with whom. There should be ongoing
process evaluation activities so that you will know what services have actually been
delivered, to whom, and when. This will help assess progress toward meeting violence
prevention goals and objectives and making mid-course corrections. Documentation of the
planning, development, and implementation stages can also help others who want to replicate
your successes and avoid any problems you may have faced. Documentation of services and
activities can be provided through written teacher or student diaries, school records, and
interviews with teachers, school administrators, parents, or community leaders about how
the interventions are being implemented.
Outcome evaluation
Outcome evaluation documents whether what has been done has made a difference. It is
conducted to determine any changes that have occurred over the time period from before an
intervention is implemented (data collected during the needs assessment) to after
32
implementation and to demonstrate that the changes identified are the result of the
intervention itself, not some other factors. Such evaluation allows you to showcase your
efforts and bring positive attention to your community. It is also a good way to convince
others to get involved.
Measure outcomes that are directly tied to your objectives. You may want to concentrate on
outcomes for which records already exist. Data items that
have already been
collected in the needs assessment should be relatively easy to collect again.
Sample outcomes to measure
Education interventions:
• change in attitudes, knowledge, and behaviours of administrators, teachers, and parents
• success in increasing student knowledge of concepts related to the curriculum provided
• changes in student attitudes about the use of violence and personal approaches to
conflict
• adoption of nonviolent methods of resolving conflict
• time spent on classroom discipline
School-wide changes:
• daily attendance
• dropout statistics
• rates of violent injury, youth suicide, and suicide attempts
• misconduct and suspension rates
School safety:
* arrests for crime on school grounds
• fighting
• number of students carrying a weapon to school
♦ changes in perceptions of school safety
Community involvement:
number and type of people involved in community violence prevention activities
Because resources for evaluation, including time, personnel, and budget, might be scarce, it
may be sufficient and more feasible to conduct a process rather than an outcome evaluation.
Too often, programmes rush to study their impact on youth without fully understanding
whether or how well implementation of the interventions occurred.
Although you do not need to be a trained researcher or social scientist to conduct an
evaluation of your efforts, it is necessary to have a good understanding of your interventions,
including your goals and objectives; a commitment to learning more about the strengths and
weaknesses of your efforts and to improving their delivery; and at least one person who is
willing to be responsible for the evaluation.63 It is also a good idea to consult someone from
the health department or a local college or university who has experience in programme
evaluation.
33
6.
ENSURING CONTINUITY IN THE SCHOOL & COMMUNITY
Some recommendations for making school policies and structures sustainable:
•
•
•
•
•
•
•
•
Collaborate with national, regional, and international agencies.
Improve the flow of information to reach the persons who can and need to use it. Encourage
and facilitate the use of new information technologies to increase channels for disseminating
information (e.g., through the local, provincial, national, or regional network for the
development of Health-Promoting Schools).64
Groom future leaders in violence prevention.
Increase coverage of human resources training.
Develop supportive school policies and practises related to violence prevention interventions.
Infuse violence prevention principles into core subjects.
Share positive outcomes with other schools so that they can start similar violence prevention
efforts and collaborate with your school.
Communicate to community and nongovernmental organisations, district-level government,
ministries of health and education, local and mass media what you have done and still need to do
via written reports, meetings and discussions.
34
Tool 1
VIOLENCE PREVENTION ACTION PLAN
I.
Goal Statement
Five Year Goal
Ask yourself: What are we trying to accomplish with violence prevention interventions?”
Example'.
To minimize violence and bullying within the school.
What would you like to accomplish during the next year to meet this goal?
Year One Goals
II
I
n.
Measurable Objectives
Specific objectives describe outcomes that will help you determine whether you are reaching your
goal. List in the space provided four objectives you plan to accomplish in the coming year. State
your objectives in specific, measurable terms.
Examples'.
To increase the use of nonviolent methods for resolving
students and teachers by (date).
conflict among
To reduce the amount of harassment, abuse and violent behaviour on school
grounds by (x percent) by (date).
I
I
I
To reduce the amount of school absenteeism due to fear of going to and
from school by (x percent) by (date).
To change school policies and procedures to ensure nonviolent forms of
discipline by (date).
iI
I
I
i -• ■
i
1
t
35
Year One Objectives
1.
2.
3.
4.
36
HI.
Helping and Hindering Forces
Identify below the forces that will help or hinder the achievement of your goals and
objectives. Helping forces are anything that will assist in the completion of your goal:
people, funding, community support, political climate. Hindering forces are whatever
makes reaching your goal difficult: people, funding, lack of community support. Be creative
in thinking about what is already happening and what may benefit your efforts. Be specific
about what you think may interfere with progress.
Helping Forces
IV.
Hindering Forces
Work Plan
On the form below, list an objective. Make a separate page for each objective. Identify the
strategies/activities needed to achieve each objective, who will take responsibility for the
completion of the strategy/activity, when the strategy/activity will be completed, what resources
will be required, and how effectiveness will be measured.
OBJECTIVE #
ACTIVITY/
STRATEGY
PERSON(S)
BY WHEN
RESOURCES
RESPONSIBLE
COMPLETED
REQUIRED
37
EVALUATION
PLAN
ANNEX 1
OTTAWA CHARTER FOR HEALTH PROMOTION
Co-sponsored by the Canadian Public Health Association,
Health and Welfare Canada, and
the World Health Organization
This conference was primarily a response to growing expectations for a new public health
movement around the world. Discussions focused on the needs in industrialized countries, but took into
account similar concerns in all other regions. It built on the progress made through the Declaration on
Primary Health Care at Alma-Ata, the World Health Organization's Targets for Health for All document,
and the recent debate at the World Health Assembly on intersectoral action for health.
HEALTH PROMOTION
Health promotion is the process of enabling people to increase control over, and to improve, their
health. To reach a state of complete physical, mental and social well-being, an individual or group must
be able to identify and to realize aspirations, to satisfy needs, and to change or cope with the
environment. Health is, therefore, seen as a resource for everyday life, not the objective of living.
Health is a positive concept emphasizing social and personal resources, as well as physical capacities.
Therefore, health promotion is not just the responsibility of the health sector, but goes beyond healthy
life-styles to well-being.
PREREQUISITES FOR HEALTH
The fundamental conditions and resources for health are:
- peace,
- shelter,
- education,
- food,
- income,
- a stable eco-system,
- sustainable resources,
- social justice, and
- equity.
Improvement in health requires a secure foundation in these basic prerequisites.
ADVOCATE
Good health is a major resource for social, economic and personal development and an important
dimension of quality of life. Political, economic, social, cultural, environmental, behavioural and
biological factors can all favour health or be harmful to it. Health promotion action aims at making these
conditions favourable through advocacy for health.
38
ENABLE
Health promotion focuses on achieving equity in health. Health promotion action aims at reducing
differences in current health status and ensuring equal opportunities and resources to enable all people to
achieve their fullest health potential. This includes a secure foundation in a supportive environment,
access to information, life skills and opportunities for making healthy choices. People cannot achieve
their fullest health potential unless they are able to take control of those things which determine their
health. This must apply equally to women and men.
MEDIATE
The prerequisites and prospects for health cannot be ensured by the health sector alone. More
importantly, health promotion demands coordinated action by all concerned: by governments, by health
and other social and economic sectors, by nongovernmental and voluntary organization, by local
authorities, by industry and by the media. People in all walks of life are involved as individuals, families
and communities. Professional and social groups and health personnel have a major responsibility to
mediate between differing interests in society for the pursuit of health
Health promotion strategies and programmes should be adapted to the local needs and possibilities of
individual countries and regions to take into account differing social, cultural and economic systems.
HEALTH PROMOTION ACTION MEANS:
BUILD HEALTHY PUBLIC POLICY
Health promotion goes beyond health care. It puts health on the agenda of policy makers in all
sectors and at all levels, directing them to be aware of the health consequences of their decisions and to
accept their responsibilities for health.
Health promotion policy combines diverse but complementary approaches including legislation, fiscal
measures, taxation and organizational change. It is coordinated action that leads to health, income and
social policies that foster greater equity. Joint action contributes to ensuring safer and healthier goods
and services, healthier public services, and cleaner, more enjoyable environments.
Health promotion policy requires the identification of obstacles to the adoption of healthy public
policies in non-health sectors, and ways of removing them. The aim must be to make the healthier choice
the easier choice for policy makers as well.
CREATE SUPPORTIVE ENVIRONMENTS
Our societies are complex and interrelated. Health cannot be separated from other goals. The
inextricable links between people and their environment constitutes the basis for a socio-ecological
approach to health. The overall guiding principle for the world, nations, regions and communities alike,
is the need to encourage reciprocal maintenance - to take care of each other, our communities and our
natural environment. The conservation of natural resources throughout the world should be emphasized
as a global responsibility.
Changing patterns of life, work and leisure have a significant impact on health. Work and leisure
should be a source of health for people. The way society organizes work should help create a healthy
society. Health promotion generates living and working conditions that are safe, stimulating, satisfying
and enjoyable.
39
Systematic assessment of the health impact of a rapidly changing environment -particularly in areas of
technology, work, energy production and urbanization - is essential and must be followed by action to
ensure positive benefit to the health of the public. The protection of the natural and built environments
and the conservation of natural resources must be addressed in any health promotion strategy.
STRENGTHEN COMMUNITY ACTION
Health promotion works through concrete and effective community action in setting priorities,
making decisions, planning strategies and implementing them to achieve better health. At the heart of this
process is the empowerment of communities - their ownership and control of their own endeavours and
destinies.
Community development draws on existing human and material resources in the community to
enhance self-help and social support, and to develop flexible systems for strengthening public
participation in and direction of health matters. This requires full and continuous access to information,
learning opportunities for health, as well as funding support.
DEVELOP PERSONAL SKILLS
Health promotion supports personal and social development through providing information,
education for health, and enhancing life skills. By so doing, it increases the options available to people to
exercise more control over their own health and over their environments, and to make choices conducive
to health.
Enabling people to learn, throughout life, to prepare themselves for all of its stages and to cope with
chronic illness and injuries is essential. This has to be facilitated in school, home, work and community
settings. Action is fhquired through educational, professional, commercial and voluntary bodies, and
within the institutions themselves.
REORIENT HEALTH SERVICES
The responsibility for health promotion in health services is shared among individuals, community
groups, health professionals, health service institutions and governments. They must work together
towards a health care system which contributes to the pursuit of health.
The role of the health sector must move increasingly in a health promotion direction, beyond its
responsibility for providing clinical and curative services. Health services need to embrace an expanded
mandate which is sensitive and respects cultural needs. This mandate should support the needs of
individuals and communities for a healthier life, and open channels between the health sector and broader
social, political, economic and physical environmental components.
Reorienting health services also requires stronger attention to health research as well as changes in
professional education and training. This must lead to a change of attitude and organization of health
services which refocuses on the total needs of the individual as a whole person.
MOVING INTO THE FUTURE
Health is created and lived by people within the settings of their everyday life; where they learn,
work, play and love. Health is created by caring for oneself and others, by being able to take decisions
and have control over one's life circumstances, and by ensuring that the society one lives in creates
conditions that allow the attainment of health by all its members.
40
Caring, holism and ecology are essential issues in developing strategies for health promotion.
Therefore, those involved should take as a guiding principle that, in each phase of planning,
implementation and evaluation of health promotion activities, women and men should become equal
partners.
COMMITMENT TO HEALTH PROMOTION
The participants in this Conference pledge:
- to move into the arena of healthy public policy, and to advocate a clear political commitment to
health and equity in all sectors;
- to counteract the pressures towards harmful products, resource depletion, unhealthy living
conditions and environments, and bad nutrition; and to focus attention on public health issues such
as pollution, occupational hazards, housing and settlements;
- to respond to the health gap within and between societies, and to tackle the inequities in health
produced by the rules and practices of these societies;
- to acknowledge people as the main health resource; to support and enable them to keep themselves,
their families and friends healthy through financial and other means, and to accept the community
as the essential voice in matters of its health, living conditions and well-being;
- to reorient health services and their resources towards the promotion of health; and to share power
with other sectors, other disciplines and, most importantly,’ with people themselves;
- to recognize health and its maintenance as a major social investment and challenge; and to address
the overall ecological issue of our ways of living.
The Conference urges all concerned to join them in their commitment to a strong public health
alliance.
CALL FOR INTERNATIONAL ACTION
The Conference calls on the World Health Organization and other international organizations to
advocate the promotion of health in all appropriate forums and to support countries in setting up strategies
and programmes for health promotion.
The Conference is firmly convinced that if people in all walks of life, nongovernmental and voluntary
organizations, governments,* the World Health Organization and all other bodies concerned join forces in
introducing strategies for health promotion, in line with the moral and social values that form the basis of
this CHARTER, Health For All by the year 2000 will become a reality.
•J
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41
ANNEX 2
Examples of violence prevention curricula
Life. Skills Education seeks to teach a range of social competencies that adolescents need to
successfully accomplish many of the developmental challenges they may face. These skills include:
communication skills; decision-making; problem solving; critical thinking; assertiveness; pressure
resistance; self-assessment; coping with emotions; stress management; social adjustment; and selfawareness. Key components of Life Skills Education include:65
1. Facilitating the learning of life skills for psychosocial competence
2. Practising life skills in relation to everyday life and the key prevention issues to which they are
relevant
3. Facilitating the acquisition of skills using interactive, student-centred methods, such as role play
and guided practise
4. Encouraging parental involvement and reinforcement of the skills learned
5. Offering opportunities for application of life skills in community projects.
Conflict Resolution seeks to help young people understand conflict and develop a range of skills
including critical thinking, communication, empathy, anger management, problem solving, impulse
control, and withstanding peer pressure. Role playing of conflict situations and analysis of
responses to conflict are usually components. Conflict resolution curricula help students to define
problems and generate solutions, anticipate consequences of behaviour choices, learn self-control,
and form and retain friendships. They are most often taught in social studies and health, usually
through one teaching unit that lasts two to four weeks.
Mediation Interventions involve the participation of a third party (a trained student or teacher) who
assists the people in the disagreement to resolve their conflicts. In addition to many of the areas of
training in conflict resolution, mediators are taught to be good listeners and skilled in calming the
disputants and assisting them in reaching win-win solutions. Mediators can empower students to
help one another resolve their conflicts without adult involvement, and provide student mediators
with the skills to resolve their own conflicts more effectively.66 Generally, student mediators work
in pairs to mediate conflicts after completing a 15-20 hour training that includes both students and
teacher-advisors. The conflicts they mediate involve such issues as bullying and fighting. Student
mediators are sometimes selected by the students; in other cases, they volunteer or are chosen by
the school staff. Peer mediation can be used in conjunction with conflict resolution programmes..
Crime Prevention and Law-Related Education offers students ways to reduce their chances of
becoming victims of crime by increasing their knowledge of the types of crime committed in the
school and community and developing appropriate safety measures. It encourages them to take
action to prevent crime in general in their community and also increases their awareness of the legal
system—the justice system and the juvenile justice system in particular.
Communication Skill Education teaches students to express thoughts and feelings in clear,
acceptable, non-threatening, and creative ways. It includes basic communication skills (i.e.,
speaking clearly, active listening, responding when spoken to, expressing feelings through “I
42
messages”), anger management skills, conflict management and resolution skills, inclusion skills,
and empathy for others.
Decision-making Skills help students to cope with challenges such as dealing with peer pressure,
refusal skills, problem-solving skills, critical thinking, making friends, healing after loss or rejection,
crisis/stress management, handling emotions, rejecting stereotypes, developing positive attitudes,
setting and achieving goals.
Aggression Reduction/Anger Management Education conveys the message that anger is a normal
human emotion. It explores healthy and unhealthy ways to express anger and may focus on
violence as a consequence. Skills that teach ways that anger can be channelled appropriately and
violence avoided can also be included in these curricula.
Peace Education takes a very broad approach, looking at violence prevention not only in an
interpersonal context but at many different levels, from the individual to social groups, and within
and among societies as a whole. They may be explicitly pacifist in approach and explore issues of
fundamental justice in many different settings. In the context of peace education, skills are taught
that are similar to those taught in Life Skills Education; including assertiveness, communication
skills, critical thinking, and problem solving. A list of peace education programmes can be obtained
from the WHO, Division of Mental Health.
Prejudice Reduction/Cultural Awareness curricula attempt to overcome the stereotypes and
prejudices that can foster violence. They use a variety of approaches from exploring historical
events to looking at the strengths and contributions of different ethnic and social groups.
Adapted from EDC (1995) Taking Action to Prevent Adolescent Violence: Educational Resources
for Schools and Community Organizations (an annotated bibliography of over 90 curricula and
descriptions of over 200 videos).67
43
ANNEX 3
Examples of Grade-Specific Objectives for Violence Prevention Skills
Kindergarten
• Discuss how to say no to situations threatening one’s health or well-being (e.g.,
“no to breaking family or school rules”, and “no to strangers”).
• Discuss the importance of resolving conflict with peers in a positive manner.
Grade 1
• Identify situations where refusal skills are necessary (e.g., say no to suggestion
of stealing).
• Identify how positive behaviour can resolve conflict and where/when to go for
help when a conflict arises.
Grade 2
• Recall situations where refusal skills are important and practise using them.
• Recognise conflict as a normal part of interpersonal relationships; recognise the
importance of good communication and fact-finding; and recognise compromise
as a way to negotiate a conflict.
Grade 3
• Demonstrate attentive listening skills and effective interpersonal
communication skills which show care, consideration and respect.
♦ Discuss and practise the steps of the peer mediation process (e.g., ground rules,
brainstorming).
Grade 4
• Assess personal use of positive communication skills.
• Discuss and practise the peer mediation process.
• Analyse the consequences of violent versus nonviolent means to resolve conflict
(e.g., reputation/labelling; isolation; physical injury; self-confidence; attention).
Grade 5
• Propose guidelines for healthy communication (e.g., respect, listening); role-play
healthy communication and refusal skills.
• Use the peer mediation process to resolve conflict.
• Identify skills and responsibilities that support healthy family relationships;
practise communication skills which promote good family relationships.
Grade 6
• Identify important decisions made during adolescence; analyse the cause and
effect relationship between decision-making and long- and short-term
consequences (e.g., injury).
• Describe the benefits of team decision-making; identify strategies to become a
good team member; practise team decision-making.
Grade 7
• Demonstrate strategies to manage conflict and stressful situations.
• Describe causes of conflict among youth in schools and communities.
• Analyse environmental factors contributing to violence; discuss barriers to
violence prevention.
• Identify community resources and services for violence prevention.
44
Grade 8
• Demonstrate the ability to communicate ideas and work together to achieve a
common goal (e.g., cooperative learning group).
• Identify reasons individuals become depressed and/or consider suicide; describe
the referral procedures for these health issues.
• Identify factors in the home, school, and community that decrease violence;
identify the behavioural characteristics of perpetrators and victims of violence.
• Examine ways conflicts can be resolved; identify barriers to communication and
potential triggers for violent behaviour.
Secondary
• Demonstrate the ability to work cooperatively and resolve conflict peacefully.
• Differentiate between emergency situations that are life-threatening and those
that are not and list action steps for each situation; demonstrate first aid skills
and simulate responses to emergencies.
• Evaluate violent situations and determine how best to avoid and/or resolve these
situations.
Adapted from Instructional Goals and Objectives for Health Education. (1997). West Virginia
Department of Education Office of Healthy Schools. (Draft)
45
ANNEX 4
Resources to help you in your health promotion and violence prevention efforts
Mr L. Sanwogou
World Health Organization
Regional Office for Africa
Medical School, C Ward
Parirenyatwa Hospital
Mazoe Street
P.O. Box BE 773
Belvedere
Harare
Zimbabwe
Dr Ilona Kickbusch
Director
Health Promotion, Education and
Communication
World Health Organization
CH-1211 Geneve 27
Switzerland
Dr Desmond O’Byrne
Chief
Health Education and Health Promotion Unit
World Health Organization
CH-1211 Geneve 27
Switzerland
Dr Ma. Teresa Cerquiera
World Health Organization
Regional Office for the Americas
Pan American Sanitary Bureau
525, 23rd Street, N.W.
Washington D.C. 20037
USA
Mr Jack T. Jones
School Health Team Leader
Health Education and Health Promotion Unit
World Health Organization
CH-1211 Gendve27
Switzerland
Dr E. Ziglio
World Health Organization
Regional Office for Europe
8, Scherfigsvej
DK-2100 Kobenhauvn 0
Dr M. Al Khateeb
World Health Organization
Regional Office for the Eastern
Mediterranean
P.O. Box 1517
Alexandria 21511
Egypt
Mrs M. Osei
World Health Organization
Regional Office for South-East Asia
World Health House
Indraprastha Estate
Mahatma Gandhi Road
New Delhi 110002
India
Dr A. Reynolds
World Health Organization
Regional Office for the Western Pacific
P.O. Box 2932
Manila 1099
Philippines
46
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r
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