SCHOOL HEALTH CARE REFORM

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New Zealand has a long history of utilizing schools in order to promote the health of children. New Zealand is undergoing Health Care Reform at the present time. This situation has led the New Zealand Public Health Commission to propose a "Healthy Schools Initiative." School health could play a major role in health care reform for children and youth in both New Zealand and the United States. Preliminary discussions with proposed collaborators in New Zealand indicate that the timing of a Senior International Fellowship for School Health would be advantageous in order to share expertise and the exchange of ideas and information on a rapidly developing, advancing field of health services delivery for children and youth. The opportunity to study the proposed demonstration projects in New Zealand should have major implications regarding the implementation of similar projects in the context of health care reform in the United States. The specific aims of the fellowship will be: (1) To develop and evaluate demonstration School Health Projects in New Zealand, linking primary health care and appropriate educational and social services to children and youth in a prevention-oriented, family-focused, integrated system, and (2) To evaluate the outcomes of the above demonstration project on: selected health and educational indicators for children and families; and, the development of health policy for children and youth. The proposed evaluation of the "New Zealand Healthy Schools Initiative" will utilize an experimental design which randomizes the order in which the same specific interventions are carried out among 40 participating schools. School sites will select two from a menu of four interventions and prioritize their first and second choices. Schools selecting identical interventions will be stratified and half will be randomly selected to serve as comparison schools to a paired intervention school. For all 40 schools, all four intervention outcomes will be monitored at baseline and at T1 and T2, two and three years post baseline. In addition, national secular trend data will include monitoring the four outcomes over 3 years. Characteristics of participating and non- participating schools will be determined by a survey of all 2,810 schools in New Zealand. Outcome indicators have been selected to parallel desired demonstration projects in the U.S.