The international HPH Network welcomes the new members of 2018
The international Network of Health Promoting Hospitals and Health Services welcomes the 39 new hospital, health service and affiliated members who signed up to become members during 2018.
Of the new members, 32 have joined existing National/Regional Networks; Japan, Italy, Hong Kong, Catalonia, Iran and Norway. The remaining 7 are new individual members in countries and regions without existing networks; Three new members from China, and one from Pakistan, Quebec, Ireland and France respectively. A special mention goes to the Japanese National HPH Network, which is experiencing a high members growth. With their 20 new members, the Japanese HPH Network now consist of 98 members altogether.
The international HPH Network welcomes all our new members. By the end of 2018, the international HPH Network consist of 597 members. Below you can see how the N/R Networks and members are represented world-wide.
Join the international HPH Network
If your hospital, health service or organisation is interested in joining the international HPH Network, please go to the HPH website and read more about what the network can do for your organisation and how health promotion can beneft your patients, staff and community.
For more information visit
Update of the HPH website
The HPH website has undergone an update to a new platform, which offers better visuals and better accessibility.
On the website you can learn about HPH members, news from HPH Task Forces and Working Groups, access HPH documents, such as standards, guides, and stay updated on news from the network.
New HPH Governance Board
At the 24th meeting of the HPH General Assembly in Bologna on June 6, 2018 a new Governance Board was elected for the period 2018-2020. The elected board consist of the following seven members:
The board has already had a number of meetings during the second half of 2018 and they look forward to continuing the work for the rest of the period.
Alan Siu, Hong Kong HPH Network
Ying-Wei Wang, Taiwanese HPH Network
Antonio Chiarenza, Emilia Romagna HPH Network
Chair Margareta Kristenson, Swedish HPH network
Vice-chair Sally Fawkes, Australian HPH Network
Cristina Iniesta Blasco, Catalan HPH Network
Kjersti Fløtten, Norwegian HPH Network
The 27th international Conference on Health Promoting Hospitals and Health Services takes place in Warsaw Poland under the title:
Balancing High Tech and High Touch in Health Care: Challenges and Chances of Digitalization for Dialogue The conference intends to address if high tech and high touch are competing or even contradictory issues or reconcilable principles for the future of health care and health promotion. Opportunities and challenges arising from technological development for health care and life style interventions are emerging rapidly. But how does this development impact high touch interaction and communication in health care and health promotion? The conference will deal not only with the drivers coming from technology, but also with trends and changes in health care systems and public health itself. The conference takes place at Warsaw Marriot Hotel
27th international HPH Conference takes place in Warsaw on May 29-31, 2019
Intervention: Online Survey and Focus Group Follow-up
After the project period, 17-question Healthcare Provider and Staff Online Survey was administered to healthcare providers and staff who had direct contact with patients. Follow-up focus groups were conducted to collect additional information about participants’ perceptions and overall experiences with the project, including the healthcare provider training. Six focus groups were held in the geographic areas of the participating pediatrician practices. Practices were selected based on their ability to attend the scheduled focus group dates. Table 2 lists the focus group questions.
Sixty-six Healthcare Provider and Staff Online Surveys were completed (n=33: Medical providers: 12 physicians, 12 nurses, 4 nurse practitioners, 4 physician assistants, 1 psychologist; n=31 office workers: Medical Assistant/Office Manager/Rooming Assistant, and 2 who did not indicate their profession). One survey was incomplete and excluded from the total. Survey responses are summarized in Table 3. This data indicated that most respondents “strongly agreed” or “agreed” that healthcare professionals play an important role in bullying prevention, and that although professionals feel they should address this issue, over 1/3 of respondents were not asking their patients about bullying prior to this project. Six-seven percent (67%) of respondents felt that participation in the pilot project enhanced their practice, and if the BEST tool or similar survey was available, 71% indicated that they would like to use it to screen for bullying. Eighty percent (80%) of respondents indicated they were “comfortable” or “very comfortable” discussing bullying with patients as a result of the project and 86% agreed that the tool helped to identify correlations between bullying exposure levels and symptoms. Interestingly, 42% said they have shared what they learned with others in their profession.
At the end of the pilot, six focus groups were held and each lasted approximately 45 minutes. Responses (n=42) were recorded and transcribed and a qualitative analysis was completed. The results of the qualitative analysis were grouped into five categories: provider knowledge about bullying, perceptions about the BEST tool and the Decision Tree, clinical challenges with screening, and planned clinical changes as a result of the project. The focus group responses supported the APA survey findings that healthcare providers are aware of the child’s vulnerability to bullying, but they lack knowledge, skill, and competence to respond in a therapeutic and consistent fashion. Responses from the focus group are summarized in Table 4.
All adults who are in contact with children need to understand the psychological, physical and academic consequences of bullying, and have the ability to intervene appropriately and effectively when they see or suspect a child is being bullied. Previous studies indicate that healthcare providers currently do not have the tools and/or necessary training to meet these needs, which results in their reluctance to broach the subject. To optimize the clinical encounter, previous research has shown that promising clinician-focused strategies to improve delivery of preventive services include screening and decision support tools (22).
This project demonstrates that a bullying screening tool and related training can provide healthcare professionals with the necessary skills and information to provide effective assessment and intervention. It also demonstrates that healthcare providers and staff want to address bullying issues with their patients, and when given the proper tools and training, they are willing to do so. The study also indicates that those in physician extender roles such as physician assistants and/or nurse practitioners may also be utilized to effectively address the subject of bullying with patients. Interestingly, 42% of participating healthcare providers and staff said they shared what they learned with others in their profession which may reflect their comfort with new knowledge. If effective bullying prevention strategies and screening tools are to be adopted on a wider scale, more professionals need to share what they know and encourage others to advocate for these tools.
It is important to note that practitioners did not feel that the screening process was challenging to implement or that it took too much time to incorporate into their daily practice. The data collected indicated that providers felt the training and survey tools were effective, that the project built capacity within their practices to address bullying, and that the screening tool was easy to use and something they would like to continue to use, especially if it were a reimbursable service. These findings suggest that if this screening process was available on a larger scale to healthcare providers many practices would adopt.
However, a significant barrier to a larger-scale implementation of this screening tool is the issue of reimbursement for the screening and counseling time within an office practice and the lack of its incorporation into an electronic medical record (EMR). Bullying prevention screening and its subsequent counseling requirements are at best only partially reimbursed by health insurance companies. Reimbursement systems need to be modified to foster this screening process. Additional work and research is needed in this area, but given the correlation between bullying and health consequences (9) it is important that providers and insurance companies consider including bullying prevention screening as a reimbursable service. Doing so would allow healt-hcare providers more time and flexibility to hold conversations with all their patients about bullying and not just the ones who are negatively affected by it. It would also enhance awareness of the correlation between exposure to bullying and its health consequences as they evaluate their patients.
Limitations of this project include that surveys of patients and staff relied on self-reporting and included all office staff that had direct contact with the patient, regardless of their role or ability to address the bullying-related issues. While it is important to survey all staff involved in implementing the project to understand whether or not the actual screening method worked in the clinical setting, questions specifically about the content of the screening tool and utilization of the Decision Tree would be better asked only of those who directly counseled patients and families, and questions about survey implementation be directed to the office staff. The pilot was a relatively small convenience sample. Future studies are needed to determine if the screening would be as effective in a larger setting and to study the effects of the bullying prevention resources for patients and families.
Healthcare providers play a critical role in bullying prevention, but many lack education and resources to do so effectively. The pilot project demonstrates that using an evidence-based screening tool together with specialized training, appropriate anticipatory guidance, follow-up referrals when indicated, and bullying prevention resources was an effective method of increasing healthcare providers’ capacity to address bullying issues in their practices. Creating safe and caring places for youth involves a comprehensive and coordinated effort on the part of all adults who come into contact with children, including healthcare providers.
Conception and Design: AM, DS, SB, KJG Acquisition of Data: AM, DS Analysis and Interpretation of Data: AM, DS, SB, KJG Drafting, Revising and Final Approval of the Article: AM, DS, SB, KJG
Permission to use Bull-M was granted by the author Arnulfo Ramose-Jimenez. IRB approval was given for this project by The Children’s Institute in Pittsburgh, PA.
Conflicts of interests
The project was funded by a grant from the Highmark Foundation, Inc., Pittsburgh, PA. Project funders had no role in the project development, implementation, evaluation, or report writing. No other competing interests was declared.
(1) American Educational Research Association. Prevention of Bullying in Schools, Colleges, and Universities: Research Report and Recommendations. Available at: Release/Prevention%20of%20Bullying%20in%20Schools,%20Colleges%20 and%20Universities.pdf (Accessed February 16, 2018).
(2) Radford L, Corral S, Bradley C, et al. The prevalence and impact of child maltreatment and other types of victimization in the UK: Findings from a population survey of caregivers, children and young people and young adults. Child Abuse Neglect. 2013; 37:801–813. Doi:10.1016/j.chiabu.2013.02.004
(3) Centers for Disease Control and Prevention-Division of Adolescent and School Health. Trends in the prevalence of behaviors that contribute to violence-National YRBS: 1991—2015. Available at: healthyyouth/data/yrbs/pdf/trends/2015_us_violence_trend_yrbs.pdf (Accessed February 16, 2018).
(4) Nansel T, Overpeck M, Haynie D, Ruan W, Scheidt, P. Relationships between bullying and violence among US youth. Arch Pediat Adol Med. 2003; 157(4): 348-353. Doi:10.1001/archpedi.157.4.348
(5) Olweus, D. Bullying at school: What we know and what we can do. Malden, MA: Cambridge: Blackwell Publishing; 1993.
(6) Nansel T, Overpeck M, Pilla R, Ruan W, Simons–Morton B, Scheidt P. Bullying behaviors among us youth: prevalence and association with psychosocial adjustment. JAMA. 2001; 285(16): 2094–2100. Doi:10.1001/ jama.285.16.2094.
(7) Ttofi M, Farrington D, Losel F, Loeber R. The predictive efficiency of school bullying versus later offending: A systematic/meta-analytic review of longitudinal studies. Criminal Behaviour and Mental Health. 2011; 21: 80–89 Doi: 10.1002/cbm.808
(8) Srabstein J, McCarter R, Shao C, Huang, Z. Morbidities associated with bullying behaviors in adolescents. School based study of American adolescents. Int J Adolesc Med Health. 2006; 18(4): 587–596.
(9) Fekkes M, Pijpers F, Verloove-Vanhorick S. Bullying behavior and association with psychosomatic complaints and depression in victims. J Pediatr. 2004; 144(1): 17-22. Doi: 10.1016/j.jpeds.2003.09.025
(10) Srabstein J. & Piazza, T. Public health, safety and educational risks associated with bullying behaviors in American Adolescents. Int J Adolesc Med. 2008; 20(2): 223-233. (11) Gini G, Pozzoli T. Association between bullying and psychosomatic problems: a meta-analysis. Pediatrics. 2009; 123(3): 1059-65. Doi:10.1542/ peds.2008-1215
(12) Gini G, Pozzoli, T. Bullied children and psychosomatic problems: a meta-analysis. Pediatrics. 2013; 132(4). Doi:10.1542/peds.2013-0614
(13) Lereya, S.T., Copeland, W.E., Costello, E.J., & Wolke, D. Adult mental health consequences of peer bullying and maltreatment in childhood: Two cohorts in two countries. The Lancet Psychiatry. 2015; 2: 524-531.
(14) Hay C, Meldrum,R. Bullying victimization and adolescent self-harm: testing hypotheses from general strain theory. J Youth Adolescence. 2010; 39: 446-459.
(15) Sourander A, Klomek A, Niemelä S, et al, Childhood predictors of completed and severe suicide attempts: findings from the Finnish 1981 Birth Cohort Study. Arch Gen Psychiat. 2009; 66: 398-406. Doi: 10.1001/archgenpsychiatry.2009.21
(16) McClowry R. Miller M, Mills G. What family physicians can do to combat bullying. Journal of Family Practice. 2017; 66(2): 17.
(17) Lynznicki J, McCaffree MA, Robinowitz C. Childhood bullying: implications for physicians. American Family Physician.2004; 70(9). (18) Leff, SS & Feudtner, C. Tackling bullying: Grounds for encouragement and sustained focus. Peds 2017; 139: e20170504
(19) Committee on Injury, violence, and Poison Prevention. Role of the Pediatrician in Youth Violence Prevention. Pediatrics 2009; 124 (1):393-402.
(20) Cdc.gov. (2018). Violence Prevention Home Page. Available at: https:// (Accessed Feb 16, 2018.)
(21) Sion H, Aalsma, M Weitzman, E, Garcia-Huidobro D, Wong C, Hadland S, Santelli J, Park MJ, Ozer E. Research on clinical preventive services for adolescents and young adults: Where are we and where do we need to go? Journal of Adolescent Health. 2017; 60(3): 249-260
(22) Hickner J. It’s time to screen for bullying. Journal of Family Practice. 2017; 66(2).
(23) Ramos-Jimenez A, Wall-Medrano A, Esparaza-Del Villar O, Hernandez-Torres R. Design and validation of a self-administered test to assess bullying (Bull-M) in high school Mexicans: a pilot study. BMC Public Health. Available at: (Accessed February 18, 2018).
(24) Bonnano RA, Hymel S. Beyond hurt feelings: Investigation why some victims of bullying are at great risk for suicidal ideation Merrill-Palmer Q. 2010: 56: 420-440.
(25) Abaza, W. & Lu, M. Protecting Youth from Bullying: the Role of the Pediatrician. (Accessed February 18, 2018).
(26) U.S. Department of Health and Human Services. Understanding the Roles of Health and Safety Professionals in Community-Wide Bullying Prevention Efforts. hrsa_guide_health-and-safety-professionals_508v2.pdf (Accessed February 18, 2018).
(27) Barto S, Canazaro S, Cecil H, Molnar-Main S, Nutter M, Robel T, Schroeder D, Kiely Tyndale, A. Pennsylvania Bullying Prevention Toolkit Resources for Parents, Educators and Professionals Serving Children, Youth and Families. (Accessed February 18, 2018).