The entire K-12 content area or discipline of health education needs a new identity. My generation and older remembers health ed as the class where you learned to Just Say No, or that having sex means you'll have blisters on your genitalia. We remember reading Chapter 11 on smoking cigarettes and answering 5 questions at the end of the chapter to assess our knowledge that smoking is bad.
Unfortunately, health education has continued to be branded in peoples' minds as drug ed and sex ed. Those embarrassing activities or conversations that felt uncomfortable and forced. And sadly, due to a lack of professional development and support to people teaching health, how health was taught 30 years ago is still happening today.
If the goal of K-12 school health education is health literacy, the ability for students to use, analyze, interpret, access, advocate for resources, information and products that are health-enhancing, we still have a long way to go. Many of the textbooks, activities and instructional methods used are about teaching content and it's time we leave those practices behind.
Fortunately, over the years, we have more adolescent brain research to understand how the tween/teen brain makes decisions (or fails to). Teenagers behave in irrational and sometimes harmful ways and we question why. Science proves that many times, it's because making decisions and solving problems isn't thought out like the fully mature adult brain. Brains continue to mature through young adulthood, in fact, the frontal cortex, the area of the brain that controls reasoning and helps us think before we act, develops later.
An article on the Teen Brain: Behavior, Problem Solving, and Decision Making by the American Academy of Child and Adolescent Psychiatry shares that based on the stage of their brain development, adolescents are more likely to:
-act on impulse
-misread or misinterpret social cues and emotions
-get into accidents of all kinds
-get involved in fights
-engage in dangerous or risky behavior
Adolescents are less likely to:
-think before they act
-pause to consider the consequences of their actions
-change their dangerous or inappropriate behaviors
Some health teachers aren't aware of the research, nor are organizations, content specialists and non-profits that are writing content for health education. This is not to point blame, but rather, due to the lack of knowledge and professional development support. Much of the curriculum out there is still based on assuming youth can make great decisions every time if they just read about the risks and dangers.
Health education has gone through quite a paradigm shift. Teachers are just catching up. Understanding the adolescent brain is one piece of research that has been helpful, but another shift is skills-based instruction, learning, demonstrating and assessment. We've started to ask better questions...
- Does answering 5 questions correctly at the end of a tobacco unit mean that the student will have excellent refusal skills when offered a cigarette?
- Do students need to know the names of the germs in order to effectively wash their hands?
- Do students need to memorize the 206 bones of the body in order to fit a helmet properly, wear elbow/knee pads and wear a seatbelt consistently and correctly 100% of the time while riding in a vehicle?
Having the skill to memorize and recite Martin Luther King's exact words doesn't mean you understand the Civil Rights Movement. The answer is NO! to all of these questions above. If our goal is health literacy, every lesson, activity, demonstration, video, assessment should lead to healthy behavior outcomes (HBOs). And, if it doesn't- let it go! (You can find a list of HBOs in the HECAT, in the boxes on the front page of each module.
So, as we started to focus on skills in the classroom, we have also started to question what content is important? Benes and Alperin define functional information as information that is useable, applicable, and relevant. It is not arbitrary, traditional, or extensive. Functional information is the context in which the skills will be taught and the base for students’ developing functional knowledge. (Benes & Alperin, 2016)
I know, many of you are saying, I do skills-based. But, then I hear... it's important for a middle school student to know the body systems. To an extent, yes. But students aren't all going into pre-med in high school. In order to keep your heart healthy, you don't need to be able to diagram it, but rather, what behaviors help keep it healthy? And, how do you set some goals around those behaviors? What do students really need to know and demonstrate in order to lead to a healthy behavior outcome? Not much, actually. They need to practice skills, and be able to master those skills.
RMC Health's Health Skills Models define what mastery looks like for each of the skill standards by grade level band. For example, for Advocacy, high school students should:
• Students are able to identify a health-enhancing behavior using peer and societal norms.
• Students are able to demonstrate how they can influence and support others into making positive health choices.
• Students are able to work cooperatively with a group, analyze and solve various barriers they may encounter
• Students are able to adapt the health message to a specific audience.
• Students are able to reflect on the process and make adjustments as needed.
State Departments of Education are shifting to creating State Content Standards that are more focused on the skills and what mastery looks like for the skills and less on content, leaving that to local decision making. And, I agree with that. I think districts should spend the time reviewing any local data they can get their hands on and using student behavior data to drive/inform their local scope and sequences. Write down the concerning data points and determine which HECAT HBOs will address the concerning points. Which skill and knowledge expectations from the HECAT modules will address those student risk behaviors? Limit the number of units you teach. In fact, I suggest calling units the skills, not the content areas.
I believe instead of teaching mental/emotional health promotion in September, you teach accessing information with 2-3 content areas as context to the skill. And, you move on to another skill... maybe goal setting and you teach 2-3 content areas for context. The district scope and sequence process is guided by those initial concerning data points.
If we go this way, truly, it means we need to re-brand our discipline. Our education leaders still think of drug ed and sex ed. Many do not understand that the skills in health education are life skills (analyzing influences, accessing information, interpersonal communication, goal setting, decision making, self management and advocacy). At multiple events, I have heard from businesses and employers that they expect the people they hire to have communication skills, decision making skills, negotiation skills... that is HEALTH EDUCATION! But, nobody recognizes it, because we still have health educators that aren't here yet. They aren't teaching skills-based, so our field continues to be stereotyped that it's the same it was 30 years ago.
I want to re-brand our field. This is the first of many health education posts in this series. Upcoming topics include:
- What does a skills-based unit really look like?
- How do we re-brand our field?
- How does the ACES research support health education?
- How our legislators creating bills to teach content isn't helping the field.
- How to begin shifting our schools to CSHEIs- Comprehensive School Health Education Initiatives