Teacher-centered and discipline-based health education reform in California

At the state level, California has undertaken a series of efforts to strengthen school health programs through discipline- and teacher-centered educational reform. Four strategies are described: publication of the Health Framework for California's Public Schools, Kindergarten through Grade Twelve, the evaluation and adoption of basic instructional resources in grades K-8 that support and reinforce the guidelines set forth in the Health Framework, the initiation of three Physical Education-Health Projects for sustained teacher professional development and the development of comprehensive subject matter standards for teacher preparation programs in health science.

The primary causes of death, disease and social problems among young people in the United States today are largely the result of learned behaviors such as failure to use safety belts, internalized and externalized violence, tobacco, alcohol and other drug use, sexual behaviors, dietary behaviors and habits of physical inactivity (Behrman, 1994; Centers for Disease Control and Prevention, 1993). These national trends have led many educators to examine the role of schools in promoting the health of students (e.g., Kann, Collins, Pateman, Small, Russ, Kolbe, 1995) and call for stronger school health programs (e.g., Dryfoos, 1990; USDHHS, 1990; National School Boards Association, 1991). Others cite the inseparable links between students' academic success and their health: "accomplishment in academic subjects relies in part on understanding and practicing health-enhancing behaviors" (National School Health Education Coalition, 1995). At the state level, California has undertaken a series of efforts to strengthen school health programs through discipline- and teacher-centered educational reform (Little, 1993). In 1994 the California Legislature approved the Health Framework for California's Public Schools, Kindergarten through Grade Twelve as a guide and resource for the development of school health programs by local districts, schools, and teachers (California Department of Education, 1994). In the following year proposed health curricula were evaluated using the Health Framework and recommended to the State Legislature as part of its Health Instructional Resources Adoption process. In 1996, the subject areas of Health and Physical Education were added to an existing statewide network of subject matter projects providing opportunities for teacher professional development. In the fourth component of this reform effort, the state's Commission on Teacher Credentialing (CTC) developed new Standards of Program Quality and Effectiveness in Health Science for evaluating subject matter programs for prospective teachers, and drafted a set of Specifications for Assessing the Subject Matter Knowledge and Competence of Prospective Teachers. These four interrelated reform efforts are described more fully in this article as current representations of teacher-centered and discipline-based reform efforts to promote the health of young people through comprehensive school health programs. Health Framework

In California, the State Board of Education periodically develops subject specific curriculum frameworks for the purpose of publishing broad minimum standards and guidelines for educational programs kindergarten through grade twelve. Subject area frameworks describe the "scope and sequence" of what students learn in a given subject area. The frameworks also provide guidance regarding effective teaching strategies and assessment of student learning. Frameworks often include other information relevant to curriculum development such as accommodating student diversity, legal issues and requirements and teacher professional development. The frameworks are meant to be up-to-date, flexible resources for those who design, implement and evaluate K-12 instruction.

The central goal of California's new Health Framework is to develop health literacy in all students. Health literacy is "the capacity of an individual to obtain, interpret, and understand basic health information and services in ways which are health-enhancing-" Furthermore, individuals who are health literate develop a growing mastery of knowledge, skills and behaviors in four key areas critical to healthy living: Acceptance of personal responsibility for lifelong health

Respect for and promotion of the health of

others

Understanding the process of growth and development

Informed use of health-related information, products and services.

These four unifying ideas of health literacy are central themes throughout the framework with the curriculum drawing content from nine major areas: Personal health

Consumer and Community Health Injury Prevention and Safety

Alcohol, Tobacco and Other Drugs Nutrition

Environmental Health Family Living

Individual Growth and Development Communicable and Chronic Disease

Woven throughout the content areas are concepts related to mental and emotional health. The content areas are not distinct from the four unifying ideas. Rather, the unifying ideas are expressed throughout and connect all of the content areas. Emphasis is placed on developing lifelong positive health-related attitudes and behaviors.

The Health Framework calls for health education to be provided within the context of a comprehensive schoolwide health system (CSHS) consisting of eight integrated components (see also Allensworth & Kolbe, 1987):

Health Education

Physical Education

Nutrition Services

Health Services

Psychological and Counseling Services

Safe and Healthy School Environment

Health Promotion for Staff

Parent and Community Involvement

These eight components collaborate to develop and reinforce health knowledge, skills, attitudes, and behaviors and support health as an important priority at the school site. When planned and implemented in a consistent manner, the eight components achieve far more in promoting health literacy than is possible without a coherent integrated system. This system provides the school and community with a sound approach for preventing student health problems and dealing with them in a systematic way when they occur. (Refer to Table 1 for more information on the Health Framework.) Health Instructional Resources Adoption In October 1995, the California State Board of Education approved the adoption of new instructional resources for health education for grades K-8 based on the guidelines set forth in the Health Framework. According to Dr. Del Alberti, Chairperson of the Health Subject Matter Committee for the state's Curriculum Development and Supplemental Materials Commission, "state adopted instructional resources put the Health Framework into action in the classrooms."

Using criteria developed from the Health Framework, twenty-four Instructional Resources Evaluation Panel (IREP) members, appointed by the State Board of Education, evaluated the resources against the Health Framework using the K-8 Health Instructional Resources Evaluation Form approved by the Board. Additionally, the instructional resources submitted by publishers were on display at the twenty-six Learning Resources Display Centers located throughout the state, allowing broad public review. The Curriculum Commission used the IREP report, considered public comments received in writing and at two public hearings and reflected on their own individual study of the submitted resources to develop their recommendations to the Board. Based on the recommendations of the Curriculum Commission, the State Board of Education adopted the basic instructional resources in health described in Table 2. Supplemental resources, or resources covering less than the entire course content, were not separately evaluated during the process, nor were they adopted.

The instructional resources in health that have been adopted share several notable strengths: (1) The nine content areas of health education are interwoven and linked with learning in other academic disciplines; (2) Students' personal and cultural experiences are used in problem-solving and decision making; (3) Students are engaged in authentic inquiry and reflection; (4) Health instruction in the classroom is connected with the comprehensive school health system, the home and the broader community.

The adoption of instructional resources allows school districts in California to use their Instructional Materials Fund or IMF to purchase materials for kindergarten thorough grade eight according to the state Board of Education expenditure policy. The policy states that seventy percent of the state IMF funds allocated to a school district must be spent on state-adopted instructional materials, twenty-five percent of IMF funds may be spent on materials which are non-adopted materials which have passed legal compliance review at the state level, and five percent may be spent on any instructional material that has passed a state or local level legal compliance review.

Physical Education-Health Subject Matter Project

The subject areas of Physical Education and Health were recently added to California's network of discipline-based teacher professional development projects. This model of professional development proposes that the improvement of classroom instruction will be grounded in teachers' deeper understanding of and relationship with academic disciplines. Furthermore, the model proposes that teachers who possess a strong disciplinary base will derive more benefit from other professional development activities that focus on teaching skills or introducing teachers to new materials. Therefore, California's subject matter projects aim to provide opportunities for teachers to gain both disciplinary knowledge and pedagogical skills through sustained, authentic practice of the disciplines they teach. Teachers participating in the subject matter projects are immersed in the traditions, ideas, practices and perspectives of academic disciplines. They engage in challenging discipline-based learning activities that are appropriate for their own intellectual growth. It is the goal of the subject matter projects that authentic, adult-level practicing of disciplines will inspire and empower teachers to create similar learning experiences for their students (St. John,1993).

In addition to providing teachers with challenging intellectual and reflective activities, the subject matter projects promote an environment and culture in which to develop and support teacher leadership. "Teachers teaching teachers" is a central tenet in which teachers share their knowledge, experience and reflections with each other. A supportive community of learners is created while simultaneously placing demands on teachers for involvement and leadership. Teachers take on a central role in creating and directing the work of the projects.

Three local site California Physical Education-Health Projects (CPE-HP) were funded in 1996. The sites are located in the broader Los Angeles, San Diego and San Francisco Bay areas. While each CPE-HP will develop its own culture, content and traditions, they all reflect the model of discipline- and teacher-centered professional development established by existing projects. Each site will undertake intensive summer institutes in which teachers participate in authentic, stimulating experiences with physical education and health education. Teachers will examine personal health beliefs and practices, set and work towards personal health and fitness goals and support each other in these endeavors. The institutes will be distinguished by a variety of physical activities, cooking, eating and analyzing nutritious meals, the integration of health and physical education with other academic disciplines including literature, writing, math, science and social studies, and visitations to exemplary community health and education programs. They will document their work to enhance self-reflection and share with others.

The work of the summer institutes will be extended during fall and spring "follow-up" activities focusing on leadership and building networks of teachers skilled in health and physical education. Project teachers who have had authentic practice and teaching of the disciplines of health and physical education conduct workshops at their schools, develop and disseminate effective units of health instruction and participate in school, district and statelevel professional activities. It will be these teachers who translate the activities of the CPEHP into school and classroom experiences for students. It is their leadership that will extend the work of the CPE-HP by creating a broader community of educators who advocate for and assist to develop healthy schools throughout California. (Refer to Table 1 for additional information about the CPE-HP.)

Standards for Teacher Preparation and Assessment

One aspect of educational reform that has been given less attention is the subject matter preparation of teachers. In 1995 the state's Commission on Teacher Credentialing established the Health Science Teacher Preparation and Assessment Advisory Panel composed of educators and other professionals particularly qualified by training and experience to know what subject matter knowledge and abilities are required for successful teaching performance in health science. The panel developed new Standards of Program Quality and Eff"ectiveness in Health Science for reviewing and evaluating subject matter programs in Califomia's postsecondary institutions that address the pedagogical knowledge needed by prospective teachers of health. Each of the sixteen proposed standards is accompanied by a rationale and a set of factors to be considered by evaluators who determine whether each standard is met. The proposed standards have incorporated the ten traditional health education content areas, seven areas of competency identified for entry-level health educators and six categories of risk-taking behaviors identified as contributing to the leading causes of death and disease. In addition, two new standards that have been proposed include

Comprehensive School Health System and Professionalism and Ethics. The Health Science ance for the professional preparation of school health educators who are enrolled in California colleges and university programs entitled Health Science, Health Education, and Health Promotion, among others. Within California, a teaching credential in the single subject area of Health Science is equivalent to the preparation of school health educators, who are credentialed to teach health topics in departmentalized or single subject classes in secondary schools. All California colleges and university health science teacher preparation programs will be regularly reviewed based on the standards. The second task of the panel was to draft a set of Specifications for Assessing the Subject Matter Knowledge and Competence of Prospective Teachers. The panel generated a content outline based on the proposed standards to guide the development of a new multiple-choice and constructed response subject matter examination for health science. The Commission on Teacher Credentialing will formally adopt the program standards and begin the examination process in 1996. This examination will not be required for a Health Science Teaching credential. However, teachers who already possess a credential in another subject area and wish to add Health Science as a supplementary authorization will have the option of taking additional coursework or passing the new Health Science examination. This will increase the available pool of credentialed health educators in California's public schools as well as make teachers more competitive on the job market as they increase the range of their skills. Conclusion

California has undertaken a series of interrelated efforts to strengthen comprehensive school health systems within the scope of broader educational reforms. One strategy has been the development of the Health Framework for California's Public Schools that provides guidelines for the development of health instruction and content standards. A second strategy has been the evaluation and adoption of basic instructional resources in grades K through 8 that support and reinforce the guidelines set forth in the Health Framework. A third strategy has been the initiation of three Physical Education-Health Projects for sustained professional development and educational reform that is driven by teachers and embedded in rigorous and authentic participation in health and physical education activities. A fourth strategy is the development of new standards to review and evaluate Health Science programs in institutions of higher education preparing secondary school health educators. laken together, these activities set the stage for building the capacity of teachers to participate in and lead state educational reform in their classrooms, schools and districts. Moreover, these strategies contribute to the ultimate goal of educational reform - to increase student achievement. For the promise of health education reforms to be fully realized, however, serious consideration must be given to state legislation making health education a high school graduation requirement, thus ensuring its place in the "core curriculum" for all high school students in California. Similarly, the evaluation of student competencies in health should be carefully thought about in the development of the state's new assessment program. We applaud the noteworthy effort that California has made to improve the health outcomes of young people by strengthening school health programs. And we watch with interest the progress of these projects and future efforts to further institutionalize comprehensive health education within California's school system.

No knowledge is more crucial than knowledge about health. Without it, no other life goal can be successfully achieved The Carnegie Foundation Report on Secondary Education in America.

Table Ommitted

Teen Health, Course I& 2, Grade Levels 6-8; Glencoe/McGraw Hill, (818) 898-1391. This two-course program includes a student and teacher's text for each level. Each course is accompanied by a variety of other materials, including resource books; assessment materials, including software; a videodisk; audiocassettes; a video kit; parent letters and activities in Spanish; and summaries, parent letters and activities in Vietnamese, Cantonese, Hmong and Cambodian. The unifying ideas are consistently supported by current and accurate science-based content throughout all components of the program including the technology-based resources, and there are many dear references to current research.

Healthy You! Grade Levels 4-6: Harcourt Brace, (714) 470-7945. This program includes three soft-bound students books per grade level; a teacher's guide; and a variety of other resources; including assessment materials; letters to parents in English, Spanish, Vietnamese, Cantonese, Hmong, and Cambodian; video tapes; teacher resources information; and computer software. The approach encourages students to work together to explore and seek solutions to real life issues. Health information is integrated with other academic areas. Personal responsibility for one's own health and the health of others is emphasized. Comprehensive Health. Grade Levels K-3: Health Promotion Wave. (203) 968-9781. This program includes teacher's manuals, student materials in English for all grade levels and in Spanish for kindergarten through grade two, and a health kit at each grade level containing a variety of materials, including posters, games, literature books, videos, evaluations, and parent components. The integration of health content with language arts through the use of high-quality literature is particularly noteworthy.

Primarily Health. Grade Levels K-3: Wright Group. (800) 523-2371. This program includes twelve self-contained health units including Big Books, Teacher's Guides, little books, audio cassettes, pictures, posters, and manipulatives. Student reading and audiocassette materials are also in Spanish. Three units contain videos. Two CD-ROMs are also included. The units of instruction address health content through a strong language arts-based program that stresses learning lifelong health habits and attitudes.

Note: Adapted from the Curriculum Commission's report to the State Board of Education, Recommendations for the Health Instructional Resources Adoption.

References

Allensworth, D.D., & Koble, L.J. (1987). The comprehensive school health program: Exploring an expanded concept. Journal of School Health, 57(10), 409-412. Behrman, R.E. (1994). The future of children: Critical health issues for children and youth. Los Altos, CA: The David and Lucile Packard Foundation. California Department of Education. (1994). Health framework for California public schools. Sacamento, CA: Author.

California Department of Education. (1995). Training manual for Instructional Resources Evalution Panel members, 1995 Adoption California Basic Instructional Resources, Health. Sacramento, CA: Author. Centers for Disease Control and Prevention (CDC). (1993). Chronic disease and health promotion MMWR reprints: 1990-1991 Youth Risk Behavior Surveilance System. Atlanta, GA: Author.

Curriculum Development and Supplemental Materials Commission. (1995). Recommendations for the health instructional resources adoption, report to the California State Board of Education. Sacamento, CA: Author.

Dryfoos, J. (1990). Adolescents at risk: Prevalence and

prevention. New York, NY: Oxford University Press. Kann, L., Collins, J.L., Pateman, B.C., Small, M.L., Ross, J.G., & Kolbe, L.J. (1995). The School Health Policies and Programs Study (SHPPS): Rationale for a nationwide status report on school health programs. Journal of School Health, 65(8), 291-294. Little, J.W. (1993). Teachers' professional development in a climate of educational reform. Educational Evaluation and Policy Analysis, IS(2),129-151. National Schools Boards Association. (1991). School health: Helping children leam. Alexandria, VA: Author.

Table Ommitted

National School Health Education Coalition. (1995). Be a leader in academic achievement. Washington, D.C.: Author

St. John, M. (1993). Studies of the California Subject Matter Projects. An annual update and progress report: Exploring the rationale for state investment. Sacramento, CA: Inverness Research Associates.

U.S. Department of Health and Human Services (USDHHS). (1990). Healthy people 2000: National health promotion disease prevention objectives (DHHS Publication no. [PHS] 90-50212). Washington, DC: U.S. Government Printing Office.

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