Standards-based assessment in school health education

Our country's educational system is in the midst of an educational reform movement. Health education, like disciplines within the educational system, is involved in educational reform. Currently, the field is redefining performance standards that will guide health curricula, instruction, and assessment practices of school health programs across the United States. This paper presents an overview of the Council of Chief State School Officers Health Education Assessment Project and the National Health Education Standards. Discussion includes assessment and curricular issues facing health education and describes the assessment protocols developed by the Health Education Assessment Project. Suggestions are presented for using the standards and assessment data to improve school health education programs.

Introduction

It is an exciting time to be involved in education. Our nation's educational system is in the midst of immense curricular reform. The development and implementation of national standards and performance-based assessments aligned to those standards are changing the way educators view their curricula and programs. It is inevitable that significant change generates controversy, but controversy is both a challenge and an opportunity.

For more than a decade, states have attended to toughening state graduation standards, instituted professional testing of teachers, and introduced countless methods designed to improve teaching and learning (Jennings, 1995). The goal of this reform movement has been to prepare students to become responsible members of the community. The hope was that out of this reform movement, students would acquire knowledge of, and the ability to use, skills related to critical thinking, problem-solving, decision-making, communication, and literacy (Joint Committee, 1995). The cornerstone of the educational reform movement is that of "standards-based" education. Educators in subjects such as art, civics, English, foreign language, geography, history, mathematics, and science have all been writing content and performance standards (Nitko, 1995).

The development of national standards arose out of the need to develop national education goals. Jennings (1995) has asserted that, historically, local decisions in the development of curriculum have failed to bring about any significant improvement. As a result, the Goals 2000: Educate America Act has placed national goals and the support to attain them into law. Standards development represents the most recent effort to systematically identify essential content. Therefore the development of standards professes to have a major impact not only on teaching, but also on the format and focus of educational assessment (Jennings, 1995; Nitko, 1995).

Educational excellence in the traditional content areas, however, may not be sufficient to insure the future competitiveness of the country. There are a myriad of health concerns that threaten our nation. Alcohol, tobacco, and other drugs, poor nutritional practices, and stress are but a few of the things which impact negatively on social, educational, financial, medical, and family systems. More importantly, if a child is to master other subjects in school, that child must be healthy. There is a sufficient body of evidence which suggests that the absence of good health reduces academic performance (Carnegie Council for Adolescent Development, 1989). It is for the above reasons that national health education standards have recently been written (Joint Committee, 1995).

This paper will examine the historical development and implementation of a standards-based assessment related to the National Health Education Standards. Further, it will raise issues for the future of health education curricula, how these curricula are taught, and how they might change.

National Health Education Standards

Goals 2000 is an effort to transform American education. The outcome will be to establish a structure for education that will "focus on demanding academic standards and assessments and tighten the links between standards, curriculum, assessment and instruction" (Cohen, 1995, p. 751).

The National Health Education Standards, which have evolved as part of the educational reform movement, are crucial to the development of healthy children. The Standards will serve as a foundation for health curriculum development, health instruction, and assessment of student performance. The Standards represent a framework upon which each state or school district can develop curricula designed to create a "well-educated, literate person within the context of health" (Joint Committee, 1995, p. 5). The health-literature student will become a healthy, productive adult, and collectively, healthy adults will create a healthier United States. Healthy adults will be more productive in the workplace and will require less service from the already stressed health care system. The Health Education Standards (Joint Committee, 1995) are as follows:

1. Comprehend concepts related to health promotion and disease prevention

2. Access valid health information, products, and services

3. Practice health-enhancing behaviors and reduce health risks

4. Analyze the influence of culture, media,and technology on health

5. Use interpersonal communication skills to enhance health

6. Use goal-setting and decision-making to enhance health

7. Advocate for personal, family and community health.

Overview of the Health Education Assessment Project

The State Collaborative on Assessment and Student Standards (SCASS) Health Education Assessment Project is collaborative effort of thirty states, coordinated by the Council of Chief State School Officers (CCSSO), the U.S. Centers for Disease Control Division of Adolescent School Health (CDC/DASH), and Harcourt Brace Educational Measurement, the project contractor. The Health Education Assessment Project was initiated in 1992 as a mechanism for member states to pool their resources and experts to develop assessment materials and strategies. Assessment strategies have been identified that can be powerful tools for aligning health curricula, instruction, and assessment. Further, these assessment strategies serve to encourage exemplary classroom instruction, foster higher-order thinking and problem-solving, and promote relevant handson instruction.

The primary purpose of the project has been to develop and validate a "variety of assessment materials which are appropriate for use in large-scale assessments of health education at the elementary, junior-high/middle school, and high school levels to determine student status relative to the standards, as well as ... classroom assessments for use by teachers" (Council of Chief State Officers, 1994, pp. 1314). The framework for developing the materials included the recently-developed National Health Education Standards, which were generated during the same time period as Phase One of the CCSSO Health Education Assessment Project. Additional components of the assessment development framework came from the six areas of adolescent risk behavior identified by the CDC/DASH Youth Risk Behavior Survey (YRBS) of 1990 (Kolbe, Kann, & Collins, 1993). The YRBS assessed the prevalence of six categories of health risk behaviors usually established during adolescence which contribute to the leading causes of death and disease among adults. The Standards and risk behaviors were addressed in the context of six health topic areas:

alcohol and other drug use prevention

family and personal relationships

personal and consumer health

community and environmental health

nutrition and physical activity

unintentional and intentional injury prevention

The assessment items constructed for each of the content areas above were developed in multiple formats so that the assessments could accurately measure different aspects of health education outcomes. The assessments are directed toward skills and practices as well as knowledge and concepts. The formats included selected responses, constructed responses, performance events, and performance tasks. Each is explained in detail below.

Selected Response

Selected response (multiple-choice) items are intended to assess a broad range of knowledge and concepts. Each selected response item consists of a direct question or an incomplete question stem, followed by four response choices. Students are asked to select the correct answer and record its corresponding letter on the answer sheet. Selected response items span a range of difficulty levels and measure a range of conceptual knowledge.

Constructed Response

Constructed response items were created to assess understanding beyond simple recall and to enable a broader assessment of knowledge and skills than could be addressed by selected response items. Most constructed response performance items are designed to elicit responses ranging from one or two sentences to one or two paragraphs. The constructed response items could also prompt the student to produce a chart, graph, schematic diagram, or to respond in some other written form during the time provided for answering these items. The purpose of constructed response items was to present students with authentic contexts and prompt student responses that could not be obtained through selected responses.

Performance Events

Performance Events are designed to evaluate conceptual thinking and behavioral skills. Specifically, items were created to appraise decision-making, problem-solving, communication (including resistance/refusal skills), and stress management. Performance events are curriculum-embedded activities that students complete within a single class period. Although a performance event might include some limited group work, the emphasis is on an individual written response to a problem situation. This response could take the form of an extended response answer, a public service announcement script, an advertising copy, a schematic diagram (concept map), or any other form of writing that the student could reasonably be expected to complete. Performance events are intended to be grounded as much as possible in authentic student experiences, involving perceptions, beliefs, aspirations, and interpersonal interactions. The interactions are designed to be genuine for children and adolescents in their social and physical contexts, such as peers, family, school, and community environments.

Performance Tasks

Performance tasks, like performance events, are also curriculum-embedded projects They are unique in that students complete performance tasks over an extended period of time (in excess of one class period). Students may complete some work in groups, but the final product always includes one or more individually completed components. Although performance tasks require a knowledge of health facts and concepts specific to the context of the assessment, they are intended to assess thinking and behavioral skills, including decision-making, problem identification and problem-solving, communication (including resistance/refusal skills, and stress management. Task activities might include community or library research, brainstorming, group work, report writing, role playing or other behavioral demonstrations within the classroom setting, or the production of art work such as posters and brochures. As with performance events performance tasks are also intended to be grounded as much as possible in authentic student experiences, involving perceptions, beliefs, aspiration, and interpersonal interactions. The interactions are designed to be genuine for children and adolescents in their social and physical contexts, such as peers, family, school, and community environments.

Scoring Rubrics

The National Health Education Standards were developed around the essential knowledge and skills necessary for a student to be "health literate". The knowledge referred to includes "the most important and enduring ideas, issues and concepts related to achieving good health. Those skills include the ways of communicating, reasoning, and investigating which characterize a health-literate person" (Joint Committee, p. 9). With this in mind, holistic scoring rubrics were written to measure the knowledge and skill dimensions provided by the Standards. The scoring rubric describes the characteristics, or traits that define the points on the scoring scale based on fairness and consistency. According to White (1985), "this also allows the test to combine the best aspects of norm-referenced testing and criterion-referenced testing" (p. 24).

The National Health Education Standards served as a framework for developing scoring rubrics and designing a set of procedures for applying the same holistic rubrics to student work for each type of assessment within each health content area through all grade levels. The development of rubrics relied heavily upon the expertise of health educators to examine student responses and develop drafts of holistic scoring rubrics. The draft scoring rubrics were further validated by representatives of participating states in the CCSSO/SCASS Health Education Assessment Project.

The scoring rubric development procedures were designed to yield a complete scoring system. This system included a score scale with scale point descriptors, to identify exemplar responses that illustrated the score point descriptors, and commentary to explain why any exemplar response was scored as it was. In addition, other sample student responses were chosen for use in training readers to score the assessment.

Currently, preliminary data are being analyzed from Spring and Fall 1995 instrument tryouts. These data will be used to construct final instrument forms for a Spring 1996 instrument standardization, using representative samples from among the states participating in the CCSSO/SCASS Project.

Two types of secure large-scale assessment instruments (data for state use only) will be constructed for standardization. Each type of instrument form will be cross-topical and reflect coverage across the Health Education Standards. One form of the instrument is designed to measure mastery of knowledge through the use of traditional selected response items. The second type of instrument is a mixed form which consists of multiple choice as well as constructed response performance items. The constructed response performance items will require the students to apply their available skills and knowledge in relevant problem contexts. Both types of secure instruments will be made available to participating states so the states can use the secure instruments to help evaluate the status of their health education curricula.

The Project will also produce an item bank of nonsecure assessment exercises that teachers can use to improve health teaching and the health literacy of students in their classrooms. These nonsecure test items will consist of standardized performance items (performance events and tasks) related to specific topic areas, risk factors, and skill development in health education. With these items, students will be expected to access procedural knowledge, use it to reason productively, and demonstrate that they can create a product, e.g., a report, research paper, artistic creation, etc. These products might even be used as evidence of student work within a portfolio. The issues raised by performance-based assessment which is grounded in the National Health Education Standards are emerging. How these issues will be viewed and addressed are crucial to the profession.

Issues for Health Education

Health education is at a crossroad. Educational reform, the development of standards, and performance-based assessment may be leading health education toward redefinition All of these activities will shape what it is that students should be able to know and do. Health Education standards and the assessment process should also serve to create a framework to help schools develop instructional programs. These programs will enable students to acquire knowledge and skills which promote individual health and contribute to the improvement of the nation's health status. What follows is a discussion of some issues facing health education.

Traditionally, health education has been organized around health content areas. The emphasis has been largely placed on knowledge associated with the health education "basics" not on the advanced concepts of skills acquisition and behavior change. States and local education agencies will be able to use the YRBS data, the risk behaviors identified by CDC/DASH and assessment outcomes to develop curricula that will serve the youth of their communities. This approach will allow the local agencies to maintain flexibility and control over curricular issues. It will also ensure that the National Health Education Standards continue to provide impetus for the state and local agencies to move toward a more skillsbased approach to health education (Joint Committee, 1995).

Not to be overlooked is the impact standardsbased assessment will have on what and how health education is taught. The Association for the Advancement of Health Education plans on assisting with this reform by offering regional staff development workshops to inform professionals and administrators about the Standards.

Another issue will be the design and use of health education materials. Most health textbooks currently focus on knowledge, not behavior and skills. These texts will need revising to align with the reform movement and the assessment process. Teachers can expect to see a shift from textbooks organized around content areas and risk factors to the development of materials and activities that address the concepts and skills needed for a young person to be health literate. Moreover, we will see teachers and school districts seeking textbooks that support the assessment process and a skillsbased health education curriculum.

A curriculum issue facing the field is the integration of health content, knowledge, skills and strategies into the learning process. It is important for young people to develop healthy lives. Using the Standards to plan programs and evaluate outcomes will help achieve this goal. All of this reform is likely to have a profound influence on the classroom teacher. Gone are the days when only facts are distributed during a health classroom lecture. Learning, in general, and health education specifically, is now action-oriented or outcome-based. Students need life skills that they can take away from the classroom. For example, it is not enough to tell students about the hazards of smoking. They need to be empowered with decision-making skills, along with the ability to communicate their health-promoting decisions to other people who try to influence them to smoke.

School personnel will need to consider the interrelationships of the content areas, risk factors, and Standards. Should they all be considered of equal importance? This issue will have direct implications for any state or local district who will use the standards as a resource for transforming curricula. Who will determine the importance of one concept or skill over another? In most cases, traditional content areas have received equal coverage within textbooks but not within courses. With the paradigm shift to a skills-based approach to health, and with a more rigorous skills-based assessment program, the balance between content coverage and skills will remain an issue that needs to be resolved locally.

An area of concern might be the fact that standards-based assessment may lead to "teaching to the test". This will not be unexpected since every state now has some form of mandated testing (Cawelt, 1993). Jennings (1995) asserts that unlike other countries, public education in the United States tends to have a history of not training students on the material they will be tested upon. Now, learning and accountability are becoming so closely linked that a relationship between teaching and testing will improve the attainment of objectives. Should teachers teach to the tests? Again, this is an issue school districts and states will need to address according to content and standardsbased assessment.

Scoring issues represent another area to be resolved. States involved in this project will be using large-scale assessments. One of the main concerns voiced by health educators is whether the assessment instrument, particularly those sections which are not selected response items, must be scored by someone in the profession. Is it possible that an "educated generalist" could be trained to score performance items on the concepts and skills professed to be unique to the field? Will state and local educational agencies have the resources to use only health educators for this task? Will it be deemed necessary to elicit the data needed to contribute to the realignment of health education? The current trials will include opportunities for non-health educators to assess performance using the rubrics developed with the test items.

Many issues color the health education reform movement. Making sense of and creating understanding out of all this activity is the challenge facing school administrators and teachers of health education. Those involved in the reform movement must embrace the health education profession and invite its members into dialogue that will deepen our understanding of the curricular and assessment issues. Only through a combined effort will the field move toward higher levels of assessment literacy. The result will be a more positive environment for identifying the necessary tools for aligning curricula, instruction,a nd assessment in school health education.

References

Carnegie Council on Adolescent Development. (1989). Turning Points: Preparing Youth for the 21st Century. Washington, DC: Carnegie Council on Adolescent Development.

Cawelt, G., (ed.) (1993). Challenges and Achievements of American Education. Alexandria, VA: Association for Supervision and Curriculum Development. Cohen, D. (1995). What standards for national standards? Phi Delta Kappan, 76, 751-757.

Council of Chief State Officers. (1994, March). Request for Proposal: Technical Support Contractor for Assessment Development Services for Health Edu

cation Project. (RFP: 25301). Washington, D.C.: Author.

Jennings, J.F. School reform based on what is taught and learned. Phi Delta Kappan, 76, 765-769.

Joint Committee on National Health Education Standards. (1995). National Health Education Standards. (Available from the American Cancer Society, Inc., 1559 Clifton R., NE, Atlanta, GA 30329-4251.

Kolbe, L.J., Kann, L. and Collins, J. (1993). Overview of the Youth Risk Behavior Surveillance System. Public Health Reports, 108, Supplement 1, 2-10.

Nitko. A. (1995). Is the curriculum a reasonable basis for assessment reform? Educational Measurement: Issues and Practice, 14, 5-35.

White, E.M. (1985). Teaching and Assessing Writing, San Francisco: Jossey-Bass, Inc.

Willis, S. (November 1994). Making sense of national standards. ASCD Update, 36, 9.

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