California State Framework

California State Framework
Health Framework
for California
Public Schools
Kindergarten Through
Grade Twelve
California
Adopted by the C
alifornia SState
tate Board of Education, 2002
Published by the California Department of Education
Sacramento, 2003
Health Framework
for California
Public Schools
Kindergarten Through
Grade Twelve
Developed by the
Curriculum Development and Supplemental
Materials Commission
Adopted by the
California State Board of Education
Published by the
California Department of Education
Publishing Information
When the Health Framework for California Public Schools: Kindergarten
Through Grade Twelve was adopted by the California State Board of
Education on March 6, 2002, the members of the State Board were the
following: Reed Hastings, President; Joe Nuñez, Vice-President; Robert
Abernethy; Donald G. Fisher; Susan Hammer; Nancy Ichinaga; Carlton
Jenkins; Marion Joseph; Vicki Reynolds; Suzanne Tacheny; and Erika
Goncalves.
The framework was developed by the Curriculum Development and
Supplemental Materials Commission. (See pages vi–xi for the names of the
members of the commission and the names of the principal writers and others
who made significant contributions to the framework.)
This publication was edited by Dixie Abbott, working in cooperation with
Greg Geeting, Assistant Executive Director, State Board of Education, and
Thomas Adams, Director, Thomas Akin, Consultant, and Christopher Dowell,
Consultant, Curriculum Frameworks and Instructional Resources Division,
California Department of Education. It was designed and prepared for printing
by the staff of CDE Press, with the cover and interior design created and
prepared by Cheryl McDonald. Typesetting was done by Jeannette Huff.
The framework was published by the Department of Education, 1430 N Street,
Sacramento, California (mailing address: P.O. Box 944272, Sacramento, CA
94244-2720). It was distributed under the provisions of the Library
Distribution Act and Government Code Section 11096.
© 2003 by the California Department of Education
All rights reserved
ISBN 0-8011-1574-4
Ordering Information
Copies of this publication are available for $17.50 each, plus shipping and
handling charges. California residents are charged sales tax. Orders may
be sent to the California Department of Education, CDE Press, Sales Office,
P.O. Box 271, Sacramento, CA 95812-0271; FAX (916) 323-0823. Prices on
all publications are subject to change.
An illustrated Educational Resources Catalog describing publications, videos,
and other instructional media available from the Department can be obtained
without charge by writing to the address given above or by calling the Sales
Office at (916) 445-1260 or (800) 995-4099.
iii
Contents
Foreword ........................................................................................................ v
Acknowledgments .......................................................................................... vi
Chapter 1—The Vision: Health Literacy, Healthy Schools,
Healthy People ......................................................................................... 1
Schools and Health..................................................................................... 4
Unifying Ideas of Health Literacy ............................................................... 6
The School’s Role in Promoting Children’s Health .................................... 7
Collaboration to Benefit the Whole Child .................................................. 9
The Benefits of Prevention ....................................................................... 10
Structures for a Coordinated School Health System ................................. 11
Positive Youth Development, Asset Development, and Resiliency ............ 16
Use of Evaluation and Survey Data in School Health Programs................ 21
California’s Healthy Start Initiative .......................................................... 27
Chapter 2—Developing Health Literacy in the Classroom
and in the School ....................................................................................
Elements of Successful Health Education .................................................
Effective Implementation .........................................................................
Importance of Research-Based Programs ..................................................
Life Skills and Positive Behaviors ..............................................................
Health Education Planning and Development .........................................
Needs of Special Populations ....................................................................
31
32
35
41
43
44
48
Chapter 3—Health Education ................................................................... 55
I. The Health Curriculum: An Overview ............................................ 56
II. Content Areas, Kindergarten Through Grade Twelve ..................... 58
Personal Health ................................................................................ 58
Consumer and Community Health .................................................. 58
Injury Prevention and Safety ............................................................. 59
Alcohol, Tobacco, and Other Drugs ................................................. 59
Nutrition .......................................................................................... 61
Environmental Health ...................................................................... 62
Family Living .................................................................................... 63
Individual Growth and Development ............................................... 65
Communicable and Chronic Diseases ............................................... 65
III. Expectations and Content, by Grade Level ..................................... 67
Structure of the Instructional Guidelines for Each Grade .................. 67
Kindergarten Through Grade Three .............................................. 67
Grades Four Through Six .............................................................. 82
Middle School ............................................................................... 98
High School ................................................................................ 122
Scope and Sequence of Health Instruction ...................................... 149
iv
Chapter 4—Beyond Health Education ....................................................
Components of a Coordinated School Health System ............................
Interrelationships of Components ..........................................................
Linkages Within the School ....................................................................
Involvement of the School, the Family, and the Community ................
Local Advisory or Coordinating Councils ...............................................
Health Services in Schools ......................................................................
Mental Health Issues in Schools .............................................................
The California Public Mental Health System and Schools ......................
Safe Schools and Violence Prevention .....................................................
Suicide Prevention ..................................................................................
The School Health Ship .........................................................................
183
184
189
189
193
195
196
200
203
205
210
211
Chapter 5—Assessment of Health Literacy .............................................
Student Assessment ................................................................................
Staff Assessment .....................................................................................
System Assessment..................................................................................
215
217
219
220
Chapter 6—Criteria for Evaluating Instructional Materials
for Kindergarten Through Grade Eight .............................................. 221
Criterion 1: Health Content/Alignment with Curriculum ...................... 222
Criterion 2: Program Organization ......................................................... 224
Criterion 3: Assessment .......................................................................... 225
Criterion 4: Universal Access .................................................................. 225
Criterion 5: Instructional Planning and Support .................................... 225
Appendixes
Appendix A—Selected Legislative Code Sections .................................... 227
Appendix B—Project TEACH Recommendations on
Preservice Teacher Training in Health Education .............................. 238
Appendix C—Guidelines for Evaluating Web Sites ................................ 240
Works Cited .............................................................................................. 243
Additional References and Resources ......................................................... 249
v
Foreword
T
he California State Board of Education and the California Depart­
ment of Education are pleased to present the 2003 edition of the
Health Framework for California Public Schools, adopted by the State
Board of Education on March 6, 2002. This edition contains the content of the
1994 framework and provides updated information on curriculum develop­
ment, health literacy, positive asset development among youths, research-based
programs, school safety, and special student populations.
In the years since the approval of the 1994 framework, educators have
come to understand the importance of positive approaches to health education.
Curriculum that is based on the updated framework will help students build
strong relationships with their families and communities while strengthening
their resiliency and personal decision-making skills for healthy living. Health
education within the context of a coordinated school health program contrib­
utes to results such as decreased tobacco use and improved choices about
nutrition and physical activity.
The framework includes an important change for teachers as it gives greater
guidance on what should be taught at each grade level. At the end of Chapter 3,
“Health Education,” the Grade-Level Emphases Chart suggests specific topics
to emphasize in each grade. Although the topics appeared in the 1994 edition,
they have been placed in specific grades for the first time in this new edition.
While the 2003 framework reflects many positive developments in health
education, it also addresses the concerns resulting from tragic events. Noteworthy are the updated discussions of school safety, mental health, and violence
prevention. We cannot stress enough the need to make schools safe, free from
intolerance, and a place for learning.
The framework has been strengthened by a discussion about research-based
programs and the use of survey data. Rigorous criteria for evaluating programs,
derived from the Centers for Disease Control and Prevention and the Califor­
nia Department of Education publication series Getting Results, are presented to
give health educators the tools they need to select the most effective programs
for educating students.
Good health, by definition, requires lifelong learning. A better life for our
youths begins with teaching them from an early age how to be physically and
mentally healthy.
JACK O’CONNELL
State Superintendent of Public Instruction
REED HASTINGS
President, State Board of Education
vi
Acknowledgments
T
he Health Framework for California Public Schools, Kindergarten
Through Grade Twelve, was adopted by the California State Board of
Education on March 6, 2002. On October 7, 1999, the State Board
of Education directed the California Department of Education and the Cur­
riculum Development and Supplemental Materials Commission (Curriculum
Commission) to retain the content of the 1994 framework while updating it
with the development of sixteen health topics.* The names of the persons who
contributed to the development of the Health Framework, starting with those
who contributed to the 2003 edition, are as follows:
Health Framework (2003 edition)
The following persons served on the Curriculum Commission when the
2003 Health Framework was recommended to the State Board of Education
on January 18, 2002:
Susan Stickel, Chair
Norma Baker
Catherine Banker
William Brakemeyer
Mary Coronado Calvario
Edith Crawford
Milissa Glen-Lambert
Lora L. Griffin
Sandra Mann
Veronica Norris
Leslie Schwarze
Dale Webster
Karen S. Yamamoto
Note: The titles and affiliations of persons named in this section were current at the time the document
was developed.
* The following chapters contain the newly developed health topics: Chapter 1 (definitions
of terms; schools and health; positive youth development, asset development, and resiliency; use
of evaluation and survey data in school health programs; California’s Healthy Start Initiative);
Chapter 2 (importance of research-based programs; life skills and positive behaviors; health
education planning and development; needs of special populations); Chapter 3 (scope and
sequence of health instruction); and Chapter 4 (local advisory or coordinating councils; health
services in schools; mental health issues in schools; the California public mental health system
and schools; safe schools and violence prevention; suicide prevention).
vii
Guidance for the development of the 2003 framework was provided by the
Chair, Health Subject Matter Committee of the Curriculum Commission:
Veronica N. Norris, Tustin, California
Other members of the Health Subject Matter Committee were:
Roy Anthony, Valhalla High School, Grossmont Union High School
District
Milissa Glen-Lambert, Monlux Elementary School, Los Angeles Unified
School District
Lora L. Griffin, Retired Educator, Sacramento City Unified School District
Richard Schwartz, Torrance High School, Torrance Unified School District
Susan Stickel, Elk Grove Unified School District
Karen Yamamoto, Westmore Oaks Elementary School, Washington
Unified School District
Coordination of the development of the 2003 framework was provided by:
Sherry Skelly Griffith, Assistant Superintendent, Curriculum Frameworks
and Instructional Resources Division, California Department of
Education; and Executive Secretary, Curriculum Commission
Thomas Adams, Administrator, Curriculum Frameworks and Instructional
Resources Division, California Department of Education
The principal writer was Hank Resnik.
Coordination of content was provided by:
Jeri Day, Health Education Specialist, School Health Connections,
California Department of Education
Caroline Roberts, Administrator, School Health Connections,
California Department of Education
Chapter 3, “Health Education,” contains the “Grade-Level Emphases
Chart,” developed in part by a focus group of educators in July 2001.
Members of that focus group were:
Glenda Bensussen, Los Angeles Unified School District
Phyllis Camp, San Francisco Unified School District
Meri Fedak, Long Beach Unified School District
Tracy Harrington, Long Beach Unified School District
Jane Huston, Mount Shasta Unified School District
Robert LaChausse, California State University, San Bernardino
Tracy Parker, Galt Unified School District
Ann Rector, Long Beach Unified School District
Enrique Robles, Los Angeles Unified School District
Deborah Wood, Healthy Kids Resource Center
viii
Contributions to the completion of the framework were made by the
following staff members in the Curriculum Frameworks and Instructional
Resources Division, California Department of Education:
Thomas Akin, Consultant
Christopher Dowell, Consultant
Teri Ollis, Staff Services Analyst
Tonya Odums, Support Staff
Lino Vicente, Support Staff
Beverly Wilson, Support Staff
Additional staff members from the California Department of Education who
contributed to the completion of the framework were:
Jackie Allen, Counseling and Student Support Services
Donna Bezdecheck, School Health Connections
John Boivin, Educational Options
Linda Davis-Alldritt, School Health Connections
Rona Gordon, Child, Youth, and Family Services
Mary Lu Graham, Healthy Start and After-School Partnerships
Joanna Knieriem, School Health Connections
Jan Lewis, Nutrition Services
Vivian Linfor, Safe Schools and Violence Prevention
Karen Lowrey, Counseling and Student Support Services
John Malloy, Healthy Start and After School Partnerships
Doug McDougall, Healthy Start and After School Partnerships
Paul Meyers, Counseling and Student Support Service
Patricia Michael, Special Education
Roberta Peck, Healthy Start and After School Partnerships
Rachel Perry, Evaluation
Ronda Simpson-Brown, Youth Education Partnerships
Bill White, Safe Schools and Violence Prevention
Bonnie Williamson, Safe Schools and Violence Prevention
Milt P. Wilson, Retired Annuitant
Dianne Wilson-Graham, School Health Connections
Other contributors included:
Gregory Austin, Director, Health and Human Development Program,
WestEd
Dave Neilsen, California Department of Mental Health
Jackie Russum, Healthy Kids Resource Center
Deborah Wood, Healthy Kids Resource Center
ix
Health Framework (1994 edition)
Guidance for the development of the 1994 framework was provided by the
Chair, Health Subject Matter Committee, Curriculum Commission:
Eugene Flores, Arroyo Grande High School, Lucia Mar Unified School
District
The 1994 Health Curriculum Framework and Criteria Committee,
composed of nine California health educators and health professionals, was
chaired by:
Justin Cunningham, Healthy Kids Regional Center, Region IX, San Diego
Office of Education
The other committee members were:
Claudia Baker, Los Angeles Unified School District
Diane Chagnon, Somerset Senior Elementary School, Sylvan Union
Elementary School District
Linda Davis-Alldritt, Elk Grove Unified School District
Ellen Jones, Alameda County Office of Education
Shirley Knight-Lopez, Pajaro Valley Unified School District
Nathan Matza, Westminster High School, Huntington Beach Union High
School District
Cornelia Owens, Los Angeles Unified School District
Marilyn Wells, Alhambra City Elementary and High School District
Coordination for the development, field review, and preparation of the
1994 framework was provided by:
Glen Thomas, Curriculum Frameworks and Instructional Resources Office,
California Department of Education
The principal writer of the field-review version of the framework was
William Boly.
Chapter 3 of the 1994 framework was based on preliminary work done by
a committee of educators during 1989–90. Members of the model curriculum
guide committee were:
Peter Cortese, California State University, Long Beach
Justin Cunningham, San Diego County Office of Education
Gus Dalis, Los Angeles County Office of Education
Margaret Leeds, Beverly Hills High School, Beverly Hills Unified School
District
Ric Loya, California Association of School Health Educators
Pamela Luna, Riverside County Office of Education
Priscilla Naworski, Comprehensive Health Education Resource Center,
Alameda County Office of Education
x
Staff support from the California Department of Education to the model
curriculum guide committee was provided by:
Amanda Dew Manning, Healthy Kids, Healthy California Office
Jennifer Rousseve, Healthy Kids, Healthy California Office
Jacqui Smith, Healthy Kids, Healthy California Office
Detailed information for Chapter 3 was provided by:
Ruth Bowman, Washington Unified School District
Justin Cunningham, San Diego County Office of Education
Joan Davies, Alameda County Office of Education
Pamela Luna, Riverside County Office of Education
Priscilla Naworski, Comprehensive Health Education Resource Center,
Alameda County Office of Education
Jean Varden, Ventura County Office of Education
The final stages of the development of the 1994 framework were directed by:
Justin Cunningham, San Diego County Office of Education
Ellen Jones, Alameda County Office of Education
Critical support was provided by:
Nancy Sullivan, Curriculum Frameworks and Instructional Resources
Office, California Department of Education
The State Board of Education’s liaisons to the Curriculum Commission,
Kathryn Dronenburg and Sark “Bill” Malkasian, provided invaluable
direction and support in the final stages of development of the framework.
The principal writer of the final version of the 1994 framework was
Hank Resnik.
Staff support from the California Department of Education was
provided by:
Ples Griffin, Health Promotion Office
Jennifer Rousseve, Healthy Kids, Healthy California Office
Robert Ryan, Healthy Kids, Healthy California Office
Nancy Sullivan, Curriculum Frameworks and Instructional Resources
Office
In addition, many other persons in the California Department of
Education provided assistance during the development process of the
1994 framework, most notably:
Janice DeBenedetti, Home Economics Education Unit
Mary Lu Graham, Migrant Education Program
Emily Nahat, Interagency Youth and Children Services
Dennis Parker, Categorical Programs Division
Roberta Peck, Nutrition and Food Service Education Section
Jacqui Smith, Healthy Kids, Healthy California Office
xi
Janine Swanson, Special Education Division
Kathy Yeates, Healthy Kids, Healthy California Office
Members of the Health Subject Matter Committee of the Curriculum
Commission responsible for overseeing the development of the 1994 framework, including the field review, were:
Del Alberti, Washington Unified School District
Gloria Blanchette, Sacramento Unified School District
Dan Chernow, Pacific Theaters Corporation, Los Angeles
Bruce Fisher, Fortuna Elementary School, Fortuna Union Elementary
School District
Eugene Flores (Chair, 1992), Arroyo Grande High School, Lucia Mar
Unified School District
Harriet Harris, Del Mar Elementary School, Fresno Unified School District
Charles Kloes, Beverly Hills High School, Beverly Hills Unified School
District
Charles Koepke, Upland Junior High School, Upland Unified School
District
Tom Vasta (Chair, 1991), Elk Grove Unified School District
Vivian Lee Ward, Sequoia High School, Sequoia Union High School
District
We need to make a national commitment to health education
that is far greater than the routine and merely ceremonial attention
we usually give it. . . . We need to teach youngsters that they must
take charge of their health—all of their lives. . . . And we must
do more than teach; we must set an example in the way we live.
—C. Everett Koop, M.D.
Koop: The Memories of America's Family Doctor
C HAPTER 1
The Vision:
Health Literacy,
Healthy Schools,
Healthy People
2
Chapter 1
The Vision:
Health Literacy,
Healthy Schools,
Healthy People
Emphasis must be
placed on developing
lifelong, positive healthrelated attitudes and
behaviors.
I
n recent decades Americans have successfully coped with serious health
problems. Many diseases and illnesses, such as polio and diphtheria, that
once threatened vast numbers of people can now be prevented or treated
effectively. As a result, a growing percentage of the population is staying
healthier and living longer. However, far too many children and youths die
because of injuries that are unintentional or result from violent behavior, and
others compromise their health through unhealthy behaviors, such as using
alcohol, tobacco, or other drugs. In addition, diseases brought on by unhealthy
behaviors often cause the premature deaths of adults. Responding to these
health problems requires a commitment to health education. Individuals must
understand the role they must play in protecting, maintaining, and promoting
their health and the health of others through healthy behaviors and choices.
Two factors central to this new approach to health education are as follows:
• Emphasis must be placed on developing lifelong, positive health-related
attitudes and behaviors. Such attitudes and behaviors begin to be
developed in the home. But the school, working in close partnership
with families and communities, is also an appropriate arena for develop­
ment and reinforcement.1
• Health education in the schools must be supported by a comprehensive
schoolwide system to promote children’s health and must be developed
and sustained by the collaborative efforts of school personnel, parents,
school board members, community leaders, and health and social
services agencies and providers.
Health literacy is “the
capacity of an individual
to obtain, interpret, and
understand basic health
information and services
and the competence to
use such information and
services in ways which
are health-enhancing.”
—Journal of Health
Education
When these elements are in place, children and youths can be helped to
develop a lifelong commitment to their own health and well-being.
Throughout this framework the knowledge, skills, and behaviors needed for
healthy living are referred to as health literacy. According to the Association for
the Advancement of Health Education, health literacy is “the capacity of an
individual to obtain, interpret, and understand basic health information and
services and the competence to use such information and services in ways
which are health-enhancing.”2 A health-literate person understands scientifi­
cally based principles of health promotion and disease prevention, incorporates
that knowledge into personal health-related attitudes and behaviors, and makes
good health a personal priority.
This framework is based on the premise that health literacy is as important
in today’s complex, challenging world as linguistic, mathematical, and scien­
tific literacy. The major goal of this framework is to describe health education
and schoolwide health promotion strategies that will help children and youths
1
In this document the term community includes religious institutions, community leaders, businesses,
health-care providers, and other agencies and organizations involved in children’s development.
2
“Report of the 1990 Joint Committee on Health Education Terminology,” Journal of Health
Education, Vol. 22, No. 2 (1991), 104.
3
become health-literate individuals with a lifelong commitment to healthy
living.
Because every aspect of health is tangibly connected to life and students’
experiences, effective health education provides abundant opportunities for
engaging students in purposeful learning. Health-literate students will make a
commitment to their own health and the health of others, enhancing school
efforts to involve students in collaborative, meaningful learning experiences.
The following commonly used terms have been defined to facilitate the
use of this framework. They were adapted from a report of the Association for
the Advancement of Health Education and have been updated from the 1994
edition of the Health Framework.
Chapter 1
The Vision:
Health Literacy,
Healthy Schools,
Healthy People
Health. A state of complete physical, mental, and social well-being, not
merely the absence of disease and infirmity.
Health literacy. The capacity of an individual to obtain, interpret, and
understand basic health information and services and the competence to use
such information and services in ways that are health-enhancing.
Coordinated school health system (updated term for comprehensive school
health system as recommended in the books Health Is Academic and Schools
and Health ).3 An organized set of policies, procedures, and activities
developed and implemented through a collaborative effort that includes
parents, the school, and the community. The system is designed to protect
and promote the health and well-being of students and staff. A coordinated
school health system includes health education, physical education, health
services, nutrition services, psychological and counseling services, a safe and
healthy school environment, health promotion for staff, and parent and
community involvement.
Health education. One component of a coordinated school health system.
It includes the development, delivery, and evaluation of a planned,
sequential curriculum for students in kindergarten through grade twelve
and for parents and school staff and is designed to influence positively
people’s knowledge, attitudes, skills, and behaviors related to health. Health
education addresses the four unifying ideas of health literacy and the
following nine content 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; and communicable and chronic diseases.
3
Health Is Academic: A Guide to Coordinated School Health Programs. Edited by Eva Marx, Daphne
Northrop, and Susan Frelick Wooley. New York: Teachers College Press, 1998; Schools and Health: Our
Nation’s Investment. Edited by Diane Allensworth and others. Washington, D.C.: National Academy Press,
1997.
Health education focused
on developing health
literacy through a
student-centered
curriculum will enhance
school-reform efforts
and the understanding
students have of health.
4
Chapter 1
The Vision:
Health Literacy,
Healthy Schools,
Healthy People
Other documents have used the terms comprehensive health education,
comprehensive school health education, or comprehensive school health instruction
to describe health education. To avoid confusion and simplify terms, this
document uses the term health education. However, that choice should not be
seen as an attempt to undermine the purpose of addressing all nine content
areas and all four unifying ideas.
This edition of the Health Framework can be used to support the positive
health behaviors of children. The achievement of optimal health, positive
health behaviors, and health literacy is a collaborative, supportive effort. Health
and learning are interdependent, and a quality health education curriculum
imbedded in a coordinated school health program is essential for the
accomplishment of all the goals of education.
Schools and Health
The report Schools and Health: Our Nation’s Investment is noteworthy for
its emphasis on scientific research and empirically based findings.4 In 1994 the
Institute of Medicine, a division of the National Academy of Sciences, con­
vened a committee of national experts on school health to carry out a major
study of comprehensive school health programs in kindergarten through grade
twelve. The committee had several specific charges:
• Develop a framework for determining the desirable and feasible health
outcomes, including mental, emotional, and social health, of comprehen­
sive school health programs.
• Examine the relationship between health outcomes and education
outcomes.
• Consider which factors are necessary in the school setting in order to
optimize those outcomes.
• Appraise existing data on effectiveness, including cost effectiveness, of
comprehensive school health programs and identify possible additional
strategies for evaluating the effectiveness of those programs.
• Recommend mechanisms for wider implementation of health programs
that have proven to be effective.
A series of meetings brought committee members together with numerous
other experts on school health to develop position papers addressing each of the
key focus areas, after which the committee published its findings and recom­
mendations in Schools and Health.
One of the report’s most important conclusions is that “the period prior to
high school is the most crucial for shaping attitudes and behaviors. By the time
students reach high school, many are already engaging in risky behaviors or
4
See note 3.
5
may at least have formed accepting attitudes toward these behaviors.”5 Given
that premise, Schools and Health provides a platform and a research base on
which to build effective school health programs for the future. The report
makes the following recommendations:
• All students should receive sequential, age-appropriate health education
every year during the elementary and middle or junior high grades and a
minimum of a one-semester health education course at the secondary level.
• All elementary teachers should receive substantive preparation in health
education content and methodology during their preservice college
training.
• School health services should be formally planned, and the quality of
services should be continuously monitored as an integral part of the
community public health and primary care systems.
• Research should be conducted on school-based services, particularly on
the organization, management, efficacy, and cost-effectiveness of extended
services.
• Confidentiality of health records should be given high priority by the
school, and confidential records should be handled in a manner similar
to the way in which health records are handled in nonschool health care
settings.
• Established sources of funding for school health services should continue
from both public health and education funds, and new approaches to
funding should be developed.
• Federal leadership for coordinated school health programs should be
revitalized by reaffirming the mission of the federal Interagency Committee on School Health (ICSH) and related leadership organizations.
• An official state interagency coordinating council for school health should
be established in each state to integrate the diverse elements of coordinated
school health systems.
• Every school district should establish a formal organization with broad
representation to function as a coordinating council for school health.
• Individual schools should establish a school health committee and appoint
a school health coordinator to oversee the school health program.
• The training and use of competent, properly prepared personnel should
be expanded to implement quality coordinated school health programs.
• An active research agenda on coordinated school health programs should
be pursued and a major research effort launched to establish model
programs and studies.
• Further study should be carried out in each of the components of coordi­
nated school health programming.
5
Schools and Health, p. 140.
Chapter 1
The Vision:
Health Literacy,
Healthy Schools,
Healthy People
6
Chapter 1
The Vision:
Health Literacy,
Healthy Schools,
Healthy People
Schools and Health is based on the assumption that education and health are
closely linked and that schools have the potential to become an important
element in addressing the health needs of children and youths. The report also
acknowledges that much work needs to be done and that coordinated school
health programs and systems exist more as a concept than as a reality. The
purpose of the report is to provide the research, analysis, and recommendations
to bring about lasting change and move the field forward significantly.
Health Is Academic provides documentation on the critical link between
health and learning. It begins with this quote from the National Commission
on the Role of the School and the Community in Improving Adolescent
Health: “Efforts to improve school performance that ignore health are
ill-conceived, as are health improvement efforts that ignore education.”6
Many school leaders indicate that their efforts to coordinate health programs
result in improved attendance, less smoking among students and staff, lower
rates of teen pregnancy, increased participation in physical fitness activities, and
healthier dietary choices. School leaders have found that greater use of school
health and counseling services decreases disciplinary problems and can delay the
onset of health-risk behaviors that jeopardize students’ health and academic
achievement.
Both Schools and Health and Health Is Academic substantiate the need for a
coordinated approach to school health programs and a framework with funda­
mental guidelines on how to implement a coordinated program model through
school, parent, and community collaboration.
Unifying Ideas of Health Literacy
For the first time in
recent history, the next
generation of Californians
may not be as well off as
the one which preceded it.
—Children Now,
1992 Annual Report:
Saving the Dream
Health-literate individuals develop a growing mastery of knowledge, skills,
and behaviors in four key areas critical to healthy living:
• Acceptance of personal responsibility for lifelong health. Health-literate
individuals acknowledge that they have some control over their health,
incorporate health-related knowledge into everyday behavior, and make
a lifelong commitment to healthy living.
• Respect for and promotion of the health of others. Health-literate individu­
als understand and acknowledge the effects of personal behavior on the
health and well-being of others. In addition, they understand the
influence that people have on the environment and the way in which
elements within the environment affect the health of groups and
individuals. They translate this understanding into concern for the
health of others in the family, school, peer group, and community.
6
Health Is Academic, p. 1.
7
• An understanding of the process of growth and development. Health-literate
individuals understand and acknowledge the aspects of physical, mental,
emotional, and social growth and development common to all people as
well as those aspects that are unique to individuals. They respect the
dignity of all individuals and recognize that people continue to develop
throughout their lives.
Chapter 1
The Vision:
Health Literacy,
Healthy Schools,
Healthy People
• Informed use of health-related information, products, and services. Healthliterate individuals select and use available health-related information,
products, and services carefully and wisely. Being health literate involves
the ability to think critically about health-related information and be a
selective consumer of health-related services and products.
The four unifying ideas of health literacy are central themes throughout this
framework and are reiterated and reinforced in a variety of contexts.
The School’s Role in Promoting
Children’s Health
Growing numbers of children are coming to school with a variety of healthrelated problems that make successful learning difficult or impossible, and
many children in school routinely participate in behaviors that endanger their
health. Many of the most serious health problems in our society affect the
school-age population. A Children’s Defense Fund report concluded that
because of declining access to health services, children under eighteen years of
age are at increasing risk of contracting infectious diseases and developing
physical and mental disabilities. The report also pointed to the rising incidence
of such preventable childhood diseases as measles, mumps, and rubella.7 A
national study on adolescents conducted by the U.S. Centers for Disease
Control and Prevention (CDC) found alarming levels of the use of alcohol and
other drugs, weapon-carrying among high school students, early sexual activity,
and suicide. CDC has determined that the most detrimental health-risk behav­
iors practiced by young people fall into six categories: (1) behaviors that result
in unintentional or intentional injuries; (2) use of alcohol and other drugs;
(3) sexual behaviors that result in HIV infection, other sexually transmitted
diseases, or unintended pregnancy; (4) use of tobacco; (5) unhealthy diet; and
(6) reduced physical activity.8
Trends in California are consistent with disturbing national findings.
Although California’s teen birth rate has declined in recent years, it remains
higher than the teen birth rate in many other states. The percentage of incarcer­
ated juveniles is also high. Many juveniles are confined, directly or indirectly,
7
The Health of America’s Children. Washington, D.C.: Children’s Defense Fund, 1992.
Chronic Disease and Health Promotion: Reprints from the MMWR 1990-1991 Youth Risk Behavior
Surveillance System. Atlanta: Centers for Disease Control and Prevention, n.d.
8
School programs need
to recognize the
bidirectional connection
between health and
education. Children must
be healthy in order to be
educated and children
must be educated in
order to stay healthy.
—Public Health Reports
8
Chapter 1
The Vision:
Health Literacy,
Healthy Schools,
Healthy People
With parent involvement
. . . schools can influence
health behaviors
significantly. They can
state explicitly that
certain behaviors are
unhealthy but that other
behaviors will enhance
health. . . . Schools can
teach and model healthy
choices.
because of their use of alcohol or other drugs or because of their possession or
use of weapons. Further, California’s children tend to be physically unfit. They
have higher percentages of body fat, are less physically active, and score lower
on objective measures of physical fitness than in the past. Injuries, intentional
or unintentional, which are the leading cause of death and disability among
children and youths in California, have had an enormous impact. On average
eight children in California die from injuries every day, and many more are
seriously disabled.
An article appearing in Public Health Reports emphasizes the combined
roles of the education and health sectors in promoting lifelong good health.9
The Healthy Kids, Healthy California Initiative, launched by the California
Department of Education in 1989, and the Healthy Start Initiative (Senate
Bill 620/1991) support the development of a positive, health-oriented school
climate that recognizes health as being intimately linked to learning.
An emphasis on health is consistent with the goals for school reform in
California. The major policy and planning documents that will influence
California’s schools for many years to come acknowledge that good health is
basic to academic success.10 A common theme is the need for schools to take an
active role in developing and promoting the physical, mental, emotional, and
social health of students. The documents also call for students to be engaged in
meaningful work. Because health is relevant to students, health-related tasks can
be used to capture student interest and enhance development of knowledge and
skills in other curriculum areas.
Working with families and the community, schools have a unique opportu­
nity to influence the health of children positively. In the past many schools
resisted allocating resources to health beyond the bare minimum because
evidence of its benefits was insufficient. Health seemed to have little relevance
to day-to-day learning. Today, however, the benefits of health education and
coordinated school health approaches are clear. Many studies have found that
school-based programs have brought about positive changes in a wide range of
health-related behaviors among children, such as decision making and the
ability to resist negative influences.11 Researchers have found that instruction
combining scientifically based information about health issues and continual
reinforcement of positive health behaviors can also be effective.
9
A. C. Novello and others, “Healthy Children Ready to Learn: An Essential Collaboration Between
Health and Education,” Public Health Reports, Vol. 107, No. 1 (1992), 3–14.
10
See California Department of Education publications Here They Come: Ready or Not! Report of the
School Readiness Task Force, 1988; It’s Elementary! Elementary Grades Task Force Report, 1992; Caught in the
Middle: Educational Reform for Young Adolescents in California Public Schools, 1987; Second to None: A Vision
of the New California High School, 1992.
11
D. Kirby and others, “Reducing the Risk: Impact of a New Curriculum on Sexual Risk-Taking,”
Journal of School Health, Vol. 23, No. 6 (1991), 253–63. See also J. R. Seffrin, “The Comprehensive School
Health Curriculum: Closing the Gap Between State-of-the-Art and State-of-the-Practice,” Journal of School
Health, Vol. 60, No. 4 (1990), 151–56.
9
Through education and comprehensive prevention strategies developed and
implemented with parent involvement and education, schools can influence
health behaviors significantly. They can state explicitly that certain behaviors are
unhealthy but that other behaviors will enhance health and well-being. For
example, schools can state that (1) violent behavior and actions that demean
others are not acceptable; (2) alcohol, tobacco, and other drugs are not healthy
and should not be used by children and youths; (3) sexual activity is not appro­
priate for young people; (4) safety practices should be followed and protective
equipment and devices, such as seat belts and helmets, should be used; and
(5) excessive consumption of fat and insufficient physical activity are not
healthy, but healthy food choices and physical activity can enhance health.
Schools can teach and model healthy choices and empower young people to take
responsibility for their own health and well-being.
Given the needs of today’s children and the potential of schools to address
children’s health issues, schools must make health a priority in the curriculum
and the overall school program. Because basic patterns of healthy living are
formed in childhood and adolescence, schools, working in partnership with
families and communities, are an ideal place to promote healthy attitudes and
behaviors.
Chapter 1
The Vision:
Health Literacy,
Healthy Schools,
Healthy People
Collaboration to Benefit the Whole Child
The health of children and their success in school are intimately linked.12
Increasingly, the value and importance of educating the whole child, including
focusing on children’s health, is being supported by empirical studies. Inad­
equate nutrition and a wide range of negative and self-destructive behaviors,
such as the use of alcohol, tobacco, and other drugs, have been linked to poor
school performance. The converse is also true; that is, children who are helped
to accept responsibility for their health are more likely to succeed in school and
to become healthier, more responsible, and more successful adults. Schools are
collaborating with parents and the community to address problems and behav­
iors that influence school performance. That approach is central to Not Schools
Alone, which charts the course for alcohol, tobacco, and other drug education
and prevention programs in California schools.13
Not Schools Alone emphasizes the importance of the school and the commu­
nity in influencing children’s health. Children and adolescents are more likely to
practice healthy behaviors when those behaviors are broadly supported at school,
at home, and in the community. A variety of risk factors influence whether or
12
School Health: Helping Children Learn. Alexandria, Va.: National School Boards Association, 1991,
pp. 1–5. See also Promoting Health Education in Schools: A Critical Issues Report. Arlington, Va.: American
Association of School Administrators, 1985, pp. 7–9.
13
Not Schools Alone: Guidelines for Schools and Communities to Prevent the Use of Tobacco, Alcohol, and
Other Drugs Among Children and Youth. Sacramento: California Department of Education, 1991.
School systems are not
responsible for meeting
every need of their
students. But where the
need directly affects
learning, the school must
meet the challenge.
So it is with health.
—Turning Points: Preparing
American Youth for the
21st Century
10
Chapter 1
The Vision:
Health Literacy,
Healthy Schools,
Healthy People
For health education to
be made meaningful,
systems must be in place
that support effective
health education and
make health an important
priority in the school.
not a child will be healthy and will maintain a commitment to health. The
school, the home, the community, and the peer group are four major areas of
a child’s life in which these risk factors may be found. The risk factors include,
among others, economic deprivation, neighborhood disintegration, poor
family-management practices, peers who use alcohol and other drugs, low
expectations for children’s success, and academic failure. Although some risk
factors are far beyond a school’s control, others can be addressed directly and
effectively through health education supported by collaborative efforts that
include parents, the school, and the community.
Balancing, buffering, and reducing risk in children’s lives are protective factors.
They include having opportunities to practice health-related skills, such as
decision-making or refusal skills; knowing that clearly defined expectations
and norms exist for appropriate behavior at school and at home; experiencing
positive bonding to the family, the school, peers, and the community; and
receiving recognition for participation in positive activities and personal
accomplishments. These protective factors lead to the development of a sense
of personal competence and resiliency. Together, schools, families, and the
community can work to strengthen the protective factors and build resiliency.
The physical, emotional, and social benefits of such collaborative efforts can
be significant.
The Benefits of Prevention
Promoting children’s health can be highly cost-effective for schools and
communities; neglecting it can mean spiraling costs for health care. As the cost
of health care continues to increase, disease prevention, health promotion, and
access to services are assuming greater importance in the public health agenda.
Recent increases in the incidence of several easily preventable diseases, such
as measles and mumps, have underscored the cost-effectiveness of a preventionoriented approach. For example, a single dose of vaccine against measles,
mumps, and rubella costs approximately $25. But the cost of not being vacci­
nated can be staggering. Complications from measles can result in death or
blindness, mumps can leave males sterile, and rubella infection in pregnant
women can seriously compromise their pregnancies. Clearly, the cost of preven­
tion is far less than the cost to treat those diseases and their complications.
Prevention and collaboration to ensure adequate access to services while
avoiding duplication of services have become fundamental components of
health policy and health-care reform nationally and statewide. One indication
of those trends is the movement toward school-linked services, such as afterschool child-care and recreation programs.
For example, California’s Healthy Start Initiative (Senate Bill 620/1991)
provides funds for schools and community public and private organizations to
work together to provide a system of comprehensive, integrated health, psycho-
11
social, and educational services. The school-linked services initiative promotes
the reconfiguration of existing community resources. A center at or near the
school site serves as the gateway for a continuum of services (such as primary
health care, mental-health services, academic support, counseling, parenting
education, nutrition services, health education, youth development, or
substance-abuse prevention) for students and families who need assistance.
Some services are offered on site. Others are offered through referral from
the center’s family advocate to a provider in the community. Services are
family-focused and prevention- and result-oriented. School-linked services help
ensure that existing community resources are used effectively by individuals and
families who need assistance. Ongoing collaboration and consultation among
school personnel, parents, and service providers result in more efficient and
supportive delivery of services. Teachers are able to refer families to needed
assistance and community agency staff can target services to families who want
help. Together, the school, the school-linked service providers, and the family
provide consistent efforts to support the student’s success at school. (See
Appendix B for an example of school-linked services.)
Chapter 1
The Vision:
Health Literacy,
Healthy Schools,
Healthy People
Structures for a Coordinated
School Health System
Preventing health problems, promoting health literacy, and supporting
students’ success at school through a comprehensive, collaborative approach
may involve significant changes at some schools. However, working with
families and the community, schools can establish an effective system for
preventing health problems and promoting health literacy.
This framework envisions a coordinated school health system based on the
assumption, strongly supported by research and practice, that the teaching of
health information alone is insufficient for children and youths to achieve
health literacy. Effective health education must combine scientifically based
information with approaches that develop positive health attitudes and behav­
iors and incorporate a wide range of learning styles, activities, and teaching
strategies. It engages children on many different levels to develop knowledge,
skills, attitudes, and behaviors that will make health education not the presenta­
tion of a set of facts to be studied, memorized, and quickly forgotten but a
meaningful part of children’s lives. In addition, it relates health information to
a variety of disciplines and learning situations.
For health education to be made meaningful, systems must be in place that
support effective health education and make health an important priority in the
school. The school’s approach must be well planned, must be coherent, must
be implemented consistently, and must be supported by all adults in the school.
All the components of the school’s program must be mutually supportive and
The school’s approach
must be well planned,
must be coherent,
must be implemented
consistently, and must
be supported by all adults
in the school. All the
components of the
school’s program must
be mutually supportive
and consistent with the
overall goal of promoting
and enhancing children’s
health literacy.
12
Chapter 1
The Vision:
Health Literacy,
Healthy Schools,
Healthy People
consistent with the overall goal of promoting and enhancing children’s health
literacy.
This schoolwide approach is referred to in this framework as a coordinated
school health system with eight components:14
•
•
•
•
•
•
•
•
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 work together to develop and reinforce healthrelated knowledge, skills, attitudes, and behaviors and make health an impor­
tant priority at the school. The components are linked in a mutually support­
ive, cooperative system focusing on children’s health issues and the develop­
ment of health literacy. Each of the eight components is a critical link in the
overall support system for school health and is integrally related to the other
components. Some of the components focus on education, others on services,
and still others on the school environment. When they are planned and imple­
mented in a supportive and consistent manner, the eight components achieve
far more in promoting health literacy than is possible without a coherent,
integrated system. The entire support system is shown in figure 1.
• Health education and physical education focus on helping students gain
the knowledge, skills, and behaviors needed for health literacy and on
engendering the attitudes they also need for lifelong healthy behaviors.
Health education is the primary focus of this framework. Physical
education taught within the context of a coordinated school health
system is the subject of its own framework. Readers seeking detailed
information about the design of exemplary physical education curricu­
lum should consult the Physical Education Framework.
• Health services, nutrition services, and psychological and counseling services
reinforce the knowledge, skills, and behaviors taught in health education
and physical education; help families support and promote students’
health; and provide students with opportunities to practice healthy
behaviors. For example, school nutrition services support healthy growth
and development by providing nutritious foods to students. School
nutrition services also offer students opportunities to apply knowledge
14
The model of a coordinated school health system described in this framework was most recently
presented in the Healthy Kids, Healthy California Initiative. For information about the initiative, contact the
Safe and Healthy Kids Program Office, California Department of Education, 1430 N Street, Sacramento
(mailing address: P.O. Box 944272, Sacramento, CA 94244-2720); telephone 916-319-0920).
13
Fig. 1. A Coordinated School Health System
Health Education
Parent and Community
Involvement
Physical Education
Eight Components
of a Coordinated
School Health
System
Health Services
Health Promotion
for Staff
Safe and Healthy
School Environment
Psychological and
Counseling Services
Nutrition
Services
14
Chapter 1
The Vision:
Health Literacy,
Healthy Schools,
Healthy People
of nutrition learned in the classroom to their selection of nutritious
foods at school.
Health services, including early and periodic health screenings, such as
examinations of vision and hearing, provided at or near the school site
offer students access to vital health care that is often not available to
them from any other source. Psychological and counseling services
provided at or near the school site offer students assistance and support
in making healthy decisions, coping with crises, and resolving or
managing problems that might influence success at school. When
provided in the context of a coordinated school health system, these
types of services can also help students and their families find the
support they need in a coordinated and effective manner.
• Safe and healthy school environment, health promotion for staff, and parent
and community involvement all support and reinforce the school’s
commitment to the development of health literacy. A safe and healthy
school environment ensures that students and adults at the school site
are physically safe and that the school environment supports health
literacy and successful learning. Health promotion for staff empowers
teachers and other staff members to make a commitment to lifelong
healthy behaviors and model those behaviors for students. In addition,
parent and community involvement brings parents, the community,
and the school together to develop and support health literacy. As a
result the school views itself as an integral part of the community and
works in partnership with parents to promote the success of students.
When a well-designed
curriculum and a
supporting structure are
available, the goal of
health literacy for all
children is realistic and
achievable.
Parents and the community are involved in a variety of roles in the
school, ranging from occasional volunteering to active, meaningful
leadership on school committees. Parent and community involvement,
health promotion for staff, and a safe and healthy school environment
all contribute to developing a schoolwide commitment to health. Each
of these components should be developed and supported as a necessary
part of the coordinated school health system. Together, the components
of a coordinated school health system empower students to develop and
apply knowledge and skills leading to healthy choices and lifelong good
health. This system provides the school and community with a sound
approach for preventing health problems when possible and dealing
with them in a systematic way when they do occur. When a welldesigned curriculum and a supporting structure are available, the goal
of health literacy for all children is realistic and achievable.
15
Parents as Providers and Decision Makers
Parents and guardians should be closely involved in the design
and implementation of efforts to support children’s health from
the very beginning of the process. This involvement should go well
beyond token participation.
Why is it important to involve parents? First, it helps to keep
the planning and implementation of the coordinated school health
system on the right track. As experts on their children and on
their own communities, parents can ensure that schools address
the issues that families and communities perceive as relevant.
Second, active participation is in itself an intervention for the
individual parents who get involved. Providing individuals with
opportunities to be connected, to grow and develop, and to give
back to their community allows them to see new possibilities for
themselves. Third, involving parents builds the community’s
capacity for self-sufficiency. Community members learn to do for
themselves and each other, rather than wait for an outside person
or group to provide for them or to lead them. Fourth, community
parents can bring valuable assets to family outreach work, includ­
ing a knowledge of different community cultures and languages, an
ability, as peers, to build close and trusting relationships quickly,
and an ability to identify unique solutions to problems that profes­
sionals might not see.
Therefore, schools should involve parents in developing and
providing support activities, such as organizing transportation,
following up with tardy children in the neighborhood each morn­
ing, overseeing an after-school study club, organizing parent
support groups on various topics, fund-raising for small projects,
and so on. Schools may also consider involving parents in more
paraprofessional types of support, such as individual peer counsel­
ing or case management. When parents will be filling paraprofes­
sional roles, the school must provide parents with the necessary
training in maintaining confidentiality, keeping records, conducting
interviews, and so forth.
Parents and guardians should also be key decision makers on
policy issues and should be represented in sufficient numbers to
have an impact. Parents should be involved in all decisions that will
affect them, especially on such matters as which services are to be
offered to families and how services should be adapted to make
them culturally meaningful.
Chapter 1
The Vision:
Health Literacy,
Healthy Schools,
Healthy People
16
Chapter 1
The Vision:
Health Literacy,
Healthy Schools,
Healthy People
Positive Youth Development,
Asset Development, and Resiliency
The developmental assets that link individual resiliency with positive health
behavior are an increasingly important part of a coordinated school health
system. The importance of using related data to determine needs, develop
plans, and evaluate the components of coordinated school health programs is
highlighted in this section.
The concept of positive youth development, often in association with the
development of resiliency and developmental assets among youths, has gained
wide attention and support among proponents of coordinated school health
programs. To a great extent, that support has been brought about by a growing
body of psychological and sociological research on youth development that
links individual resiliency and developmental assets with health promotion and
disease prevention.
The document Getting Results, Update 1: Positive Youth Development:
Research, Commentary, and Action focuses entirely on research, commentary,
and specific programs and activities related to positive youth development.15
This document, which contains numerous references to additional sources of
information on the topic, is an essential starting point and will lead to further
readings. It also contains an optional module on resilience assessment from the
California Healthy Kids Survey.
Before schools proceed in developing a school health program, it is impor­
tant to establish definitions of the terms that are most often encountered in the
promotion of health and prevention of disease among youths:
Youth development. An approach that helps youths build strong relation-
ships with others, learn new skills, and give back to the community
Resiliency. The ability to bounce back in the face of adversity; the ability to
weather the effects of stress, insult, and injury (This area of research and
practice is grounded in environmental and psychological factors that help
children transcend adversity.)
Developmental assets. The building blocks of human development, such as
family support, creative activities, and achievement motivation, that pro-
mote health and protect young people from risk-taking behaviors
External protective factors. Peer, family, school, and community influences
on youths’ attitudes, perceptions, and behaviors; external supports and
opportunities, such as caring relationships, high expectations, and opportu­
nities to participate and contribute
15
Getting Results, Update 1: Positive Youth Development: Research, Commentary, and Action. Sacramento:
California Department of Education, 1999.
17
Internal protective factors. Individual attitudes, perceptions, and behaviors
(e.g., self-efficacy, positive beliefs about self)
Pioneering research on resiliency was done by the psychologist Emmy
Werner, who for more than three decades studied the development of 700
children born on the Hawaiian island of Kauai. As described in Bonnie Benard’s
summary of a report by Werner and fellow psychologist Ruth S. Smith, approx­
imately one-third of the children were at significant risk of a variety of personal
and health problems. Yet when these high-risk children were studied at the age
of eighteen, about one-third were “doing well in getting along with parents and
peers, doing fine in school, avoiding serious trouble, and having good mental
health.”16 A follow-up study of the same cohort at age thirty-two found that
some two-thirds of the adolescents who were at high risk at age eighteen had
become healthy, competent, caring, successful adults.17
An analysis of those findings led Werner and Smith to theorize that, despite
stressful childhood environments that place children at high risk of numerous
personal and health-related problems, many youths develop protective factors
that help them to function successfully and effectively throughout their lives.
The main protective factors, according to this research, are as follows:
• The development of social skills that enable people to reach out to family
members and others for support
• The presence of a committed caregiver, particularly during the first year of
life
• A broad community support system18
As interest in the concept of protective factors has grown, health educators
and youth advocates have increasingly questioned the major assumptions on
which youth-focused health promotion and disease prevention programs
traditionally have been based. The dominant model, observes Peter L. Benson,
a leading developmental assets researcher with the independent Search Institute,
focuses on the concept of deficit reduction: “naming, counting, and reducing
the negative;” that is, reducing risks to young people’s health and well-being.19
The converse is a focus on positive aspects of young people’s development—
protective factors and developmental assets that help young people to function
16
Bonnie Benard, “Resiliency Study,” in Getting Results, Part I: California Action Guide to Creating Safe
and Drug-Free Schools and Communities. Sacramento: California Department of Education, 1998, p. 136,
citing Emmy E. Werner and Ruth S. Smith, Vulnerable but Invincible: A Longitudinal Study of Resilient
Children and Youth. New York: Adams, Bannister, and Cox, 1989.
17
Bonnie Benard, citing Emmy E. Werner and Ruth S. Smith, Overcoming the Odds: High-Risk Children
from Birth to Adulthood. New York: Cornell University Press, 1992.
18
Ibid.
19
Peter L. Benson, “Promoting Positive Human Development: The Power of Schools,” in Getting
Results, Update 1, p. 14.
Chapter 1
The Vision:
Health Literacy,
Healthy Schools,
Healthy People
18
Chapter 1
The Vision:
Health Literacy,
Healthy Schools,
Healthy People
and grow in ways that lead to personal success, competence, effectiveness,
health, and well-being. Researcher Michael D. Resnick notes that a major
assumption of the positive youth development approach is that “young people
are resources to be treasured and developed, not problems to be solved.”20
The Search Institute is an independent, nonprofit, nonsectarian organization
whose mission is to advance the well-being of adolescents and children by
generating knowledge and promoting the application of that knowledge. The
institute’s research has resulted in the identification of 40 developmental assets.
Developmental Assets Identified by the Search Institute
In 1990 the Search Institute compiled 40 developmental assets, relying on
research on child and adolescent development, risk prevention, and resiliency.
Research surveys of more than one million sixth graders and twelfth graders
show that youths who experience these assets are more likely to make healthy
choices and avoid a wide range of high-risk behaviors than are youths who do
not experience these assets, which are described as follows:
EXTERNAL ASSETS
Support
1. Family support—Family life provides high levels of love and support.
2. Positive family communication—Young person and her or his parent(s)
communicate positively, and young person is willing to seek advice and
counsel from parent(s).
3. Other adult relationships—Young person receives support from three
or more non-parent adults.
4. Caring neighborhood—Young person experiences caring neighbors.
5. Caring school climate—School provides a caring, encouraging environ­
ment.
6. Parent involvement in schooling—Parent(s) are actively involved in
helping young person succeed in school.
Empowerment
7. Community that values youths—Young person perceives that adults in
the community value youths.
Developmental Assets reprinted with permission from the Search Institute, Minneapolis, Minn.
© Search Institute, 1996. http://www.search-institute.org.
20
Michael D. Resnick, “Resiliency, Protective Factors, and Connections That Count in the Lives of
Adolescents,” in Getting Results, Update 1, p. 29, citing Milbrey W. McLaughlin and others, Urban
Sanctuaries: Neighborhood Organizations in the Lives and Futures of Inner-City Youth. San Francisco:
Jossey-Bass, Inc., 1994.
19
8. Youths as resources—Young people are given useful roles in the com­
munity.
9. Service to others—Young person serves in the community one hour or
more per week.
10. Safety—Young person feels safe at home, at school, and in the neigh­
borhood.
Boundaries and Expectations
11. Family boundaries—Family has clear rules and consequences and
monitors the young person’s whereabouts.
12. School boundaries—School provides clear rules and consequences.
13. Neighborhood boundaries—Neighbors take responsibility for monitor­
ing young people’s behavior.
14. Adult role models—Parent(s) and other adults model positive, respon­
sible behavior.
15. Positive peer influence—Young person’s best friends model responsible
behavior.
16. High expectations—Both parent(s) and teachers encourage the young
person to do well.
Constructive Use of Time
17. Creative activities—Young person spends three or more hours per week
in lessons or practice in music, theater, or other arts.
18. Youth programs—Young person spends three or more hours per week
in sports, clubs, or organizations at school and/or in the community.
19. Religious community—Young person spends one or more hours per
week in activities in a religious institution.
20. Time at home—Young person is out with friends “with nothing special
to do” two or fewer nights per week.
INTERNAL ASSETS
Commitment to Learning
21. Achievement motivation—Young person is motivated to do well in
school.
22. School engagement—Young person is actively engaged in learning.
23. Homework—Young person reports doing at least one hour of homework every school day.
24. Bonding to school—Young person cares about her or his school.
25. Reading for pleasure—Young person reads for pleasure three or more
hours per week.
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Healthy Schools,
Healthy People
20
Chapter 1
The Vision:
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Healthy People
Positive Values
26. Caring—Young person places high value on helping other people.
27. Equality and social justice—Young person places high value on pro­
moting equality and reducing hunger and poverty.
28. Integrity—Young person acts on convictions and stands up for her or
his beliefs.
29. Honesty—Young person “tells the truth even when it is not easy.”
30. Responsibility—Young person accepts and takes personal responsibility.
31. Restraint—Young person believes it is important not to be sexually
active or to use alcohol or other drugs.
Social Competencies
32. Planning and decision making—Young person knows how to plan
ahead and make choices.
33. Interpersonal competence—Young person has empathy, sensitivity, and
friendship skills.
34. Cultural competence—Young person has knowledge of and comfort
with people of different cultural/racial/ethnic backgrounds.
35. Resistance skills—Young person can resist negative peer pressure and
dangerous situations.
36. Peaceful conflict resolution—Young person seeks to resolve conflict
nonviolently.
Positive Identity
37. Personal power—Young person feels she or he has control over “things
that happen to me.”
38. Self-esteem—Young person reports having a high self-esteem.
39. Sense of purpose—Young person reports, “my life has purpose.”
40. Positive view of personal future—Young person is optimistic about her
or his future.
Implementation of Youth Development
Despite significant new research on the importance of resiliency and devel­
opmental assets, the concept of positive youth development cannot be reduced
to a simple curriculum or program. As noted by Benson, “There are no magic
potions or quick fixes that steer lives toward success, productivity, and respon­
sibility.”21 Rather, promoting resiliency among children and youths and
emphasizing developmental assets need to be part of a schoolwide and
communitywide approach to nurturing and fostering healthy, productive
young people. Although specific program components and curricula can be
21
Peter L. Benson, p. 15.
21
helpful in implementing a broad-based health strategy of this kind, implemen­
tation should take many different factors into account, including the following
action steps suggested in Getting Results, Update 1:
• An emphasis on cooperation, pro-social development, and positive
relationships among children and youths
• A focus on developing a positive and cooperative school climate
• Program planning and development that involves and empowers children
and youths in taking a positive and active role in their schools and
communities (e.g., through participation in school and community
service programs)
• Peer leadership and peer-helping programs
• Training for school staff in positive youth development concepts and
approaches22
Use of Evaluation and Survey Data
in School Health Programs
Why evaluate school health programs? Schools and communities need data
to guide their program decision making and development, to obtain program
support and funding, and to demonstrate progress in meeting their program
goals. Schools are required increasingly to collect data that objectively assess
student achievement and behavior. Schools also are encouraged to set concrete
and measurable goals for making improvement. Researchers Sarvela and
McDermott indicate that the purpose of evaluation is to improve rather than
to prove and that evaluation is the process of sharing accountability, not
assigning accountability.23 Other research finds that the essential function of
evaluation should be to collect, analyze, and report valid, credible information
that can make a constructive impact on program decision making.24
Some Basic Terms
The following basic terms are used in the ensuing discussion of evaluation
and survey data:
Data. Facts and figures from which conclusions can be inferred
Evaluation. Systematic collection of valid, credible information on the
operation of a program, the effects of the program, other questions of
interest, or a combination of such information
22
“Research into Action: Action Steps for Schools,” in Getting Results, Update 1, pp. 55–61.
Paul D. Sarvela and Robert J. McDermott, Health Education Evaluation and Measurement:
A Practitioner’s Perspective. Dubuque, Iowa: Brown and Benchmark, 1993.
24
Joan L. Herman, Lynn Lyons Morris, and Carol Taylor Fitz-Gibbon, Evaluator’s Handbook. Newbury
Park, Calif.: Sage Publications, 1987.
23
Chapter 1
The Vision:
Health Literacy,
Healthy Schools,
Healthy People
22
Chapter 1
The Vision:
Health Literacy,
Healthy Schools,
Healthy People
Evaluation design. A plan that determines the groups or individuals who
will participate in an evaluation, the types of data that will be collected, and
when the evaluation instruments or means will be administered and by
whom
Program. Action taken to cause an effect
Stakeholders. Groups of people who have a direct or indirect interest in
evaluation results
Survey. A detailed study made by gathering and analyzing information
Evaluation and Survey Considerations
Many youth health behavior surveys are conducted, and none should be
mistaken for an evaluation. Changes in behavior rates, by themselves, do not
explain why and how the changes occurred. The changes may not be the effect
of a current program, but rather one from prior years that may be showing
long-term effects. In any program it is advisable to include an evaluation
component. An evaluation may have one of many purposes, such as attainment
of program objectives, assessment of strengths and weaknesses, acquisition of
data for decision making, or monitoring of standards of performance.
Reliance on health behavior survey measures alone to demonstrate successful
health education programs is not advisable because knowledge and skills often
are not put into practice. The ultimate goal of health promotion is the practice
of positive health behaviors. Those behaviors are preceded by knowledge and
skills. It is important to measure these indicators as benchmarks of teaching and
learning effectiveness, and the Health Framework clearly delineates skill and
knowledge expectations at the various grade levels. (Refer to “Resources for
Program Planning” and “Health Literacy Assessment” in Chapter 2 for more
information on health education assessment strategies.)
In the planning of an evaluation or a survey, several factors should be
considered:
• What is the purpose of the data?
• Who are the stakeholders and decision makers who will review the data?
• What kind of data are needed to make decisions or to tailor the evaluation
or data presentation to the interests of the identified stakeholders?
At least five different categories of stakeholders and the characteristics of
their interests must be considered when planning data collection or evaluation
or both:
1. The organization, to justify program costs, gain support for programs,
satisfy accountability for funding agencies, or determine future program
plans
2. The program administrator, to bring favorable attention to the program, increase probability for promotion, or gain greater control of the
program
23
3. The funding agency, to ensure efficiency, demonstrate program effects,
or gain political favor and possibly additional funding
4. The public, to ensure that tax dollars are spent efficiently, learn about
the benefits/disadvantages of a program, or increase public participation
in programs
5. Program evaluator, to help support the program’s goals, contribute to
disciplinary and applied knowledge, or advance professionally
As the research concludes: “Evaluation, in short, is an endeavor which is
partly social, partly political, and only partly technical.”25
Basic Evaluation Models
According to Sarvela and McDermott, most evaluators organize evaluation
into two general areas—formative and summative:
• Formative evaluation refers to the ongoing process of evaluation while a
program is being developed and implemented. The primary goal is to
improve the program. For example, a typical formative evaluation ques­
tion would be whether or not the program’s curricular materials match
the program’s objectives. Sometimes formative evaluations are referred to
as process evaluations because they are designed to examine the processes
that are taking place while the program is being developed and imple­
mented.
• Summative evaluation assesses the degree to which a program has met
predetermined objectives or the degree to which the program has been of
use to its target population. Summative evaluations most often use
quantitative approaches. Quantitative procedures include experimental
design and the use of standardized achievement tests or other objective
measures.26
A good evaluation reference is an essential tool for the health program
professional. Several agencies and Web sites that offer guidance on the evalua­
tion process are listed in Additional References and Resources.
Some Cautions About Surveys
Health surveys can bring about controversy, causing concern among officials
that the results will make the school or community “look bad.” Survey plan­
ning should involve parents and community members. Effective use of data
begins with the building of community consensus on why the survey is being
conducted and how the information will be used. Such involvement will foster
allies in the community and among parents, whose contributions to the
presentation of the results to the community might be of significant value.
25
26
Joan L. Herman and others, p. 11.
Paul D. Sarvela and Robert J. McDermott.
Chapter 1
The Vision:
Health Literacy,
Healthy Schools,
Healthy People
24
Chapter 1
The Vision:
Health Literacy,
Healthy Schools,
Healthy People
Surveys on school violence and high-risk behaviors are not particularly
effective when administered only once. The real value of survey data is realized
when data are gathered over the course of several years. It is the only way in
which trends in the nation, state, school, or district can be discerned. Although
comparisons to state and national samples are important, the bottom-line
question that must be answered at the local level is “Are we doing better?”
Most behaviors do not change dramatically in one year. As a general rule, it is
recommended that schools conduct a student health survey every two years in
selected student populations.
Parental Consent
All health-risk behavior surveys conducted in schools are confidential and
anonymous. They require written parental consent for student participation.
Parents must be fully informed about the information requested in the survey,
the purpose of the survey, and the intent when the results are published.
Student participation in the survey is voluntary, and students may decline to
answer any or all of the questions. Education Code Section 51513 states, “No
test, questionnaire, survey, or examination containing any questions about the
pupil’s personal beliefs or practices in sex, family life, morality, and religion, or
any questions about the pupil’s parents’ or guardians’ beliefs and practices in
sex, family life, morality, and religion, shall be administered to any pupil in
kindergarten or grades 1 to 12, inclusive, unless the parent or guardian of the
pupil is notified in writing that this test, questionnaire, survey, or examination is
to be administered and the parent or guardian of the pupil gives written permis­
sion for the pupil to take this test, questionnaire, survey, or examination.”
Current Data on the Health-Related Behaviors of Young People
The health of young people is linked to the health-related behavior they
choose to adopt. According to the Centers for Disease Control and Prevention,
a limited number of behaviors contribute markedly to today’s major health
problems. These behaviors, often established during youth, include:
•
•
•
•
•
Tobacco use
Unhealthy dietary behaviors
Inadequate physical activity
Alcohol and other drug use
Sexual behaviors that may result in HIV infection, other sexually trans­
mitted diseases, and unintended pregnancies
• Behaviors that may result in intentional injuries (violence and suicide)
and unintentional injuries (motor vehicle crashes)
Over the last decade substantial information has been gained about the
prevalence of behaviors by young people that put their health at risk. Many
25
sources of survey data exist from which to choose in meeting a variety of
program evaluation and planning needs.
Multiple data sources should be used to confirm, enrich, and provide
context to an assessment. Comparisons of local, county, state, and national data
can help interpret and give meaning to the profile of the student population
that is being assessed. The following descriptions of the various types of
available survey data are offered to assist in the selection of data sources.
Local Surveys
Support for school programs is often undermined by a lack of local aware­
ness—or even denial—of the extent of youth health risks on campus. Many
factors that contribute to health-risk behaviors by youths are also found outside
the school setting. Prevention researchers have long recognized the importance
of changing the general social environment and norms in order to sustain the
impact of school-based programs. Drug use, violence, and other health-risk
behaviors are the concern and responsibility of the entire community. Schools
and the community must work together to prevent and reduce health-risk
behaviors and increase academic achievement among youths.
The California Healthy Kids Survey (CHKS) is a comprehensive youth
health-risk and resilience data collection system sponsored by the California
Department of Education and is available to all local educational agencies
(LEAs). The elementary school version of CHKS is an easily customized, selfreport youth survey that assesses all major areas of health-related risk behavior
and resilience. This low-cost survey support system uses the latest technology to
help local agencies collect and use CHKS data to improve prevention and
health programs. (See the CHKS Web site at <http://www.wested.org/hks/>.)
The secondary school version of CHKS consists of a general core
(Module A) and a set of five in-depth, behavior-specific, optional supplemen­
tary modules that an LEA can configure to meet local needs and standards.
Individual modules assess youth development and resilience (Module B);
alcohol- and other drug-use prevention (Module C); tobacco-use prevention
(Module D); physical health and nutrition (Module E); and sexual behavior
and pregnancy (Module F). A single elementary school instrument provides
comparable, developmentally appropriate data focusing on risk and resilience
factors.
A growing body of research provides evidence of external and internal factors
that protect some adolescents from engagement in a variety of risk behaviors
and foster positive developmental outcomes. The CHKS resilience module,
developed with the assistance of a national panel of experts, provides a measure
of local protective factors and resilience traits or assets. It can help identify the
strength of students’ external assets in the school, family, community, and peer
environments as well as the degree and nature of internal assets among stu­
dents. It can provide a positive balance to the profile of a community.
Chapter 1
The Vision:
Health Literacy,
Healthy Schools,
Healthy People
26
Chapter 1
The Vision:
Health Literacy,
Healthy Schools,
Healthy People
State Surveys
The California Student Survey (CSS) is a biennial survey sponsored by the
Office of the Attorney General since 1985. The survey has now been expanded
to a comprehensive health risk survey that covers all of the items in the CHKS
general core. CSS is a good source of statewide data representative of all
students in California. (See the CSS Web site at <http://caag.state.ca.us/cvpc/
schoolsurvey.htm>.)
The California Safe Schools Assessment provides annual data on the incidents
of reported crimes on campus, notably drug use and violence.
National Surveys
The Youth Risk Behavior Survey (YRBS) is a biennial national-level survey
and is conducted during the even-numbered years. California uses a random
procedure to select schools for the state sample. Schools with larger enrollments
have a greater chance of being included in the sample. (See the YRBS Web site
at <http://www.cdc.gov/nccdphp/dash/yrbs/index.htm>.)
Additional Sources
Many other sources of data exist that may be well suited to program plan­
ning needs. Examples include the following:
• California Youth Tobacco Survey, a statewide telephone tobacco-use survey
<http://www.dhs.cahwnet.gov/tobacco/documents/youthsmoking.pdf>
• Fitnessgram, an annual statewide physical fitness assessment <http://
www.cde.ca.gov/cyfsbranch/lsp/health/pefitnesstest.htm>
• Monitoring the Future, a national survey of alcohol, tobacco, and other
drug use <http://www.monitoringthefuture.org>
• School Health Education Profile, a biennial survey of health education
policies and programs in California and the United States
<http://www.cdc.gov/nccdphp/dash/profiles>
Data Presentation Strategies
The critical principle for the effective presentation of data is to tailor the
data to the interests and needs of stakeholders and decision makers. The
California Healthy Kids Survey is supplemented with a handbook that provides
valuable guidance on the collection, organization, use, and presentation of data.
27
California’s Healthy Start Initiative
The Healthy Start initiative, a California state program, was established in
1991 (Education Code sections 8800 et seq.) to facilitate partnerships among
local educational agencies, families, and communities to benefit children and
youths. Healthy Start brings together local school-linked, community-based
partnerships to (1) help young people from kindergarten through high school
to learn and reach their full potential; and (2) strengthen families and commu­
nities.
This initiative takes shape in forms that are as different as are the communi­
ties across California in that it builds on the strengths, assets, and needs of each
neighborhood. At each local level, the initiative follows a process that includes
collaborative decision making, community assessment, prioritization of goals,
selection of effective strategies, integration and tracking of initiative compo­
nents, and evaluation of results. This process is cyclical and continuous; it
involves ongoing work to reassess, reevaluate, and reform so that the initiative
continues to grow and change along with the community. Healthy Start also
provides a process to move communities beyond isolated, separate systems to
interconnected teams with children and youths at their center.
The initiative’s philosophy is grounded in the belief that educational success,
physical health, emotional support, and family and community strength are
inseparable. Because the ability to learn well is so important to a successful and
happy life, Healthy Start places a special emphasis on improved school perfor­
mance. The goals of the initiative are as follows:
• Ensure that each child and youth receives the physical, emotional, and
intellectual support—in school, at home, and in the community—that he
or she needs to learn well.
• Build the capacity of students and parents to be participants, leaders, and
decision makers in their schools and communities.
• Help schools and other agencies serving children and families to reorga­
nize, streamline, and integrate their services to provide more effective
support to children and their families.
How Healthy Start Works
Because each school-community has its own combination of assets and
needs, the “mix” of services and supports varies. Local Healthy Start initiatives
may include the following support services:
•
•
•
•
Social services providers
Educators
Health, mental health, and dental health providers
Law enforcement personnel
Chapter 1
The Vision:
Health Literacy,
Healthy Schools,
Healthy People
28
Chapter 1
The Vision:
Health Literacy,
Healthy Schools,
Healthy People
•
•
•
•
Employment development counselors
Recreation, arts, faith, and service organization representatives
Business representatives
Student and family peer-support groups
Funding Structures
Healthy Start provides planning grants of up to $50,000, for use over a oneto two-year period, to local educational agencies in collaborative partnerships
that demonstrate a readiness to plan for school-integrated support services.
Healthy Start also funds operational grants of up to $300,000 and start-up
grants of up to $100,000. Healthy Start operational grants are awarded to
school-communities that demonstrate an inclusive, collaborative decisionmaking process that involves students and families in leadership roles; includes
a comprehensive community assessment; prioritizes needs and identifies
strengths and assets; and includes a plan for integration of effective support
services with an emphasis on improved school performance and evaluation to
ensure continuous improvement and sustainability. Healthy Start provides 90
percent of the local funding to school-community collaboratives that meet
eligibility requirements; for example, elementary schools in which 50 percent of
pupils are eligible to receive free and reduced-price meals and middle and high
schools in which 35 percent of pupils are eligible to receive free and reducedprice meals. Up to 10 percent of Healthy Start funds can be awarded to schools
that qualify under special factors that warrant consideration.
Evaluation Results
Healthy Start evaluation projects are designed by individual grantees.
Although individual grantees may choose to collect a variety of data on their
programs, educational results are the only data that grantees are required to
submit. Each grantee submits an annual report that includes schoolwide data
for each school as well as information on the core clients who have been
targeted to receive intensive coordinated services. In addition to the educational
results, each Healthy Start grantee reports on at least one optional cluster of
data that reflects the results each project hopes to achieve for children and
families.
Evaluation data were reported for 286 grantees in 1999. The reports in­
cluded data on almost 7,000 case-managed clients, 75 percent of whom were
school-age children and were reported as students most in need. However,
because data are not weighted for the size or number of sites, they are not
necessarily representative of all Healthy Start core clients statewide. Within
these limitations, evaluation results do show that participation in Healthy Start
projects correlated with positive impacts.
29
Among the projects that monitored health indicators of case-managed
clients, significant improvements were reported in the following areas:
•
•
•
•
Rate of overdue physical exams
Status of such basic needs as food and shelter
Rate of substance abuse
Rate of child abuse
A copy of the complete evaluation report is available from the California
Department of Education’s Healthy Start Office.
The Healthy Start story is being written in school communities across
California. Funding for the Healthy Start initiative (HSI) has grown from an
initial level of $19 million in the 1991-92 fiscal year to $39 million in 2001-02.
More than 500 operational partnerships at more than 1,200 elementary,
middle, and high schools in nearly all of California’s 58 counties now have the
potential to reach more than one million young people and their families.
Participants in Healthy Start around the state live in every kind of commu­
nity—urban neighborhoods and barrios, rice and cotton fields, resort towns
and suburbs, isolated logging towns. Every school and community is different,
and every Healthy Start site reflects the unique culture, politics, and economics
of its location. What every Healthy Start site shares as part of the coordinated
school health “family” is a commitment to making life better for California
children, youths, families, and communities. Further information on HSI,
including current availability of funds, can be found at the Web site <http://
www.cde.ca.gov/healthystart>.
Chapter 1
The Vision:
Health Literacy,
Healthy Schools,
Healthy People
C HAPTER 2
Developing
Health Literacy
in the Classroom
and in the
School
32
Chapter 2
Developing Health
Literacy in the
Classroom and
in the School
H
ow can schools foster health literacy in all students? This chapter
contains suggestions on how schools can deliver quality health
education within the context of a coordinated school health system
to meet the needs of all students. Although there are many ways to design and
implement an effective school health system, this chapter is meant to be a
starting point, a guide that schools and school districts can use in creating their
own system and overall strategy to promote health literacy. It deals with the
elements of successful health education, the effective implementation of a
coordinated school health system, research-based school health programs, life
skills and positive behaviors, health education planning and development, and
the needs of special populations.
Elements of Successful Health Education
To help students develop the knowledge, skills, attitudes, and behaviors
needed for a lifelong commitment to health, effective health education:
Curriculum reform has
several important
ramifications for
teachers. . . . Teachers
have to redesign their
courses for a higher level
of student work and use
methods that enable
more students to
succeed at this level.
—Second to None: A Vision
of the New California
High School
• Presents current, accurate content. All health-related education is based on
up-to-date scientific information. It draws on new knowledge about
health and maintains a rigorous scientific viewpoint.
• Recognizes similarities and differences among students. Effective health
education emphasizes the similarities and universal qualities of human
beings, helping students see that although differences do exist, many
people face similar health-related issues and choices. Regardless of differ­
ences in age, culture, disability, ethnic background, gender, primary
language, religion, sexual orientation, or socioeconomic background,
the students must understand that the knowledge, skills, and behaviors
discussed in class apply to all students. Differences should also be
discussed, but care should be taken not to emphasize them to the point
of divisiveness.
• Emphasizes not just health-related information but the importance of behav­
ior. Information alone does not change people’s behavior. A lifelong
commitment to health results from knowledge, skills, attitudes, and
positive behaviors continually repeated and reinforced. Focusing on
behavior involves providing students with opportunities to learn, practice,
and apply new skills, such as making decisions, refusing negative influ­
ences, and accessing health and social service programs to maintain good
health. Seen in this way, effective health education does not limit itself to
the pages of a textbook but views the school as a safe laboratory for
learning, practicing, and reinforcing new behaviors.
• Is culturally appropriate. Attitudes, beliefs, and values regarding healthrelated topics may vary according to the ethnic and cultural makeup of
the community. Effective health education should be based on an aware­
ness of the culture and background of students within each classroom and
33
the influence of culture on the information and skills to be taught. Such
an awareness will affect the teaching strategies used and the content of the
curriculum. For example, many health education programs teach students
how to be assertive and resist negative influences. Yet in some cultures
young people are expected to be quiet and obedient, and in other cultures
public discussion of certain health-related topics may be considered
inappropriate. Whatever the approach, the cultural attitudes and values of
the students, their families, and the community must be taken into
account.
• Makes the curriculum accessible. Not all students learn in the same way, nor
are they motivated by the same factors. Therefore, a variety of teaching
strategies, both teacher-directed and student-centered, should be used in
health education. Activities should provide students with a common
experiential base. A variety of grouping strategies allowing students to
work individually, in pairs, in small cooperative groups, and in large
groups should be used. Instruction should be provided through the
primary language and sheltered English whenever possible to make the
curriculum accessible to limited-English-proficient (LEP) students.
Grouping students to ensure that LEP students have access to bilingual
peers, making instructional resources available in the home language, and
connecting instruction to students’ life experiences will also promote
access to the curriculum.
• Takes advantage of opportunities for active learning. Every aspect of health
education focuses on behaviors or choices, and every topic presents
opportunities for engagement and motivation. An effective health educa­
tion curriculum considers students’ needs, appeals to their interests, and
capitalizes on those interests in many different ways. It offers abundant
opportunities for critical thinking and analysis and remains focused on
helping students develop a deep understanding of health literacy. It also
provides students with many opportunities to be engaged in creating and
constructing what they learn rather than in passively receiving factual
information. Students may practice specific skills in the classroom, report
on school and community resources for health, and complete meaningful,
open-ended homework assignments and large projects that help connect
classroom instruction with the home and the community. Classrooms,
school cafeterias, nurses’ offices, and school-linked community organiza­
tions, such as after-school recreation programs or organizations sponsoring
community-service projects, should all become laboratories for healthrelated experiences.
• Focuses on mental and emotional health throughout. At one time mental and
emotional health was viewed as a separate content area. Increasingly,
however, mental and emotional health is considered crucial to an
individual’s motivation to act on health-related knowledge and use healthrelated skills. Accordingly, concepts related to mental and emotional
Chapter 2
Developing Health
Literacy in the
Classroom and
in the School
Effective health
education should be
based on an awareness
of the culture and
background of students
within each classroom
and the influence
of culture on the
information and
skills to be taught.
34
Chapter 2
Developing Health
Literacy in the
Classroom and
in the School
Through the health
education curriculum,
students learn strategies
for making positive,
healthy decisions based
on such ethical principles
as integrity, courage,
responsibility, and
commitment.
health are discussed throughout this framework. They are basic to all of
health education and are not an independent component that can be
covered in a short unit and ignored in the rest of the curriculum.
• Emphasizes character development. Health education can promote charac­
ter development. Through the health education curriculum, students
learn strategies for making positive, healthy decisions based on such
ethical principles as integrity, courage, responsibility, and commitment.
They learn about the importance of consistent choices in all areas of their
lives and how those choices affect their health and the health of others.
Throughout the health education curriculum, moreover, the development
of positive commitments to one’s own health and the health of the
broader community and society is emphasized.
• Uses technology to enhance learning. Technology should be made an
integral element of health education. In the classroom students can use
technology-based resources to practice skills (e.g., decision making). By
using nutrient analysis software, students can assess how the nutritional
values of choices for their own meals compare with nutritional standards.
They can also develop a personal health profile that tells them where they
stand in relation to group norms on a variety of health indicators such as
weight and allows them to set and monitor progress toward achieving
goals for improvement. In some communities students may have an
opportunity to learn to operate analytical instruments used in medical
laboratories, in laboratories monitoring environmental conditions, and in
clinics and hospitals. Technology can also assist educators. It can help
them keep pace with the rapidly changing field of health information;
provide network exchanges of instructional programs, resources, services,
and research articles; and access resources outside the school and the
school district.
• Focuses on meaning and thinking by connecting concepts in health education
with other learning and experiences. Children learn best when the curricu­
lum is focused on meaning and thinking. Effective health education
emphasizes how ideas are connected within the curriculum and with
other aspects of the overall school program:
1. Connections with other areas of health education. Effective health
education highlights the connections among traditional health topics
so that students can explore interrelationships in health. For example,
individual growth and development are influenced by nutrition;
personal health habits can affect the spread of communicable diseases;
and the use of alcohol, tobacco, or other drugs increases the risk of
disease and injury.
2. Connections with the other components of a coordinated school health
system. Effective health education also links the health curriculum and
the other components of a coordinated school health system so that
35
knowledge and skills learned in the classroom are supported and
reinforced throughout the school. For example, the importance of
physical fitness in health promotion and disease prevention can be
reinforced and enhanced in the physical education class. Further
suggestions for connecting the components of a coordinated school
health system can be found in Chapter 4.
A note of caution is in order here. Because parental notification is
legally mandated before a discussion of human reproductive organs
may occur, schools may wish to limit the integration of sex education
with other topics.
With these principles of effective health education in place, a foundation can
be laid for promoting health literacy and lifelong healthy behaviors. However,
health education alone is not enough to promote health literacy in children.
Health-related knowledge, skills, attitudes, and behaviors need to be reinforced
and supported. The supportive, collaborative structure needed to achieve health
literacy can be provided by a coordinated school health system.
Effective Implementation
Having all the components of a coordinated school health system in place
will take time and require careful planning. The approaches that have proven
successful for program organization and implementation are as follows:
• Create a common vision. Although many factors contribute to an effective
coordinated school health system, none is more critical than a vision
shared by the school and its parents and community. The development
of that vision provides a forum for the school and all facets of the
community to examine their roles in implementing a coordinated school
health system. Once developed, the vision becomes a unifying force for
decision making and system development. It should include clearly
defined goals and outcomes for all the components of a coordinated
school health system.
• Provide strong administrative support. The commitment of school and
school district leaders is the key to building an effective program. One
good way to start is for the school board to develop and adopt a policy
clearly stating its commitment and supporting the eight components
of a coordinated school health system (see Chapter 1). Specific district
policies may already offer guidance on such health matters as dispensing
medication, such as that for asthma, providing school nutrition services,
or dealing with HIV-infected students. These supporting policies can be
reviewed for their consistency in furthering the overall goals and be
revised as needed. Because the most effective policies are those that cover
Chapter 2
Developing Health
Literacy in the
Classroom and
in the School
36
Chapter 2
Developing Health
Literacy in the
Classroom and
in the School
This framework
recommends that the
kindergarten through
grade twelve course of
study in health be
anchored by a full year’s
work at the middle
school level and a second
full year’s work at the
high school level.
all issues surrounding health and contain enforcement procedures as well,
school districts may choose to combine existing health policies into one
comprehensive policy that contains the vision, goals, and policies and
procedures for implementation and enforcement.
• Ensure sufficient time for health education. Because the goal of health
education is to influence students’ lifelong health-related behavior, the
commitment of a realistic amount of time for health education is essen­
tial. Studies have shown that when students receive instruction in health
education over several years, their health-related behavior is influenced
positively and significantly. Health education should begin before kinder­
garten and be continued yearly from kindergarten through grade twelve.
Several national research studies suggest that significant changes in
knowledge about health and attitudes toward health seem to occur after
50 hours of classroom instruction per school year or about one and
one-half hours per week.1 This framework recommends that the kinder­
garten through grade twelve course of study in health be anchored by a
full year’s work at the middle school level and a second full year’s work at
the high school level. Various options exist for including health education
in the curriculum at those levels, and decisions on how best to offer
health education should be made locally. What is essential is that adequate amounts of time be allocated for such instruction.
• Encourage broad-based involvement. Broad-based involvement is crucial to
developing and maintaining articulated kindergarten through grade
twelve health education and instituting a coordinated school health
system. Many individuals can be involved in a schoolwide effort. Effective
strategies for creating involvement include the following:
1. Forming a school-site health team or health committee. This group can
have responsibility for guiding the process, including planning,
coordinating parent and community involvement, developing
curriculum, and implementing program components consistently.
Membership should be representative of the entire school: classroom
teachers; teachers of health education, physical education, home
economics, science, and special education; school nurses; counselors;
school nutrition services personnel; categorical program staff; admin­
istrators; others at the school site; parents; and community members.
School-linked service providers, such as social workers, child-care
providers, recreation specialists, probation officers, and others, may
also be included.
1
D. Connell and others, “Summary of Findings of the School Health Education Evaluation: Health Promotion Effectiveness, Implementation, and Costs,” Journal of School Health, Vol. 55, No. 8 (1985), 316–21.
37
2. Fostering parent and community involvement. Parent and community
involvement is discussed in more detail in Chapter 4 as one compo­
nent of a coordinated school health system. However, it is important
to note here that strong ties to the community will enhance the
school’s efforts to promote health literacy. The process of develop­
ing a consensus about community needs and wants regarding a
coordinated school health system should be continuing, open, and
responsive.
3. Providing mechanisms for effective coordination, collaboration, and
communication. Designating a staff member to coordinate activities
and facilitate communication among the various participants helps
ensure that these critical activities are handled effectively. The roles
and responsibilities of a coordinator might include working with the
on-site team and others to assess the school’s health education
curriculum; providing or arranging for in-service training of staff on
health-related issues; maintaining continuing and open communica­
tion among school staff; working with the appropriate staff to plan
and implement connections between health education and other
curriculum areas; organizing meetings to share information with
parents and community members; writing grant proposals; monitor­
ing the progress of the overall program; establishing clear and appro­
priate lines of referral between the school, parents, and community
agencies; and maintaining a dialogue with county-level groups
involved with services for children and youths.
• Identify resources for program support. Many communities are able to
provide a variety of resources for a coordinated school health system.
Some of these resources (e.g., targeted funding, after-school activities, and
staff who can assist with program implementation) are a response to local
needs, such as gang activity or a high incidence of drug use. The organiz­
ers and coordinators of school-based programs should look to community
health and human-service providers for available resources and find ways
to create linkages between those resources and the school.
Such linkages can enhance an effective coordinated school health system.
Only through the collaborative efforts of school personnel, parents, and
community agencies and representatives will most schools be able to assist
students and their families in obtaining needed health, mental health,
social, and other support services, ranging from basic food, clothing, and
housing programs to child-care and recreational programs. These commu­
nity linkages can also enrich health education by offering real-life experi­
ences to students through health-related issues, practices, and programs.
Chapter 2
Developing Health
Literacy in the
Classroom and
in the School
What makes the
difference in a healthy
school is that all the
people who can have an
impact on children’s
health—administrators,
teachers, physical
educators, nurses,
counselors, support staff,
food services staff, family
members, community
service providers, law
enforcement representa­
tives—take time to sit
down together and talk
about how they can work
cooperatively and
collaboratively to make
the most of the
resources available
to them.
—Toward Healthy Schools:
The Future Is Now
38
Chapter 2
Developing Health
Literacy in the
Classroom and
in the School
Project TEACH
(Teacher Education to
Achieve Comprehensive
Health), funded by the
California Department of
Education and College
Health 2000, was
designed to improve
preservice teacher
training in health
education.
(See Appendix B.)
The entire staff [and
parents] should be
offered training in the
philosophy of the
coordinated school
health system and their
roles in helping students
develop lifelong healthy
behaviors.
• Provide adequate training. Different kinds of training and different
approaches for diverse audiences will be needed as the school’s coordi­
nated school health system unfolds, including the following:
1. Teacher training. High-quality staff development, a key factor in
effective education, is especially needed for health education. The
teacher must have a good understanding of the content, a sensitivity
to and enthusiasm for nurturing the health of each student, and an
ability and willingness to model healthy living. New teachers, includ­
ing all elementary teachers, must be adequately prepared to teach this
area of the curriculum by taking an accredited university course
dealing with teaching health education. High school teachers who
teach a specific health class or who teach health as part of a home
economics or science course also need special preservice preparation
and training.
In addition, all those teaching health need continuing professional
development opportunities so that they can maintain their knowledge
of current health topics and successful instructional strategies. Each
district should ensure that teachers have sufficient opportunities for
professional development in health education.
2. Training for other staff. Nonteaching staff at the school, such as
secretaries, school maintenance personnel, and classroom assistants,
interact with and influence young people. The entire staff should be
offered training in the philosophy of the coordinated school health
system and their roles in helping students develop lifelong healthy
behaviors. In addition, opportunities for cross-training with schoollinked health and human-services providers will greatly strengthen the
coordinated school health system. Training of this type is consistent
with and may be a part of efforts to restructure schools. The major
California school reform documents challenge schools to look at the
entire curriculum and the environment of the school to ensure that all
students succeed. Involvement of staff members in the coordinated
school health system supports that goal.
3. Training and informational presentations for parents. Parents should be
offered opportunities to learn more about the content of the health
education curriculum and the philosophy behind the coordinated
school health system. They should understand the range of topics in
the curriculum and should also have access to content.
• Keep the vision in focus. Once there is commitment to the vision and
broad-based input, planning for further implementation of the compo­
nents of a coordinated school health system should be a continuing
process. Developing, evaluating, and refining specific goals and objectives
for the coordinated school health system will ensure that the vision
39
remains at the heart of the effort. Many schools will have some compo­
nents of a coordinated school health system already in place and function­
ing well, others will be in place but in need of change, and still others will
not yet be under way. Strategic thinking and planning will be needed, but
the vision of a comprehensive approach will be the essential guide.
A quality health education curriculum supported by the components of a
coordinated school health system with high visibility, effective monitoring, and
qualified and enthusiastic participants is not an impossible goal. Although
planning and implementation will take time and thoughtful effort, a coordi­
nated school health system can be achieved when families, communities, and
schools work together and make the health of children and youths a priority.
School Policies on Health Issues
A clearly stated policy that defines the coordinated school health
system and expresses support for this system can greatly facilitate
effective implementation. Specific district policies on a variety of healthrelated issues can be reviewed for their consistency with the coordi­
nated school health system and incorporated into this policy. Addressing
all health issues in one board policy helps ensure consistency and
facilitates review and revision when necessary.
Districts developing policies for the first time or districts updating
policies may wish to consider the California State Board of Education’s
policy on nutrition and state law regarding tobacco-free policies. These
policies are summarized below:
Policy on Nutrition
The State Board of Education recommends that local educational
agency and county office governing boards adopt policies that address all
of the following issues:
1. A statement summarizing the district’s or county office’s nutrition
policy
2. A plan for policy implementation and enforcement
3. A description of the local enforcement procedure
The policy should apply to all school-approved groups, including but
not limited to students, teachers, parents, booster groups, and outside
vendors. It would be appropriate for elementary school policies to be
more restrictive than those for junior and senior high schools. Local
policies that are more restrictive than existing state or federal laws and
regulations are also acceptable.
Tobacco-Free Policies
“All school districts and county offices of education . . . shall adopt
smoke-free campus policies and shall prohibit the use of tobacco on
(Continued on next page)
Chapter 2
Developing Health
Literacy in the
Classroom and
in the School
Meeting these challenges
is the only wise course
toward securing the
future of the nation. But
more than that, it is the
right and moral thing to
do for our young people,
and we must accept
nothing less.
—Code Blue: Uniting for
Healthier Youth
40
Chapter 2
Developing Health
Literacy in the
Classroom and
in the School
school property no later than July 1, 1996” (Health and Safety Code
Section 24167[q][2]). A fully implemented tobacco-free policy includes
the following:
• Policy prohibits the use of tobacco products anywhere, anytime�
on county or district property and in county or district vehicles.�
• Enforcement procedures are established.�
• Information about the policy and enforcement procedures are�
communicated clearly to county, district, or school personnel,�
parents, students, and the larger community.�
• Signs stating the prohibition of tobacco use are prominently�
displayed at all entrances to county, district, or school property.�
• A referral program to smoking cessation support programs is made�
available, and students and staff are encouraged to participate.�
41
Importance of Research-Based Programs
Elementary and secondary education in recent years have seen an increasing
emphasis placed on higher standards, accountability, and results. Given this new
educational environment, effective, research-based programs and curricula have
become as important to school health programs as they are to any other curricular
area.
Several health education topics, including tobacco, alcohol and other drugs,
nutrition, and human immunodeficiency virus/acquired immunodeficiency
syndrome (HIV/AIDS), have received categorical funding. The requirements
of such funding, of course, include accountability for program effectiveness. The
Centers for Disease Control and Prevention (CDC), through its Division of
Adolescent and School Health (DASH), has a particular interest in prevention
programs that address risk factors known to be the major causes of morbidity
and mortality in the United States. From 1992 to 2002 DASH undertook a
process to identify effective prevention programs for youths. The process focused
on the prevention of HIV/AIDS, sexually transmitted diseases (STDs), pregnancy,
and tobacco use. Curricula that provided credible evidence of effectiveness were
called “Programs That Work.”
The following criteria were among those required for inclusion in Programs
That Work:
• The intervention was a complete curricular program or package, not just
a single component, such as a video.
• The intervention involved a classroom or other group setting.
• Content areas were specific to the program’s health focus (e.g., tobacco-use
prevention or STD prevention).
• The study population was composed of school-age youths (particularly
middle school through high school for HIV, STD, and pregnancy
prevention curricula).
• The research design included an intervention group and a control or com­
parison group.
• Follow-up measurement took place at least four weeks after the HIV, STD,
or pregnancy prevention intervention ended or at least six months after the
tobacco-use intervention ended.
• A report of the study had been published or accepted for publication in a
peer-reviewed journal (e.g., a professional publication focusing on school
health, psychology, or drug-abuse prevention).
• The study measured specific risk behaviors and health outcomes related
to the content areas.
• The results found an association between exposure to the intervention
and at least one specifically defined positive outcome related to the
targeted health-risk behavior.
• The curriculum could be used by the average teacher, with appropriate
training.
Chapter 2
Developing Health
Literacy in the
Classroom and
in the School
42
Chapter 2
Developing Health
Literacy in the
Classroom and
in the School
During the Programs That Work review process, CDC appointed a panel of
evaluation experts to assess the validity of the program’s evaluation and a panel
of program experts to assess the feasibility of replicating the program. If both
panels recommended adoption, CDC designated the curriculum as a Program
That Works.
In California a similar Department of Education initiative has been the
development of a series of guides and professional literature reviews under the
general rubric of Getting Results (see Additional References and Resources).
Established in conjunction with the federally funded Safe and Drug-Free
Schools and Communities program and the state-funded Tobacco-Use
Prevention Education program, Getting Results emphasizes the need for careful
selection of research-based practices. The following criteria are among those
that can be used for the selection of an effective, research-based health curricu­
lum or program:
• The program is based on a theory that is accepted by experts.
• The theory provides a logical explanation of why the program should
work.
• The program has produced the desired changes in the target population.
• The research has been conducted by reputable researchers and published
in a reputable journal (preferably a peer-reviewed journal).
• The study has used a rigorous evaluation design.
• The study shows few negative effects.
• The study has been replicated at more than one site.
• The program has been implemented by school staff in the study.
• The students in the study are similar to students in the district selecting
the curriculum or program.
• The program appears to be cost-effective.
Districts and schools are well advised to ensure that health instruction is
based on current and confirmed research and complies with Education Code
mandates. Therefore, the process of selecting and implementing programs that
fit the criteria noted above requires great care. Establishing a good match
between what a particular program offers and the school district’s unique needs
is a central element of that process. “No single curriculum or scientifically
validated prevention strategy,” writes education researcher J. Fred Springer,
“will replace the skill and judgment of program designers and deliverers in
constructing programs that make sense in their schools and communities.”2
2
J. Fred Springer, “Beyond the Magic Bullet: How We Can Achieve Science-Based Prevention,” in
Getting Results, Update 1: Positive Youth Development: Research, Commentary, and Action. Sacramento:
California Department of Education, 1999, p. 39.
43
Life Skills and Positive Behaviors
Traditional health education has relied heavily on providing students with
relevant health knowledge. The assumption has been that unhealthy behavior is
the result of ignorance, but research does not support this assumption.3 For
example, a meta-analysis of smoking prevention programs for adolescents
showed that the effects of traditional or “rational” approaches to influencing
health behavior were small and insignificant.4
Recent research on HIV/AIDS, smoking, and drug use has shown that the
inclusion of personal and social skills development is an effective approach for
attaining positive health behavior.5 Further credibility for emphasizing personal
and social skills development can be found in a social influences model.6 This
model recognizes and emphasizes the social environment as a critical factor in
shaping health behavior. Influences such as the family, school, the faith com­
munity, cultural contexts, peer behavior, and media are of great importance.
The implications of this research are that health education should not only
provide relevant health knowledge but also build the skills students need to
recognize and resist negative influences. These skills need to be both personal
(intrapersonal) and social (interpersonal). Skills development should include
but not be limited to analysis of media messages, decision making, coping
strategies, assertiveness, refusal skills, validation of perceived social norms, and
resolution of conflicts. To a great extent, the development of personal and
social skills has been missing from health education. That shortcoming has
resulted in ineffective efforts to promote positive health behavior.
3
B. R. Flay, “Psychosocial Approaches to Smoking Prevention: A Review of Findings,” Health
Psychology, Vol. 4, No. 5 (1985), 449–88; P. M. Lantz and others, “Investing in Youth Tobacco Control:
A Review of Smoking Prevention and Control Strategies,” Tobacco Control, Vol. 9 (2000), 47–63.
4
W. H. Bruvold, “A Meta-Analysis of Adolescent Smoking Prevention Programs,” American Journal of
Public Health, Vol. 83 (1993), 872–80.
5
T. Baranowski, C. L. Perry, and G. S. Parcel, “How Individual Environments and Health Behavior
Interact: Social Cognitive Theory,” in Health Behavior and Health Education. Edited by K. Glanz, F. M.
Lewis, and B. K. Riner. San Francisco: Jossey-Bass, Inc., 1997; S. I. Donaldson and others, “Resistance Skill
Training and Onset of Alcohol Use: Evidence for Beneficial and Potentially Harmful Effects in Public and in
Private Catholic Schools,” Health Psychology, Vol. 14 (1995), 291–300; W. B. Hansen and R. B. McNeal,
“Drug Education Practice: Results of an Observational Study,” Health Education Research: Theory and
Practice, Vol. 14, No. 1 (1999), 85–97; N. S. Tobler and H. H. Stratton, “Effectiveness of School-Based
Drug Prevention Programs: A Meta-Analysis of the Research,” Journal of Primary Prevention, Vol. 18, No. 1
(1997), 71–128.
6
A. Bandura, Social Foundations of Thought and Action. Englewood Cliffs, N.J.: Prentice Hall, 1986;
G. C. Homans, Elementary Forms of Social Behavior (Second edition). New York: Harcourt Brace Jovanovich,
1974; W. McGuire, “Social Psychology,” in New Horizons in Psychology. Edited by P. C. Dodwell.
Middlesex, England: Penguin Books, 1972; S. Schinke, B. Blythe, and L. Gilchrest, “Cognitive-Behavioral
Prevention of Adolescent Pregnancy,” Journal of Counseling Psychology, Vol. 28 (1981), 451–54; Mark K.
Smith, Paulo Freire. The Home of Informal Education Web site. <http://www.infed.org/thinkers/et-freir.htm>.
1997.
Chapter 2
Developing Health
Literacy in the
Classroom and
in the School
44
Chapter 2
Developing Health
Literacy in the
Classroom and
in the School
Researchers William B. Hansen and Ralph B. McNeal offer the following
insights on the state-of-the-art research on substance abuse, delinquency, and
other high-risk behaviors.7 A key feature of the research is its focus on the
characteristics known broadly as risk and protective factors. Health education
in California is at a stage of development in which considerable effort and
expertise are required of educators to make programs work as they are intended
to work. To create programs using life skills or social influence, researchers
spend their time investigating which risk factors and protective factors are
important targets for change and how those changes should be accomplished.
Not all risk or protective factors are equal. New studies reinforce the concept
that prevention is often the result of changing only a limited number of factors.
Some examples of promising factors include peer norms, a sense of bonding to
school, a commitment to avoid risk behaviors, and tolerance toward others.
Programs that target these factors hold great promise for effective prevention
of risk behaviors.
Health Education Planning
and Development
School health programs and systems vary widely from one school district to
another and may also differ among individual schools within a district. Perhaps
the most important aspect of any school health program is the leadership,
which depends on persons who are convinced of the importance of school
health to academic achievement and are willing to be champions for effective
program planning and implementation.
A variety of resources for planning and developing school health programs
are widely available throughout California. The use of these resources in
conjunction with the Health Framework and Education Code requirements will
help schools establish a unified and coherent school health program.
Resources for Program Planning
In addition to the resources identified in other sections of this framework,
many locally available resources may be considered in planning the program.
These include the following:
• Community resources—local health departments, law enforcement
agencies, state agencies, services for children and families, libraries,
community health information centers, and county offices of education
• School district resources—school board members who are advocates of
student health and well-being; nutrition specialists; and district staff
responsible for curriculum, instruction, and staff development
7
W. B. Hansen and R. B. McNeal, “Drug Education Practice: Results of an Observational Study,”
Health Education Research: Theory and Practice, Vol. 14, No. 1 (1999), 85–97.
45
• School site resources—administrators, teachers, librarians, and school
psychologists who are personally involved in and committed to health and
well-being; health teachers; physical education teachers; school nurses;
and representatives of special-interest school organizations, such as Future
Nurses and Friday Night Live
• Family resources—family members working in the health professions;
family members who coach local sports teams; and families whose
children have special health needs
The Health Curriculum
Intended as an aid to curriculum planning, the information in Chapter 3 of
this framework presents the scope and sequence of health instruction together
with grade-span descriptions and grade-level emphases. Other aids to curricu­
lum planning are as follows:
• Education Code. The Education Code (EC) contains legislated require­
ments related to health education that should be incorporated into the
curriculum planning process (see Appendix A).
• State-adopted instructional materials. The State Board of Education
approves new or revised curricular materials for health education on
a regular basis, usually once every seven years. All materials adopted by
the State Board since 1995 are available for loan and review at no charge
from the Healthy Kids Resource Center, 313 W. Winton Avenue,
Room 180, Hayward, CA 94544-1187; (510) 670-4583; <http://
www.californiahealthykids.org>.
• School library resources and support. The public school library continues
to evolve into an active and technology-rich environment sustained by the
power of information. Information literacy is knowing how to access and
use that information and is the foundation of lifelong learning. The
school library provides a wealth of resources, both print and online, that
support the health curriculum. In addition, professional school library
media teachers are trained to conduct collaborative information literacy
instruction. The process of analyzing, applying, evaluating, and interpret­
ing health-related information, products, and services is an important part
of information literacy training.
Examples of these skills and behaviors that build sequentially are highlighted in Chapter 3 and include a variety of critical-thinking skills for
reading and interpreting information as well as skills for analyzing and
applying criteria to various ideas. The school library can provide a wealth
of resources and strategies.8
8
Information Power: Building Partnerships for Learning. Chicago: American Library Association, 1998.
Chapter 2
Developing Health
Literacy in the
Classroom and
in the School
46
Chapter 2
Developing Health
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Classroom and
in the School
Health Literacy Assessment
Assessment is an integral component of a health education program.
Chapter 5 of this framework provides guidelines for the assessment of health
literacy and states, “A wide array of assessment methods and instruments that
measure behavior and skill development and support critical thinking and a
student-centered curriculum should be used to assess student health literacy”
(p. 217). Under the leadership of national organizations, such as the Centers
for Disease Control and Prevention (CDC) and the Council of Chief State
School Officers (CCSSO), several important health education standards and
assessment initiatives have emerged. One such initiative is the CCSSO State
Collaborative on Assessment of Student Standards (SCASS). This collaborative
includes health education experts from throughout the country.
The CCSSO-SCASS Health Education Assessment Project’s Assessing Health
Literacy: Assessment Framework provides invaluable information for building a
foundation to support a quality comprehensive health education program.9
The document provides the overall infrastructure for developing all assessment
items. It prioritizes skills and concepts for health education assessment, not
instruction. California’s Health Framework closely parallels the National Health
Education Standards. The national standards, along with CDC’s six priority
adolescent risk behaviors, provided the driving forces for the development of
Assessing Health Literacy. Table 1, “Relationship Between Health Education and
Adolescent Risk Behaviors,” illustrates the relationship between the Health
Framework’s recommended health education content areas, the four unifying
ideas and related student expectations, and the priority risk behaviors identified
by CDC.
Cost, personnel, and time constraints make it impossible to assess all of the
content delivered within a given health education curriculum. Assessing Health
Literacy organizes assessment items at the elementary, middle, and high school
levels for skills and concepts that are most likely to yield health-promoting
behaviors among youths. A total of more than 2,800 items have been developed
and tested. The types of items used in the project include selected response
(multiple choice), constructed response (short answer/extended response),
performance events, and performance tasks.
9
Assessing Health Literacy: Assessment Framework. Prepared by the Council of Chief State School Officers.
Soquel, Calif.: ToucanEd Publications, 1998.
Communicable and chronic
diseases
Individual growth and
development
Family living
Environmental health
Nutrition
Alcohol, tobacco, and
other drugs
Injury prevention and safety
Consumer and community
health
Personal health
Health Education
Content Areas
Unifying Idea: Informed Use of Health-Related Information,
Products, and Services
Students will identify information, products, and services that may be
helpful or harmful to their health.
Unifying Idea: An Understanding of the Process of Growth and
Development
1. Students will understand the variety of physical, mental, emotional,
and social changes that occur throughout life.
2. Students will understand and accept individual differences in
growth and development.
3. Students will understand their developing sexuality, will choose to
abstain from sexual activity, will learn about protecting their sexual
health, and will treat the sexuality of others with respect.
Unifying Idea: Respect for and Promotion of the Health of Others
1. Students will play a positive, active role in promoting the health
of their families.
2. Students will promote positive health practices within the school
and community, including developing positive relationships with
their peers.
Unifying Idea: Acceptance of Personal Responsibility for Lifelong Health
1. Students will demonstrate ways in which they can enhance and
maintain their health and well-being.
2. Students will demonstrate behaviors that prevent disease and
speed recovery from illness.
3. Students will practice behaviors that reduce the risk of becoming
involved in potentially dangerous situations and react to potentially
dangerous situations in ways that help to protect their health.
Unifying Ideas and Student Expectations
Promoted in the Health Framework
Table 1
Relationship Between Health Education and Adolescent Risk Behaviors
Sedentary lifestyle
Dietary patterns that
contribute to disease
Tobacco use
Sexual behaviors that result in
HIV infection, other STDs,
or unintended pregnancy
Use of alcohol and other drugs
Behaviors that result in
intentional and unintentional
injury
Adolescent Risk Behaviors
Identified by Centers for Disease
Control and Prevention
47
48
Chapter 2
Developing Health
Literacy in the
Classroom and
in the School
Implications for Health Literacy Assessment
The information provided in Assessing Health Literacy can help educators
direct health literacy education accountability systems in the following ways:
• Conduct needs assessments for health instruction.
• Establish baseline data regarding student health literacy.
• Measure the extent to which the Health Framework’s grade-level
expectations have been achieved.
• Align the Health Framework, classroom instruction, and assessment
methodologies.
• Facilitate the transition from teaching health knowledge to teaching
health skills.
• Develop an assessment system that reflects improvements in students’
health-related knowledge and skills.
• Evaluate the effectiveness of programs.
CCSSO has developed a series of CD-ROMs that present all the assessment
items, examples, rubrics, and skill cards discussed in Assessing Health Literacy.
The CD-ROMs and other related resources are available for loan from the
Healthy Kids Resource Center.
Involvement of Other Health Experts
When planning a health education curriculum, leaders should keep in
mind that many professionals with special health-related expertise and interest
are available in schools and communities. Potential human resources include
health care providers; public health educators in tobacco, alcohol, and drug
prevention; public health nurses; juvenile justice staff; environmental health
specialists; mental health counselors; and nutritionists.
Opportunities for student involvement in health issues in the community
can be added to the curriculum through these experts’ participation in the
learning experience. When guests are invited to participate in the classroom,
school policies should be considered and adequate precautions taken to ensure
student safety and the guests’ adherence to curriculum standards and practices.
Needs of Special Populations
The mission of the California Department of Education is to provide
leadership, assistance, oversight, and resources so that every Californian has
access to an education that meets world-class standards. Some students face
barriers that impede learning or access to educational, health-related resources.
Educators and administrators must make accommodations to minimize the
impact of those barriers on students’ education. The most commonly affected
populations are students with exceptional needs, expectant and parenting teens,
49
homeless children and youths, and foster children and youths. Guidelines to
accommodate those students are as follows:
Education for Students with Exceptional Needs
The United States Congress has declared that “Disability is a natural part
of the human experience and in no way diminishes the right of individuals to
participate in or contribute to society. Improving educational results for chil­
dren with disabilities is an essential element of our national policy of ensuring
equality of opportunity, full participation, independent living, and economic
self-sufficiency for individuals with disabilities” (Individuals with Disabilities
Education Act, 1997, Part A, Section 601[c][1]).
Advances in science and technology, in conjunction with society’s increased
commitment to promoting optimal learning and development for all children,
have increased opportunities for students with exceptional needs to better
realize their own potential. However, these advances bring with them substan­
tial challenges for families, schools, communities, and society as a whole. To
meet the challenges in an effective, efficient, and safe manner, experts in
education, health, social services, law, financing, and municipal services must
collaborate with families and communities to identify and promote practices
and programs that will enhance the quality of life for these students.
The protection of education rights for students with exceptional needs is
guaranteed by the following legislation:
• Public Law 94-142, passed in 1975, renamed the Individuals with
Disabilities Education Act (IDEA) in 1990, and reauthorized in 1997
(20 United States Code [USC] sections 1400 et seq.; and 34 Code of
Federal Regulations [CFR], parts 300 and 303)
• The federal Rehabilitation Act, Section 504 (29 USC 705 [20]
and 794; and 34 CFR, Part 104)
• The federal Americans with Disabilities Act (ADA) (42 USC 12101–
12213; 47 USC 225 and 611; and 28 CFR, Part 35)
• Education Code, Part 30 (Section 56000 et seq.)
• California Code of Regulations, Title 5 (Section 3000 et seq.)
• Government Code, Chapter 26.5 (Section 7570 et seq.)
Of the three federal legislative pieces, only IDEA is specific to education.
Section 504 of the Rehabilitation Act and ADA are civil rights legislation
concerned with discrimination and equal access and, as such, guarantee
students with disabilities an education comparable to that provided to
nondisabled students.
Note: Staff development programs must be provided for regular and special
education teachers, administrators, certificated and classified employees,
volunteers, community advisory committee members, and, as appropriate,
Chapter 2
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Classroom and
in the School
50
Chapter 2
Developing Health
Literacy in the
Classroom and
in the School
members of the district and county governing boards. Such programs shall
include, but not be limited to, the provision of opportunities for all school
personnel, paraprofessionals, and volunteers to participate in ongoing develop­
ment activities pursuant to a systematic identification of pupil and personnel
needs (Education Code sections 56240 and 56241[a]).
Other resources related to special education programs are as follows:
• “California Special Education Programs: A Composite of Laws
Database,” Education Code, Part 30, Other Related Laws, and California
Code of Regulations, Title 5 at <http://www.cde.ca.gov/spbranch/sed/
lawsreg2.htm>
• A Composite of Laws, California Special Education Programs, 25th Edition
(Sacramento: California Department of Education, 2003)
• The California Law Web site at <http://www.leginfo.ca.gov/calaw.html>
• California Code of Regulations Web site at <http://ccr.oal.ca.gov>
• United States Code Web site at <http://uscode.house.gov/usc.htm>
• Code of Federal Regulations Web site at <http://www.access.gpo.gov/
nara/cfr/ >
Expectant and Parenting Teens
Teen pregnancy is one of the most pressing and poignant problems facing
society and carries personal and social costs. It is a complex issue of physical,
social, cultural, and economic factors that hold myriad ramifications for
individuals, families, communities, the state, and the nation.
According to the State Superintendent of Public Instruction’s Report to the
Legislature, teen pregnancy presents challenges not only to teens, their children,
and their families, but also to state and local governments and society as a
whole in terms of strained resources.10 Many challenges facing the educational
system are caused by the following conditions:
• Pregnancy and parenting responsibilities are the number-one reason that
females drop out of school.
• A high correlation exists between low basic skills and teen pregnancy.
• A high correlation exists between low birth weight in infants and the need
for special education services.
• Pregnancy among females younger than fifteen years of age is increasing.
The California School Age Families Education (Cal-SAFE) Program,
established by Chapter 1078, Statutes of 1998, became operational in
July 2000. This comprehensive, community-linked, school-based program
is designed to increase the availability of support services necessary for enrolled
expectant and parenting students to improve their academic achievement and
parenting skills and to provide a quality child care and development program
10
Delaine Eastin, A Report to the Legislature. Sacramento: California Department of Education, 1996.
51
for their children. Cal-SAFE builds on education reform initiatives, ensures a
quality education program with high standards for enrolled students, and
mandates accountability of local educational agencies for the performance of
students and their children in meeting program goals. Comprehensive health
education is one of the allowable expenditures of Cal-SAFE Program funds.
More information is available on CDE’s Cal-SAFE Program Web site at
<http://www.cde.ca.gov/calsafe>.
Through existing school resources or collaboration with community part­
ners, such as the Adolescent Family Life Program (AFLP) and the Cal-Learn
Program, schools can coordinate strategies to help expectant and parenting
students gain access to such necessary support services as perinatal care, child
care, and transportation between home and school. Strategies for addressing
these students’ special needs are as follows:
• Health education. Pregnancy and subsequent parenthood call attention to
the need for health education for teen parents and health care for their
children and for themselves. In addition to being more aware of their own
bodies’ needs, pregnant teens and also teen mothers and fathers should be
concerned and have knowledge about the health of their children. An
effective strategy to meet this need is to modify the content areas of the
health education curriculum to focus on the priorities and unique needs
of expectant and parenting students. For example, tobacco prevention
education is more relevant when discussed in terms of the effects of
smoking on teens’ unborn children and the effects of secondhand smoke
on children. Expectant and parenting teens are facing adult responsibili­
ties, and this period in their lives holds an opportunity for them to
develop lifelong healthy habits and act as positive role models for their
children.
• Nutritious meal supplements, education, and counseling. Good nutrition is
a crucial part of prenatal and postnatal care. Pregnancy intensifies the
nutritional needs of teenagers, increasing in particular the need for
calcium, protein, and certain vitamins and minerals. Poor diet and
improper weight gain or loss on the part of pregnant teens can lead to
poor outcomes, such as premature and low-birth-weight babies. Teen
mothers must make sound nutrition decisions for the well-being of their
children. Teen parents also need to know about appropriate feeding
patterns, including breastfeeding, for their children as they move through
the infant, toddler, and preschool stages. Teen parents must develop
responsible, healthful eating habits in order to provide good role models
for their children.
• Physical education program. One of the most neglected aspects of a
pregnant or parenting student’s educational experience is the teen’s
physical education/fitness program. With physician approval, pregnant
Chapter 2
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in the School
52
Chapter 2
Developing Health
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women can engage in a moderate level of physical activity to maintain
cardiorespiratory and muscular fitness throughout pregnancy and the
postpartum period. An individualized physical education/fitness program
should be developed for each teen under the direction of a physician to
promote the pregnant teen’s safe engagement in physical activity that
strengthens and tones muscles, increases stamina and endurance, and
improves general health.
The major considerations in the design of a modified physical education/
fitness program related to pregnancy include (1) regulation of body
temperature (remain well hydrated and avoid exercise in high heat or
humidity); (2) avoidance of a supine position in the mid and late stages
of pregnancy (perform abdominal exercises while standing or on hands
and knees); (3) limitation of the range of motion (avoid heavy lifting and
high-impact activities); and (4) recognition of the change in center of
gravity, which may cause balance problems and the risk of falling (avoid
activities requiring sudden changes in direction or position).
• Counseling/case management. Teen pregnancy and teen parenting affect
not only the teen parents and their children but also the adult parents of
the teens, any siblings, and the extended family. This period is a time of
profound change and may cause friction between the teen mother and the
father of her child as well as between the families of the young parents.
Schools may need to provide individual or family counseling either
directly or through referral to a public or private mental health agency.
Peer support groups and counseling may be available through school
programs targeting the special needs of expectant and parenting students
and their children. Support services for grandparents, siblings, and teen or
adult fathers of babies born to teen mothers may be needed to promote
success in school for the students.
• Prenatal education and service referral. Pregnant women, regardless of age,
need early referral to prenatal education and care in order to promote
positive birth outcomes for them and their children. Pregnant teens may
delay seeking health care for a variety of reasons. School nurses and staff
working in programs for pregnant and parenting students can promote
positive birth outcomes by providing appropriate health education
instruction, including reproductive health care, and by referring students
to community agencies and programs that address the needs of pregnant
women.
Children and Youths Living in Homeless Situations
In California an estimated 222,000 children and youths from birth to
eighteen years of age live in homeless situations, as defined by Education Code
Section 1981.2, during all or part of the school year. Students in this group
53
present special challenges to teachers, administrators, counselors, and other
school staff. Education Code Section 48200, the compulsory attendance law,
requires school attendance for children six to eighteen years of age. Federal law
(No Child Left Behind [NCLB] Act of 2001 [PL103-382], Title I, Part A)
requires local educational agencies to reserve funds to provide services, includ­
ing education-related support services, to homeless children and youths who are
eligible under Title I. The Stewart B. McKinney Homeless Assistance Act
(PL 100-77) provides assistance to ensure that homeless youths have equal
access to a free, appropriate public education. District policies and procedures
must be in place to ensure that homeless children and youths are not denied
the opportunity to enroll in, attend, and succeed in school.
Outreach and awareness are key components in overcoming barriers facing
the education of homeless children and youths. School districts may assist with
transportation services to encourage consistent attendance and instructional
continuity. In-service training should be provided to district and school
personnel to foster an understanding of the issues and needs facing homeless
students and to create a positive learning environment for them. To enroll a
child in school, families must meet certain requirements and provide appropri­
ate documentation, conditions that often present obstacles for those living in
homeless situations. School personnel may satisfy the enrollment requirements
with alternative documents to facilitate the enrollment of homeless children
and youths. Some of the conditions that must be met include residency require­
ments, placement in the school of origin or attendance, and the verification of
documents. Records are required to verify birth date, grade level, up-to-date
immunizations, parent or guardian, and emergency contacts. To verify that a
child has received the necessary immunizations to enroll in school, schools need
an immunization record from a health clinic, doctor, school, or social service
agency. If the information is unobtainable, school officials should direct the
family to the nearest health clinic or health provider. The parent or guardian
should provide a medical release for the student and emergency notification
information on the standard school emergency card. If a parent or guardian
cannot be reached in an emergency, schools should follow normal policies and
procedures in providing care for the student.
More information on issues affecting the education of children and youths
living in homeless situations can be found in the publications Enrolling Students
Living in Homeless Situations and Pieces of the Puzzle: Creating Success for
Students in Homeless Situations.11
11
Enrolling Students Living in Homeless Situations. Sacramento: California Department of Education,
1999; B. James and others, Pieces of the Puzzle: Creating Success for Students in Homeless Situations. Austin:
University of Texas, 1997.
Chapter 2
Developing Health
Literacy in the
Classroom and
in the School
54
Chapter 2
Developing Health
Literacy in the
Classroom and
in the School
Foster Children and Youths
Foster Youth Services (FYS) programs provide support services to displaced
students to reduce the traumatic effects of being removed from their families
and schools and placed in unfamiliar home settings. The programs have the
authority to ensure that health and school records are obtained to establish
appropriate placements and coordinate instruction, counseling, tutoring,
mentoring, vocational training, and emancipation services for foster children
and youths. These services are designed to improve the children’s educational
performance and personal achievement.
Currently, approximately 105,000 to 110,000 children in California are in
foster care. When foster children experience changes in care and school place­
ment, they face the stresses of falling behind academically, losing academic
credit, and losing contact with persons who are aware of their health and
welfare needs. In 1999–2000 FYS projects served approximately 3,400 foster
youths, and countywide programs provided services for approximately 13,000
foster youths residing in group homes. Data collected from providers of FYS
programs demonstrate that these services have resulted in major quantitative
improvements in pupil academic achievement, the incidence of pupil discipline
problems or juvenile delinquency, and pupil dropout and truancy rates.
Schools are clearly a focal point for identifying foster children’s academic
and behavioral problems and needs. Through interagency collaboration
providers of foster youth services work with social workers, probation officers,
group home staff, school staff, and community service agencies to influence the
day-to-day routines of foster children both during and after school. The Health
and Education Passport (Education Code Section 49069.5) includes complete
health and school records and is a tool for establishing appropriate placements
and coordinating instruction, counseling, tutoring, mentoring, and other
training and related services for foster youths. Accurate student information
facilitates appropriate placement, increases the stability of placements, and
ensures that children receive appropriate support services that improve their
educational performance and personal achievement.
Additional information and resources or a copy of the Report to the
Governor and Legislature on Foster Youth Services Programs (Education Code
Section 42923), dated February 15, 2000, are available from the Educa­
tional Options Office, California Department of Education, telephone
(916) 322-5012; Web site <http://www.cde.ca.gov/spbranch>.
C HAPTER 3
Health
Education
56
I.
The Health Curriculum:
An Overview
H
ealth education is integral to a coordinated school health system.
A well-designed health curriculum for students in kindergarten
through grade twelve offers abundant opportunities for engaging
students and involving them in meaningful learning experiences. The curricu­
lum should provide students with opportunities to explore concepts in depth,
analyze and solve real-life problems, and work cooperatively on tasks that
develop and enhance their conceptual understanding. It also provides students
with the knowledge and skills that can lead to lifelong positive attitudes and
behaviors related to health.
The major goal of health education envisioned in this framework is the
development of health literacy in all students. The four unifying ideas of health
literacy emphasized throughout the health curriculum are the following:
• Acceptance of personal responsibility, including responsibility for personal
lifelong health, acceptance of the idea that the individual has some
control over health, and incorporation of health-related knowledge into
everyday behavior
• Respect for and promotion of the health of others, including an understand­
ing and acceptance of the influence of behavior on the health and wellbeing of others, of people on the environment, and of the environment
on the health of groups and individuals
• An understanding of the process of growth and development, including the
importance of both universal and individual aspects of physical, mental,
emotional, and social growth and development
• Informed use of health-related information, products, and services, including
the ability to select and use health-related information, products, and
services carefully and wisely
A curriculum that addresses the four unifying ideas will draw content from
the nine major content areas of health education:
•
•
•
•
Personal Health
Consumer and Community Health
Injury Prevention and Safety
Alcohol, Tobacco, and Other Drugs
57
•
•
•
•
•
Nutrition
Environmental Health
Family Living
Individual Growth and Development
Communicable and Chronic Diseases
The content areas are the traditional, widely used subject categories of health
education. With minor variations they have appeared consistently in previous
California frameworks and in other state and national descriptions of compre­
hensive health education. Together, the content areas describe the range of
health concepts, skills, and behaviors important for today’s students. In the
course of a year, most if not all of the content areas should be included in the
curriculum. To be woven throughout the content areas are the concepts related
to mental and emotional health. Basic to all parts of health education, those
concepts are to be included in the curriculum each year.
The content areas are not distinct from the four unifying ideas of health
literacy. Rather, the unifying ideas run through and connect the content areas
in a student-centered approach that makes instruction meaningful to students.
A well-designed health curriculum combines the four unifying ideas with the
content areas in a continuing spiral of knowledge and skill development from
kindergarten through grade twelve. This chapter presents the broad outlines of
such a program.
Chapter 3
Health Education
I. The Health Curriculum:
An Overview
58
II.
Content Areas, Kindergarten
Through Grade Twelve
T
he following descriptions of the nine content areas apply across grade
levels from kindergarten through grade twelve. Expectations and
content for specific ranges of grade levels can be found in Section III.
Personal Health
Personal health lays the foundation for good general health. Instruction in
personal health encourages a positive commitment to health and well-being
rooted in respect for oneself and one’s physical, mental, emotional, and social
health. Understanding that exercise is essential to good health, a person realizes
that to stay healthy and fit is basic to personal health.
Three ideas are central to personal health. First, good health is not simply a
matter of luck or accident; it involves taking responsibility and making deliber­
ate choices. Second, good health involves an interaction of physical, mental,
emotional, and social aspects of health, reflecting the interdependence of body
and mind. Third, a commitment to personal health is one basis for leading a
happy, healthy, productive life.
Consumer and Community Health
As a nation we face a growing concern about the cost of health care and the
need to focus on health promotion and disease prevention. Addressing that
concern implies a shift not only in how health-care services are provided but
also in how individuals take an active role in deciding on their use of healthcare services and health-related products.
Three main ideas are central to this content area. First, the age-old principle
of buyer beware is particularly relevant to health-related decisions. In many
cases medical problems may get better without treatment or with simple
treatment at home. When skilled health care is needed, one should know how
to find the appropriate services and avoid products or services that may be
useless or even harmful. Second, preventing illness and promoting health are in
the best interest of both individuals and society. Third, a variety of community
organizations and agencies are available to assist those experiencing problems.
59
Injury Prevention and Safety
However childhood injury is measured (in number of deaths, dollar costs for
treatment, relative rankings with other health problems, or loss of potential
years of life), it ranks first among health problems affecting children in Califor­
nia and the nation. Historically, although childhood mortality due to disease
has been reduced dramatically, that due to injury has increased steadily. Unin­
tentional injuries, mainly those involving motor vehicles but also those caused
by drowning, fire, suffocation, or poisoning, together with intentional injuries
resulting from violent behavior, rank among the greatest threats to the health of
children and young adults.
Yet the causes of injuries can be prevented or avoided. This content area
focuses on prevention through safe living habits and positive, healthy decisions.
Simple precautions and an awareness of the consequences of one’s choices and
decisions can help to prevent many unintentional injuries. This content area
also acknowledges that violence is a public health issue. The curriculum at all
grade levels should include a comprehensive approach to the prevention of
violence.
Another focus of this content area is knowing what to do when confronted
with emergencies. Appropriate responses are critically important in emergencies
resulting from natural disasters or the actions of dangerous persons.
Note: See summary of Education Code Section 51202 (personal and public
health and safety) in Appendix A. The requirements of this code section should
be understood prior to the development of curriculum in this content area.
Chapter 3
Health Education
II. Content Areas,
Kindergarten Through
Grade Twelve
Violence is a public
health issue. The
curriculum at all grade
levels should include
a comprehensive
approach to the
prevention of violence.
Alcohol, Tobacco, and Other Drugs
The use of alcohol, tobacco, and other drugs, so pervasive and so potentially
damaging to the health of individuals and society, has major implications in the
lifelong health of individuals. Successful efforts to prevent the use of tobacco are
effective against four of the five leading causes of death in California: heart
disease, cancer, chronic obstructive lung disease, and fire caused by smoking.
A multifaceted approach, including a full range of prevention and interven­
tion components, is required to safeguard the health of students from the effects
of alcohol, tobacco, and other drugs. As a starting point information should be
presented on the effects of alcohol, tobacco, including smokeless tobacco and
secondhand smoke, and other drugs on the body. Information should also be
presented on all types of drugs, including medicines and such performanceenhancing substances as steroids. The proper use of medication and the role of
medication in the treatment of disease are key concepts. The effects of alcohol,
tobacco, and other drugs on pregnant women and their children should also be
addressed, together with the social effects of their use and the relation of alcohol
and drug use to suicide, violence, and other health and safety issues.
A multifaceted approach,
including a full range of
prevention and
intervention components,
is required to safeguard
the health of students
from the effects of
alcohol, tobacco, and
other drugs.
60
Chapter 3
Health Education
II. Content Areas,
Kindergarten Through
Grade Twelve
As important as the development of knowledge related to alcohol, tobacco,
and other drugs is the need for young people to develop skills in resisting the
influence of peers and the media to use legal and illegal substances that are
potentially harmful. With so many health-related choices influenced by peers,
skill-building activities, such as development of refusal and communication
skills, are a necessary component of instruction at all grade levels. Students
should know that the consumption of alcohol and the use of tobacco and other
drugs (with the exception of appropriate medications) are prohibited at school
and should be familiar with the consequences for failure to comply.
The environment in which alcohol, tobacco, and other drugs are made
available must also be considered. Society accepts the adult use of tobacco and
alcohol, sending conflicting messages to young people regarding their use. As a
result children must be prepared to deal with situations in which they cannot
control the use of alcohol, tobacco, and other drugs by others. To strengthen
the school’s message and provide for consistency at home and in the commu­
nity, parents and other members of the community should be involved in
developing curriculum and intervention strategies designed to prevent the use
of alcohol, tobacco, and other drugs and should be encouraged to support the
school’s no-use message to students. They should work together to identify and
reduce specific risks and increase protection.
Collaborative efforts are also helpful in refining and enhancing procedures
for identification, assessment, referral, and ongoing support for children and
youths who have previously used alcohol, tobacco, or other drugs and in
providing information on available counseling, treatment, and reentry programs and services to students and employees. One important, appropriate
function of community involvement is communicating information to parents
and the community about problems with the use of alcohol, tobacco, and other
drugs experienced by youths as well as effective strategies to prevent their use.
In addition, community involvement brings law enforcement agencies and the
community into the schools, builds bridges between the school and the
community, and develops more effective communication and cooperative
relationships. Through a well-coordinated effort, schools, families, law enforce­
ment agencies, and the community can work together to develop, promote,
and carry out a clear, unified position on the use of alcohol, tobacco, and other
drugs.
Note: See summaries of Education Code sections 51202 (personal and public
health and safety) and 51203 (alcohol, narcotics, restricted dangerous drugs,
and other dangerous substances) in Appendix A. The requirements of these
code sections should be understood prior to the development of curriculum in
this content area.
61
Nutrition
To be ready to learn and to achieve their fullest potential, children need to
be well nourished and healthy. For that reason they must have an adequate
supply of healthy foods and the knowledge and skills required to make wise
food choices. A primary issue for all children, then, especially the increasing
number of children living in poverty, is access to an adequate diet. Effective
nutrition education provides children and their families with information on
gaining access to adequate food sources, including the range of school nutrition
programs available.
Nutrition Services Specialists:
Resources for Health Education
Often overlooked as health education or program resources
are the professional nutritionists and registered dietitians affiliated
with child nutrition programs. These nutrition specialists can
provide tremendous resources. They and other child nutrition staff
can help augment classroom activities and assist teachers with the
integration of nutrition- or food-related activities with many
subject areas and various schoolwide programs and services.
Examples of such activities include:
•­ Providing assistance with mathematical calculations of the
nutritional values of foods, recipes, and menus
•­ Developing consumer education skills, such as reading labels
and getting the most for students’ food dollars
•­ Increasing respect for other cultures and the foods of those
cultures
•­ Providing assistance with lessons on the chemical reactions
that take place in foods and lessons on safe food-handling
practices and the relationship between food-handling and
microbiology
•­ Providing assistance in developing disaster-preparedness plans
and food kits for students
•­ Providing parent education in nutrition and food-related
consumer practices
•­ Addressing the nutritional concerns of students with special
health conditions
By including child nutrition professionals in programs and
services, districts can maximize their resources and make the
health team more comprehensive.
Chapter 3
Health Education
II. Content Areas,
Kindergarten Through
Grade Twelve
62
Chapter 3
Health Education
II. Content Areas,
Kindergarten Through
Grade Twelve
The link between nutrition and good health or, conversely, between poor
nutrition and illness is another key concept. Healthy eating habits and an active
lifestyle can increase resistance to communicable diseases and reduce the risk of
chronic disease, developmental disabilities, and infant mortality, a particularly
serious problem of teenage pregnancy. In California the basis for nutrition
recommendations is the California Daily Food Guide,1 which incorporates the
federal dietary guidelines for Americans and the dietary recommendations of
other national health authorities. Current nutrition recommendations are
illustrated in the food guide pyramid developed by the U.S. Department of
Agriculture.
Students learn that food choices are intimately linked with physical, mental,
emotional, and social health; energy level; self-image; and physical fitness.
This content area provides students with the knowledge, skills, and motivation
needed to make wise food choices throughout their lives. Ideally, nutrition
education uses the school’s child nutrition programs as an essential part of the
educational process. Food-tasting and preparation experiences at all grade levels
can provide an excellent opportunity for classroom teachers to work coopera­
tively with school nutrition personnel and use the cafeteria as a learning
laboratory for classroom lessons as required by federal and state legislation.
(Public Law 95-166 provides funds to states for the development of compre­
hensive nutrition education programs that make full use of the school
cafeteria.) One model nutrition curriculum is contained in the California
Department of Education’s Choose Well, Be Well series.2
Environmental Health
The primary focus of environmental health is to make students aware of how
environmental issues affect their personal health. The content area also suggests
specific steps that students can take as individuals and citizens to protect and
improve the environment.
A number of health conditions are either caused or exacerbated by environ­
mental factors. For example, asthma and other lung ailments can be aggravated
by air pollutants; skin cancer, by unprotected exposure to the sun; intestinal
disorders, by polluted water; and allergies, by pollens, dust, or animal dander.
In addition, environmental teratogens, both naturally occurring and synthetic,
can cause birth defects and developmental disabilities. Health hazards from air
pollution, water pollution, excessive noise levels, unprotected sun exposure,
and unhealthy working or living conditions are also unfortunate features of
modern life.
1
The California Daily Food Guide. Developed by the California Department of Health Services in
collaboration with the California Department of Aging and the California Department of Education.
Sacramento: California Department of Education, 1990.
2
Choose Well, Be Well is a series of nutrition curriculum materials designed by teachers and nutrition
experts for students in preschool through grade twelve, published 1982–84.
63
Students need to learn about health hazards resulting from the environment.
They also need to be taught about the precautions and behaviors they can
practice to safeguard their health from environmental hazards. This awareness
should be combined with an awareness of practices that will reverse or at least
slow down environmental pollution and related problems. Lessons that relate to
recycling, conservation of resources, and an appreciation of the finite limits of
environmental resources are important in this content area.
Note: See summary of Education Code Section 51202 (personal and public
health and safety) in Appendix A. The requirement of this code section should
be understood prior to the development of curriculum in this content area.
Family Living
In the teaching of family living, particular attention must be paid to the
legislative codes and guidelines that affect curriculum planning and instruction
within this content area. Note: See summaries of Education Code sections
51550 and 51555 (parent notification), 51553 (sex education course criteria,
emphasizing abstinence), 51554 (parental notification of outside speakers
for family life, AIDS, STDs), 51201.5 (HIV/AIDS prevention), and 51513
(personal beliefs) in Appendix A. The requirements of these code sections
should be understood prior to the development of curriculum in this content
area.
A functional family unit is vital to the well-being of children. Children
usually develop best when they live in a stable environment with their mother
and father and receive from their parents consistent love, support, and direc­
tion. However, children from nontraditional families can also develop successfully. Given the variety of nontraditional families in contemporary society, it is
important that children not reared in two-parent families be convinced that
their situation can also be conducive to growth and development.
Further, it is important that children not be denigrated because of their
living arrangement or the composition of their family. All students, regardless
of their current living arrangement, can benefit from classroom instruction and
discussion on family living. They can learn how they can contribute to making
the family unit harmonious and successful now as well as in the future—when
they will likely become parents.
This content area promotes the development of positive family interactions
in all types of families, including those that face unusual challenges. Families
that have members with physical or mental disabilities can experience major
effects on patterns of family interaction. Ideally, families can adapt to these
challenges and in fact may develop stronger, more supportive family relationships as a result. Members of these families should feel comfortable participat­
ing in classroom discussions of family interactions.
Instruction in family living also focuses on sexuality, the reproductive
process, dating relationships, and the selection of a mate. Abstinence from
Chapter 3
Health Education
II. Content Areas,
Kindergarten Through
Grade Twelve
64
Chapter 3
Health Education
II. Content Areas,
Kindergarten Through
Grade Twelve
Abstinence from sexual
activity is strongly
encouraged because it is
the healthiest course of
action for young people.
Because parents should
be the primary source of
sex education and values
relating to this subject,
they must be notified
before lessons in sex
education are offered.
sexual activity is strongly encouraged because it is the healthiest course of action
for young people. Statistics based on the latest medical information citing the
failure and success rates of condoms and other contraceptives in preventing
pregnancy shall be provided to students. In addition, the moral, legal, and
economic responsibilities of parenthood are highlighted.
Sexually transmitted diseases and their prevention are discussed. Because
parents should be the primary source of sex education and values relating to
this subject, they must be notified before lessons in sex education are offered.
The Education Code permits parents to withdraw their children from this
portion of the health curriculum.
Decisions regarding developing specific instruction in family living within
the parameters of legal requirements rest with school districts. The approach of
this framework is to encourage districts to work with parents and community
members in developing curriculum, especially in the area of family living. The
intent of the curriculum in this content area is not to invade the privacy of
families and their right to teach values to their children but to assist families in
teaching about family living and encourage effective family communication.
Because of the sensitive nature of this content area, school districts may wish
to arrange same-sex groupings during presentation of this portion of the
curriculum to younger students. Districts should work with parents and
community members to decide how controversial issues such as homosexuality,
abortion, and masturbation will, or will not, be addressed. Parents should be
informed of the district’s position, and teachers should receive clear training in
fulfilling the district’s policies.
Family life curricula must include factual, substantiated information that is
free of racial, ethnic, and gender bias and, if consistent with district policy, an
opportunity for students to explore different aspects of issues within the
parameters allowed by law. The school district must determine what constitutes
factual, substantiated information3 and ensure that all instructional resources
are subject to the district’s review and approval process. If guest speakers are
invited to participate in the discussion of those issues, the speakers’ activities
must be made to adhere to district policy and state law. Further, districts
must ensure that schools comply with all legal requirements concerning family
life education, including providing written notification to parents before
conducting classes in which the human reproductive organs and their functions
are described, illustrated, or discussed.4
3
Education Code Section 51553(b): “(1)(A) Factual information presented in course material and
instruction shall be medically accurate and objective. (B) For purposes of this section, the following
definitions apply: (i) ‘Factual information’ includes, but is not limited to, medical, psychiatric, psychologi­
cal, empirical, and statistical statements. (ii) ‘Medically accurate’ means verified or supported by research
conducted in compliance with scientific methods and published in peer-review journals, where appropriate,
and recognized as accurate and objective by professional organizations and agencies with expertise in the
relevant fields such as the Centers for Disease Control and Prevention.”
4
School district governing boards dealing with policy issues should refer to Appendix A.
65
Individual Growth and Development
An important element of health is our view of ourselves and our sense of our
relationship to those around us. This content area provides information about
the wide range of patterns and rates of physical, mental, emotional, and social
development that occur among children and young adults. This information
includes the stages of the life cycle from conception through death, physical
changes that occur during puberty, and changes in relationships with others
that accompany social development and the aging process.
This content area encourages students to take pride in their personal iden­
tity. It teaches them to view self-esteem as being based not only on one’s
accomplishments but also on personal values and ethical considerations.
Further, self-esteem frees one to make healthy decisions and refuse to take part
in negative behaviors without the fear of rejection that may inhibit some
individuals.
In addition, this content area focuses on the importance of positive interpersonal relationships as an element in individual health and well-being.
Friendships are essential to a feeling of belonging and self-worth. Skills for
sustaining long-term friendships can be cultivated, and friends can help each
other make responsible decisions.
Finally, this content area addresses the growing number of physically or
mentally challenged students being mainstreamed into regular classes and
promotes their acceptance. As a result of mainstreaming, more children will be
exposed to classmates with serious illness and may even experience the death of
a classmate. Studying this content area will help students understand and
respond appropriately to students with special needs.
Communicable and Chronic Diseases
The most important message to convey in this content area is that students
have a considerable measure of control over their health and that chances of
contracting most illnesses can be greatly influenced by students’ health-related
choices and decisions. Such communicable diseases as sexually transmitted
diseases (STDs), including HIV/AIDS and hepatitis B, dramatically illustrate
the point. Chances of contracting these diseases are greatly reduced when
young people abstain from sexual activity and intravenous drug use and
use universal precautions when dealing with other people’s body fluids.
Note: The importance of abstinence education is emphasized in the section
on family living.
Although the effects of heredity must be considered, behaviors and decisions
also affect the development of such chronic diseases as cardiovascular disease,
cancer, hypertension and stroke, diabetes, and osteoporosis. The risk factors for
these diseases can begin to be detected early in life and are greatly influenced by
Chapter 3
Health Education
II. Content Areas,
Kindergarten Through
Grade Twelve
Chances of contracting
most illnesses can be
greatly influenced by
students’ health-related
choices and decisions. . . .
Sexually transmitted
diseases (STDs), including
HIV/AIDS and hepatitis B,
dramatically illustrate
this point.
66
Chapter 3
Health Education
II. Content Areas,
Kindergarten Through
Grade Twelve
health-related choices. Communicable and chronic diseases are too often the
consequences of short-sighted or uninformed choices.
With so many health-related choices influenced by peers, skill-building
activities, such as development of refusal and communication skills, are a
necessary component of instruction at all grade levels. Physically or mentally
challenged children are especially susceptible to peer pressure and should be
included in skill-building instruction and practice.
This content area also includes the skills necessary to act in a supportive yet
safe manner toward people with diseases. Although it is important to promote
tolerance toward people with disease, individuals and society also need to work
to control and eradicate disease.
The discussion of sexually transmitted diseases and HIV infection and AIDS
is a necessary and important part of this content area. Note: See summaries of
Education Code sections 51550 (parent notification), 51553(a) (sex education
course criteria, emphasizing abstinence), 51201.5 (HIV/AIDS prevention), and
51513 (personal beliefs) in Appendix A. The requirements of these code
sections should be understood prior to the development of curriculum in this
content area. As with the family life content area, parents must be notified
before sex education classes are offered in which the human reproductive organs
and their functions are described, illustrated, or discussed, including discussion
of sexually transmitted diseases. Parents may withdraw their children from this
portion of the health curriculum.
The discussion of communicable and chronic diseases can be sensitive and
have cultural, socioeconomic, genetic, or religious implications. Although
decisions regarding curriculum content rest with school districts, the approach
of this framework is to encourage districts to work with parents and commu­
nity members in developing the curriculum.
67
III.
Expectations and Content,
by Grade Level
T
he four unifying ideas of health literacy and the related grade-span
expectations are presented first. Then, in the new material, the
grade-span expectations are organized into a chart indicating specific
emphases for each elementary grade level and for middle school and high school.
Structure of the Instructional
Guidelines for Each Grade
Each of the following sections introduces concepts and suggestions designed
to facilitate the planning of curricula, instructional units, and instructional
resources. Each section focuses on the four unifying ideas of health literacy and
follows a specific format.
• Unifying idea: acceptance of personal responsibility for lifelong health;
respect for and promotion of the health of others; an understanding of the
process of growth and development; and informed use of health-related
information, products, and services
• Grade-level expectations
• Concepts and content to be emphasized
• Examples of skills and behaviors to be taught and reinforced
Kindergarten Through Grade Three
Although much of their environment and daily living activities are beyond
their control, students in kindergarten through grade three can choose many
behaviors that contribute to good health. Because young children tend to be
unself-consciously egocentric, a curriculum that focuses on them and on what
they can do to promote their well-being captures their interest and attention.
The curriculum should begin with the children and their immediate environ­
ment so that they can make clear connections to information, concepts, skills,
and behaviors. It should also sustain a focus on the children’s social develop­
ment as members of the classroom, the school, families, and communities.
Throughout, the prevention of unhealthy behaviors and promotion of attitudes
and behaviors that can lead to lifelong health practices should be strongly
emphasized.
68
Unifying Idea
Acceptance of personal responsibility
for lifelong health
Chapter 3
Health Education
III. Expectations
and Content,
by Grade Level
Expectations:
1. Students will demonstrate ways in which they can
enhance and maintain their health and well-being.
2. Students will understand and demonstrate behaviors
that prevent disease and speed recovery from illness.
3. Students will practice behaviors that reduce the risk of
becoming involved in potentially dangerous situations
and react to potentially dangerous situations in ways
that help to protect their health.
Kindergarten
Through
Grade Three
Expectation 1
Students will demonstrate ways in which they can enhance and maintain
their health and well-being.
Grade-level concepts and content
Examples of skills and behaviors
The human body:
Children at this level are curious
about the function of body parts
and their own bodies. Teaching
them how their bodies function and
the care required to maintain health
empowers them to choose healthy
behaviors. The curriculum should
focus on habits related to physical
care of the body and those related
to protecting the body.
Practicing good personal hygiene,
including caring for teeth, gums, eyes,
ears, nose, skin, hair, and nails
Using protective equipment or prac­
ticing behaviors to protect the body,
such as:
1. Using a seat belt or helmet
2. Using sunscreen or a hat in
bright sunlight
3. Keeping sharp objects away
from one’s eyes, ears, nose
4. Protecting ears from exposure
to excessive noise
5. Wearing appropriate clothing and
protective equipment for sports
6. Playing or exercising at times and
in ways that minimize exposure
to such environmental hazards
as excessive heat and smog
7. Practicing ways to maintain
correct posture and prevent
back injuries
69
Grade-level concepts and content
Examples of skills and behaviors
Chapter 3
Health Education
Food choices:
Because food preferences and
dietary practices begin to be formed
in childhood, students should begin
investigating healthy eating patterns,
exploring different food grouping
systems, and learning how to select a
variety of foods that promote health.
They should become acquainted with
the variety of foods available, includ­
ing foods from various cultures, and
have opportunities to try foods that
may not be a part of their regular
diet. The concept that all foods have
a place in a healthy diet should be
emphasized. Although some foods
provide more of the things the body
needs than other foods, none have to
be eliminated from a healthy diet
except for medical or religious
reasons. The California Daily Food
Guide and the USDA food pyramid
should be introduced and used to
assist students in making healthy
food choices.
Making healthy food choices
Grouping foods in many different
ways—for example, by taste, smell,
feel, color, sound, origin (plant or
animal), or category
Establishing and maintaining
healthy eating practices
Preparing and trying a variety
of healthy foods, using safe and
sanitary food preparation and
storage techniques
Analyzing how food choices are
influenced by peers, the media, the
family, and the community
Physical activity:
Students should have opportunities to participate in enjoyable
physical activities. As they enjoy
movement, they can begin to
develop an understanding of the
means of achieving physical fitness.
This understanding includes
knowing the characteristics of a
physically fit person and the physical, mental, emotional, and social
benefits of regular physical activity.
Participating regularly in active play
and a variety of enjoyable physical
activities, with a focus on the
pleasure of being active
Obtaining a sufficient amount
of sleep
Observing safety rules during
physical activities
Exploring ways to engage in enjoyable out-of-school play activities
that promote fitness and health
III. Expectations
and Content,
by Grade Level
Kindergarten
Through
Grade Three
Unifying Idea:
Acceptance of personal
responsibility for
lifelong health
70
Chapter 3
Health Education
Expectation 1 (Continued)
Grade-level concepts and content
III. Expectations
and Content,
by Grade Level
Kindergarten
Through
Grade Three
Unifying Idea:
Acceptance of personal
responsibility for
lifelong health
Examples of skills and behaviors
Mental and emotional health:
As children explore the effects
that eating nutritious foods and
exercising sufficiently have on good
health, they should learn that good
health is a dynamic, unified state of
physical, mental, emotional, and
social well-being. A balanced routine
of rest, work, play, and healthy food
choices contributes to physical
fitness and good health. In addition,
fostering good family relationships
and friendships and learning to base
one’s actions on personal values and
ethical considerations promote
mental and emotional health. The
curriculum should, therefore, help
students learn to balance self-interest
with concern and caring for others.
Identifying and sharing feelings
in appropriate ways
Demonstrating personal charac­
teristics that contribute to selfconfidence and self-esteem, such as
honesty, integrity, respect for the
dignity of others
Developing protective factors that
help foster resiliency, such as
participating in activities that
promote positive bonding to peers
and adults in the school and com­
munity and identifying a support
system
Developing and using effective
communication skills to enhance
social interactions
Developing and using effective
coping strategies, including critical
thinking; effective decision making;
goal setting; practice of problem
solving, assertiveness, and refusal
skills; and taking time for exercise
and relaxation
Avoiding self-destructive behaviors
and practicing self-control
71
Chapter 3
Health Education
Expectation 2
Students will understand and demonstrate behaviors that prevent disease
and speed recovery from illness.
Grade-level concepts and content
Examples of skills and behaviors
III. Expectations
and Content,
by Grade Level
Disease prevention:
The curriculum should emphasize
how behaviors can help prevent
disease or reduce its influence.
Students can explore ways in which
communicable diseases are spread by
pathogens. They should begin to
understand that the risk of develop­
ing chronic diseases is influenced not
only by one’s behavior but also by
environmental conditions and
genetic predisposition. The content
should include symptoms of major
communicable diseases and the
effect immunizations, health screen­
ings, and sanitary practices can have
on preventing the spread of diseases.
Students can also investigate how
faulty handling, storage, and prepa­
ration of food can produce foodborne illnesses.
Practicing good personal hygiene to
prevent the spread of disease, such as
washing one’s hands and covering
one’s mouth when sneezing or
coughing
Practicing positive health behaviors
to reduce the risk of disease, such as:
1. Participating regularly in
physical activities
2. Making healthy food choices
3. Acknowledging the impor­
tance of immunizations and
demonstrating a willingness to
cooperate in immunizations
4. Limiting exposure to commu­
nicable diseases as much as
possible
5. Caring for wounds in a man­
ner that supports healing
Cooperating in regular health
screenings, including dental
examinations
Preparing food in the classroom
or school cafeteria as a way of
learning about the importance
of sanitary food preparation and
storage to avoid communicable
diseases and food-borne illnesses
Kindergarten
Through
Grade Three
Unifying Idea:
Acceptance of personal
responsibility for
lifelong health
72
Chapter 3
Health Education
Expectation 2 (Continued)
Grade-level concepts and content
Treatment of disease:
III. Expectations
and Content,
by Grade Level
Kindergarten
Through
Grade Three
Unifying Idea:
Acceptance of personal
responsibility for
lifelong health
Examples of skills and behaviors
Students at this level should
investigate the common symptoms
of illness and recognize that being
responsible for personal health also
means alerting parents, guardians, or
appropriate health-care personnel to
any symptoms of disease. Students
should explore how their behavior
can help them recover from disease
or manage its effects over the long
term. Why medicines should be
taken properly and why they should
be taken only under the supervision
of responsible adults should be
emphasized.
Recognizing symptoms of common
illnesses, such as fever, rashes,
coughs, congestion, and wheezing,
and describing them to parents or
health-care providers
Cooperating with parents and
health-care providers in the treat­
ment or management of disease,
such as asthma
Taking prescription or over-thecounter medicines properly under
the direction of parents or healthcare providers
Expectation 3
Students will practice behaviors that reduce the risk of becoming involved
in potentially dangerous situations and react to potentially dangerous
situations in ways that help to protect their health.
Potentially dangerous situations:
A key concept at this level is
recognizing the potential for danger
in everyday situations and behaving
in ways that help to protect one’s
own safety and well-being. Students
should be able to describe the
characteristics of a safe environment
and should be given opportunities to
practice behaviors that promote a
safe environment for themselves and
others. The curriculum should
include descriptions of potential
dangers when students are in or near
motor vehicles and when they are
Developing and using appropriate
skills to identify, avoid when
possible, and cope with potentially
dangerous situations
Practicing safe behavior in or near
motorized vehicles, including
crossing streets safely
Practicing safe behavior in recre­
ational activities, such as cycling and
skating
Practicing safe behavior in and near
water
Interacting safely with strangers
73
Grade-level concepts and content
Examples of skills and behaviors
Chapter 3
Health Education
Potentially dangerous situations:
engaged in recreational activities,
including references to drowning
and falls. Students should know
what to do if they become lost or
separated from parents and should
understand that they should never
willingly go off with a stranger. They
should be aware that being home
alone is a big responsibility and is
potentially dangerous. In addition,
the curriculum should emphasize
that young children should not
handle firearms, which present a
serious threat to the children’s safety.
Developing and using appropriate
skills to avoid, resolve, and cope
with conflicts
Reporting or obtaining assistance
when faced with unsafe situations
Practicing behaviors that help
prevent poisonings, including
learning never to smell, taste, or
swallow unfamiliar items
Alcohol, tobacco, and other drugs:
Students should learn about
the negative impact that chemical
substances can have on health.
The curriculum should discuss
what drugs are, including alcohol,
tobacco, and others, and describe
the differences between helpful and
potentially harmful substances. The
concept of dependency should be
introduced. And students should
begin to learn to cope with an
environment in which alcohol,
tobacco, and other drugs are used
and dependency exists by developing
skills and behaviors that support
positive health behaviors.
Exercising self-control
Developing and using interpersonal
and other communication skills
Distinguishing between helpful and
harmful substances
Identifying ways to cope with or
seek assistance as necessary when
confronted with situations involving
alcohol, tobacco, and other drugs
III. Expectations
and Content,
by Grade Level
Kindergarten
Through
Grade Three
Unifying Idea:
Acceptance of personal
responsibility for
lifelong health
74
Chapter 3
Health Education
Expectation 3 (Continued)
Grade-level concepts and content
III. Expectations
and Content,
by Grade Level
Kindergarten
Through
Grade Three
Unifying Idea:
Acceptance of personal
responsibility for
lifelong health
Examples of skills and behaviors
Child abuse, including sexual exploitation:
After parents are notified and local
standards are complied with, ageappropriate information about child
abuse or neglect can be introduced.
Included should be reference to each
person’s right to the privacy of his or
her body and the appropriateness of
telling others when touching is not
welcome. Instruction should empha­
size that a child is not at fault if the
child is touched in an improper or
uncomfortable way by an adult. The
child’s responsibility in this situation
is to tell a trusted adult what had
occurred.
Identifying ways to seek assistance if
worried, abused, or threatened,
including how to tell a trusted adult
if uncomfortable touching occurs
Developing and using communica­
tion skills to tell others when
touching is unwanted
Emergencies:
Students should be taught appro­
priate ways to react during and after
an emergency, including emergencies
resulting from natural disasters, such
as earthquakes. The first step is to
recognize the seriousness of the
situation. The second is to obtain
assistance. Mitigating steps can
substantially reduce health hazards
resulting from natural disasters.
Instruction should include descrip­
tions of appropriate responses to fires
and earthquakes and, depending on
local needs, responses to such other
potential disasters as floods.
The role of adults in emergencies
should be emphasized. For example,
parents or teachers can help children.
However, if they are not available,
children should know how to seek
help from other appropriate adults.
Recognizing emergencies and
responding appropriately, including:
1. Knowing how to get out of the
home in the event of a fire
2. Using a telephone appropriately
to obtain help, including
calling 911 if available
3. Providing name, address, and
telephone number to a respon­
sible adult
4. Knowing how to treat simple
injuries, such as scratches, cuts,
bruises, and first-degree burns
5. Practicing the stop, drop, and
roll response to a clothing fire
6. Identifying and obtaining help
from police officers, fire
fighters, and medical personnel
Practicing appropriate behavior
during fire drills, earthquake drills,
and other disaster drills
75
Unifying Idea
Respect for and promotion of the health
of others
Expectations:
4. Students will understand and demonstrate how to
play a positive, active role in promoting the health
of their families.
5. Students will understand and demonstrate how to
promote positive health practices within the school
and community, including how to cultivate positive
relationships with their peers.
Expectation 4
Students will understand and demonstrate how to play a positive, active
role in promoting the health of their families.
Grade-level concepts and content
Examples of skills and behaviors
Roles of family members:
Students should learn that a
common trait of all successful families
is a commitment to fostering the
physical, mental, emotional, and
social welfare of every member.
Healthy people are actively and
positively involved with their families.
Students should explore the role
of parents and the extended family in
supporting a strong family and
promoting the health of children. For
example, the limits parents set for
children, the values or religious beliefs
taught, and the behaviors and values
modeled influence the behavior of
children. Students can also explore
the role of health-related rules in
promoting the health of family
members. For example, parents may
require children to stay home when
they have certain illnesses.
Students should explore the role
of children in promoting the health
Supporting and valuing all family
members
Demonstrating ways in which
children can help support positive
family interactions, such as listening
to and following directions, follow­
ing family rules, showing care and
concern toward other family
members, and interacting appro­
priately with family members
Developing and using effective
communication skills, including
nonviolent conflict resolution
Chapter 3
Health Education
III. Expectations
and Content,
by Grade Level
Kindergarten
Through
Grade Three
76
Chapter 3
Health Education
Expectation 4 (Continued)
Grade-level concepts and content
III. Expectations
and Content,
by Grade Level
Kindergarten
Through
Grade Three
Unifying Idea:
Respect for and
promotion of the
health of others
Examples of skills and behaviors
Roles of family members:
of the family and begin to develop
the skills necessary to be a supportive
family member.
Change within the family:
Such changes as pregnancy, birth,
marriage, divorce or separation,
illness, or death affect all family
members and can generate strong
emotions. Students should explore
strategies for coping with change in
the family.
Identifying feelings related to
changes within the family and
effectively expressing them to others
in a positive way
Using effective strategies to cope
with change in the family, such as
learning how to handle emotions by
talking with a parent or other trusted
adult about those feelings
Expectation 5
Students will understand and demonstrate how to promote positive health
practices within the school and community, including how to cultivate
positive relationships with their peers.
Friendship and peer relationships:
The curriculum should include an
opportunity for students to examine
how positive peer relationships contri­
bute to good health. This exploration
will help to lay the foundation for
resisting negative peer pressure in
later years. Students should explore
the importance of having friends and
the characteristics of good friends
and begin to examine how others
influence their behavior. They should
also be helped to recognize that good
communication is important for
developing and maintaining friendships and should be guided to seek
out healthy, positive friendships.
Knowing and using appropriate
ways to make new friends
Demonstrating acceptable methods
of gaining attention
Demonstrating acceptable ways to
show or express feelings
Demonstrating positive actions
toward others, including acts of
trust, kindness, respect, affection,
listening, patience, and forgiveness
and avoiding demeaning statements
directed toward others
Resolving conflicts in a positive,
constructive way
77
Grade-level concepts and content
Examples of skills and behaviors
Chapter 3
Health Education
Friendship and peer relationships:
III. Expectations
and Content,
by Grade Level
Students should also be encour­
aged to respect the dignity and
worth of others, all of whom have
special talents and abilities. Positive
interactions are different from
friendships, however. Although we
may not like everyone with whom we
interact, being able to communicate
and work effectively with a variety
of people is an important skill.
Violence is a public health issue.
When conflicts cannot be resolved in
a nonviolent manner, society suffers.
Recognizing that there are positive
ways to resolve conflict, students
should begin to develop conflictresolution skills at this time. They
should learn a variety of strategies for
handling negative feelings, including
feelings of anger and disappointment.
Kindergarten
Through
Grade Three
Unifying Idea:
Respect for and
promotion of the
health of others
School and community-based efforts to promote and protect health:
Students should understand why
rules about health exist at home and
at school and why students should
respect those rules and encourage
their friends and family members to
do so as well. Students should be
encouraged to assume responsibility
for following the rules without being
specifically reminded. In addition,
the curriculum should include
opportunities for students to develop
an understanding of the way behavior
affects the environment and partici­
pate in school or community efforts
to support positive health behaviors.
For example, students might examine
sources of litter and determine ways
to lessen the problem.
Understanding and following school
rules related to health
Participating in school efforts to
promote health—for example, a
walk-a-thon, fund-raising events, or
practices that support healthy food
choices
Assuming responsibility for helping
to take care of the school, such as
picking up trash on the school
grounds or helping other students
assume responsibility for that action
Participating in community efforts
to address local health and
environmental issues—for example,
recycling
78
Unifying Idea
An understanding of the process of growth
and development
Chapter 3
Health Education
III. Expectations
and Content,
by Grade Level
Expectations:
6. Students will understand the variety of physical,
mental, emotional, and social changes that occur
throughout life.
Kindergarten
Through
Grade Three
7. Students will understand and accept individual
differences in growth and development.
Expectation 6
Students will understand the variety of physical, mental, emotional, and
social changes that occur throughout life.
Grade-level concepts and content
Examples of skills and behaviors
Life cycle:
Students should learn that all
living things come from other living
things and have life cycles. For
humans this process includes
physical, mental, emotional, and
social growth. Students should
understand the stages of the life
cycle from infancy to old age.
Describing the cycle of growth and
development in humans and other
animal species
Demonstrating an understanding of
the aging process, such as understanding why some older adults,
including grandparents and greatgrandparents, may have needs
different from those of younger
adults and children.
Expectation 7
Students will understand and accept individual differences in growth
and development.
Growth and development:
Students should explore the
universal aspects of growth. However, they should also recognize that
each individual has a unique pattern
of growth and development. The
major factors that determine indi­
vidual differences, especially in
height and weight, should be
Demonstrating an understanding of
individual differences, such as
differences in appearance or learning
styles, through positive, constructive
actions
79
Grade-level concepts and content
Examples of skills and behaviors
Chapter 3
Health Education
Growth and development:
highlighted, including genetics and
dietary and exercise habits.
Although persons with disabilities
are different from others, they are
not inferior. Students should be
encouraged to accept those with
disabilities. They should try to walk
in the shoes of a person with special
needs and determine how they
would like people to treat them if
they had disabilities.
Adapting group activities to include
a variety of students—for example,
blind students or students in wheelchairs
Kindergarten
Through
Grade Three
Unifying Idea:
An understanding of
the process of growth
and development
Mental and emotional development:
Students should explore the
mental and emotional aspects of
growth and development. For
example, they should learn that
many of the emotions they experi­
ence throughout life are also felt by
other people. When feeling sad,
angry, or confused, they will find
that talking about feelings with a
parent, trusted peer, or other adult is
an appropriate coping skill.
III. Expectations
and Content,
by Grade Level
Identifying, expressing, and manag­
ing feelings appropriately
Developing and using effective
communication skills
80
Unifying Idea
Informed use of health-related information,
products, and services
Chapter 3
Health Education
III. Expectations
and Content,
by Grade Level
Expectation:
8. Students will identify information, products, and
services that may be helpful or harmful to their
health.
Kindergarten
Through
Grade Three
Expectation 8
Students will identify information, products, and services that may be
helpful or harmful to their health.
Grade-level concepts and content
Examples of skills and behaviors
Products and services:
Students should begin to explore
how the health-care system functions
by identifying places for obtaining
health services and learning what
specific services are offered. They
should identify types of health-care
workers and persons qualified to
provide health advice and care,
thereby laying the groundwork for a
discussion of health quackery in later
years. They should also explore
sources of health-related information
and products. Students at this grade
span should begin to recognize that
they are consumers and that con­
sumer decisions are influenced by a
variety of factors. They should begin
to explore the advertising strategies
used to influence the selection and
use of health-related products and
services as well as the use of alcohol
and tobacco.
Identifying places for obtaining
health and social services and
learning what types of services are
provided
Identifying health-care workers
Identifying a variety of consumer
influences and analyzing how those
influences affect decisions
81
Grade-level concepts and content
Examples of skills and behaviors
Chapter 3
Health Education
Food choices:
Students should explore how
family, school, friends, the commu­
nity, advertising, and the food
industry all play a role in influencing
what children prefer to eat, what is
available for them to eat, and what
their eating environments are like.
Students should recognize that all of
these factors influence the food
choices they make.
Students should explore sources
of nutrition information and
recognize that food labels are a
convenient and important source for
this information. They should learn
how to identify the contents of
packaged foods and begin to learn
how to use labels to compare food
products.
Reading and interpreting some of
the information available on food
labels, such as identifying sugar, salt,
and fat as ingredients
Using labels to compare the contents
of food products
Identifying ads and recognizing
strategies used to influence decisions
Practicing various positive responses
to those influences
III. Expectations
and Content,
by Grade Level
Kindergarten
Through
Grade Three
Unifying Idea:
Informed use of
health-related
information,
products,
and services
82
Chapter 3
Health Education
III. Expectations
and Content,
by Grade Level
Grades Four Through Six
Students in grades four through six are assuming more responsibility for
their own health and well-being. They can benefit from instruction that fosters
the development of positive health behaviors and prevention of negative,
unhealthy behaviors. Particularly important in the middle grades is the onset of
adolescence, which can begin as early as third grade for some students. Others
will develop more slowly. Students at this level begin to become acutely aware
of their physical development and the varying rates of development among
their peers. In addition, children’s orientation to the peer group tends to
increase during this age span. Most children experience a growing need to be
and feel normal at precisely the time when growth and development vary
widely even within the same classroom. Many students are also likely to feel
pressure to act grown-up by experimenting with alcohol, tobacco, or other
drugs. Acceptance of differences in individual growth and development as well
as strategies to prevent the use of alcohol, tobacco, and other drugs need to be
woven throughout the curriculum at this time.
Unifying Idea
Acceptance of personal responsibility
for lifelong health
Expectations:
1. Students will demonstrate ways in which they can
enhance and maintain their health and well-being.
2. Students will understand and demonstrate behaviors
that prevent disease and speed recovery from illness.
3. Students will practice behaviors that reduce the risk of
becoming involved in potentially dangerous situations
and react to potentially dangerous situations in ways
that help to protect their health.
Expectation 1
Students will demonstrate ways in which they can enhance and maintain
their health and well-being.
Grade-level concepts and content
Examples of skills and behaviors
The human body:
As students assume responsibility
for personal care and self-grooming,
they should continue to explore the
link between their behavior and
■ Practicing
good personal hygiene,
with particular attention to the
changing needs of preadolescents
and adolescents
■ Identifies previously introduced skills or behaviors that should be built on and reinforced.
83
Grade-level concepts and content
Examples of skills and behaviors
Chapter 3
Health Education
The human body:
health. For example, as puberty
begins, behavioral changes related to
personal health habits may be
involved for some students.
The curriculum at this level
should also include more in-depth
information about body systems and
their relation to personal health.
Students should learn how body
systems are interrelated, how they
function to fight disease, and how
they are influenced by environmen­
tal conditions.
■ Using
protective equipment, such
as a helmet when cycling, or
practicing behaviors to protect the
body, such as applying sunscreen
when appropriate
Grades Four
Through Six
Unifying Idea:
Acceptance of personal
responsibility for
lifelong health
Food choices:
Building on the concepts and
skills learned at the kindergarten
through grade three level, students
should continue to explore how food
choices can affect their health and
well-being. They should continue to
learn about food classification
systems and begin to learn about the
nutrients in foods. The California
Daily Food Guide and the USDA
food pyramid should be used to
assist students in making healthy
food choices from a variety of ethnic
cuisines. The effects food choices
have on body composition and
optimal health should be explored as
well as the dangers of eating disor­
ders. Students should examine how
food-preparation methods and foodhandling practices affect the safety
and nutrient quality of foods.
III. Expectations
and Content,
by Grade Level
■ Making
healthy food choices, with
emphasis on:
1. Basing decisions upon nutrient
content
2. Selecting foods that promote
oral health
■ Establishing
and maintaining
healthy eating practices
■ Preparing
a variety of healthy
foods, using safe and sanitary food
preparation and storage tech­
niques, with an emphasis on how
food-handling and preparation
practices affect the safety and
nutrient quality of foods
■ Analyzing
how food choices are
influenced
Practicing kitchen safety, such as
using knives, stoves, and ovens
correctly and carefully
■ Identifies previously introduced skills or behaviors that should be built on and reinforced.
84
Chapter 3
Health Education
III. Expectations
and Content,
by Grade Level
Grades Four
Through Six
Unifying Idea:
Acceptance of personal
responsibility for
lifelong health
Expectation 1 (Continued)
Grade-level concepts and content
Examples of skills and behaviors
Physical activity:
Students should continue to enjoy
physical activities and should learn to
set and use personal goals for devel­
oping or maintaining physical fitness,
recognizing that even moderate
regular activity can help prevent
obesity and heart disease. Students
should also investigate the relationships involving aerobic endurance,
body composition, flexibility,
muscular strength and endurance,
and self-image.
■ Obtaining
a sufficient amount
of sleep
■ Observing
safety rules during
physical activities
■ Exploring
ways to engage in
enjoyable out-of-school play
activities that promote fitness
and health
Participating regularly in a variety
of enjoyable physical activities that
promote aerobic conditioning,
flexibility, and muscular strength
and endurance both inside and
outside of school
Setting personal fitness goals
Monitoring progress toward meeting
fitness goals
Mental and emotional health:
Mental and emotional health, like
physical fitness, can be cultivated and
enhanced. Students in grades three
through six have an increasing
sensitivity to peer influence and feel
acutely the need to belong to a
group. The curriculum should
continue to include opportunities for
students to identify and seek protective factors that help foster resiliency.
Students should learn that although
preadolescence and adolescence are
frequently periods of emotional
turmoil, various coping strategies can
be used to overcome feelings of
inadequacy and depression.
■ Identifying
and sharing feelings in
appropriate ways
■ Demonstrating
personal characteristics that contribute to selfconfidence and self-esteem, such
as honesty, integrity, respect for
the dignity of others
■ Developing
protective factors that
help foster resiliency, such as
participating in activities that
promote positive bonding to peers
and adults in the school and the
community
■ Developing
and using effective
communication skills
■ Identifies previously introduced skills or behaviors that should be built on and reinforced.
85
Grade-level concepts and content
Examples of skills and behaviors
Chapter 3
Health Education
Mental and emotional health:
High self-esteem and a sense of
optimism and control over one’s life
are linked to one’s success as a
happy, productive human being.
Students should have opportunities
to bond to the school and commu­
nity and to receive positive recogni­
tion for success. This age level is
appropriate for introducing students
to the effects of stress, including a
discussion of what causes stress and
how it can be detrimental to health
unless various coping strategies are
used to deal with it.
■ Developing
and using effective
coping strategies, including critical
thinking, effective decision
making, goal setting, and problem
solving; practicing assertiveness
and refusal skills; and taking time
for exercise and relaxation
■ Avoiding
self-destructive behaviors
Practicing strategies for resisting
negative peer pressure
Expectation 2
Students will understand and demonstrate behaviors that prevent disease
and speed recovery from illness.
Disease prevention:
A wide range of communicable
and chronic diseases, including
genetic disorders, should be the
focus of the curriculum for this
outcome at this grade span. Students
should develop an understanding of
the difference between communi­
cable and noncommunicable
diseases. Causes of diseases and the
role of positive health practices
(e.g., regular medical and dental
examinations, immunizations,
aerobic exercise, proper nutrition) in
avoiding, delaying, or minimizing
the onset of diseases should also be
emphasized. The curriculum should
investigate how people with diseases
■ Practicing
good personal hygiene
to prevent the spread of disease
■ Practicing
positive health behav­
iors to reduce the risk of disease
■ Cooperating
in regular health
screenings, including dental
examinations
Demonstrating safe care and concern
toward ill persons in the family, the
school, and the community
■ Identifies previously introduced skills or behaviors that should be built on and reinforced.
III. Expectations
and Content,
by Grade Level
Grades Four
Through Six
Unifying Idea:
Acceptance of personal
responsibility for
lifelong health
86
Chapter 3
Health Education
Expectation 2 (Continued)
Grade-level concepts and content
III. Expectations
and Content,
by Grade Level
Grades Four
Through Six
Unifying Idea:
Acceptance of personal
responsibility for
lifelong health
Examples of skills and behaviors
Disease prevention:
are treated, including how prejudice
and ignorance can lead to discrimi­
nation against persons with diseases
or chronic conditions.
Treatment of disease:
As students take more responsi­
bility for their health, they develop a
deeper understanding of the need to
follow prescribed health-care
procedures and cooperate with
parents and health-care providers to
facilitate recovery from disease when
possible or to enhance long-term
management of chronic diseases.
The treatment or management of
the major communicable and
chronic diseases should be presented,
including scientific contributions
that have helped to protect people
from disease and disorders. Students
who have health problems or
chronic conditions should begin to
accept responsibility for their role in
treatment, including the proper use
of medication. The effects of family
and cultural influences on the care of
disease and the usefulness of partici­
pating in support groups or activities
should also be explored.
■ Recognizing
symptoms of
common illnesses
■ Cooperating
in treatment or
management of disease, with an
emphasis on accepting responsi­
bility for such cooperation and
communicating appropriately with
parents and health-care providers
■ Taking
prescription and over-thecounter medicines properly; never
taking medicine prescribed for
someone else
Interpreting correctly instructions
for taking medicine
■ Identifies previously introduced skills or behaviors that should be built on and reinforced.
87
Chapter 3
Health Education
Expectation 3
Students will practice behaviors that reduce the risk of becoming involved
in potentially dangerous situations and react to potentially dangerous
situations in ways that help to protect their health.
Grade-level concepts and content
Examples of skills and behaviors
Potentially dangerous situations:
At this level students should learn
that some potentially dangerous
situations can be handled through
routine safety precautions, including
behaving appropriately in or near
motor vehicles; observing safe play
and exercise practices; identifying
hazards in the home, school, and
community; and participating in
activities to remove hazards.
Students should understand how
to minimize the potential for injury
when interacting with others who
exhibit dangerous behavior. For
example, one option is to leave the
situation or, if appropriate, encour­
age the individual to stop the
dangerous behavior. Conflictresolution skills should be further
refined and practiced.
■ Developing
and using appropriate
skills to identify, avoid when
possible, and cope with potentially
dangerous situations
■ Practicing
safe behavior in and
near motorized vehicles
■ Practicing
safe behavior in recre­
ational activities
■ Practicing
safe behavior in and
near water
■ Developing
and using appropriate
skills to avoid, resolve, and cope
with conflicts, emphasizing how
peers can help each other avoid
and cope with conflict
■ Reporting
or obtaining assistance
when faced with unsafe situations
Understanding and following rules
prohibiting possession of weapons
at school
Alcohol, tobacco, and other drugs:
Because experimentation with
alcohol, tobacco, or other drugs
often begins in the upper elementary
grades, students should develop the
knowledge, skills, and strategies for
choosing not to use a wide range of
harmful chemical substances. They
should learn ways to identify drugs;
the effects of drugs on different parts
III. Expectations
and Content,
by Grade Level
■ Exercising
self-control
■ Developing
and using interper­
sonal and other communication
skills, such as assertiveness,
refusal, negotiation, and conflictresolution skills, to avoid use of
alcohol, tobacco, and other drugs
■ Distinguishing
between helpful
and harmful substances
■ Identifies previously introduced skills or behaviors that should be built on and reinforced.
Grades Four
Through Six
Unifying Idea:
Acceptance of personal
responsibility for
lifelong health
88
Chapter 3
Health Education
Expectation 3 (Continued)
Grade-level concepts and content
III. Expectations
and Content,
by Grade Level
Grades Four
Through Six
Unifying Idea:
Acceptance of personal
responsibility for
lifelong health
Examples of skills and behaviors
Alcohol, tobacco, and other drugs:
of the body; the reasons for not using
specific substances; and the effects
and consequences of use. In addition,
they should learn the school rules
prohibiting the use of alcohol,
tobacco, and other drugs and should
be aware that these substances are
illegal for minors or all persons.
Students should understand the
influences that promote drug use and
develop the skills necessary to resist
those influences; know how and
where to obtain help when confronted with potentially dangerous or
harmful situations involving chemi­
cal substances; and make a commit­
ment not to use or distribute alcohol,
tobacco, or other drugs.
■ Identifying
ways to cope with or
seek assistance as necessary when
confronted with situations involving alcohol, tobacco, or other drugs
Differentiating between the use and
misuse of prescription and nonpre­
scription drugs
Avoiding, recognizing, and respond­
ing to negative social influences and
pressure to use alcohol, tobacco, or
other drugs
Using positive peer pressure to help
counteract the negative effects of
living in an environment where
alcohol, tobacco, or other drug abuse
or dependency exists
Identifying ways of obtaining help
to resist pressure to use alcohol,
tobacco, or other drugs
Child abuse, including sexual exploitation:
Students should be aware that no
one, not even a parent, has the right
to abuse a child or another family
member physically. Neglect and
child abuse are serious problems that
may require outside assistance.
After parents are notified, the
strategies presented in discussions of
alcohol, tobacco, and other drugs can
be expanded to help students learn
how to resist pressure to become
sexually active and where to seek help
or advice if needed. Information on
how to resist sexual abuse or exploi­
tation should also be presented.
■ Identifying
ways to seek assistance
if concerned, abused, or threat­
ened, including how to overcome
fear of telling
Recognizing and avoiding situations
that can increase risk of abuse, such
as leaning into a car when giving
directions to a stranger
■ Identifies previously introduced skills or behaviors that should be built on and reinforced.
89
Grade-level concepts and content
Examples of skills and behaviors
Chapter 3
Health Education
Emergencies:
Building on earlier instruction in
proper responses to natural disasters,
students should have the opportu­
nity to learn and demonstrate
emergency preparation procedures
and proficiency in basic first-aid
procedures, including proper
response to breathing and choking
problems, bleeding, shock, poison­
ings, and minor burns. Older
students can also learn cardiopulmo­
nary resuscitation, in addition to
basic first aid, if taught by certified
instructors.
Recognizing emergencies and
responding appropriately, including:
1. Knowing where to find
emergency supplies, such as a
flashlight and a first-aid kit
2. Demonstrating proficiency
in basic first-aid procedures,
such as proper response to
breathing and choking
problems, bleeding, shock,
poisonings, and minor burns
3. Using universal precautions
when dealing with other
people’s blood
Understanding the family emergency
plan and developing the skills
necessary to follow the plan
III. Expectations
and Content,
by Grade Level
Grades Four
Through Six
Unifying Idea:
Acceptance of personal
responsibility for
lifelong health
90
Unifying Idea
Respect for and promotion of the health
of others
Chapter 3
Health Education
III. Expectations
and Content,
by Grade Level
Expectations:
4. Students will understand and demonstrate how to
play a positive, active role in promoting the health
of their families.
Grades Four
Through Six
5. Students will understand and demonstrate how to
promote positive health practices within the school
and community, including how to cultivate positive
relationships with their peers.
Expectation 4
Students will understand and demonstrate how to play a positive, active
role in promoting the health of their families.
Grade-level concepts and content
Examples of skills and behaviors
Roles of family members:
Building on the concept of the
family as a major source of a person’s
health, students should recognize
that because the roles of children
change as they mature, parents
may have different expectations
of children versus adolescents.
Students should explore ways in
which they can contribute to their
family, including participating in
family activities, practicing healthpromoting behaviors with the
family, and assuming more responsi­
bility for household tasks.
■ Supporting
and valuing all family
members
■ Demonstrating
ways in which
children can help support positive
family interactions
■ Developing
and using effective
communication skills
Practicing health-promoting behav­
iors with the family, such as encour­
aging family walks and meals at
which the entire family is present
Participating in daily activities that
help maintain the family
Change within the family:
Changes within and outside the
family may affect both individuals
and family members. Students at
this grade level should have the
opportunity to examine the effects
of change on the family and develop
■ Identifying
feelings related to
changes within the family and
effectively expressing them to
others in a positive way
■ Identifies previously introduced skills or behaviors that should be built on and reinforced.
91
Grade-level concepts and content
Examples of skills and behaviors
Chapter 3
Health Education
Change within the family:
coping strategies to deal with
changes when they occur. The
important point to consider is that
although families are challenged by
such events as a serious illness or
divorce, families can and do cope
and may in fact grow stronger as a
result of the challenge. Good
communication in a family is a key
coping skill, and positive ways to
resolve conflict should continue to
be addressed. Students should be
able to identify community resources
that provide help to families with
problems.
■ Using
effective strategies to cope
with change in the family, includ­
ing identifying a support system
Grades Four
Through Six
Unifying Idea:
Respect for and
promotion of the
health of others
Expectation 5
Students will understand and demonstrate how to promote positive health
practices within the school and community, including how to cultivate
positive relationships with their peers.
Friendship and peer relationships:
Students should explore how
people can play active roles in
promoting healthy relationships
with peers. They should be aware
that peer influence has the potential
to be either positive or negative.
Students should be encouraged to
seek opportunities to be a positive
role model.
III. Expectations
and Content,
by Grade Level
■ Knowing
and using appropriate
ways to make new friends
■ Demonstrating
acceptable meth­
ods of gaining attention
■ Demonstrating
acceptable ways to
show or express feelings
■ Demonstrating
positive actions
toward others
■ Resolving
conflicts in a positive,
constructive way
Demonstrating how to resist
negative peer pressure
■ Identifies previously introduced skills or behaviors that should be built on and reinforced.
92
Chapter 3
Health Education
Expectation 5 (Continued)
Grade-level concepts and content
III. Expectations
and Content,
by Grade Level
Grades Four
Through Six
Unifying Idea:
Respect for and
promotion of the
health of others
Examples of skills and behaviors
School and community-based efforts to promote and protect health:
Students should explore how their
school promotes and protects the
health of students. For example,
students should examine school
policies related to health, nutrition,
and safety and understand the
reasons for those policies. They
should understand that by following
the policies, they are helping to
promote health at school. Further,
students should explore how people
can play active roles in the school
and community to promote health
and should have opportunities
to participate in positive health
practices in school and community
settings.
They should begin to explore the
role of the health department and
other community health and social
service agencies in health promotion
and disease prevention. Local, state,
and national laws and regulations
that promote public health and the
safety of the community should be
identified and examined, including
those designed to protect the
environment. Recycling, developing
safe and adequate food supplies and
environmentally safe food packag­
ing, and dealing with hunger and
food waste within their communities
should be introduced. Students
should investigate ways in which
they can participate in or enhance
school and community efforts to
promote health.
■ Understanding
and following
school rules related to health
■ Participating
in school efforts to
promote health; for example,
helping to select fund-raising
activities that are consistent with
efforts to promote health, such as
choosing a jog-a-thon rather than
a candy sale
■ Assuming
responsibility for
helping to take care of the school,
such as picking up trash on the
school grounds and helping other
students assume responsibility for
that action
■ Participating
in community efforts
to address local health and envi­
ronmental issues
Contributing to the strengthening
of health-related policies at school,
such as serving on a student safety
committee
Recognizing that public policies and
laws influence health-related issues
■ Identifies previously introduced skills or behaviors that should be built on and reinforced.
93
Unifying Idea
An understanding of the process of growth
and development
Expectations:
6. Students will understand the variety of physical,
mental, emotional, and social changes that occur
throughout life.
7. Students will understand and accept individual
differences in growth and development.
Expectation 6
Students will understand the variety of physical, mental, emotional, and
social changes that occur throughout life.
Grade-level concepts and content
Examples of skills and behaviors
Life cycle:
Note: The Education Code
requires parental notification before
discussion of human reproductive
organs and their functions and
processes.
Students at this level are begin­
ning to enter puberty and are
curious, perhaps concerned, about
the physical changes they are
experiencing. Instruction should
emphasize that all people are sexual
beings and that it is natural for
preadolescents and adolescents to
want to understand human sexual­
ity. The curriculum should help
students understand the human
reproductive process and the
physical, mental, emotional, and
social changes that occur during
puberty. To be included are descrip­
tions of sexual maturation, acne,
changes in voice, growth of body
and facial hair, menstruation, and
sperm development. As they reach
puberty, students should be made
Recognizing the changes that occur
during preadolescence
Using correct terminology for body
parts
Practicing good personal hygiene,
paying particular attention to the
changing needs of preadolescents
and adolescents
Recognizing emotions
Managing feelings appropriately,
including being able to express
feelings and practice self-control
Developing and using effective
communication skills to discuss
with parents or other trusted adults
the changes that occur during
preadolescence
Chapter 3
Health Education
III. Expectations
and Content,
by Grade Level
Grades Four
Through Six
94
Chapter 3
Health Education
Expectation 6 (Continued)
Grade-level concepts and content
III. Expectations
and Content,
by Grade Level
Grades Four
Through Six
Unifying Idea:
An understanding of
the process of growth
and development
Examples of skills and behaviors
Life cycle:
aware of toxic shock syndrome
(TSS), its symptoms, and the means
of preventing it. Also important are
the social and emotional changes of
adolescence—for example, a growing
sensitivity to peer influence, family
tensions, and mood swings. Cogni­
tive and intellectual development
should also be considered. Students
should be encouraged to talk to their
parents or other responsible adults if
they have questions about sexuality
or puberty and related changes.
Expectation 7
Students will understand and accept individual differences in growth
and development.
Growth and development:
The rate of change during puberty
varies with each person. Students
should be encouraged to be comfortable with their own progress and to
like and accept themselves. The
curriculum should emphasize that
there is no perfect body type and that
people vary widely in size, height,
shape, and rate of maturation.
■ Demonstrating
an understanding
of individual differences
■ Adapting
group activities to
include a variety of students
Developing a realistic body image
Recognizing problems associated
with not having a realistic body
image, including dieting and eating
disorders, and seeking appropriate
help
Mental and emotional development:
Students should continue to
explore the mental and emotional
aspects of growing and developing.
■ Identifying,
expressing, and
managing feelings appropriately
■ Identifies previously introduced skills or behaviors that should be built on and reinforced.
95
Grade-level concepts and content
Examples of skills and behaviors
Chapter 3
Health Education
Mental and emotional development:
They should be encouraged to focus
on the future and develop strategies
for coping with the changes of
adolescence. Instruction should
emphasize understanding differ­
ences, including individuals’ unique
strengths and weaknesses and the
ways in which students can support
each other in facing the uncertainties
of adolescence. It is especially
important at this time, when many
students begin to be more grouporiented, to emphasize the need to
include all students, especially those
with disabilities and special needs.
■ Developing
and using effective
communication skills
Recognizing one’s own strengths and
limitations
Developing and using coping
strategies, including critical thinking, effective decision making, goal
setting, and problem solving;
developing assertiveness and refusal
skills; and taking time for exercise
and relaxation
Developing a focus on the future,
such as having realistic short-term
and long-term goals and delaying
gratification
Unifying Idea
Informed use of health-related information,
products, and services
Expectation:
8. Students will identify information, products, and
services that may be helpful or harmful to their
health.
Expectation 8
Students will identify information, products, and services that may be
helpful or harmful to their health.
Grade-level concepts and content
Examples of skills and behaviors
Products and services:
Students at this level should
begin to identify the range of health
services in the community and
explore how their families can access
■ Identifying
places for obtaining
health and social services and
knowing what types of services
are provided
■ Identifies previously introduced skills or behaviors that should be built on and reinforced.
III. Expectations
and Content,
by Grade Level
Grades Four
Through Six
96
Chapter 3
Health Education
Expectation 8 (Continued)
Grade-level concepts and content
III. Expectations
and Content,
by Grade Level
Grades Four
Through Six
Unifying Idea:
Informed use of
health-related
information,
products,
and services
Examples of skills and behaviors
Products and services:
needed services, including developing
the ability to distinguish between
situations that require health services
and those that do not. An examina­
tion of community health services can
be linked to an exploration of healthrelated careers, including careers
related to food preparation and food
service.
Consumer health care products
are another important focus of the
curriculum at this level. Students
should be able to distinguish products
and services that are necessary, those
that are not necessary, and those that
may be harmful. Characteristics of
health care quackery should be
presented. To be included is the
idea that quackery is more likely to
flourish in those areas of health—
pain management, beauty aids,
weight control, cancer treatment—
where standard medicine is least
successful or when expectations are
unrealistic. Students should look
critically at health claims and the
factors that influence the selection
of products and services, including
ways in which advertising and peer
pressure can influence students’
images of themselves.
■ Identifying
health-care workers
■ Identifying
a variety of consumer
influences and analyzing how
those influences affect decisions
Recognizing helpful products and
services
Using critical-thinking skills to
analyze marketing and advertising
techniques and their influence on
the selection of health-related
services and products
Seeking care from the school nurse
or school-linked services together
with their families when appropriate,
such as when needed for proper
management of asthma
Discussing home care with parents
when appropriate
Food choices:
As students mature, they become
increasingly more responsible for
their own health and have greater
■ Reading
and interpreting the
information available on food
labels, such as the amount of sugar,
salt, or fat contained in the food
■ Identifies previously introduced skills or behaviors that should be built on and reinforced.
97
Grade-level concepts and content
Examples of skills and behaviors
Chapter 3
Health Education
Food choices:
opportunities to purchase and
prepare their own food. Thus, the
need for good consumer skills
increases. Students should explore
the influence of self-image, peer
influences, and advertising on food
choices. They should learn to use all
the information on food labels when
making decisions about which foods
to buy and should have opportuni­
ties to learn basic food-preparation
and handling techniques.
Because of their growing indepen­
dence, many students have more
frequent opportunities to eat away
from home. As a result they have
opportunities to try new foods and
practice ways to maintain a nutri­
tionally balanced diet. The curricu­
lum should include ways to make
food choices in a variety of eating
environments, including fast-food
outlets. As their circle of friends
expands, students will have greater
exposure to differing family customs,
backgrounds, and eating patterns.
This is an opportune time to explore
a variety of ethnic and cultural
foods, food patterns, and customs,
using both the classroom and the
school cafeteria.
■ Using
labels to compare the
contents of food products, includ­
ing a comparison of the cost of
various foods according to their
nutritional value
Using critical-thinking skills to
analyze marketing and advertising
techniques and their influence on
food selection
Using valid nutrition information to
make healthy food choices
Purchasing nutritious foods in a
variety of settings
Using unit pricing to determine the
most economical purchases
Analyzing and tasting foods from
different ethnic and cultural groups
Developing basic food-preparation
skills, including safe and sanitary
food preparation and storage
■ Identifies previously introduced skills or behaviors that should be built on and reinforced.
III. Expectations
and Content,
by Grade Level
Grades Four
Through Six
Unifying Idea:
Informed use of
health-related
information,
products,
and services
98
Chapter 3
Health Education
III. Expectations
and Content,
by Grade Level
Middle School
Students in middle school are becoming more independent of their parents
and increasingly more subject to peer approval than are younger children. They
are concerned, at times preoccupied, with changes in their bodies and they
often begin to focus on themselves and to be critical of themselves and others.
Able to understand that certain behaviors have undesirable consequences, they
may have difficulty in accepting that such consequences could happen to them.
An awareness of immediate consequences (for example, bad breath as a result
of smoking) rather than long-term consequences is more likely to motivate
students. The curriculum for this grade span focuses in part on the personal
health habits appropriate to the changing needs of adolescents. But students
should also continue to explore and practice the skills necessary for developing
lifelong positive health habits. Although prevention remains the mainstay of
the curriculum at this level, additional elements are the early identification
of health problems and appropriate intervention. Students should always be
encouraged to discuss personal and health problems with their parents or
guardians. Information about local resources for health-related support and
assistance should also be provided as part of the curriculum.
Unifying Idea
Acceptance of personal responsibility
for lifelong health
Expectations:
1. Students will demonstrate ways in which they can
enhance and maintain their health and well-being.
2. Students will understand and demonstrate behaviors
that prevent disease and speed recovery from illness.
3. Students will practice behaviors that reduce the risk of
becoming involved in potentially dangerous situations
and react to potentially dangerous situations in ways
that help to protect their health.
99
Chapter 3
Health Education
Expectation 1
Students will demonstrate ways in which they can enhance and maintain
their health and well-being.
Grade-level concepts and content
Examples of skills and behaviors
III. Expectations
and Content,
by Grade Level
The human body:
The immediate and long-term
effects of personal health habits on
body systems are appropriate areas of
study for this grade span. For example, students might explore the
short-term and long-term effects of a
high-fat diet and a sedentary lifestyle
on the cardiovascular system. They
should continue to examine how
body systems are interconnected and
how the immune system prevents or
combats disease. Because environ­
mental conditions also affect body
systems, students should be able to
demonstrate ways to protect themselves from exposure to conditions
that are potentially harmful.
As they continue to explore the
unifying idea of acceptance of
personal responsibility and the
human body, students continue to
recognize that a perfect body type
does not exist and that people vary
widely in size, height, shape, and rate
of maturation. They should be
encouraged to be comfortable with
their own progress and to like and
accept themselves.
■ Practicing
good personal hygiene,
including accepting responsibility
for making those behaviors part of
a normal routine
■ Recognizing
and avoiding when
possible, environmental conditions
that are potentially harmful, such
as exposure to pesticides or lead
paint
■ Using
protective equipment, such
as goggles to protect the eyes when
appropriate, or practicing behav­
iors to protect the body, such as
applying sunscreen, exercising, or
making healthy food choices
Recognizing and accepting differ­
ences in body types and maturation
levels
Food choices:
Students should be encouraged to
develop a personal nutrition plan
based on food choices and calorie
levels that promotes health and
reduces the risk of disease. They
■ Making
healthy food choices in a
variety of settings, including the
selection of foods according to
calculated energy expenditure and
healthy body composition
■ Identifies previously introduced skills or behaviors that should be built on and reinforced.
Middle School
Unifying Idea:
Acceptance of personal
responsibility for
lifelong health
100
Chapter 3
Health Education
Expectation 1 (Continued)
Grade-level concepts and content
III. Expectations
and Content,
by Grade Level
Middle School
Unifying Idea:
Acceptance of personal
responsibility for
lifelong health
Examples of skills and behaviors
Food choices:
should continue to explore the wide
variety of healthy food choices
available in all cultures and should
have opportunities to taste and
prepare low-cost foods and favorite
foods in ways that make those foods
healthy choices. The content should
include the interrelationships among
total calories, food sources of
calories, energy expenditure, and
body composition. Because adoles­
cents have unique nutritional needs,
they should understand that the
variety and quantity of food they eat
can influence their growth and
development. Further, they should
examine how their food choices are
influenced by their own emotions
and by other sources, such as their
peers or the media.
■ Establishing
and maintaining
healthy eating practices
■ Preparing
a variety of healthy
foods, using safe food preparation
and storage techniques
■ Analyzing
how food choices are
influenced
Comparing caloric values of foods
according to the percentage of fat,
protein, and carbohydrate they
contain
Selecting appropriate practices
to maintain, lose, or gain weight
according to individual needs
and scientific research
Physical activity:
Students should be made aware of
the importance of variety and enjoyment in maintaining an exercise program and should have opportunities
to participate regularly in a variety
of physical activities at school and
outside school. In addition, they
should continue to set personal goals
for developing or maintaining physical fitness. They should look for
opportunities to set up a personal fitness program because a physically
active lifestyle contributes to their
personal health. They should examine the influence of frequency, intensity, duration, and type of physical
■ Obtaining
a sufficient amount
of sleep
■ Observing
safety rules during
physical activities
■ Exploring
ways to engage in outof-school activities that promote
fitness and health
■ Participating
regularly in a variety
of enjoyable physical activities
■ Developing
and initiating a
personal fitness plan that includes
setting fitness goals and monitoring progress toward meeting those
goals
■ Identifies previously introduced skills or behaviors that should be built on and reinforced.
101
Chapter 3
Health Education
Grade-level concepts and content
Examples of skills and behaviors
Physical activity:
activity on aerobic endurance, body
composition, flexibility, and muscu­
lar strength and endurance. Finally,
they should analyze ways in which
physical activity contributes to
physical, mental, emotional, and
social health.
Middle School
Unifying Idea:
Acceptance of personal
responsibility for
lifelong health
Mental and emotional health:
Students’ explorations of the
mental and emotional aspects of
health should build on those exam­
ined at earlier grade levels. Particular
emphasis should be placed on
emotional development during
adolescence, including an examina­
tion of mood swings, depression,
and suicide. Students should
understand that seeking assistance
for mental and emotional problems
is appropriate and should have
opportunities to develop the skills
needed to seek assistance. The
positive aspects of mental and
emotional health, such as friendship,
continue to be of great importance
and should also receive attention
in the curriculum. In addition,
students should continue to explore
the connections between physical,
mental, emotional, and social health
and should be encouraged to pursue
leisure-time activities that promote
that health.
The curriculum should provide
opportunities for all students to feel
valued and have experiences that
foster positive bonding to their
III. Expectations
and Content,
by Grade Level
■ Demonstrating
personal character­
istics that contribute to selfconfidence and self-esteem, such as
honesty, integrity, responsibility,
and respecting the dignity of
others
■ Developing
protective factors that
help foster resiliency, such as
participating in activities that
promote positive bonding to peers
and adults in the school and
community, and developing and
maintaining a focus on the future
■ Developing
and using effective
communication skills
■ Developing
and using effective
coping strategies, emphasizing
strategies for coping with feelings
of inadequacy, sadness, and
depression. Examples include
talking over problems with parents
or religious leaders, understanding
that feelings of isolation and
depression will pass, examining the
situation leading to the feelings,
seeking appropriate assistance if
depression persists, obtaining
■ Identifies previously introduced skills or behaviors that should be built on and reinforced.
102
Chapter 3
Health Education
Expectation 1 (Continued)
Grade-level concepts and content
III. Expectations
and Content,
by Grade Level
Middle School
Unifying Idea:
Acceptance of personal
responsibility for
lifelong health
Examples of skills and behaviors
Mental and emotional health:
peers, school, and community. These
experiences are especially important
for students at higher risk of suicide
because these students thereby learn
to cope with feelings of isolation,
inadequacy, sadness, and depression
and begin to overcome those feelings.
Strategies that can be explored to
help students cope with those feelings
include talking over problems,
understanding that feelings of
isolation and depression will pass,
examining the situation leading to
the feelings, seeking appropriate
assistance if depression persists,
obtaining medical treatment for
organically caused depression, and
participating in regular aerobic
exercise.
appropriate health care for depres­
sion, and participating in regular
aerobic exercise
■ Avoiding
self-destructive behaviors
■ Practicing
strategies for resisting
negative peer pressure
Identifying the strongest risk
factors for negative behaviors in
their own lives and developing
effective strategies for counteracting
the effect of these risk factors
Managing strong feelings and
boredom
Selecting entertainment that
promotes mental and physical
health
Expectation 2
Students will understand and demonstrate behaviors that prevent disease and
speed recovery from illness.
Disease prevention:
Students should acquire the
knowledge and skills needed to
develop a personal action plan for
the prevention or early detection of
disease.
Students should focus on the
major chronic and communicable
diseases prevalent at different stages
of life, analyzing risks for contracting
specific diseases based on pathogenic,
genetic, environmental, and behavioral factors. They should continue
■ Practicing
good personal hygiene
to prevent the spread of disease
■ Practicing
positive health behav­
iors to reduce the risk of disease
■ Cooperating
in regular health
screenings, including dental
examinations
■ Safely
demonstrating care and
concern toward ill persons in the
family, the school, and the
community
■ Identifies previously introduced skills or behaviors that should be built on and reinforced.
103
Grade-level concepts and content
Examples of skills and behaviors
Chapter 3
Health Education
Disease prevention:
to explore how positive health
practices, such as aerobic exercise
and proper nutrition, influence the
risk and severity of disease. They
should also learn how common
behavioral disorders contribute to
chronic conditions, perhaps studying
anorexia nervosa and its complica­
tions. They should begin to learn
self-exam procedures and understand
the role of self-examination in early
detection of disease. In addition to
learning how to prevent and cope
with diseases in themselves, students
should learn that people with
diseases need the support and
compassion of others.
The prevention of sexually
transmitted diseases (STDs), espe­
cially HIV/AIDS, should be empha­
sized at this grade span but only after
consideration of Education Code
mandates (see Appendix A). Stu­
dents should be able to describe the
causes of HIV infection and other
sexually transmitted diseases as well
as modes of transmission, symptoms,
effects, and methods of prevention.
A strong emphasis should be
placed on abstinence from sexual
activity and safer sexual practices for
those youths who are sexually active.
However, sexual activity (“safe sex”)
is not being advocated. Abstinence
from sexual activity is the only
totally effective way to avoid un­
wanted pregnancy and sexually
transmitted diseases and should be
emphasized as the best choice for
physical and emotional reasons.
Making a commitment to abstain
from sexual activity
III. Expectations
and Content,
by Grade Level
Practicing and using effective selfexamination procedures
Middle School
Unifying Idea:
Acceptance of personal
responsibility for
lifelong health
104
Chapter 3
Health Education
Expectation 2 (Continued)
Grade-level concepts and content
III. Expectations
and Content,
by Grade Level
Middle School
Unifying Idea:
Acceptance of personal
responsibility for
lifelong health
Examples of skills and behaviors
Treatment of disease:
Students at this level should be
encouraged to take greater responsi­
bility for the treatment of disease.
They need to learn the symptoms of
common diseases among youths and
the importance of early diagnosis
and treatment, including home
treatment for common illnesses and
the treatment and management of
major diseases. In addition, they
should learn when to seek qualified
medical help. The curriculum
should continue its focus on the
importance of following prescribed
health-care procedures and cooperat­
ing with parents and health-care
providers to facilitate recovery or
long-term treatment of diseases.
Other topics appropriate for this
grade span are the proper use of
medication, including how to
identify possible side effects, and
personal rights and responsibilities
involved in the treatment of disease.
The influence of family and culture
on the treatment of disease and the
usefulness of participating in support
groups or activities should continue
to be explored.
■ Recognizing
symptoms of com­
mon illnesses
■ Taking
prescription and over-thecounter medicines properly
■ Interpreting
correctly instructions
written on medicine container
labels, including using informa­
tion provided with prescription
and over-the-counter medicines to
determine potential side effects
Determining when treatment of
illness at home is appropriate and
when and how to seek further help
when needed
Accepting responsibility for active
involvement in the treatment or
management of disease, including
practicing and using effective
communication skills to discuss
illness with parents and health-care
providers
■ Identifies previously introduced skills or behaviors that should be built on and reinforced.
105
Chapter 3
Health Education
Expectation 3
Students will practice behaviors that reduce the risk of becoming involved
in potentially dangerous situations and react to potentially dangerous
situations in ways that help to protect their health.
Grade-level concepts and content
Examples of skills and behaviors
Potentially dangerous situations:
Because students in this age group
may be especially prone to high-risk
behavior, they should be given special
instruction in ways to safeguard their
lives. For example, they should be
made familiar with the basic rules of
traffic safety, including rules for
drivers, occupants of motor vehicles,
bicyclists, and pedestrians. And they
should be taught to understand that
traffic safety requires being observant
at all times because others may not
obey the rules.
Many potentially dangerous
situations can be avoided or handled
through the practice of safety precau­
tions and the use of safety equipment
in daily living. Students should learn
to identify hazards found in the
home, school, and community and
participate in activities to remove
those hazards.
Students should understand how
to minimize the potential for injury
when interacting with others who
exhibit dangerous behavior. Violence
threatens the safety of individuals and
society. Effective instruction in
violence prevention should include
opportunities to practice nonharmful
conflict-resolution strategies, includ­
ing identification of the variety of
factors that can influence such
resolution. Students should
III. Expectations
and Content,
by Grade Level
■ Developing
and using appropriate
skills to identify, avoid when
possible, and cope with potentially
dangerous situations, with empha­
sis on how peers can help each
other avoid or cope with poten­
tially dangerous situations in
healthy ways
■ Practicing
safe behavior in and
near motorized vehicles
■ Practicing
safe behavior in recre­
ational activities, even in the
absence of adults
■ Practicing
safe behavior in and
near water
■ Using
appropriate skills to avoid,
resolve, and cope with conflicts
■ Understanding
and following rules
prohibiting possession of weapons
at school
■ Reporting
or obtaining assistance
when faced with unsafe situations
Identifying factors that reduce risks
of accidents and demonstrating
corrective action
Identifying environmental factors
that affect health and safety
Recognizing that the use of alcohol
and other drugs plays a role in many
dangerous situations
■ Identifies previously introduced skills or behaviors that should be built on and reinforced.
Middle School
Unifying Idea:
Acceptance of personal
responsibility for
lifelong health
106
Chapter 3
Health Education
Expectation 3 (Continued)
Grade-level concepts and content
III. Expectations
and Content,
by Grade Level
Middle School
Examples of skills and behaviors
Potentially dangerous situations:
understand the importance of
obeying school rules prohibiting the
possession and use of weapons.
Unifying Idea:
Acceptance of personal
responsibility for
lifelong health
Demonstrating how peers can help
each other avoid and cope with
potentially dangerous situations in
healthy ways
Using thinking and decision-making
skills in high-risk situations involving
the use of motor vehicles and other
hazardous activities
Alcohol, tobacco, and other drugs:
The use of alcohol, tobacco, or
other drugs frequently plays a role in
the dangerous behaviors of adoles­
cents and adults. Students should
understand the short-term and longterm effects of using such substances,
including those that may alter
performance, such as steroids. Their
effects on the health of unborn
children should also be explored.
Students should develop their understanding of the concept of chemical
dependency and the effects of such
dependency on the body. Another
concern should be the effects on
society of the use of alcohol, tobacco,
and other drugs. Students should
learn what laws (local, state, and
federal), school policies, and family
rules govern the use of chemical
substances and should understand the
consequences of illegal use of drugs.
They should also be taught to understand the influence of peers and the
media on the use of alcohol, tobacco,
and other drugs; develop knowledge,
skills, and strategies for choosing not
to use or distribute such substances;
■ Exercising
self-control
■ Developing
and using interper­
sonal and other communication
skills, such as assertiveness,
refusal, negotiation, and conflictresolution skills to avoid the use of
alcohol, tobacco, and other drugs
■ Distinguishing
between helpful
and harmful substances
■ Differentiating
between the use
and misuse of prescription and
nonprescription drugs
■ Avoiding,
recognizing, and
responding to negative social
influences and pressure to use
alcohol, tobacco, or other drugs
■ Using
positive peer pressure to
help counteract the negative
effects of living in an environment
where alcohol, tobacco, or other
drug abuse or dependency exists
■ Identifying
ways of obtaining help
to resist pressure to use alcohol,
tobacco, or other drugs
■ Identifies previously introduced skills or behaviors that should be built on and reinforced.
107
Grade-level concepts and content
Examples of skills and behaviors
Chapter 3
Health Education
Alcohol, tobacco, and other drugs:
and learn strategies for avoiding
drug-related risk-taking situations
and should have opportunities to
practice those strategies.
Numerous resources in the school
and the community are available for
people who have problems related to
alcohol or drugs. However, many of
the risk factors associated with the
use of alcohol, tobacco, and other
drugs are outside the student’s
control. A history of alcoholism at
home, for example, or the easy
availability of other drugs in the
home or neighborhood are realities
for many students. Even in adverse
circumstances, however, students can
learn and practice coping strategies
that will reduce the risks. Students
should know how and where to
obtain help when confronted with
alcohol- or drug-related problems.
Identifying and participating in
positive alternative activities, such as
alcohol-, tobacco-, and drug-free
events
Middle School
Unifying Idea:
Acceptance of personal
responsibility for
lifelong health
Child abuse, including sexual exploitation:
Information on the neglect and
abuse of children should continue to
be presented. Students should be told
forcefully that these problems are
serious and that they may require
outside assistance. After parents are
notified of the forthcoming instruc­
tion, students should also be provided
with information on sexual abuse and
rape. In addition, students should be
helped to develop skills enabling
them to prevent, avoid, and cope
with unwanted sexual advances and
be asked to demonstrate those skills.
The skills include ability to assess
III. Expectations
and Content,
by Grade Level
■ Identifying
ways to seek assis­
tance if concerned, abused, or
threatened
■ Recognizing
and avoiding situa­
tions that can increase risk of
abuse
Avoiding, recognizing, and respond­
ing to negative social influences and
pressure to become sexually active,
including applying refusal skills
when appropriate
■ Identifies previously introduced skills or behaviors that should be built on and reinforced.
108
Chapter 3
Health Education
Expectation 3 (Continued)
Grade-level concepts and content
III. Expectations
and Content,
by Grade Level
Middle School
Unifying Idea:
Acceptance of personal
responsibility for
lifelong health
Examples of skills and behaviors
Child abuse, including sexual exploitation:
situations that may be dangerous;
avoid those situations; avoid alcohol
and other drug use; develop
assertiveness skills; and learn selfdefense techniques. Even when
precautions are taken, however,
sexual abuse or rape may occur. For
that reason students should be made
aware of and be given access to
resources available for those who
have been sexually abused, molested,
or assaulted.
Emergencies:
Building on the knowledge and
skills learned in the elementary
grades, students should explore how
to develop a detailed family emer­
gency plan and maintain safety
equipment and supplies in readiness
for emergencies and natural disasters.
Community emergency services
should be analyzed, and effective
means for using them should be
explored. In addition to the first-aid
skills learned in the upper elementary
grades, students at this level should
have the opportunity to demonstrate
proficiency in standard first-aid
procedures, abdominal-thrust maneu­
ver, and cardiopulmonary resuscita­
tion (CPR). Some students may have
fears about contracting a disease while
administering first aid or CPR.
Because some of those fears are based
on myth and some on fact, students
should be provided with scientific
data so that they can distinguish a
genuine danger from a mistaken one.
■ Recognizing
emergencies and
responding appropriately, includ­
ing demonstrating proficiency in
basic first-aid procedures, abdomi­
nal thrust maneuver, and cardiop­
ulmonary resuscitation (CPR)
Developing and maintaining, with
other family members, a personal
and family emergency plan, includ­
ing maintaining supplies in readiness
for emergencies
■ Identifies previously introduced skills or behaviors that should be built on and reinforced.
109
Unifying Idea
Respect for and promotion of the health
of others
Expectations:
4. Students will understand and demonstrate how to
play a positive, active role in promoting the health
of their families.
5. Students will understand and demonstrate how to
promote positive health practices within the school
and community, including how to cultivate positive
relationships with their peers.
Expectation 4
Students will understand and demonstrate how to play a positive, active
role in promoting the health of their families.
Grade-level concepts and content
Examples of skills and behaviors
Roles of family members:
Students should recognize that
parenting can be a rich and reward­
ing experience but requires time and
commitment. Parenting involves
moral, social, legal, and financial
responsibilities and is, therefore, an
activity appropriate for responsible
adults only. Parental responsibilities
begin even prior to conception
because health-related behavior of
both parents before and during
pregnancy influences the health of
the baby. Although various cultures
and societies have unique parenting
patterns, all parents must provide for
their children’s development. As
students explore the roles of parents,
they should recognize that balancing
the responsibilities of work and
parenting can be difficult. Being a
responsible parent means consider­
ing this challenge and striking an
appropriate balance between work
■ Supporting
and valuing all family
members
■ Demonstrating
ways in which
children can help support positive
family interactions
■ Developing
and using effective
communication techniques,
including talking openly and
honestly with parents when
problems arise and developing
skills for discussing with parents
questions about sexuality
■ Practicing
health-promoting
behaviors with the family; recog­
nizing its role in supporting
positive health practices of others,
especially younger children; and
encouraging other family members
to practice those positive behaviors
Completing self-initiated activities
beyond assigned chores to help
■ Identifies previously introduced skills or behaviors that should be built on and reinforced.
Chapter 3
Health Education
III. Expectations
and Content,
by Grade Level
Middle School
110
Chapter 3
Health Education
Expectation 4 (Continued)
Grade-level concepts and content
III. Expectations
and Content,
by Grade Level
Middle School
Unifying Idea:
Respect for and
promotion of the
health of others
Examples of skills and behaviors
Roles of family members:
and parenting. Students should also
explore ways in which parental
behavior affects children and focus
on ways in which social, economic,
and cultural factors affect family life.
For example, the values or religious
beliefs that parents teach and model
influence how children behave.
Students should recognize that
traditions, history, and family pride
are passed on by parents and extended family members.
One emphasis of the curriculum
at this level should be on the diffi­
culty and challenges of being a
teenage parent. Teenagers are still
growing and developing. Parenting
responsibilities at that age can
interrupt schooling, employment
plans, and social and family life for
both male and female teenagers.
Further, the children of teenage
parents often have more problems
than do the children of adult parents.
Birth defects, more common in
children of teenage parents, are one
example. In summary, teenage
pregnancy can have serious effects on
the teenage parent, the child, the
teenager’s family, and society.
Students should continue to
identify the skills needed to be
responsible family members and
should have opportunities to practice
those skills. They should recognize
their role in promoting the health of
family members as well as preventing
injuries and promoting safety at
home. As students explore their roles
support the family, such as doing
the dishes without being asked
Identifying safety hazards in the
home and helping to remove those
hazards
111
Grade-level concepts and content
Examples of skills and behaviors
Chapter 3
Health Education
Roles of family members:
III. Expectations
and Content,
by Grade Level
in their families, they should recog­
nize that the responsibilities of
children change as they grow older.
With adolescence usually comes
greater independence and often
greater responsibility.
As the child’s role in the family
changes, good communication with
parents is particularly important.
Effective communication skills can be
developed that can help adolescents
and their parents talk about difficult
subjects in a reasonable way. Students
can also explore the effects emotions
have on behaviors and communica­
tion. At times a cooling-off period
may be needed before conflicts can be
resolved. The importance of honesty,
trust, and mutual respect in family
communication should be empha­
sized. Occasional conflicts between
parents and adolescents are normal.
Positive ways to resolve conflict
should be a continuing emphasis of
the curriculum.
Middle School
Unifying Idea:
Respect for and
promotion of the
health of others
Change within the family:
Family interactions can be
affected by changes in the family
structure, including the results of
unexpected change, disappointment,
or grief. Yet there are healthy ways
to deal with these emotions. Coping
strategies can be developed, and
family members can help each other
through difficult times. Families
sometimes need counseling to
function well.
■ Using
effective strategies to cope
with change in the family, such as
seeking assistance from a parent, a
trusted adult, a support system, or
counseling when needed
■ Identifies previously introduced skills or behaviors that should be built on and reinforced.
112
Chapter 3
Health Education
III. Expectations
and Content,
by Grade Level
Expectation 5
Students will understand and demonstrate how to promote positive health
practices within the school and community, including how to cultivate
positive relationships with their peers.
Grade-level concepts and content
Middle School
Unifying Idea:
Respect for and
promotion of the
health of others
Examples of skills and behaviors
Friendship and peer relationships:
Positive peer relationships in
adolescence are a key to good
health. Students should be encour­
aged to reach out to and include
others; conversely, they should be
discouraged from becoming
exclusive and clique-oriented. The
curriculum should focus on the
need to respect the dignity of all
people, including students and
adults at school, and to avoid name
calling, prejudice, exclusiveness,
discrimination, and conflict.
Students should be reminded that,
although they may not like everyone with whom they interact, it is
important to be able to communi­
cate and work effectively with a
variety of people.
Students should demonstrate
decision-making and problemsolving skills to enhance interper­
sonal relationships and skills for
building and maintaining friendships. They should be encouraged
to recognize the role of positive peer
relationships in encouraging
healthy behaviors and discouraging
risk-taking behaviors. Emphasis on
skills for influencing others to avoid
the use of alcohol, tobacco, and
other drugs as well as other un­
healthy behaviors (such as eating
disorders, unsafe behaviors in and
■ Knowing
and using appropriate
ways to make new friends
■ Demonstrating
acceptable meth­
ods of gaining attention
■ Demonstrating
acceptable ways to
show or express feelings
■ Demonstrating
positive actions
toward others
■ Resolving
conflicts in a positive,
constructive way
■ Demonstrating
how to resist
negative peer pressure
Avoiding demeaning statements
directed toward others
Interacting effectively with many
different people, including both
males and females and members of
different ethnic and cultural groups
Promoting positive health behaviors
among peers, including acknowledg­
ing and supporting the special health
needs of others
Helping peers know when they
should seek help from a parent or
other trusted adult
■ Identifies previously introduced skills or behaviors that should be built on and reinforced.
113
Grade-level concepts and content
Examples of skills and behaviors
Chapter 3
Health Education
Friendship and peer relationships:
III. Expectations
and Content,
by Grade Level
around motor vehicles, and unsafe
risk-taking behaviors around bodies
of water) should be continued at this
level.
Because students at this level are
likely to be interested in attending
coeducational social activities, they
should be encouraged to develop
positive relationships with both
males and females. Good communi­
cation is important in the develop­
ment of positive relationships.
Communication skills and the causes
and consequences of miscommuni­
cation, should be explored.
Middle School
Unifying Idea:
Respect for and
promotion of the
health of others
School and community-based efforts to promote and protect health:
As students become more aware
of and involved with the larger
environment, they should have
opportunities to examine how laws,
policies, and practices influence
health locally, nationally, and
internationally. The curriculum
should include descriptions of how
public health efforts have helped to
prevent, control, and eradicate
disease and how personal and public
actions have affected the environ­
ment. To be included is the role of
public agencies in establishing rules
and laws to protect community
health now and in the future.
Students can also explore and
participate in efforts by school and
community organizations to im­
prove health at local, national, and
■ Understanding
and following
school rules related to health
■ Participating
in school efforts to
promote health
■ Assuming
responsibility for
helping to take care of the school,
such as picking up trash on the
school grounds and helping other
students assume responsibility for
that action
■ Participating
in community efforts
to address local health and envi­
ronmental issues
■ Contributing
to the strengthening
of health-related policies at school
Encouraging others to become
involved in health-promotion efforts
at school
■ Identifies previously introduced skills or behaviors that should be built on and reinforced.
114
Chapter 3
Health Education
Expectation 5 (Continued)
Grade-level concepts and content
III. Expectations
and Content,
by Grade Level
Middle School
Examples of skills and behaviors
School and community-based efforts to promote and protect health:
international levels. This is an
appropriate time to introduce
information about agencies and
organizations that provide protection against fraudulent health
products, services, and information.
The curriculum can also include a
study of food additives, recycling,
food waste, hunger, pesticide use,
and the need for a safe and adequate
food supply. Students should
promote activities centering on
disease prevention among family
and friends and learn ways to assist
others in making positive health
decisions that have an effect on
themselves and others.
Analyzing the impact of laws,
policies, and practices on healthrelated issues
Encouraging others to become
involved in health-promotion efforts
at many different levels; for example
choosing not to smoke, supporting
the school as a tobacco-free environ­
ment, and supporting local efforts to
reduce smoking in the community
Accessing appropriately services
available within the community
Unifying Idea
An understanding of the process of growth
and development
Expectations:
6. Students will understand the variety of physical,
mental, emotional, and social changes that occur
throughout life.
7. Students will understand and accept individual
differences in growth and development.
8. Students will understand their developing sexuality,
will choose to abstain from sexual activity, will learn
about protecting their sexual health, and will treat the
sexuality of others with respect.
115
Chapter 3
Health Education
Expectation 6
Students will understand the variety of physical, mental, emotional, and
social changes that occur throughout life.
Grade-level concepts and content
Examples of skills and behaviors
III. Expectations
and Content,
by Grade Level
Life cycle:
Middle School
Early adolescence and adoles­
cence are times of intense change,
growth, and development. They can
also be times of emotional turmoil,
uncertainty, anxiety, and related
health and behavior problems. If
not presented earlier, the changes
associated with puberty and the
structure and function of the male
and female reproductive systems
should be presented at this level.
In addition to learning to understand the changes occurring during
adolescence, students should be
encouraged to develop strategies for
coping with concerns and stress
related to those changes.
■ Practicing
good personal hygiene,
paying particular attention to the
changing needs of adolescents
■ Managing
feelings appropriately
■ Developing
and using effective
communication skills to discuss
with parents or other trusted
adults the changes that occur
during adolescence
Recognizing fluctuations in
emotions
Practicing behaviors that will
provide the option of healthy
parenting later in life, such as
avoidance of substance abuse
Expectation 7
Students will understand and accept individual differences in growth
and development.
Growth and development:
At a time when students are
developing in different ways and at
varying rates, differences in physical,
mental, emotional, and social
growth and development during
adolescence are an appropriate focus
of the curriculum. Students should
understand that each person experi­
ences change at his or her own pace.
There is no exact time frame or
■ Demonstrating
an understanding
of individual differences
■ Adapting
group activities to
include a variety of students
■ Developing
a realistic body image
■ Recognizing
problems associated
with not having a realistic body
image, including dieting and
■ Identifies previously introduced skills or behaviors that should be built on and reinforced.
Unifying Idea:
An understanding of
the process of growth
and development
116
Chapter 3
Health Education
Expectation 7 (Continued)
Grade-level concepts and content
III. Expectations
and Content,
by Grade Level
Middle School
Unifying Idea:
An understanding of
the process of growth
and development
Examples of skills and behaviors
Growth and development:
age for particular changes to occur.
In addition, students should understand the negative impact that
alcohol, tobacco, and other drugs,
including performance-altering
substances, have on the body and
develop strategies for avoiding the
use of those substances.
eating disorders, and seeking
appropriate help
Recognizing the effects of
performance-altering substances
and avoiding the use of those
substances
Mental and emotional development:
Although individuals vary greatly
in their physical, mental, emotional,
and social development, students
should understand that all people
face decisions that can influence
future choices. Setting short-term and
long-term goals is a helpful way of
focusing and guiding one’s life. While
acknowledging the role of heredity
in growth and development, students
should be encouraged to set shortterm and long-term goals related to
personal health and physical fitness.
■ Identifying,
expressing, and
managing feelings appropriately
■ Developing
and using effective
communication skills
■ Recognizing
one’s own strengths
and limitations
■ Using
coping strategies, including
time-management skills
Developing a focus on the future
Expectation 8
Students will understand their developing sexuality, will choose to abstain
from sexual activity, will learn about protecting their sexual health, and
will treat the sexuality of others with respect.
Sexuality:
Note: The Education Code requires
that parents be notified before any
discussion of human reproductive
organs and their functions and pro­
cesses takes place.
Developing and using effective
communication skills, including the
ability to discuss with parents
questions on sexuality
■ Identifies previously introduced skills or behaviors that should be built on and reinforced.
117
Grade-level concepts and content
Examples of skills and behaviors
Chapter 3
Health Education
Sexuality:
Sexuality is a natural and healthy
part of life. At this level it is appro­
priate to address the psychological,
social, moral, and ethical aspects of
sexuality. Students should recognize
that there are differences and simi­
larities between male and female
sexuality and that the consequences
of sexual involvement may differ.
For example, teenage pregnancy
usually has a greater impact on the
female partner.
Abstinence from sexual activity
should be an important theme in the
curriculum at this level and should
be emphasized as the wisest and
healthiest choice for young people
until marriage. Further, abstinence is
the only totally effective method of
contraception. All other methods of
contraception carry a risk of failure
in preventing unwanted teenage
pregnancy. Statistics on the effective­
ness or ineffectiveness of other birthcontrol methods in preventing
unwanted pregnancies must be
provided to students. Students who
are considering sexual activity should
be encouraged to talk with a parent
or other trusted adult.
All students should be made
aware that sexual feelings and desires
are natural but should also be taught
to recognize that they do not have to
act on those feelings. They should be
helped to understand that they can
show affection in ways other than
sexually and that love should not be
equated with sexual involvement.
Moreover, they must learn that it is
Identifying appropriate ways to
show affection
Recognizing and avoiding situations
that place one at risk of participating
in sexual activity
Avoiding, recognizing, and respond­
ing to negative social influences and
pressure to become sexually active
Demonstrating assertive and refusal
skills and applying those skills to
situations involving pressure to be
sexually active
Identifying ways to seek assistance
if abused
Practicing behaviors that support
the decision to abstain from sexual
activity
III. Expectations
and Content,
by Grade Level
Middle School
Unifying Idea:
An understanding of
the process of growth
and development
118
Chapter 3
Health Education
Expectation 8 (Continued)i
Grade-level concepts and content
III. Expectations
and Content,
by Grade Level
Middle School
Unifying Idea:
An understanding of
the process of growth
and development
Examples of skills and behaviors
Sexuality:
never appropriate to force someone
to have any type of intimate sexual
contact.
A factual, substantiated discussion
of homosexuality may be presented
at this level. (Note: School district
governing boards considering
approval of such a discussion should
refer to “Family Living” in Section II
of this chapter and to Appendix A.)
The discussion might be conducted
in a limited way during or after
grade seven and more fully in high
school. Students should recognize,
however, that most persons feel
affection for both men and women
and that affection for someone of
the same sex is not necessarily an
indicator of homosexuality. Teenag­
ers questioning their sexual orienta­
tion may be reluctant to discuss the
topic for fear of reprisal. Students
should respect the rights of others to
seek information about homosexual­
ity from a parent or other trusted
and knowledgeable adult.
The California Student Safety
and Violence Prevention Act of
2000 (AB 537) promotes an appre­
ciation of diversity in a democratic
society. Name-calling or other
hurtful actions must not be toler­
ated. Teachers, counselors, physi­
cians, religious leaders, and commu­
nity resource centers may offer
support for young people who have
concerns about their sexual orienta­
tion. Religious and personal beliefs
should be respected, and instruction
should affirm the dignity of all
people.
119
Unifying Ideai
Informed use of health-related information,i
products, and servicesi
Expectation:i
9. Students will identify information, products, and
services that may be helpful or harmful to their
health.
Expectation 9i
Students will identify information, products, and services that may be helpfuli
or harmful to their health.
Grade-level concepts and content
Examples of skills and behaviors
Products and services:
At this level students should be
encouraged to analyze in depth the
range of health services in the
community available from public
and private organizations and
agencies. They should identify those
services that seek to prevent and
treat disease. At the same time
students should be encouraged to
distinguish health concerns they can
manage from those that require
professional care. The relationship
of values, socioeconomic status, and
cultural experiences to the selection
of health-care services should be
emphasized.
Health fads and misconceptions
about treatment and prevention
options are appropriate for explora­
tion, including the influence of
advertising on the selection of health
products and services. Students
should have opportunities to
contrast advertised images with real
images. For example, they might
■ Identifying
a variety of consumer
influences and analyzing how
those influences affect decisions
■ Recognizing
helpful products and
services
■ Using
critical-thinking skills to
analyze marketing and advertising
techniques and their influence on
the selection of health-related
services and products
■ Seeking
care from the school nurse
or school-linked services with
families when appropriate
Identifying appropriate sources
of health services for a variety
of illnesses
Developing and applying criteria for
the selection or rejection of health
products, services, and information,
such as determining when appropri­
ate to take a vitamin or mineral
supplement
■ Identifies previously introduced skills or behaviors that should be built on and reinforced.
Chapter 3
Health Education
III. Expectations
and Content,
by Grade Level
Middle School
120
Chapter 3
Health Education
Expectation 9 (Continued)i
Grade-level concepts and content
III. Expectations
and Content,
by Grade Level
Middle School
Unifying Idea:
Informed use of
health-related
information,
products,
and services
Examples of skills and behaviors
Products and services:
counter the advertised image of
youth and rugged good health or a
happy cartoon character in tobacco
ads with diseases caused by smoking
that ravage a smoker’s health.
Students should develop criteria
for the selection or rejection of
health products, services, and
information. They should be able to
analyze labels on health-related
products to determine whether the
products are appropriate for personal
use and when they might be used.
The qualifications of various healthcare providers should be explored.
Because the opinions of health-care
professionals are not infallible, there
may be legitimate reasons for
requesting additional information or
a second opinion. Students should
be able to recognize when they
might wish to obtain additional
information or a second opinion and
analyze how to obtain this informa­
tion or service. The curriculum
should also include an exploration
of health- and food-related careers.
Food choices:
Increasingly, students at this
grade span purchase or prepare their
own meals and snacks at home or
away from home. They need to be
aware of the variety of low-cost
foods that provide nutritionally
adequate diets. Information should
also be provided on reliable sources
■ Using
labels to compare the
contents of food products
■ Using
critical-thinking skills to
analyze marketing and advertising
techniques and their influence on
food selection
■ Identifies previously introduced skills or behaviors that should be built on and reinforced.
121
Grade-level concepts and content
Examples of skills and behaviors
Chapter 3
Health Education
Food choices:
of nutrition information. Students
need to develop skills in identifying
and responding to influences—from
peers, family, friends, the media,
advertising, and industry—that
influence personal food choices.
Because eating disorders and fad
dieting can lead to serious health
problems, students should guard
against becoming victims of media
and peer pressures that promote an
idealized and unattainable body
image inappropriate for most
persons. Adolescents need to be
especially wary of nutrition and
health claims that promise unrealis­
tic results.
■ Using
valid nutrition information
to make healthy food choices
unit pricing to determine
the most economical purchases
III. Expectations
and Content,
by Grade Level
■ Using
■ Developing
basic food-preparation
skills, including safe and sanitary
food preparation and storage
Using effective consumer skills to
purchase healthy foods within
budget constraints in a variety of
settings
Using critical-thinking skills to
distinguish facts from fallacies
concerning the nutritional value
of foods and food supplements
Adapting recipes to make them more
healthy by lowering fat, salt, or sugar
and increasing fiber
Using critical-thinking skills to
analyze weight modification prac­
tices and selecting appropriate
practices to maintain, lose, or gain
weight according to individual need
and scientific research
■ Identifies previously introduced skills or behaviors that should be built on and reinforced.
Middle School
Unifying Idea:
Informed use of
health-related
information,
products,
and services
122
Chapter 3
Health Education
III. Expectations
and Content,
by Grade Level
High School
Several principles should be kept in mind when developing health education
for students in high school. First, although many students may seem physically
mature, they are still in the process of changing from external guidance to
internal direction. In addition, the illusion of immortality is common to them,
and the possibility of their developing a disease or disability in the distant
future may carry even less weight for them than for younger adolescents.
Therefore, instruction centering on the more immediate consequences of
behavior or the imminent transition to adulthood is likely to be more effective
than instruction emphasizing a long-term approach. Students are receptive to
information provided by trusted adults but are often overconfident about their
own knowledge and coping abilities. Therefore, positive adult and peer role
models are critically important at this stage.
A positive development among many students is that they are becoming
aware of their influence on younger children and are taking an increasingly
active role in the school and the community as concerned citizens. They are
often willing participants as role models or peer advisers. By this time most
students are also beginning to think about career and life options. The curricu­
lum can stimulate those interests and help to inform students about healthor food-related careers.
Unifying Idea
Acceptance of personal responsibility
for lifelong health
Expectations:
1. Students will demonstrate ways in which they can
enhance and maintain their health and well-being.
2. Students will understand and demonstrate behaviors
that prevent disease and speed recovery from illness.
3. Students will practice behaviors that reduce the risk of
becoming involved in potentially dangerous situations
and react to potentially dangerous situations in ways
that help to protect their health.
123
Chapter 3
Health Education
Expectation 1
Students will demonstrate ways in which they can enhance and maintain
their health and well-being.
Grade-level concepts and content
Examples of skills and behaviors
III. Expectations
and Content,
by Grade Level
The human body:
High School
The relationship among personal
health habits, personal health, and
the quality of life continues to be an
important focus at this grade level.
Students should develop a plan of
health habits appropriate to their
individual needs and analyze the
ways in which personal health needs
change during the life cycle. In
addition, students should analyze
how environmental conditions affect
body systems and be able to demon­
strate ways to protect themselves
from exposure to potentially harmful
conditions.
■ Practicing
good personal hygiene
■ Using
protective equipment,
such as a helmet when cycling,
or practicing behaviors to protect
the body, such as avoiding exposure to excessive noises
■ Recognizing
and accepting
differences in body types and
maturation levels
Responding appropriately to the
physical development of older
adolescents in ways that promote
physical health through such
preventive measures as healthy
food choices and exercise
Food choices:
The curriculum should emphasize
nutritional needs during the different
life stages—for example, prenatal
development, infancy, early childhood, adolescence, and adulthood.
Individual dietary requirements vary
by age, gender, health status, and
level of activity. The unique nutritional needs of adolescents, including
pregnant teenagers and school-age
parents, should be particularly
emphasized.
The effects of nutrition and
exercise on behavior, appearance, and
physical and mental performance
■ Making
healthy food choices in a
variety of settings
■ Establishing
and maintaining
healthy eating practices, including
developing and using a personal
nutrition plan based on food
choices and calorie levels that
promotes health and reduces risk
of disease
■ Analyzing
how food choices are
influenced, including how a busy
schedule influences food choices
■ Selecting
appropriate practices to
maintain, lose, or gain weight
■ Identifies previously introduced skills or behaviors that should be built on and reinforced.
Unifying Idea:
Acceptance of personal
responsibility for
lifelong health
124
Chapter 3
Health Education
Expectation 1 (Continued)
Grade-level concepts and content
III. Expectations
and Content,
by Grade Level
High School
Unifying Idea:
Acceptance of personal
responsibility for
lifelong health
Examples of skills and behaviors
Food choices:
should also be highlighted, together
with the role of nutrition in prevent­
ing chronic disease. Students should
develop a culturally appropriate,
long-range personal nutrition plan,
based on food choices and calorie
levels, that promotes health and
reduces the risk of disease. They
should be aware of the various food
sources of nutrients available in
different cultural and ethnic cuisines.
They should also practice healthy
food-preparation skills at home, at
school, and in the community.
based on individual needs and
scientific research
Recognizing the need for updating
the personal nutrition plan as
individual needs or activities change
and being able to do so
Physical activity:
The curriculum should continue
to emphasize the pleasure of physical
activity. Students should be encouraged to explore a variety of activities
in school and outside school. They
should explore the connections
between physical activity and mental
and emotional health. As students
plan for their transition to adulthood, they should investigate ways
to maintain regular exercise practices
and explore the potential harm of a
sedentary lifestyle.
A periodic self-assessment of
physical fitness should be a regular
practice for students at this level.
Assessment results should be used
to evaluate progress toward meeting
personal physical fitness goals and to
refine personal fitness programs as
necessary. Students should also
■ Observing
safety rules during
physical activities
■ Exploring
ways to engage in outof-school activities that promote
health
■ Participating
regularly in a variety
of enjoyable physical activities
■ Following
through with a personal
fitness plan based on personal
fitness goals and the results of
periodic self-assessments
Making the adjustments needed
for successful implementation of
the personal fitness plan, including
getting additional rest when
necessary
■ Identifies previously introduced skills or behaviors that should be built on and reinforced.
125
Grade-level concepts and content
Examples of skills and behaviors
Chapter 3
Health Education
Physical activity:
discuss and analyze factors that
influence personal motivation for
participating in regular physical
activity. If appropriate, they should
be encouraged to develop selfmotivation and self-discipline
strategies to achieve personal goals.
Students should be encouraged to
accept differences among individuals
and recognize that different activities
appeal to different people.
Analyzing personal motivators
related to pursuing physical activity
and using those motivators to
maintain ongoing participation in
physical activities
Exploring ways to continue regular
exercise practices when schedules
change, such as during travel or
while working
Mental and emotional health:
The mental and emotional aspects
of health continue to be strongly
emphasized in the curriculum at this
level. Students should have opportunities to recognize and build on
personal characteristics that contribute to self-confidence and selfesteem. They should understand
that usually there is more than one
way to solve a problem and should
have opportunities to practice
problem-solving skills. Students
should continue to be encouraged to
pursue leisure-time activities that
promote physical and mental health.
The topic of suicide, introduced
in middle school, can be explored in
more depth at this level. Students
who feel rejected or socially isolated
should be encouraged to develop
strategies for coping with and
overcoming these feelings. Acceptable alternatives include talking over
problems, understanding that
feelings of depression and isolation
■ Demonstrating
personal characteristics that contribute to selfconfidence and self-esteem, such
as honesty, integrity, responsibil­
ity, and respect for the dignity of
others
■ Developing
protective factors that
help promote resiliency, such as
developing an internal focus of
control and maintaining a future
focus
■ Developing
and using effective
communication skills
■ Developing
and using effective
coping strategies
■ Avoiding
self-destructive behaviors
■ Practicing
strategies for resisting
negative peer pressure
■ Identifying
the strongest risk
factors for negative behaviors in
their own lives and developing
effective strategies for counteracting the effect of those risk factors
■ Identifies previously introduced skills or behaviors that should be built on and reinforced.
III. Expectations
and Content,
by Grade Level
High School
Unifying Idea:
Acceptance of personal
responsibility for
lifelong health
126
Chapter 3
Health Education
Expectation 1 (Continued)
Grade-level concepts and content
III. Expectations
and Content,
by Grade Level
High School
Unifying Idea:
Acceptance of personal
responsibility for
lifelong health
Examples of skills and behaviors
Mental and emotional health:
will pass, examining the situation
leading to the problem, seeking
appropriate assistance if depression
persists, obtaining medical treatment
for organically caused depression, and
participating in regular aerobic
exercise. Students should understand
the role of denial as a negative
influence on mental and emotional
health and should have opportunities
to develop and use effective commu­
nication skills to overcome denial and
seek assistance when needed.
■ Selecting
entertainment that
promotes mental and physical
health
Identifying personal habits influenc­
ing mental and emotional health and
developing strategies for changing
behaviors as needed to promote
positive mental and emotional
health
Relating in positive ways to peers
and adults in and out of school
Expectation 2
Students will understand and demonstrate behaviors that prevent disease and
speed recovery from illness.
Disease prevention:
At this level students should
receive more detailed information on
communicable and chronic diseases
and disorders. In addition, future
trends and the social and economic
impact of such diseases and disorders
on people and society should be
discussed. Students should learn
about the major communicable and
chronic diseases prevalent at differ­
ent stages of life and be able to
explain how the immune system
functions to prevent or combat
disease. A variety of ways to prevent
the major diseases should be described. The importance of prenatal
and perinatal care and the impact of
■ Practicing
good personal hygiene
to prevent the spread of disease
■ Practicing
positive health behav­
iors to reduce the risk of disease
■ Cooperating
in regular health
screenings, including dental
examinations
■ Demonstrating
safe care and
concern toward ill persons in the
family, school, and community
■ Making
a commitment to abstain
from sexual activity, including
exploring nonphysical ways to
express affection
■ Practicing
and using effective selfexamination procedures
■ Identifies previously introduced skills or behaviors that should be built on and reinforced.
127
Grade-level concepts and content
Examples of skills and behaviors
Chapter 3
Health Education
Disease prevention:
this care on both the woman and her
child should also be stressed. This
framework encourages emphasis
on both prenatal and perinatal care
so that students will understand
the benefits of prenatal care to the
woman and her child and the impor­
tance of care after delivery, especially
for the newborn. Students should
be encouraged to practice specific
behaviors that support those who
are ill but avoid contagion.
Continued emphasis should be
given to the prevention of sexually
transmitted diseases, especially HIV/
AIDS. Students should compare the
effectiveness of abstinence with the
effectiveness or ineffectiveness of
other methods of preventing sexually
transmitted diseases.
The importance of regular exami­
nations, including self-examination
of the breasts or testicles, in detecting
and treating diseases early should be
emphasized at this time. Students
should learn how to discuss proce­
dures and test results with their
health-care providers.
Recognizing the importance of
prenatal and perinatal care
Analyzing personal behaviors to
determine how those behaviors relate
to their own health and well-being
and the fulfillment of personal goals
and how those behaviors can be
modified if necessary to promote
achievement of those goals
Treatment of disease:
Students should be encouraged to
learn ways to become fully informed
about personal illness, including how
to analyze the symptoms of disease
and how to communicate about one’s
personal health with health-care
providers. Family, social, economic,
and cultural influences also play a role
■ Recognizing
symptoms of com­
mon illnesses
■ Taking
prescription and over-thecounter medicines properly
■ Interpreting
correctly the instruc­
tions written on medicine labels
■ Determining
when treatment of
illness at home is appropriate and
■ Identifies previously introduced skills or behaviors that should be built on and reinforced.
III. Expectations
and Content,
by Grade Level
High School
Unifying Idea:
Acceptance of personal
responsibility for
lifelong health
128
Chapter 3
Health Education
Expectation 2 (Continued)
Grade-level concepts and content
III. Expectations
and Content,
by Grade Level
High School
Unifying Idea:
Acceptance of personal
responsibility for
lifelong health
Examples of skills and behaviors
Treatment of disease:
in how people care for personal
illness. The importance of cooperat­
ing with parents and health-care
providers in the treatment or
management of disease should be
continually emphasized. Students
should also analyze the beneficial
effects of medications generally and
explain why it is important to take
or administer prescription and overthe-counter medicines responsibly.
The influence of family and cultural
factors on the treatment of disease
and the usefulness of participating in
support groups or activities should
continue to be explored.
when and how to seek further help
when needed
■ Accepting
responsibility for active
involvement in the treatment or
management of disease, including
practicing and using effective
communication skills to discuss
illness, test results, or procedures
with parents and health-care
providers
Interpreting correctly the information
provided by health-care providers
regarding test results or procedures
Analyzing one’s patterns related to
treatment of disease to determine
whether those patterns are effective
and changing behaviors if necessary
to facilitate management or recovery
Expectation 3
Students will practice behaviors that reduce the risk of becoming involved
in potentially dangerous situations and react to potentially dangerous
situations in ways that help to protect their health.
Grade-level concepts and content
Examples of skills and behaviors
Potentially dangerous situations:
Because many students begin
driving automobiles during this
period and because young drivers are
at particularly high risk of being
involved in automobile accidents,
they should be taught the basic rules
of traffic safety as an important focus
■ Developing
and using appropriate
skills to identify, avoid when
possible, or cope with potentially
dangerous situations
■ Practicing
safe behavior in and near
motorized vehicles, including
observing basic traffic safety rules
■ Identifies previously introduced skills or behaviors that should be built on and reinforced.
129
Grade-level concepts and content
Examples of skills and behaviors
Chapter 3
Health Education
Potentially dangerous situations:
of the curriculum. Students should
understand that safety requires being
observant at all times because others
may not follow the rules of safe
driving.
Many potentially dangerous
situations can be avoided or handled
by the observance of safety precau­
tions and the use of safety equip­
ment in everyday life. Students
should learn to identify hazards
found in the home, the school, and
the community and participate in
activities to remove those hazards.
They should also have the opportu­
nity to examine what constitutes a
safe versus an unsafe neighborhood
and be encouraged to participate in
activities that promote neighborhood safety.
A firearm is a noteworthy example
of a hazardous object. Students
should learn that under no circum­
stances should they possess or touch
a firearm except under the direction
of a responsible adult. Students who
will be handling firearms for recre­
ation should take a firearm-safety
training course.
Students should understand how
to minimize the potential for injury
when interacting with others who
exhibit dangerous behavior. As in
grades six through nine, students
should be given opportunities to
practice nonharmful conflictresolution strategies and identify
factors that can influence conflict
resolution.
when driving, developing profi­
ciency in handling a vehicle in
difficult situations, wearing a seat
belt, and ensuring that others wear
seat belts
■ Practicing
safe behavior in recre­
ational activities, even in the
absence of adults
■ Practicing
safe behavior in and near
water
■ Using
appropriate skills to avoid,
resolve, and cope with conflicts
■ Understanding
and following rules
prohibiting possession of weapons
at school
■ Reporting
or obtaining assistance
when faced with unsafe situations
■ Identifying
factors that reduce risks
of accidents and demonstrating
corrective action
■ Identifying
environmental factors
that affect health and safety
■ Recognizing
that the use of alcohol,
tobacco, and other drugs plays a
role in many dangerous situations
■ Demonstrating
how peers can help
each other avoid or cope with
potentially dangerous situations in
healthy ways
■ Using
thinking and decisionmaking skills in high-risk situations
involving motor vehicles and other
safety hazards
Carrying emergency equipment in
their vehicle
Using latex gloves when assisting
persons who are injured
■ Identifies previously introduced skills or behaviors that should be built on and reinforced.
III. Expectations
and Content,
by Grade Level
High School
Unifying Idea:
Acceptance of personal
responsibility for
lifelong health
130
Chapter 3
Health Education
Expectation 3 (Continued)
Grade-level concepts and content
III. Expectations
and Content,
by Grade Level
High School
Unifying Idea:
Acceptance of personal
responsibility for
lifelong health
Examples of skills and behaviors
Alcohol, tobacco, and other drugs:
The short-term and long-term
effects associated with the use of
alcohol, tobacco, and other drugs
(including those that may alter
performance, such as steroids), alone
or in combination, including their
effects on reproduction, pregnancy,
and the health of children, should be
emphasized at this level. Students
should continue to explore the legal,
social, and economic consequences of
drug use. Instruction should continue
to emphasize laws, school policies,
and family rules governing the use of
chemical substances. Students should
also continue to develop knowledge,
skills, and strategies for choosing not
to use or distribute alcohol, tobacco,
and other drugs. Included should be
practice in ways to avoid situations
involving alcohol, tobacco, and other
drugs that can have a negative
influence on the students’ health.
Students should recognize that
abuse of alcohol, tobacco, and other
drugs frequently plays a role in
dangerous behavior. Results of such
behavior include house fires, motorvehicle crashes, domestic violence,
date rape, and the transmission of
HIV/AIDS through needle sharing or
sexual activity. Students should
examine the influence of chemical use
on driving ability, other physical
tasks, and judgment and should have
opportunities to practice both refusal
skills and healthy responses to highrisk situations.
■ Exercising
self-control
■ Developing
and using interper­
sonal and other communication
skills, such as assertiveness,
refusal, negotiation, and conflictresolution skills to avoid use of
alcohol, tobacco, and other drugs
■ Distinguishing
between helpful
and harmful substances
■ Distinguishing
between the use
and misuse of prescription and
nonprescription drugs
■ Avoiding,
recognizing, and
responding to negative social
influences and pressure to use
alcohol, tobacco, or other drugs
■ Using
positive peer pressure to
help counteract the negative
effects of living in an environment
in which abuse of or dependence
on alcohol, tobacco, or other drugs
is present
■ Identifying
ways to obtain help to
resist pressures to use alcohol,
tobacco, or other drugs
■ Identifying
and participating in
positive alternatives, such as
alcohol-, tobacco-, and drug-free
events
Helping to develop and support the
school’s no-use policy and working
to support it by knowing the
procedures for reporting offenses
and setting a positive example
■ Identifies previously introduced skills or behaviors that should be built on and reinforced.
131
Grade-level concepts and content
Examples of skills and behaviors
Chapter 3
Health Education
Alcohol, tobacco, and other drugs:
III. Expectations
and Content,
by Grade Level
Information should be provided
about resources in the school and
community that can help people
who have alcohol-, tobacco-, or
drug-related problems. The curricu­
lum should also explore the disease
concept of chemical dependencies.
Students should build on their
understanding of the concept that
although many of the risk factors
associated with alcohol and other
drug use are not under the student’s
control, students can learn and
practice coping strategies that will
diminish the risks. They should
analyze the role of positive coping
strategies and self-respect in counteracting peer and environmental
pressure to use drugs.
High School
Unifying Idea:
Acceptance of personal
responsibility for
lifelong health
Child abuse, including sexual exploitation:
Neglect and child abuse should
continue to be considered. Emphasis
should be placed on the fact that
these are serious problems that may
require outside assistance. After
parents are notified, students should
be given information on sexual abuse
and rape. Skills related to preventing,
avoiding, and coping with unwanted
sexual advances can be developed,
and students should demonstrate
those skills. Even when precautions
are taken, however, a rape may occur.
Students should be aware of and be
able to obtain help provided for those
who have been sexually abused,
molested, or assaulted.
■ Identifying
ways to seek assis­
tance if concerned, abused, or
threatened
■ Recognizing
and avoiding situa­
tions that can increase risk of
abuse, including avoiding the use
of alcohol and other drugs
■ Avoiding,
recognizing, and
responding to negative social
influences and pressure to become
sexually active, including applying
refusal skills when appropriate
■ Developing
and using assertiveness
skills and learning self-defense
techniques
■ Identifies previously introduced skills or behaviors that should be built on and reinforced.
132
Chapter 3
Health Education
Expectation 3 (Continued)
Grade-level concepts and content
III. Expectations
and Content,
by Grade Level
High School
Unifying Idea:
Acceptance of personal
responsibility for
lifelong health
Examples of skills and behaviors
Emergencies:
If not learned earlier, cardiopul­
monary resuscitation (CPR) and
other first-aid procedures for lifethreatening emergencies should be
mastered at this level. In addition
to the skills listed at previous grade
levels, instruction should include
caring for victims of severe insect
stings and snakebites as well as
learning how to administer first aid
to persons with broken bones and
how to transport victims properly.
The personal and legal responsibili­
ties of persons involved in emergen­
cies should be explored and analyzed.
Students should continue to work
with their families to identify and
remove safety hazards in the home,
develop and maintain a detailed
family emergency plan, and maintain
safety equipment and supplies for
emergencies and natural disasters.
Emergency supplies should be
maintained at home and in vehicles.
Students and their families should
discuss what they would do if one
or more family members were away
from home during an emergency and
include plans for coping with this
situation in their family emergency
plan. They should analyze local
emergency services and determine
the appropriate (and inappropriate)
use of those services.
■ Recognizing
emergency situations
and responding appropriately
■ Developing
and maintaining, with
other family members, a personal
and family emergency plan,
including maintaining supplies in
readiness for emergencies, includ­
ing supplies at home and supplies
in their vehicle
Identifying appropriate use of local
emergency services
Using latex gloves when assisting
persons who are injured
■ Identifies previously introduced skills or behaviors that should be built on and reinforced.
133
Unifying Idea
Respect for and promotion of the health
of others
Expectations:
4. Students will understand and demonstrate how to
play a positive, active role in promoting the health
of their families.
5. Students will understand and demonstrate how to
promote positive health practices within the school
and community, including how to cultivate positive
relationships with their peers.
Expectation 4
Students will understand and demonstrate how to play a positive, active
role in promoting the health of their families.
Grade-level concepts and content
Examples of skills and behaviors
Roles of family members:
Building on the information
presented at earlier levels, students at
this level should continue to explore
family development and the factors
that help families to stay strong and
healthy, including the sharing of a
variety of family experiences and
traditions. Family communication
remains an important area to empha­
size, especially in light of the growing
independence of adolescents.
Strong families help their mem­
bers reach their fullest potential.
Ways of strengthening families
include continually emphasizing,
within the family, ways to support
and respect all family members,
effective approaches for solving
family problems, and strategies for
dealing with crisis and change. As
adolescents develop more indepen­
dence from their parents, they may
exhibit or be tempted to exhibit
■ Supporting
and valuing all family
members
■ Demonstrating
ways in which
adolescents can help support
positive family interactions
■ Developing
and using effective
communication techniques
■ Practicing
health-promoting
behaviors with the family; recog­
nizing their role in supporting
positive health practices of others,
especially younger children; and
encouraging other family mem­
bers to practice those positive
behaviors
■ Completing
self-initiated activities
beyond assigned chores to help
support the family
■ Identifying
safety hazards in the
home and helping to remove them
Seeking assistance if living in a
family where abuse of alcohol or
■ Identifies previously introduced skills or behaviors that should be built on and reinforced.
Chapter 3
Health Education
III. Expectations
and Content,
by Grade Level
High School
134
Chapter 3
Health Education
Expectation 4 (Continued)
Grade-level concepts and content
III. Expectations
and Content,
by Grade Level
High School
Unifying Idea:
Respect for and
promotion of the
health of others
Examples of skills and behaviors
Roles of family members:
individual behavior that conflicts
with their family’s standards. Students should understand how this
behavior can affect the family and
practice family communication skills
and related approaches to solving
family problems and conflicts.
Instruction at this level should
emphasize that family members can
have conflicts while continuing to
love and support each other.
Students should analyze shortterm and long-term effects that the
abuse of alcohol, tobacco, or other
drugs can have on the roles and
relationships within the family. For
example, some students at this age
may take on roles inappropriate for
their age but necessary because of
family structure. For example, the
oldest child of alcoholic parents may
assume responsibility for monitoring
and disciplining younger siblings.
other drugs exists (e.g., participating
in support groups for teens who are
the children of alcoholics)
Change within the family:
The effects of change on family
interactions continue to be impor­
tant at this grade span. The curricu­
lum may include the influence of
religious or cultural beliefs on family
interactions. For example, students
might analyze the process of grieving
in various cultures. In addition, they
should investigate their upcoming
transition to independent living,
critique their skills related to this
transition, and create a plan to help
develop those skills necessary for a
■ Using
effective strategies to cope
with change in the family
Developing a plan to facilitate
transition from the role as a child to
the role of an independent adult and
discussing the plan with one’s parents
while it is being developed
Discussing with parents plans
to continue education beyond high
school and developing a mutual
understanding of how this change will
affect family roles and interactions
■ Identifies previously introduced skills or behaviors that should be built on and reinforced.
135
Chapter 3
Health Education
Change within the family:
successful transition. Students
should also explore how the aging
process affects families and should
understand their role in helping
their parents assist grandparents.
III. Expectations
and Content,
by Grade Level
High School
Expectation 5
Students will understand and demonstrate how to promote positive health
practices within the school and community, including how to cultivate
positive relationships with their peers.
Grade-level concepts and content
Examples of skills and behaviors
Friendship and peer relationships:
An important emphasis of the
curriculum at this level is the need
to respect the dignity of all people.
Students should demonstrate ability
to interact effectively with a wide
range of people at school and should
encourage others to behave in
similar positive ways toward others.
It will be important to distinguish
between one’s own feelings about
the opinions or behaviors of other
people and the need to respect
others’ rights and individuality.
That is, students should realize that
one can disagree with others and
still interact effectively with them.
Students should understand the
importance of their personal stan­
dards being consistent with their
behavior. They should demonstrate
decision-making and problemsolving skills to enhance interper­
sonal relationships as well as skills
for building and maintaining
friendships. Positive, healthy
■ Knowing
and using appropriate
ways to make new friends
■ Demonstrating
positive actions
toward others
■ Resolving
conflicts in a positive,
constructive way
■ Demonstrating
how to resist
negative peer pressure
■ Interacting
effectively with many
different people, including both
males and females and members
of different ethnic and cultural
groups
■ Avoiding
demeaning statements
directed toward others
■ Promoting
positive health behav­
iors among peers
Participating in group activities as
a means of getting to know other
people
Analyzing appropriate behaviors in
a dating relationship
■ Identifies previously introduced skills or behaviors that should be built on and reinforced.
Unifying Idea:
Respect for and
promotion of the
health of others
136
Chapter 3
Health Education
Expectation 5 (Continued)
Grade-level concepts and content
III. Expectations
and Content,
by Grade Level
High School
Unifying Idea:
Respect for and
promotion of the
health of others
Examples of skills and behaviors
Friendship and peer relationships:
friendships reinforce one’s sense of
self-worth. Students should recognize
the role of responsible companions in
encouraging healthy behavior and
discouraging unhealthy risk-taking,
including strategies for influencing
others to avoid the use of alcohol,
tobacco, and other drugs as well as
other negative behaviors.
Developing new friendships and
new social skills with males and
females should also be emphasized.
Students should continue to develop
and enhance their communication
skills and skills for building and
maintaining friendships. Group
activities should be encouraged that
allow teenagers to learn about others
without dating. Students should
recognize that people date for differ­
ent reasons, that not all teenagers
date, and that parents usually decide
at what age their children may start
dating. As they develop friendships,
students can begin to identify criteria
that might be used later in life to
select a mate.
Honor and respect for monoga­
mous, heterosexual marriage should
be an important emphasis of the
curriculum at this level. Students
should be able to contrast a dating
relationship with a marriage relationship. Dating can be a way to learn
about other people, about romantic
feelings and expressions, and about
what it is like to be in a love relationship. Marriage is a legal commitment
that a man and a woman make to
Respecting the dignity of the persons
with whom they interact, including
dates, and expecting that their own
dignity will be treated with respect
Respecting monogamous, hetero­
sexual marriage
137
Grade-level concepts and content
Examples of skills and behaviors
Chapter 3
Health Education
Friendship and peer relationships:
III. Expectations
and Content,
by Grade Level
share their lives and family responsi­
bilities. It requires dedication and
perseverance. A successful marriage
requires good interpersonal skills
and the ability to make adjustments
to meet the needs of another person.
The importance of open communi­
cation, respect, honesty, and mo­
nogamy in marriage should be
emphasized.
High School
Unifying Idea:
Respect for and
promotion of the
health of others
School and community-based efforts to promote and protect health:
Building on their earlier study,
students should evaluate local,
national, and international efforts
for preventing, controlling, and
eradicating disease, hunger, and
pollution. They should have oppor­
tunities to analyze how public health
policies and laws are developed and
to examine the role of interest
groups and individual advocacy in
this process and the importance of
voting. Students should examine
how nations share responsibility for
the health of all people; for example,
international response to disasters
can be explored. In addition, they
may initiate or participate in devel­
oping school and community efforts
to prevent and control disease.
Community responsibility for health
promotion can also be explored
through an analysis of the efforts of
local government and community
groups and organizations.
■ Understanding
and following
school rules related to health
■ Participating
in school efforts to
promote health
■ Assuming
responsibility for
helping to take care of the school
and helping other students assume
responsibility for that task
■ Participating
in community efforts
to address local health and envi­
ronmental issues, such as volunteer
work at hospitals, food banks,
child-care centers, centers for
persons recovering from trauma,
or centers for persons with
disabilities
■ Encouraging
others to become
involved in health-promotion
efforts at school
■ Analyzing
the influence of laws,
policies, and practices on healthrelated issues, including those
related to food and nutrition
■ Identifies previously introduced skills or behaviors that should be built on and reinforced.
138
Chapter 3
Health Education
Expectation 5 (Continued)
Grade-level concepts and content
III. Expectations
and Content,
by Grade Level
High School
Unifying Idea:
Respect for and
promotion of the
health of others
Examples of skills and behaviors
School and community-based efforts to promote and protect health:
Students should also identify the
psychosocial needs of those who are
disabled or ill and analyze the
services provided by community
organizations and agencies in
meeting these needs. For example,
students might explore the services
available to support patients afflicted
by Alzheimer’s disease and their
families. Specific strategies for
involving others in safely demon­
strating care and concern for people
who are ill should be included.
Students should recognize that while
anyone can become disabled,
disabilities are not contagious.
Students can also analyze laws
and standards related to food, food
handling, an adequate food supply,
the environment, and agriculture.
They can become active in environ­
mental and economic issues that
affect the food supply and the
nutritional quality of food.
■ Encouraging
others to become
involved in health-promotion
efforts at many different levels
■ Accessing
appropriately those
services available within the
community
Initiating and involving others in
health-promotion efforts at school
or in the community
■ Identifies previously introduced skills or behaviors that should be built on and reinforced.
139
Chapter 3
Health Education
Unifying Idea
An understanding of the process of growth
and development
III. Expectations
and Content,
by Grade Level
Expectations:
6. Students will understand the variety of physical,
mental, emotional, and social changes that occur
throughout life.
7. Students will understand and accept individual
differences in growth and development.
8. Students will understand their developing sexuality,
will choose to abstain from sexual activity, will learn
about protecting their sexual health, and will treat the
sexuality of others with respect.
Expectation 6
Students will understand the variety of physical, mental, emotional, and
social changes that occur throughout life
Grade-level concepts and content
Examples of skills and behaviors
Life cycle:
The various stages of life, includ­
ing pregnancy, infancy, childhood,
adolescence, young adulthood,
middle age, and older adulthood,
should be investigated by students at
this time. Students should recognize
that a variety of physical, mental,
emotional, and social changes occur
throughout life and that although
there are predictable stages of a
human being’s life cycle, people
develop and mature at their own
rate. A person’s ability to make
adjustments while passing through
the various stages of life can signifi­
cantly influence the quality of that
life. Students should explore changes
during the life cycle, including
■ Developing
and using effective
communication skills to discuss
with parents or other trusted
adults the changes that occur
during adolescence
■ Practicing
behaviors that will
provide for healthy parenting
later in life, such as avoidance
of substance abuse
Recognizing and being prepared
to adapt to the changes that occur
during life, such as changes associ­
ated with young adulthood, preg­
nancy, middle age, or old age
Recognizing and acknowledging
that different people progress
through different stages of the life
cycle at different rates
■ Identifies previously introduced skills or behaviors that should be built on and reinforced.
High School
140
Chapter 3
Health Education
Expectation 6 (Continued)
Grade-level concepts and content
III. Expectations
and Content,
by Grade Level
High School
Unifying Idea:
An understanding of
the process of growth
and development
Examples of skills and behaviors
Life cycle:
normal bodily growth and develop­
ment, and physical changes caused by
diseases and injuries. They should
investigate the influence of food
choices on the various stages of life
and on recovery from diseases and
injuries. Students should also analyze
how such skills as the ability to cope,
adjust, make decisions, communicate
feelings, make and keep friends, care
for others, and show concern for the
community influence individuals
through the various stages of life.
This level is appropriate for
emphasizing the reproductive process
and fetal development from concep­
tion through pregnancy to birth. The
curriculum should address the role of
prenatal care and proper nutrition in
promoting optimal health for both
the baby and the mother. Instruction
should also emphasize the importance
of a woman consulting a health-care
provider if she suspects she is preg­
nant. The harmful effects of certain
substances on the fetus (e.g., alcohol,
tobacco, and other drugs as well as
environmental hazards, such as lead)
should be emphasized, including the
periods during which the fetus is
most susceptible to developing birth
defects. Genetic disorders and
conditions can also cause birth
defects. Fortunately, they can often
be identified when they occur in
families. Some genetic disorders are
so serious that they may influence
one’s decision to become a parent.
In that event a couple may wish to
Expressing support and compassion
for others who are grieving, includ­
ing allowing their friends to be sad
and to express their feelings
Recognizing questions they have
regarding death and dying and
discussing these questions with
parents, religious leaders, and other
trusted adults
Reviewing family histories and
determining whether a genetic
disorder exists in the family
141
Grade-level concepts and content
Examples of skills and behaviors
Chapter 3
Health Education
Life cycle:
III. Expectations
and Content,
by Grade Level
consider adoption. Care of a
newborn, including the importance
of immunizations and well-baby
care, may also be discussed at this
time.
Because death and dying are a
part of the life cycle and the death
of others is a part of everyone’s
experience, students should have an
opportunity to explore death and
dying. Normal emotions associated
with death and dying include fear,
discomfort, concern, and nervous­
ness. After a death and other types
of loss, people may feel grief, anger,
resentment, abandonment, fear,
despair, pain, guilt, acceptance, or
relief. In time one progresses
through the mourning process, and
feelings of grief usually diminish.
Not everyone, however, experiences
the same mourning process. The
stages of the process may include
denial, anger, bargaining, depres­
sion, and acceptance.
High School
Unifying Idea:
An understanding of
the process of growth
and development
Expectation 7
Students will understand and accept individual differences in growth
and development.
Grade-level concepts and content
Examples of skills and behaviors
Growth and development:
A continuing emphasis on
individual differences in physical,
mental, and social growth and
development is appropriate at this
■ Demonstrating
an understanding
of individual differences
■ Adapting
group activities to
include a variety of students
■ Identifies previously introduced skills or behaviors that should be built on and reinforced.
142
Chapter 3
Health Education
Expectation 7 (Continued)
Grade-level concepts and content
III. Expectations
and Content,
by Grade Level
High School
Unifying Idea:
An understanding of
the process of growth
and development
Examples of skills and behaviors
Growth and development:
level. Students should understand
that people experience changes and
stages at their own pace.
Adolescents, especially adolescent
athletes, are often preoccupied with
attaining an idealized body size and
shape and are particularly susceptible
to nutrition quackery, eating
disorders, and the lure of perfor­
mance-enhancing substances, such
as steroids. The curriculum should
continue to emphasize the impor­
tance of basing personal nutrition
and fitness plans on valid scientific
data. Students need to be reminded
that a wide range of body types is
normal and that trying to conform
to an idealized image is not only
unrealistic but may be unhealthy.
Desperate attempts to lose weight to
conform to a culturally defined body
shape and size may result in eating
disorders that require professional
treatment.
■ Developing
a realistic body image
■ Recognizing
health, nutrition, and
psychological problems associated
with not having a realistic body
image, including dieting and
eating disorders, and seeking
appropriate help
■ Recognizing
the effects of
performance-altering substances
and avoiding the use of those
substances
■ Promoting
acceptance of a range
of body types and abilities
■ Using
scientific data as a basis for
individual nutrition and fitness
plans
Mental and emotional development:
Setting long-term goals for oneself
as a way of focusing and guiding
one’s life can be a particularly
effective strategy at this level. While
acknowledging the role of heredity in
growth and development, students
should be encouraged to set immedi­
ate and long-term personal health
and physical fitness goals. As they
develop long-term goals, students
should recognize that almost all
■ Identifying,
expressing, and
managing feelings appropriately
■ Developing
and using effective
communication skills
■ Recognizing
one’s own strengths
and limitations
■ Using
coping strategies, including
time-management skills
■ Developing
a focus on the future
■ Identifies previously introduced skills or behaviors that should be built on and reinforced.
143
Grade-level concepts and content
Examples of skills and behaviors
Chapter 3
Health Education
Mental and emotional development:
III. Expectations
and Content,
by Grade Level
students can expect to spend at least
part of their adult lives in the work
force. Increasingly, jobs and careers
of every description are open to
qualified persons regardless of
gender.
Students should have the oppor­
tunity to explore the expectation of
tragedy or loss in their lives and
examine successful coping strategies.
Events such as the loss of a loved one
or a serious illness in the family will
be experienced by most people at
some point in their lives. Students
can discuss coping strategies, such as
receiving support from family
members, drawing strength from
religious beliefs, or seeking assistance
from friends or a counselor, and can
determine which coping strategies
would be most effective in helping
them through a difficult time.
High School
Unifying Idea:
An understanding of
the process of growth
and development
Expectation 8
Students will understand their developing sexuality, will choose to abstain
from sexual activity, will learn about protecting their sexual health, and
will treat the sexuality of others with respect.
Grade-level concepts and content
Examples of skills and behaviors
Sexuality:
Note: The Education Code requires
that parents be notified before human
reproductive organs and their func­
tions and processes are discussed.
A strong emphasis on abstinence
should be continued at this grade
span. Students should be encouraged
to make a commitment to abstain
■ Developing
and using effective
communication skills, including
the ability to discuss with parents
questions regarding sexuality
■ Identifying
appropriate ways to
show affection
■ Identifies previously introduced skills or behaviors that should be built on and reinforced.
144
Chapter 3
Health Education
Expectation 8 (Continued)
Grade-level concepts and content
III. Expectations
and Content,
by Grade Level
High School
Unifying Idea:
An understanding of
the process of growth
and development
Examples of skills and behaviors
Sexuality:
from sexual activity until they are
ready for marriage. Even those who
have already engaged in sexual
intercourse can choose to be abstinent.
However, contraceptive methods and
their relative effectiveness and ineffec­
tiveness should be discussed. Instruc­
tion should emphasize that abstinence
is the only totally effective method
of contraception and that all other
methods carry a risk of failure in
preventing unwanted teenage preg­
nancy and sexually transmitted
diseases. The consequences of un­
wanted pregnancies and the effects of
teenage pregnancy on the teenagers,
their child, their parents, and society
should also be explored.
Students should be made aware
that sexual feelings and desires are
natural but that they do not have to
act on those feelings. Sexual feelings,
love, and intimacy are distinct aspects
of sexual attraction. Responsible
sexual behavior can and should be
defined. Students who date should
discuss limits with their dating
partners and should expect those
partners to respect those limits. Even
when tempted to engage in sexual
activity, students can exercise selfcontrol.
A factual, substantiated discussion
of homosexuality may be included at
this level. (Note: School district
governing boards considering such a
discussion should refer to “Family
Living” in Section II of this chapter
and to Appendix A.) Students should
recognize that it is a common experi­
ence to feel some affection for both
■ Recognizing
and avoiding situa­
tions that place one at risk of
participating in sexual activity
■ Avoiding,
recognizing, and
responding to negative social
influences and pressure to
become sexually active
■ Demonstrating
assertive and
refusal skills and applying those
skills to situations involving
pressure to be sexually active
■ Identifying
ways to seek assis­
tance if abused
■ Practicing
behaviors that support
the decision to abstain from sexual
activity, including self-control, use
of reason as a basis for action, selfdiscipline, a sense of responsibility,
religious convictions, or ethical
considerations
Analyzing messages about sexuality
from society, including the media,
and identifying how those messages
affect behavior
Evaluating what students can do to
counteract the false norms portrayed
in the media
■ Identifies previously introduced skills or behaviors that should be built on and reinforced.
145
Grade-level concepts and content
Examples of skills and behaviors
Chapter 3
Health Education
Sexuality:
men and women and that feelings of
affection for persons of the same sex
are not necessarily an indication of
homosexuality. Teenagers who have
questions about their sexual orienta­
tion may be reluctant to discuss the
topic for fear of reprisal. Students
should respect the rights of others to
seek information from a parent or
other trusted and knowledgeable
adult. The California Student Safety
and Violence Prevention Act of 2000
(AB 537) promotes an appreciation
of diversity in a democratic society.
Name-calling or other hurtful actions
must not be tolerated. Teachers,
counselors, physicians, religious
leaders, and community resource
centers may offer support for young
people who have concerns about their
sexual orientation. While respecting
religious and personal beliefs, the
curriculum in this content area
should affirm the dignity of all
people.
Physical, mental, social, and
cultural factors influence attitudes
and behaviors regarding sexuality.
Attitudes about proper behavior for
men and women differ among
families and cultures. Gender stereotypes may influence behavior, career
paths, relationships, and so on, but
these stereotypes do not have to be
accepted. Social messages about
sexuality may be confusing and
contradictory. False images of sexual
behavior are often portrayed in the
media. Students should have oppor­
tunities to explore and analyze the
effects of social and cultural influ­
ences on human sexuality.
III. Expectations
and Content,
by Grade Level
High School
Unifying Idea:
An understanding of
the process of growth
and development
146
Chapter 3
Health Education
Unifying Idea
Informed use of health-related information,
products, and services
III. Expectations
and Content,
by Grade Level
Expectation:
9. Students will identify information, products, and
services that may be helpful or harmful to their
health.
High School
Expectation 9
Students will identify information, products, and services that may be helpful
or harmful to their health.
Grade-level concepts and content
Examples of skills and behaviors
Products and services:
At this level it is especially important that students, many of whom
will receive no further instruction in
health education, become informed
health consumers. Students’ failure to
become informed can have a negative
influence not only on the students
but on all of society as well. The
health-care system is a product of our
society’s cumulative economic and
political choices. Students can help to
improve this system by becoming
well-informed, careful consumers. To
do so requires students to learn that
there are primary points of entry for
obtaining health care, including
preventive, diagnostic, and treatment
services, and that it is important to
have an established source for
primary care, rather than depend on
an emergency room.
Students should be able to apply
criteria for selecting health services,
products, and information. For
example, students might analyze
■ Identifying
a variety of consumer
influences and analyzing how those
influences affect decisions
■ Recognizing
helpful products and
services
■ Using
critical-thinking skills to
analyze marketing and advertising
techniques and their influence on
the selection of health-related
services and products
■ Seeking
care from the nurse’s office
or school-linked services with their
families when appropriate
■ Identifying
appropriate sources
of health services for a variety of
illnesses and being able to use
those services
■ Developing
and applying criteria
for the selection or rejection of
health products, services, and
information, including products
or services designed to enhance
physical fitness, such as exercise
gear
■ Identifies previously introduced skills or behaviors that should be built on and reinforced.
147
Grade-level concepts and content
Examples of skills and behaviors
Chapter 3
Health Education
Products and services:
major types of health-insurance
coverage and develop criteria for
selecting health insurance. Or they
might analyze how to access public
and private health services by
learning how to make appointments
and complete health and insurance
forms. The costs and benefits of
health products, services, and
information can also be analyzed.
Students should develop strategies
for identifying and combating
fraudulent health products, services,
and information. They should also
continue to analyze the influence of
advertising, especially targeted
advertising, on the selection of
health products and services. The
legal rights of individuals to obtain­
ing health care services should also
be explored.
Many avenues are available to
students at this level for pursuing
community service experiences
related to health care and preven­
tion. Voluntary health-care organiza­
tions offer one way to introduce
students to educational and other
resources in the community through
which they can contribute to the
support of community health needs.
■ Using
labels to compare the
contents of food products
Using critical-thinking skills to
analyze the cost benefits of health
care products and services
Developing and using strategies
for identifying and combating
fraudulent or misleading health
products, services, and information
Food choices:
As high school students become
more skilled consumers, they need to
be able to understand the factors
that influence the cost, quality,
availability, and variety of food in
■ Using
critical-thinking skills to
analyze marketing and advertising
techniques and their influence on
food selection
■ Identifies previously introduced skills or behaviors that should be built on and reinforced.
III. Expectations
and Content,
by Grade Level
High School
Unifying Idea:
Informed use of
health-related
information,
products,
and services
148
Chapter 3
Health Education
Expectation 9 (Continued)
Grade-level concepts and content
III. Expectations
and Content,
by Grade Level
High School
Unifying Idea:
Informed use of
health-related
information,
products,
and services
Examples of skills and behaviors
Food choices:
the marketplace locally, nationally,
and internationally. To be skilled
consumers, students also need to be
able to evaluate nutrition informa­
tion. Many nutritional claims,
products, and so-called research are
deceptive and can lead to serious
adverse health consequences.
Students need to know how and
where to obtain valid, reliable
information on nutrition.
■ Using
valid nutrition information
to make healthy food choices
■ Using
unit pricing to determine
the most economical purchases
■ Using
effective consumer skills to
purchase healthy foods within
budget constraints and in a variety
of settings
■ Using
critical-thinking skills to
distinguish facts from fallacies
concerning the nutritional value
of foods and food supplements
■ Adapting
recipes to make them
more healthy by lowering the
amount of fat, salt, or sugar and
increasing the amount of fiber
Using critical-thinking skills to
analyze weight modification prac­
tices and selecting appropriate
practices to maintain, lose, or gain
weight according to individual need
and scientific research
■ Identifies previously introduced skills or behaviors that should be built on and reinforced.
149
Scope and Sequence
of Health Instruction
This section presents a summary and overview of key aspects of Chapter 3
of the Health Framework. Its purpose is to describe the health curriculum across
the grade levels in a format that will make the key concepts more accessible to
curriculum planners. The grade-span expectations included in the 1994 framework have been organized into grade-level expectations. The new chart in this
section clearly indicates where the instructional emphases should be placed to
achieve the overall health education expectations. The use of this chart should
improve continuity and avoid duplication as students progress from one grade
to the next. Each skill that should be emphasized is noted by a pyramid symbol.
The content, skills, and behaviors contained in the chart are simply examples
and are not intended to be comprehensive, thus offering flexibility to each
school district to apply the unifying ideas and expectations to content areas as
appropriate within their communities.
Although designed as a guide for curriculum planning, this section is not
intended as a substitute for the careful study of the entire Health Framework.
Rather, the purpose of this section is to simplify curriculum planning by
presenting sample grade-level emphases and some of the instructional concepts
and expectations of student learning explored in this chapter. In addition,
curriculum planners should take into account the nine content areas of health
instruction reflected in the expectations of student learning and summarized
below:
•
•
•
•
•
•
•
•
•
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 Diseases
Although not identified specifically in the following matrix, the nine content
areas are the traditional focus of health education. They are embedded in the
skills and behaviors for all grade levels. This section provides an example of
how curriculum planners might reorganize the grade-level expectations.
The following Grade-Level Emphases Chart was designed by health educa­
tors who carefully selected skills and behaviors discussed in this chapter of the
framework. Each item is intended to assist teachers in helping students meet
grade-level expectations. The contributing health educators, representing each
Chapter 3
Health Education
150
Chapter 3
Health Education
of the kindergarten-through-grade-twelve levels, not only collaborated on
which skills should be taught at a given grade level, but also came to consensus
on the skills that students should have mastered at the previous grade level and
the skills that students should master at the next grade level.
The Grade-Level Emphases Chart presents these skills and behaviors, which
build sequentially, in ways that are age-appropriate. Skills and behaviors for the
later grades include and build on skills and behaviors that are developed in the
earlier grades.
Grade-Level Emphases Chart
Skills that should be emphasized are noted by a pyramid symbol (▲).
Kindergarten Through Grade Three
Expectation 1: Students will demonstrate ways in which they can enhance and maintain their health and well-being.
Kindergarten
Grade one
Grade two
Grade three
The Human Body
▲ Practice good personal hygiene.
▲ Practice good personal hygiene.
Practice good personal hygiene.
▲ Use protective equipment or
▲ Use protective equipment or
practice protective behaviors.
practice protective behaviors.
Practice good personal hygiene.
Use protective equipment or
practice protective behaviors.
Food Choices
▲ Make healthy food choices.
Make healthy food choices.
Make healthy food choices.
Group foods in many different
ways.
▲ Group foods in many different
▲ Prepare and try a variety of
healthy foods.
ways.
▲ Prepare and try a variety of
healthy foods.
Group foods in many different
ways.
▲ Prepare and try a variety of
healthy foods.
Analyze influences on food choices.
▲ Make healthy food choices.
▲ Group foods in many different
ways.
▲ Prepare and try a variety of
healthy foods.
▲ Analyze influences on food choices.
▲ Establish and maintain healthy
eating practices.
Physical Activity
▲ Participate regularly in active play
▲ Participate regularly in active play
▲ Participate regularly in active play
and enjoyable physical activities.
and enjoyable physical activities.
and enjoyable physical activities.
▲ Observe safety rules during physical
▲ Observe safety rules during physical
▲ Observe safety rules during physical
▲ Participate regularly in active play
and enjoyable physical activities.
▲ Observe safety rules during
activities.
activities.
physical activities.
Explore out-of-school play activities
that promote fitness and health.
Explore out-of-school play activities
that promote fitness and health.
Explore out-of-school play activities
that promote fitness and health.
Explore out-of-school play activities
that promote fitness and health.
151
activities.
152
Kindergarten Through Grade Three (Continued)
Expectation 1 (Continued)
Kindergarten
Grade one
Grade two
Grade three
Mental and Emotional Health
▲ Identify and share feelings in
appropriate ways.
▲ Avoid self-destructive behaviors
▲ Identify and share feelings in
appropriate ways.
▲ Avoid self-destructive behaviors
and practice self-control.
and practice self-control.
Develop and use effective coping
strategies.
Develop and use effective coping
strategies.
▲ Identify and share feelings in
▲ Identify and share feelings in
appropriate ways.
appropriate ways.
Avoid self-destructive behaviors
and practice self-control.
Avoid self-destructive behaviors
and practice self-control.
▲ Develop and use effective coping
▲ Develop and use effective coping
strategies.
strategies.
tics that contribute to selfconfidence and self-esteem.
Demonstrate personal characteris­
tics that contribute to selfconfidence and self-esteem.
Demonstrate personal characteris­
tics that contribute to selfconfidence and self-esteem.
Develop protective factors that
help foster resiliency.
Develop protective factors that
help foster resiliency.
Develop protective factors that
help foster resiliency.
Develop protective factors that
help foster resiliency.
Develop and use effective
communication skills.
Develop and use effective
communication skills.
Demonstrate personal characteris­
tics that contribute to selfconfidence and self-esteem.
▲ Demonstrate personal characteris­
▲ Develop and use effective
communication skills.
Develop and use effective
communication skills.
Expectation 2: Students will understand and demonstrate behaviors that prevent disease and speed recovery from illness.
Disease Prevention
Practice positive health behaviors
to reduce the risk of disease.
Practice positive health behaviors
to reduce the risk of disease.
Practice positive health behaviors
to reduce the risk of disease.
▲ Practice positive health behaviors
Prepare food as a way of learning
about sanitary food preparation
and storage.
Prepare food as a way of learning
about sanitary food preparation
and storage.
Prepare food as a way of learning
about sanitary food preparation
and storage.
▲ Prepare food as a way of learning
Cooperate in regular health
screenings.
Cooperate in regular health
screenings.
Cooperate in regular health
screenings.
to reduce the risk of disease.
about sanitary food preparation
and storage.
Cooperate in regular health
screenings.
Kindergarten Through Grade Three (Continued)
Kindergarten
Grade one
Grade two
Grade three
Treatment of Disease
▲ Take medicines properly under
the direction of parents or
health-care providers.
▲ Recognize symptoms of common
illnesses.
Take medicines properly under
the direction of parents or
health-care providers.
Take medicines properly under
the direction of parents or
health-care providers.
Take medicines properly under
the direction of parents or
health-care providers.
▲ Recognize symptoms of common
▲ Recognize symptoms of common
▲ Recognize symptoms of common
illnesses.
illnesses.
illnesses.
Cooperate with parents and healthcare providers in the treatment or
management of disease.
Expectation 3: Students will practice behaviors that reduce the risk of becoming involved in potentially dangerous
situations and react to potentially dangerous situations in ways that help to protect their health.
Potentially Dangerous Situations
▲ Practice safe behavior in or near
motorized vehicles.
▲ Practice safe behavior in or near
water.
▲ Interact safely with strangers.
Develop and use skills to avoid,
resolve, and cope with conflicts.
Report or obtain assistance when
faced with unsafe situations.
▲ Practice behaviors that help
prevent poisonings.
Practice safe behavior in or near
motorized vehicles.
▲ Practice safe behavior in or near
motorized vehicles.
Practice safe behavior in or near
motorized vehicles.
▲ Practice safe behavior in or near
Practice safe behavior in or near
water.
Practice safe behavior in or near
water.
water.
▲ Interact safely with strangers.
Develop and use skills to avoid,
resolve, and cope with conflicts.
▲ Report or obtain assistance when
▲ Interact safely with strangers.
Develop and use skills to avoid,
resolve, and cope with conflicts.
▲ Interact safely with strangers.
▲ Develop and use skills to avoid,
resolve, and cope with conflicts.
Report or obtain assistance when
faced with unsafe situations.
Report or obtain assistance when
faced with unsafe situations.
prevent poisonings.
Practice behaviors that help
prevent poisonings.
Practice behaviors that help
prevent poisonings.
Practice safe behavior in
recreational activities.
Practice safe behavior in
recreational activities.
Practice safe behavior in
recreational activities.
faced with unsafe situations.
▲ Practice behaviors that help
▲ Develop and use skills to identify,
153
avoid, and cope with potentially
dangerous situations.
154
Kindergarten Through Grade Three (Continued)
Expectation 3 (Continued)
Kindergarten
Grade one
Grade two
Grade three
Alcohol, Tobacco, and Other Drugs
Distinguish between helpful and
harmful substances.
▲ Distinguish between helpful and
harmful substances.
Distinguish between helpful and
harmful substances.
▲ Distinguish between helpful and
harmful substances.
Identify ways to cope with or seek
assistance when confronted with
situations involving alcohol,
tobacco, and other drugs.
▲ Develop and use interpersonal
▲ Develop and use interpersonal
and communication skills.
and communication skills.
▲ Exercise self-control.
Child Abuse, Including Sexual Exploitation (Penal Code 11166[a])
Identify ways to seek assistance
if worried, abused, or threatened.
▲ Develop and use communication
▲ Develop and use communication
▲ Develop and use communication
skills to tell others when touching
is unwanted.
skills to tell others when touching
is unwanted.
skills to tell others when touching
is unwanted.
Develop and use communication
skills to tell others when touching
is unwanted.
Emergencies
▲ Recognize emergencies and
respond appropriately.
▲ Practice appropriate behaviors
during fire drills, earthquake
drills, and other disaster drills.
respond appropriately.
Recognize emergencies and
respond appropriately.
Recognize emergencies and
respond appropriately.
Practice appropriate behaviors
during fire drills, earthquake
drills, and other disaster drills.
Practice appropriate behaviors
during fire drills, earthquake
drills, and other disaster drills.
Practice appropriate behaviors
during fire drills, earthquake
drills, and other disaster drills.
▲ Recognize emergencies and
Kindergarten Through Grade Three (Continued)
Expectation 4: Students will understand and demonstrate how to play a positive, active role in promoting the health
of their families.
Kindergarten
Grade one
Grade two
Grade three
Roles of Family Members
▲ Develop and use effective
▲ Develop and use effective
▲ Develop and use effective
▲ Develop and use effective
communication skills.
communication skills.
communication skills.
communication skills.
Demonstrate ways to help support
positive family interactions, such as
listening to and following directions
and showing care and concern
toward other family members.
Support and value all family
members.
Change Within the Family
Identify feelings related to changes
within the family.
Identify feelings related to
changes within the family.
▲ Identify feelings related to changes
within the family.
▲ Identify feelings related to changes
within the family.
Expectation 5: Students will understand and demonstrate how to promote positive health practices within the school
and community, including how to cultivate positive relationships with their peers.
Friendship and Peer Relationships
▲ Know and use appropriate ways
to make new friends.
▲ Demonstrate acceptable actions
toward others.
▲ Demonstrate positive ways to
show or express feelings.
▲ Resolve conflicts in a positive,
constructive way.
▲ Demonstrate acceptable methods
to make new friends.
▲ Demonstrate acceptable actions
toward others.
▲ Demonstrate positive ways to
show or express feelings.
▲ Resolve conflicts in a positive,
constructive way.
▲ Demonstrate acceptable methods
of gaining attention.
▲ Know and use appropriate ways
to make new friends.
▲ Demonstrate acceptable actions
toward others.
▲ Demonstrate positive ways to
show or express feelings.
▲ Resolve conflicts in a positive,
constructive way.
▲ Demonstrate acceptable methods
of gaining attention.
▲ Know and use appropriate ways
to make new friends.
▲ Demonstrate acceptable actions
toward others.
▲ Demonstrate positive ways to
show or express feelings.
▲ Resolve conflicts in a positive,
constructive way.
▲ Demonstrate acceptable methods
of gaining attention.
155
of gaining attention.
▲ Know and use appropriate ways
156
Kindergarten Through Grade Three (Continued)
Expectation 5 (Continued)
Kindergarten
Grade one
Grade two
Grade three
School and Community-Based Efforts to Promote and Protect Health
▲ Understand and follow school
▲ Understand and follow school
▲ Understand and follow school
▲ Understand and follow school
rules related to health.
rules related to health.
rules related to health.
rules related to health.
Participate in school efforts to
promote health.
Participate in school efforts to
promote health.
Participate in school efforts to
promote health.
Participate in school efforts to
promote health.
Assume responsibility for helping
to take care of the school.
Assume responsibility for helping
to take care of the school.
Assume responsibility for helping
to take care of the school.
Assume responsibility for helping
to take care of the school.
Expectation 6: Students will understand the variety of physical, mental, emotional, and social changes that occur
throughout life.
Life Cycle
Describe the cycle of growth and
development in humans and other
animal species.
▲ Describe the cycle of growth and
development in humans and other
animal species.
▲ Describe the cycle of growth and
development in humans and other
animal species.
Demonstrate an understanding of
the aging process (e.g., why older
adults may have needs different
from those of children).
Expectation 7: Students will understand and accept individual differences in growth and development.
Growth and Development
Demonstrate an understanding
of individual differences.
▲ Adapt group activities to include
a variety of students.
Demonstrate an understanding
of individual differences.
▲ Adapt group activities to include
a variety of students.
Demonstrate an understanding
of individual differences.
▲ Adapt group activities to include
a variety of students.
▲ Demonstrate an understanding
of individual differences.
▲ Adapt group activities to include
a variety of students.
Kindergarten Through Grade Three (Continued)
Kindergarten
Grade one
Grade two
Grade three
Mental and Emotional Development
Identify, express, and manage
feelings appropriately.
Identify, express, and manage
feelings appropriately.
Identify, express, and manage
feelings appropriately.
Identify, express, and manage
feelings appropriately.
Develop and use effective
communication skills.
Develop and use effective
communication skills.
Develop and use effective
communication skills.
Develop and use effective
communication skills.
Expectation 8: Students will identify information, products, and services that may be helpful or harmful to their health.
Products and Services
▲ Identify health care workers.
▲ Identify health care workers.
Identify a variety of consumer
influences and analyze how those
influences affect decisions.
▲ Identify a variety of consumer
influences and analyze how those
influences affect decisions.
▲ Identify a variety of consumer
influences and analyze how those
influences affect decisions.
Identify places for obtaining
health and social services and
learn what types of services are
provided.
Products and Services/Food Choices
Read and interpret information
available on food labels.
Use labels to compare the contents
of food products.
Identify ads and recognize strategies
used to influence decisions.
Practice various positive responses
to those influences.
157
158
Grades Four Through Six
Expectation 1: Students will demonstrate ways in which they can enhance and maintain their health and well-being.
Grade Four
Grade Five
Grade Six
The Human Body
Practice good personal hygiene, with particular
attention to the changing needs of preadoles­
cents and adolescents.
▲ Practice good personal hygiene, with particular
▲ Practice good personal hygiene, with particular
attention to the changing needs of preadoles­
cents and adolescents.
attention to the changing needs of preadoles­
cents and adolescents.
Use protective equipment or practice protective
behaviors.
Use protective equipment or practice protective
behaviors.
Use protective equipment or practice protective
behaviors.
Food Choices
▲ Establish and maintain healthy eating practices.
Make healthy food choices.
▲ Establish and maintain healthy eating practices.
Make healthy food choices.
▲ Establish and maintain healthy eating practices.
Make healthy food choices.
Prepare a variety of healthy foods.
Analyze influences on food choices.
Practice kitchen safety.
Practice kitchen safety.
Practice kitchen safety.
Physical Activity
▲ Participate regularly in a variety of enjoyable
physical activities.
▲ Participate regularly in a variety of enjoyable
physical activities.
▲ Participate regularly in a variety of enjoyable
physical activities.
Set personal fitness goals.
▲ Set personal fitness goals.
▲ Set personal fitness goals.
Explore out-of-school play activities that
promote fitness and health.
▲ Explore out-of-school play activities that
▲ Explore out-of-school play activities that
Obtain a sufficient amount of sleep.
promote fitness and health.
Obtain a sufficient amount of sleep.
promote fitness and health.
▲ Obtain a sufficient amount of sleep.
Observe safety rules during physical activities.
Grades Four Through Six (Continued)
Grade Four
Grade Five
Grade Six
Mental and Emotional Health
▲ Demonstrate personal characteristics that
contribute to self-confidence and self-esteem.
Develop and use effective communication skills.
▲ Identify and share feelings in appropriate ways.
Demonstrate personal characteristics that
contribute to self-confidence and self-esteem.
Demonstrate personal characteristics that
contribute to self-confidence and self-esteem.
▲ Develop and use effective communication skills.
▲ Develop and use effective communication skills.
▲ Develop and use effective coping strategies.
▲ Develop and use effective coping strategies.
Identify and share feelings in appropriate ways.
Identify and share feelings in appropriate ways.
Develop protective factors that help foster
resiliency.
Avoid self-destructive behaviors and practice
strategies for resisting negative peer pressure.
Expectation 2: Students will understand and demonstrate behaviors that prevent disease and speed recovery from illness.
Disease Prevention
Practice positive health behaviors to reduce the
risk of disease.
Practice positive health behaviors to reduce the
risk of disease.
Practice good personal hygiene.
Practice good personal hygiene.
▲ Practice positive health behaviors to reduce the
risk of disease.
Practice good personal hygiene.
Cooperate in regular health screenings.
Demonstrate care and concern toward ill
persons in the family, the school, and the
community.
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160
Grades Four Through Six (Continued)
Expectation 2 (Continued)
Grade Four
Grade Five
Grade Six
Treatment of Disease
▲ Recognize symptoms of common illnesses.
Recognize symptoms of common illnesses.
Recognize symptoms of common illnesses.
Take prescription and over-the-counter
medicines properly.
Cooperate with parents and health care provid­
ers in the treatment or management of disease.
Cooperate with parents and health care provid­
ers in the treatment or management of disease.
Cooperate with parents and health care provid­
ers in the treatment or management of disease.
Interpret correctly instructions for taking
medicine.
Expectation 3: Students will practice behaviors that reduce the risk of becoming involved in potentially dangerous
situations and react to potentially dangerous situations in ways that help to protect their health.
Potentially Dangerous Situations
▲ Develop and use skills to avoid, resolve, and
cope with conflicts.
Develop and use skills to identify, avoid, and
cope with potentially dangerous situations.
▲ Develop and use skills to avoid, resolve, and
cope with conflicts.
▲ Develop and use skills to avoid, resolve, and
cope with conflicts.
▲ Develop and use skills to identify, avoid, and
▲ Develop and use skills to identify, avoid, and
cope with potentially dangerous situations.
cope with potentially dangerous situations.
▲ Understand and follow rules prohibiting
possession of weapons at school.
▲ Understand and follow rules prohibiting
possession of weapons at school.
Practice safe behavior in or near motorized
vehicles.
Practice safe behavior in recreational activities.
Practice safe behavior in and near water.
Report or obtain assistance when faced with
unsafe situations.
Grades Four Through Six (Continued)
Grade Four
Grade Five
Grade Six
Alcohol, Tobacco, and Other Drugs
▲ Distinguish between helpful and harmful
substances.
Distinguish between helpful and harmful
substances.
Distinguish between helpful and harmful
substances.
▲ Avoid, recognize, and respond to negative social
▲ Avoid, recognize, and respond to negative social
influences and pressures to use alcohol, tobacco,
or other drugs.
influences and pressures to use alcohol, tobacco,
or other drugs.
Exercise self-control.
Develop and use interpersonal and communica­
tion skills.
Identify ways to cope with or seek assistance
when confronted with situations involving
alcohol, tobacco, and other drugs.
▲ Identify ways of obtaining help to resist pressure
to use alcohol, tobacco, or other drugs.
▲ Identify ways to cope with or seek assistance
when confronted with situations involving
alcohol, tobacco, and other drugs.
Identify ways to cope with or seek assistance
when confronted with situations involving
alcohol, tobacco, and other drugs.
Identify ways of obtaining help to resist pressure
to use alcohol, tobacco, or other drugs.
Identify ways of obtaining help to resist pressure
to use alcohol, tobacco, or other drugs.
Differentiate between the use and misuse of
prescription and nonprescription drugs.
Use positive peer pressure to help counteract the
negative effects of living in an environment
where alcohol, tobacco, or other drug abuse or
dependency exists.
Child Abuse, Including Sexual Exploitation (Penal Code 11166[a])
Identify ways to seek assistance if worried,
abused, or threatened.
Identify ways to seek assistance if worried,
abused, or threatened.
Identify ways to seek assistance if worried,
abused, or threatened.
161
Recognize and avoid situations that can increase
risk of abuse.
162
Grades Four Through Six (Continued)
Expectation 3 (Continued)
Grade Four
Grade Five
Grade Six
Emergencies
Recognize emergencies and respond appropri­
ately, including knowing where to find emer­
gency supplies.
▲ Understand the family emergency plan.
Recognize emergencies and respond appropri­
ately, including knowing where to find emer­
gency supplies.
Understand the family emergency plan.
▲ Recognize emergencies and respond appropriately,
including (1) knowing where to find emergency
supplies; (2) demonstrating proficiency in basic
first-aid procedures; and (3) using precautions
when dealing with other people’s blood.
Understand the family emergency plan.
Expectation 4: Students will understand and demonstrate how to play a positive, active role in promoting the health
of their families.
Roles of Family Members
Demonstrate ways to help support positive family
interactions.
Demonstrate ways to help support positive family
interactions.
Demonstrate ways to help support positive family
interactions.
Practice health-promoting behaviors with the
family.
Practice health-promoting behaviors with the
family.
Practice health-promoting behaviors with the
family.
Participate in daily activities that help maintain
the family.
Support and value all family members.
Develop and use effective communication skills.
Change Within the Family
Identify and effectively express feelings related to
changes within the family.
Use effective strategies to cope with changes within
the family, including identifying a support system.
Grades Four Through Six (Continued)
Expectation 5: Students will understand and demonstrate how to promote positive health practices within the school
and community, including how to cultivate positive relationships with their peers.
Grade Four
Grade Five
Grade Six
Friendship and Peer Relationships
Know and use appropriate ways to make new
friends.
Know and use appropriate ways to make new
friends.
▲ Resolve conflicts in a positive, constructive way.
▲ Resolve conflicts in a positive, constructive way.
Resolve conflicts in a positive, constructive way.
▲ Demonstrate positive actions toward others.
Demonstrate positive actions toward others.
▲ Demonstrate acceptable methods of gaining
attention.
Demonstrate acceptable methods of gaining
attention.
Demonstrate acceptable ways to show or express
feelings.
Demonstrate acceptable ways to show or express
feelings.
Demonstrate positive actions toward others.
▲ Demonstrate how to resist negative peer pressure.
Know and use appropriate ways to make new
friends.
▲ Demonstrate how to resist negative peer pressure.
School and Community-Based Efforts to Promote and Protect Health
Participate in school efforts to promote health.
Participate in school efforts to promote health.
▲ Participate in school efforts to promote health.
Participate in community efforts to address local
health and environmental issues.
Participate in community efforts to address local
health and environmental issues.
▲ Participate in community efforts to address local
Understand and follow school rules related to
health.
Understand and follow school rules related to
health.
▲ Understand and follow school rules related to
health and environmental issues.
health.
Assume responsibility for helping to take care of
the school.
Contribute to the strengthening of health-related
policies at school.
163
Recognize that public policies and laws influence
health-related issues.
164
Grades Four Through Six (Continued)
Expectation 6: Students will understand the variety of physical, mental, emotional, and social changes that occur
throughout life.
Grade Four
Grade Five
Grade Six
Life Cycle
Recognize the changes that occur during
preadolescence.
▲ Recognize the changes that occur during
preadolescence.
▲ Use correct terminology for body parts.
Recognize changing emotions.
Recognize the changes that occur during
preadolescence.
▲ Use correct terminology for body parts.
Recognize changing emotions.
▲ Develop and use effective communication skills
to discuss with parents or other trusted adults
the changes that occur during preadolescence.
Practice good personal hygiene.
Manage feelings appropriately.
▲ Practice good personal hygiene.
Manage feelings appropriately.
▲ Practice good personal hygiene.
Manage feelings appropriately.
Expectation 7: Students will understand and accept individual differences in growth and development.
Growth and Development
▲ Demonstrate an understanding of individual
▲ Demonstrate an understanding of individual
differences.
differences.
Develop a realistic body image.
▲ Develop a realistic body image.
Recognize problems associated with not having
a realistic body image.
Adapt group activities to include a variety of
students.
Adapt group activities to include a variety of
students.
Adapt group activities to include a variety of
students.
Grades Four Through Six (Continued)
Grade Four
Grade Five
Grade Six
Mental and Emotional Development
Identify, express, and manage feelings
appropriately.
Identify, express, and manage feelings
appropriately.
Identify, express, and manage feelings
appropriately.
Develop and use effective communication skills.
Develop and use effective communication skills.
Develop and use effective communication skills.
Develop and use strategies, including critical
thinking, decision making, goal setting, and
problem solving.
Develop and use strategies, including critical
thinking, decision making, goal setting, and
problem solving.
Develop and use strategies, including critical
thinking, decision making, goal setting, and
problem solving.
Recognize one’s own strengths and limitations.
Focus on the future (e.g., realistic short-term
and long-term goals).
Expectation 8: Students will identify information, products, and services that may be helpful or harmful to their health.
Products and Services
Use critical-thinking skills to analyze marketing
and advertising techniques and their influence.
Recognize helpful products and services.
▲ Use critical-thinking skills to analyze marketing
▲ Use critical-thinking skills to analyze marketing
and advertising techniques and their influence.
and advertising techniques and their influence.
Recognize helpful products and services.
Recognize helpful products and services.
Identify a variety of consumer influences and
analyze how those influences affect decisions.
Identify a variety of consumer influences and
analyze how those influences affect decisions.
Identify places for obtaining health and social
services and learn what types of services are
provided.
Identify health-care workers.
Seek care from the school nurse or others
(e.g., when needed for proper management
of asthma).
Seek care from the school nurse or others
(e.g., when needed for proper management
of asthma).
Seek care from the school nurse or others
(e.g., when needed for proper management
of asthma).
165
Discuss home care with parents when appropriate.
166
Grades Four Through Six (Continued)
Expectation 8 (Continued)
Grade Four
Grade Five
Grade Six
Food Choices
▲ Develop basic food-preparation skills.
▲ Develop basic food-preparation skills.
▲ Develop basic food-preparation skills.
Read and interpret information available on
food labels.
Read and interpret information available on
food labels.
Read and interpret information available on
food labels.
Use valid nutrition information to make healthy
food choices.
Use valid nutrition information to make healthy
food choices.
Use valid nutrition information to make healthy
food choices.
Use critical-thinking skills to analyze marketing
and advertising techniques and their influence
on food selection.
Use critical-thinking skills to analyze marketing
and advertising techniques and their influence
on food selection.
Use unit pricing to determine the most eco­
nomical purchases.
Use unit pricing to determine the most eco­
nomical purchases.
Use labels to compare the contents of food
products.
Purchase nutritious foods in a variety of settings.
Analyze and taste foods from different ethnic
and cultural groups.
Middle School
Expectation 1: Students will demonstrate ways in which they can enhance and maintain their health and well-being.
The Human Body
▲ Practice good personal hygiene, including accepting responsibility for making those behaviors part of a normal routine.
▲ Recognize and accept differences in body types and maturation levels.
Recognize and avoid potentially harmful environmental conditions, such as exposure to pesticides or lead paint.
Use protective equipment, such as wearing goggles to protect the eyes when appropriate, or practice behaviors to protect the body, such as applying sunscreen,
exercising, or making healthy food choices.
Food Choices
▲ Make healthy food choices in a variety of settings.
▲ Compare caloric values of foods according to the percentage of fat, protein, and carbohydrate they contain.
▲ Establish and maintain healthy eating practices.
Select appropriate practices to maintain, lose, or gain weight according to individual needs and scientific research.
Prepare a variety of healthy foods.
Analyze influences on food choices.
Physical Activity
▲ Observe safety rules during physical activities.
▲ Develop and initiate a personal fitness plan.
Obtain a sufficient amount of sleep.
Explore ways to engage in out-of-school activities that promote fitness and health.
Participate regularly in a variety of enjoyable physical activities.
Mental and Emotional Health
Demonstrate characteristics that contribute to self-confidence and self-esteem.
Develop and use effective communication skills.
Manage strong feelings and boredom.
Develop protective factors that help foster resiliency.
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168
Middle School (Continued)
Expectation 1—Mental and Emotional Health (Continued)
Develop and use effective coping strategies, emphasizing coping with feelings of inadequacy, sadness.
Avoid self-destructive behaviors.
Practice strategies for resisting negative peer pressure.
Identify risk factors for negative behaviors and develop effective strategies for counteracting these risk factors.
Select entertainment that promotes mental and physical health.
Expectation 2: Students will understand and demonstrate behaviors that prevent disease and speed recovery from illness.
Disease Prevention
▲ Practice good personal hygiene.
▲ Practice positive health behaviors to reduce the risk of disease.
▲ Cooperate in regular health screenings.
Practice and use effective self-examination procedures.
Demonstrate care and concern toward ill persons in the family, the school, and the community.
Make a commitment to abstain from sexual activity.
Receive and understand statistics based on the latest medical information citing the failure and success rates of condoms in preventing AIDS
and other sexually transmitted diseases.
Treatment of Disease
Recognize symptoms of common illnesses.
Take prescription and over-the-counter medicines properly.
Interpret correctly instructions written on medicine container labels, including information about side effects.
Determine when treatment of illness at home is appropriate and when and how to seek further help when needed.
Accept responsibility for active involvement in the treatment or management of disease.
Middle School (Continued)
Expectation 3: Students will practice behaviors that reduce the risk of becoming involved in potentially dangerous
situations and react to potentially dangerous situations in ways that help to protect their health.
Potentially Dangerous Situations
▲ Develop and use skills to identify, avoid, and cope with potentially dangerous situations.
▲ Use skills to avoid, resolve, and cope with conflicts.
▲ Understand and follow rules prohibiting possession of weapons at school.
▲ Identify risk factors that reduce risks of accidents.
Practice safe behavior in or near motorized vehicles.
Practice safe behavior in recreational activities, even in the absence of adults.
Practice safe behavior in and near water.
Report or obtain assistance when faced with unsafe situations.
Identify environmental factors that affect health and safety.
Demonstrate how peers can help each other avoid and cope with potentially dangerous situations in healthy ways.
Use thinking and decision-making skills in high-risk situations involving the use of motor vehicles and other hazardous activities.
▲ Recognize that the use of alcohol and other drugs plays a role in many dangerous situations.
Alcohol, Tobacco, and Other Drugs
▲ Develop and use interpersonal and communication skills (e.g., assertiveness, refusal, negotiation, and conflict resolution).
▲ Differentiate between the use and misuse of prescription and nonprescription drugs.
▲ Avoid, recognize, and respond to negative social influences and pressure to use alcohol, tobacco, or other drugs.
▲ Identify ways of obtaining help to resist pressure to use alcohol, tobacco, or other drugs.
▲ Identify and participate in positive alternative activities, such as alcohol-, tobacco-, and drug-free events.
Exercise self-control.
Distinguish between helpful and harmful substances.
Use positive peer pressure to help counteract the negative effects of living in an environment where alcohol, tobacco, or other drug abuse or dependency exists.
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170
Middle School (Continued)
Expectation 3 (Continued)
Child Abuse, Including Sexual Exploitation (Penal Code 11166[a])
▲ Recognize and avoid situations that can increase risk of abuse.
Identify ways to seek assistance if worried, abused, or threatened.
Avoid, recognize, and respond to negative social influences and pressure to become sexually active, including applying refusal skills when appropriate.
Emergencies
▲ Recognize emergencies and respond appropriately, including demonstrating proficiency in basic first-aid procedures.
Develop and maintain with other family members a personal and family emergency plan, including maintaining supplies for emergencies.
Expectation 4: Students will understand and demonstrate how to play a positive, active role in promoting the health
of their families.
Roles of Family Members
▲ Demonstrate ways to help support positive family interactions.
▲ Develop and use effective communication skills, including talking openly and honestly with parents when problems arise and discussing with parents
questions about sexuality.
▲ Practice health-promoting behaviors within the family.
Support and value all family members.
Complete self-initiated activities beyond assigned chores to help support the family.
Identify safety hazards in the home and help to remove them.
Change Within the Family
▲ Use effective strategies to cope with change within the family, such as seeking assistance from a parent, a trusted adult, a support system, or counseling
when needed.
Middle School (Continued)
Expectation 5: Students will understand and demonstrate how to promote positive health practices within the school
and community, including how to cultivate positive relationships with their peers.
Friendship and Peer Relationships
▲ Know and use appropriate ways to make new friends.
▲ Demonstrate positive actions toward others.
▲ Resolve conflicts in a positive, constructive way.
▲ Demonstrate how to resist negative peer pressure.
▲ Avoid demeaning statements directed toward others.
▲ Interact effectively with many different people.
▲ Promote positive health behaviors among peers.
Demonstrate acceptable methods of gaining attention.
Demonstrate acceptable ways to show or express feelings.
▲ Help peers know when they should seek help from a parent or other trusted adult.
School and Community-Based Efforts to Promote and Protect Health
▲ Understand and follow school rules related to health.
▲ Participate in school efforts to promote health.
▲ Assume responsibility for helping to take care of the school.
Participate in community efforts to address local health and environmental issues.
Encourage others to become involved in health-promotion efforts at school.
Analyze the impact of laws, policies, and practices on health-related issues.
Encourage others to become involved in health-promotion efforts at many different levels.
Access appropriately services available within the community.
Contribute to the strengthening of health-related policies at school.
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172
Middle School (Continued)
Expectation 6: Students will understand the variety of physical, mental, emotional, and social changes that occur
throughout life.
Life Cycle
▲ Practice good personal hygiene, paying particular attention to the changing needs of adolescents.
▲ Manage feelings appropriately.
▲ Develop and use effective communication skills to discuss with parents or other trusted adults the changes that occur during adolescence.
Recognize fluctuations in emotions.
Practice behaviors that will provide the option of healthy parenting later in life, such as avoidance of substance abuse.
Expectation 7: Students will understand and accept individual differences in growth and development.
Growth and Development
▲ Demonstrate an understanding of individual differences.
▲ Develop a realistic body image.
Recognize problems associated with not having a realistic body image.
▲ Recognize the effects of performance-altering substances and avoid the use of those substances.
Adapt group activities to include a variety of students.
Mental and Emotional Development
▲ Identify, express, and manage feelings appropriately.
▲ Develop and use effective communication skills.
▲ Use coping strategies, including time-management skills.
Recognize one’s own strengths and limitations.
Develop a focus on the future.
Expectation 8: Students will understand their developing sexuality, will choose to abstain from sexual activity, will learn
about protecting their sexual health, and will treat the sexuality of others with respect.
Sexuality
▲ Develop and use effective communication skills, including the ability to discuss with parents questions on sexuality.
▲ Identify appropriate ways to show affection.
Middle School (Continued)
▲ Use good judgment to recognize and avoid situations that could lead to subsequent sexual activity.
▲ Practice behaviors that support the decision to abstain from sexual activity.
▲ Demonstrate assertive and refusal skills and apply those skills to situations involving pressure to be sexually active.
Avoid, recognize, and respond to negative social influences and pressure to become sexually active.
Identify ways to seek assistance if abused.
Receive and understand statistics based on the latest medical information citing the failure and success rates of condoms and other contraceptives
in preventing pregnancy and sexually transmitted diseases.
Expectation 9: Students will identify information, products, and services that may be helpful or harmful to their health.
Products and Services/Food Choices
▲ Identify a variety of consumer influences and analyze how those influences affect decisions.
▲ Use critical-thinking skills to analyze marketing and advertising techniques and their influence.
▲ Identify appropriate sources of health services for a variety of illnesses.
▲ Develop and apply criteria for the selection or rejection of health products, services, and information.
Recognize helpful products and services.
Seek care from the school nurse or school-linked services when appropriate.
▲ Use critical-thinking skills to analyze marketing and advertising techniques and their influence on food selection.
Use labels to compare the contents of food products.
Use valid nutrition information to make healthy food choices.
Use unit pricing to determine the most economical purchases.
Develop basic food-preparation skills, including sanitary food preparation and storage.
Use effective consumer skills to purchase healthy foods within budget constraints.
Use critical-thinking skills to distinguish facts from fallacies concerning the nutritional value of foods.
Adapt recipes to make them more healthy by lowering fat, salt, or sugar and increasing fiber.
Use critical-thinking skills to analyze weight modification practices and select appropriate practices to maintain, lose, or gain weight.
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174
High School
Expectation 1: Students will demonstrate ways in which they can enhance and maintain their health and well-being.
The Human Body
Practice good personal hygiene.
Use protective equipment, such as wearing a helmet when cycling, or practice behaviors to protect the body, such as avoiding exposure to excessive noises.
Recognize and accept differences in body types and maturation levels.
Respond appropriately to the physical development of older adolescents in ways that promote physical health through such preventive measures as healthy food
choices and exercise.
Food Choices
▲ Make healthy food choices in a variety of settings.
▲ Establish and maintain healthy eating practices.
Select appropriate practices to maintain, lose, or gain weight based on scientific research.
▲ Recognize the need for updating one’s personal nutrition plan as individual needs or activities change.
▲ Analyze influences on food choices.
Physical Activity
Observe safety rules during physical activities.
▲ Participate regularly in a variety of enjoyable physical activities.
▲ Analyze personal motivators related to pursuing physical activity.
▲ Explore ways to continue regular exercise practices when schedules change, such as during travel or while working.
Explore ways to engage in out-of-school activities that promote fitness and health.
Follow through with a personal fitness plan based on fitness goals and the results of periodic self-assessment.
Make adjustments needed for successful implementation of a personal fitness plan.
High School (Continued)
Mental and Emotional Health
▲ Demonstrate characteristics that contribute to self-confidence and self-esteem.
▲ Develop and use effective communication skills.
▲ Develop and use effective coping strategies.
▲ Avoid self-destructive behaviors and practice strategies for resisting negative peer pressure.
▲ Relate in positive ways to peers and adults in and out of school.
▲ Identify risk factors for negative behaviors and develop effective strategies for counteracting these risk factors.
Develop protective factors that help foster resiliency.
Select entertainment that promotes mental and physical health.
Identify personal habits influencing mental and emotional health and develop strategies for changing behaviors as needed to promote positive mental
and emotional health.
Expectation 2: Students will understand and demonstrate behaviors that prevent disease and speed recovery from illness.
Disease Prevention
▲ Practice positive health behaviors to reduce the risk of disease.
▲ Cooperate in regular health screenings.
▲ Practice and use effective self-examination procedures.
▲ Analyze personal behaviors in relation to health, well-being, and personal goals.
Practice good personal hygiene.
Recognize the importance of prenatal and perinatal care.
Demonstrate care and concern toward ill persons in the family, the school, and the community.
Make a commitment to abstain from sexual activity.
Receive and understand statistics based on the latest medical information citing the failure and success rates of condoms in preventing AIDS and other sexually
transmitted diseases.
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176
High School (Continued)
Expectation 2 (Continued)
Treatment of Disease
▲ Recognize symptoms of common illnesses.
Take prescription and over-the-counter medicines properly.
Interpret correctly instructions written on medicine container labels, including information about side effects.
Determine when treatment of illness at home is appropriate and when and how to seek further help when needed.
Accept responsibility for active involvement in the treatment or management of disease.
Interpret correctly information provided by health-care providers regarding tests or procedures.
Analyze one’s patterns related to treatment of disease to determine their effectiveness.
Expectation 3: Students will practice behaviors that reduce the risk of becoming involved in potentially dangerous
situations and react to potentially dangerous situations in ways that help to protect their health.
Potentially Dangerous Situations
▲ Develop and use skills to identify, avoid, and cope with potentially dangerous situations.
▲ Use skills to avoid, resolve, and cope with conflicts.
▲ Understand and follow rules prohibiting possession of weapons at school.
▲ Identify factors that reduce risks of accidents.
▲ Recognize that the use of alcohol, tobacco, and other drugs plays a role in many dangerous situations.
▲ Use thinking and decision-making skills in high-risk situations involving motor vehicles and other safety hazards.
▲ Practice safe behavior in or near motorized vehicles, including observing basic traffic safety rules when driving, developing proficiency in handling
a vehicle in difficult situations, wearing a seat belt, and ensuring that others wear seat belts.
Carry appropriate emergency equipment and use latex gloves when assisting individuals who are injured.
Practice safe behavior in recreational activities, even in the absence of adults.
Practice safe behavior in and near water.
Report or obtain assistance when faced with unsafe situations.
Identify environmental factors that affect health and safety.
Demonstrate how peers can help each other avoid and cope with potentially dangerous situations in healthy ways.
High School (Continued)
Alcohol, Tobacco, and Other Drugs
▲ Exercise self-control.
▲ Develop and use interpersonal and communication skills such as assertiveness, refusal, negotiation, and conflict resolution.
▲ Avoid, recognize, and respond to negative social influences and pressure to use alcohol, tobacco, or other drugs.
▲ Use positive peer pressure to help counteract the negative effects of living in an environment where alcohol, tobacco, or other drug abuse or dependency exists.
▲ Identify ways of obtaining help to resist pressure to use alcohol, tobacco, or other drugs.
Distinguish between helpful and harmful substances.
Differentiate between the use and misuse of prescription and nonprescription drugs.
Identify and participate in positive alternative activities, such as alcohol-, tobacco-, and drug-free events.
Help to develop and support the school’s no-use policy and work to support it.
Child Abuse, Including Sexual Exploitation (Penal Code 11166[a])
▲ Identify ways to seek assistance if worried, abused, or threatened.
▲ Avoid, recognize, and respond to negative social influences and pressure to become sexually active, including applying refusal skills when appropriate.
Recognize and avoid situations that can increase risk of abuse.
Develop and use assertiveness skills and learn self-defense techniques.
Emergencies
▲ Recognize emergencies and respond appropriately.
Develop and maintain with other family members a personal and family emergency plan and emergency supplies at home and in vehicles.
Identify appropriate use of local emergency services.
Use latex gloves when assisting persons who are injured.
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High School (Continued)
Expectation 4: Students will understand and demonstrate how to play a positive, active role in promoting the health
of their families.
Roles of Family Members
▲ Develop and use effective communication skills.
▲ Seek assistance if living in a family where abuse of alcohol or other drugs exists (e.g., participating in a support group for teens who are the children
of alcoholics).
Support and value all family members.
Demonstrate ways to help support positive family interactions.
Practice health-promoting behaviors within the family.
Complete self-initiated activities beyond assigned chores to help support the family.
Identify safety hazards in the home and help to remove them.
Change Within the Family
Use effective strategies to cope with change within the family.
Develop a plan to facilitate transition from the role of a child to the role of an independent adult.
Discuss with parents plans to continue education beyond high school and develop a mutual understanding of how this will affect family roles and interactions.
Expectation 5: Students will understand and demonstrate how to promote positive health practices within the school
and community, including how to cultivate positive relationships with their peers.
Friendship and Peer Relationships
▲ Know and use appropriate ways to make new friends.
▲ Demonstrate positive actions toward others.
▲ Resolve conflicts in a positive, constructive way.
▲ Interact effectively with many different people, including males and females and members of different ethnic and cultural groups.
▲ Analyze appropriate behaviors in a dating relationship.
High School (Continued)
Demonstrate how to resist negative peer pressure.
Avoid demeaning statements directed toward others.
Promote positive health behaviors among peers.
Participate in group activities as a means of getting to know other people.
Respect the dignity of others.
Respect marriage.
School and Community-Based Efforts to Promote and Protect Health
Understand and follow school rules related to health.
Participate in school efforts to promote health.
Assume responsibility for helping to take care of the school.
Participate in community efforts to address local health and environmental issues.
Encourage others to become involved in health-promotion efforts at school.
Analyze the impact of laws, policies, and practices on health-related issues.
Encourage others to become involved in health-promotion efforts at many different levels.
Access appropriately services available within the community.
Initiate and involve others in health-promotion efforts at school or in the community.
Expectation 6: Students will understand the variety of physical, mental, emotional, and social changes that occur
throughout life.
Life Cycle
▲ Practice behaviors that will provide the option of healthy parenting later in life, such as avoidance of substance abuse.
▲ Recognize and be prepared to adapt to the changes that occur during life, such as changes associated with young adulthood, pregnancy, middle age, or old age.
Develop and use effective communication skills to discuss with parents or other trusted adults the changes that occur during adolescence.
Recognize and acknowledge that different people progress through different stages of the life cycle at different rates.
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High School (Continued)
Expectation 6—Life Cycle (Continued)
Express support and compassion for others who are grieving.
Recognize and discuss with parents and other trusted adults questions regarding death and dying.
Review family histories and determine whether a genetic disorder exists in the family.
Expectation 7: Students will understand and accept individual differences in growth and development.
Growth and Development
▲ Demonstrate an understanding of individual differences.
▲ Develop a realistic body image.
Recognize problems associated with not having a realistic body image.
▲ Recognize the effects of performance-altering substances and avoid the use of those substances.
Adapt group activities to include a variety of students.
Promote acceptance of a range of body types and abilities.
Use scientific data as a basis for individual nutrition and fitness plans.
Mental and Emotional Development
▲ Identify, express, and manage feelings appropriately.
▲ Develop and use effective communication skills.
Recognize one’s own strengths and limitations.
Use coping strategies, including time-management skills.
Develop a focus on the future.
Expectation 8: Students will understand their developing sexuality, will choose to abstain from sexual activity, will learn
about protecting their sexual health, and will treat the sexuality of others with respect.
Sexuality
▲ Use good judgment to recognize and avoid situations that could lead to subsequent sexual activity.
▲ Avoid, recognize, and respond to negative social influences and pressure to become sexually active.
High School (Continued)
▲ Demonstrate assertiveness and refusal skills and apply those skills to situations involving pressure to be sexually active.
▲ Practice behaviors that support the decision to abstain from sexual activity.
▲ Analyze messages about sexuality from society, including the media, and identify how those messages affect behavior.
Develop and use effective communication skills, including the ability to discuss with parents questions on sexuality.
Identify appropriate ways to show affection.
Identify ways to seek assistance if abused.
Evaluate what students can do to counteract the false norms portrayed in the media.
Receive and understand statistics based on the latest medical information citing the failure and success rates of condoms and other contraceptives
in preventing pregnancy and sexually transmitted diseases.
Expectation 9: Students will identify information, products, and services that may be helpful or harmful to their health.
Products and Services/Food Choices
▲ Identify a variety of consumer influences and analyze how those influences affect decisions.
▲ Use critical-thinking skills to analyze marketing and advertising techniques and their influence.
Recognize helpful products and services.
Seek care from the school nurse or school-linked services when appropriate.
Identify appropriate sources of health services for a variety of illnesses.
Develop and apply criteria for the selection or rejection of health products, services, and information.
Use critical-thinking skills to analyze the cost benefits of health care products and services.
Develop and use strategies for identifying and combating fraudulent or misleading health products, services, and information.
▲ Use critical-thinking skills to analyze marketing and advertising techniques and their influence on food selection.
▲ Use valid nutrition information to make healthy food choices.
▲ Use critical-thinking skills to distinguish facts from fallacies concerning the nutritional value of foods and food supplements.
181
Expectation 9—Products and Services/Food Choices (Continued)
▲ Use critical-thinking skills to analyze weight modification practices and select appropriate practices to maintain, lose, or gain weight according
to individual need and scientific research.
Use labels to compare the contents of food products.
Use unit pricing to determine the most economical purchases.
Use effective consumer skills to purchase healthy foods.
Adapt recipes to make them more healthy by lowering the amount of fat, salt, or sugar and increasing the amount of fiber.
182
High School (Continued)
C HAPTER 4
Beyond
Health
Education
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Chapter 4
Beyond Health
Education
C
entral to an effective coordinated school health system is a carefully
planned approach to developing and reinforcing health literacy in
students. Health education and the coordinated school health system
offer abundant opportunities for everyone in the school and the community to
become involved in a collaborative undertaking. This chapter offers a variety of
ways in which that reinforcement and involvement can take place.
The participation of a wide range of adults in the school and the community
is an essential element of a successful coordinated school health system. The
principal, the faculty, the support staff, the parents—everyone in the school—
must recognize children’s health as an important priority. A schoolwide focus
on health ensures that emphasis will be placed on developing and sustaining
healthy behaviors. If the environment of the school and the community does
not reinforce healthy behaviors and choices, students may perceive that such
behaviors and choices are not uniformly valued. For example, although stu­
dents may, through the health curriculum, learn about the importance of a
balanced diet, their behavior may be undermined by the easy availability of
nonnutritious foods in hallway vending machines or at school-sponsored
activities. Similarly, although the importance of regular aerobic physical activity
may be emphasized in health education and physical education classes, many
adults at the school may remain inactive. A mixed message about health and a
lack of adult role modeling and support for health literacy can undermine the
best health education program.
Components of a Coordinated
School Health System
This chapter focuses on how schools can build a coordinated school health
system to support and reinforce instruction on healthy behavior and health
literacy. A coordinated school health system consists of eight components:
•
•
•
•
•
•
•
•
Health Education
Physical Education
Health Services
Nutrition Services
Psychological and Counseling Services
Health Promotion for Staff
Safe and Healthy School Environment
Parent and Community Involvement
185
Health Education
Health education, described in detail in Chapter 3, “Health Education,”
should be comprehensive and multidimensional and should not be limited to
classroom exercises, textbook readings, or seat work. It should promote active
student involvement, critical thinking, development and reinforcement of
positive health behaviors, and a variety of engaging health-related projects both
in and out of school. To complement the description of health education, the
following discussion focuses on the other seven components of a coordinated
school health system—how they are interrelated and how they can be supported and strengthened.
Physical Education
Physical education should provide all students with opportunities to partici­
pate in a comprehensive, sequentially planned physical education program.
Through movement, physical education advances the physical, mental, emo­
tional, and social well-being of every person in the pursuit of lifelong health.
Students should have opportunities to develop and enhance their movement
skills and their understanding of how their body moves and should participate
in a variety of activities leading to lifelong enjoyment of physical activity.
Physical education for children in kindergarten through grade twelve is the
subject of another framework. Detailed information on the design of an
effective physical education curriculum is provided in the Physical Education
Framework.1
Health Services
Health services are those health-related procedures, screenings, or referrals
coordinated at the school site by the credentialed school nurse or school-linked
service providers. The nature and extent of health services vary from place to
place. In general, however, all schools should be prepared to:
1. Treat minor illness and injuries, provide routine first aid, and assist in
medical emergencies.
2. Identify and help manage the care of students with chronic conditions.
3. Conduct preventive health screenings, such as those for vision, hearing,
or detection of scoliosis.
4. Refer the family to health providers in the community when problems
are detected and do the necessary follow-up with the family as needed.
5. Keep up-to-date records of immunizations and health status.
1
Physical Education Framework for California Public Schools, Kindergarten Through Grade Twelve.
Sacramento: California Department of Education, 1994.
Chapter 4
Beyond Health
Education
Ten Benefits of
Comprehensive
School Health
Systems
1. Less school vandalism
2. Improved attendance
by students and staff
3. Reduced health care
costs
4. Reduced substitute
teaching costs
5. Better family
communications,
even on sensitive
issues, such as
sexuality
6. Stronger selfconfidence and
self-esteem
7. Noticeably fewer
students using
tobacco
8. Improved cholesterol
levels for students
and staff
9. Increased use of seat
belts
10. Improved physical
fitness
—Healthy Kids for the
Year 2000: An Action
Plan for Schools
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Beyond Health
Education
The school nurse is an
invaluable asset to a
coordinated school health
system and represents a
highly cost-effective
community investment in
the prevention of health
problems.
According to the National Association of School Nurses, an acceptable nurseto-student ratio is generally 1:750 but lower in schools with a concentration of
special-needs students.2 Most schools in California do not have a full-time nurse
of their own. Often, a nurse or nurse practitioner spends time at two or more
schools and may have to supervise one or more on-site health aides. This failure
to provide adequate nursing is regrettable because the school nurse is an invalu­
able asset to a coordinated school health system and represents a highly costeffective community investment in the prevention of health problems.
Another approach to providing health services and support to families can be
found in the growing number of school-based or school-linked health services.
These services may be offered by public health agencies or the school district and
may be funded by a combination of public and private funds. In some commu­
nities school health clinics and school-linked services provide a range of health
and support services, such as immunizations and acute care for infections, to
students who might otherwise go without medical care and offer an excellent
opportunity for school-community collaboration. The decision to provide
school-linked support services and the guidelines for operating them are sensi­
tive matters that should be determined by the local community and the school
district governing board.
Nutrition Services
An effective nutrition
services program is basic to
successful learning in
schools. . . . Nutrition
services can help to alleviate
the physical signs and
behaviors related to hunger
and improve resistance to
some communicable
diseases.
An effective nutrition services program is basic to successful learning in
schools. Hungry children can neither learn nor achieve their potential in
physical development, level of activity, or mental ability. Nutrition services
can help to alleviate the physical signs and behaviors related to hunger and
improve resistance to some communicable diseases. In addition, when received
by pregnant teenagers, these services help to reduce the risk of developmental
disabilities and greatly reduce infant mortality, a serious problem in teenage
pregnancy. Depending on the needs of the students and the community,
nutrition services might include breakfast and lunch programs, a summer
feeding program, a pregnant and lactating teen program, a special milk
program, and a child-care food program.
A national health goal is that at least 90 percent of the school lunch and
breakfast programs provide food choices consistent with such dietary recom­
mendations as those contained in The California Daily Food Guide.3 Specifically,
the goal is to increase the consumption of whole grains, fruits, and vegetables
and moderate the consumption of fat, salt, sugar, and empty-calorie foods. In
addressing this goal, nutrition services can offer students a variety of foods that
promote optimal health while reflecting student preferences. However, the
2
Resolutions and Policy Statements. Scarborough, Maine.: National Association of School Nurses,
1990, p. 22.
3
The California Daily Food Guide: Dietary Guidance for Californians. Sacramento: California Department
of Education, 1990.
187
school nutrition program does more than feed students; it functions as a living
laboratory for the practice of good eating habits learned in the classroom.
Nutrition services personnel can also be an invaluable resource to the classroom, providing assistance in nutrition-related lessons.
Chapter 4
Beyond Health
Education
Psychological and Counseling Services
Psychological and counseling services at the school site provide students with
support and assistance in making healthy decisions, managing emotions, coping
with crises, and setting short-term and long-term goals. Symptoms of mental,
emotional, and social problems may be especially apparent among adolescents,
ranging from abuse of alcohol, tobacco, and other drugs to eating disorders,
antisocial aggression, and suicidal depression. Early detection of mental and
emotional problems among children in elementary school should also be an
important priority. Further, psychological and counseling services can provide
support to students and their families after disasters or violent occurrences at or
near the school.
Every school should have a well-coordinated and fully supported program
led by a certificated professional who can help identify students with high-risk
behaviors and intervene early with necessary assistance to parents and referrals
to appropriate agencies. The primary responsibility for these services should be
assigned to a professional counselor whose time should not be monopolized by
administrative duties. However, because student health is a schoolwide con­
cern, every adult on campus should watch out for troubled youngsters and
assist them in finding the help and support they need.
Health Promotion for Staff
Part of the value of a staff health-promotion program lies in the numerous
personal benefits it can offer staff members. Consistent with the growing
number of health and fitness programs supported by private industry, schools
should view health promotion for staff as part of an overall approach to disease
prevention and sound health policy. In addition, adults must view themselves
as role models for healthy behavior if they are serious about helping young
people achieve health literacy.
School-based health and fitness programs for staff members and other adults
can take many forms, including work-site health promotion programs; healthrisk appraisals; personal goal-setting sessions; support groups; employee assis­
tance programs; and classes in aerobics, stress management, weight control, and
smoking cessation. The common denominator throughout is teaching by
example and promoting the health of all adults in the school.
Adults must view
themselves as role
models for healthy
behavior if they are
serious about helping
young people achieve
health literacy.
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Chapter 4
Beyond Health
Education
Above all, a safe and
healthy school environ­
ment ensures that the
school is a haven from
the violence many young
people encounter
elsewhere.
Safe and Healthy School Environment
This component relates to the physical and emotional environments of
the school. Above all, a safe and healthy school environment ensures that the
school is a haven from the violence many young people encounter elsewhere.
Such an environment is one that is well maintained and is free of such hazards
as asbestos dust or drinking water contaminated by lead. A plan to be imple­
mented in case of fire or natural disasters or other emergencies should be
provided and should be well rehearsed. In addition, lavatories and other
sanitary facilities should be kept clean, supplied with soap and towels, and
maintained well; play equipment should be inspected for safety at regular
intervals; and the school grounds should be monitored and kept free of
alcohol, tobacco, and other drugs.
The human side of a safe and healthy environment is less tangible but just
as important. It involves effective leadership and a sense of collaboration and
community. Healthy schools are characterized by a culture of concern and
mutual support among staff members and students. The importance of social
values—caring for others, treating others with respect, affirming diversity, and
being a responsible member of a group—should be clearly stated, recognized,
and modeled by all adults. Demeaning statements or actions directed to staff
members or students should not be tolerated.
Parent and Community Involvement
Involving families and the community in the coordinated school health
system is essential to encouraging positive health behaviors in children. Family
values and community norms help shape the health decisions of young people.
It follows, then, that if schools are to promote children’s health literacy, they
must reach out to key influence groups in the community. Working together,
the school, the family, and the community can tailor the coordinated school
health system to meet the school’s specific needs.
Although the school receives support from family members in many different
ways, it must uphold the role of the parent or guardian as the child’s primary
caretaker. To do so includes understanding and respecting the different ways in
which families and cultural and ethnic groups may view health-related issues.
It also includes a recognition that the law provides parents with basic rights
regarding the review of certain health-related instructional materials and the
option of removing their children from those parts of instructional programs
dealing with health, family life education, or sex education that conflict with
the parents’ religious training or beliefs (Education Code Section 51513).
189
Interrelationships of Components
Each component of a coordinated school health system has its own
characteristics and involves adults possessing distinct professional orientation
and specialized skills. To view the components as completely independent and
separate from each other is, however, inconsistent with the philosophy of a
coordinated school health system and is counterproductive.
Taken together, all eight components make up a coordinated school health
system. All relate to the development of health literacy in students, and all are
important. The more school health planners can establish connections and
interrelationships among the components, the stronger will be the overall
coordinated school health system and the more positive will be the outcomes
for children’s health. A well-integrated system creates unity, coherence, and
consistent support for students’ health literacy. Rather than being limited to
discrete time slots labeled health, the system permeates the school day. It is
schoolwide, involving students and adults within the school and in the
community.
The following discussion of connections and interrelationships focuses on
two key aspects of organizing the coordinated school health system; that is,
linkages within the school and linkages between the school and the community.
Both are important to a successful coordinated school health system. Throughout, examples are used to illustrate ways in which interrelationships can be
established and reinforced; however, they are not intended to constitute a
complete or exhaustive list. Because there is no single correct way to organize
a school health effort, specifics will vary from one setting to another.
Linkages Within the School
The most important principle for organizing and establishing relationships
among the components of a coordinated school health system is the same as it
is for health education; that is, interrelationships should be guided by the four
unifying ideas of health literacy. All eight components should reinforce each
other and complement the ways in which the unifying ideas are used to guide
health education. Examples include the following:
Accepting Personal Responsibility
• The physical education program can emphasize the development of
individual skills and talents and a positive attitude toward physical activity
that contributes to lifelong health and fitness. Physical educators can
encourage students to participate in physical activities and develop skills
and talents involving movement and dance that can be used throughout
their lives. By emphasizing children’s abilities to meet physical challenges
Chapter 4
Beyond Health
Education
A well-integrated school
health system creates
unity, coherence, and
consistent support for
students’ health literacy.
190
Chapter 4
Beyond Health
Education
Accepting personal
responsibility requires,
among other things, an
ability to gain access to
and use health services
when necessary or
appropriate.
and stay physically fit, physical education can help to enhance the
relationship between acceptance of responsibility for one’s physical wellbeing and consequent self-esteem.
• Accepting personal responsibility requires, among other things, an ability
to gain access to and use health services when necessary or appropriate.
The school nurse and school-linked health-care providers can play a role
in reinforcing personal responsibility by encouraging students to learn
more about the functioning of their bodies through periodic health
screenings and treatment of minor injuries. Personal responsibility
involves self-diagnostic skills—knowing, for example, whether and when
it is important to see the school nurse or another health-care provider.
Students who take regular medication will interact with the school nurse
and may also need the assistance of the nurse from time to time.
• The nutrition services program can and should offer students a wide range
of healthy food choices. Beyond choosing the food they eat, students can
be encouraged to contribute to and design menus, focusing on healthy
ingredients and varied methods of food preparation.
• Health promotion for staff can provide role modeling for students when the
adults in the school demonstrate personal responsibility for their health
and well-being. Joint staff-student games and physical activities can help
to promote the idea that health and fitness are enjoyable pursuits for
people of all ages.
Respecting and Promoting the Health of Others
• Physical education can reinforce respect for and promotion of the health of
others by promoting an understanding of individual differences, effective
teamwork, and cooperation. An important outgrowth of an effective
physical education program is the development of positive, healthy
relationships in children.
• Promotion of a safe and healthy school environment is particularly impor­
tant in reinforcing respect for and promotion of others’ health. The
culture of the school should be one that values respect and caring for
others and social and civic responsibility. One application of this culture
of concern for others would be to make a safe and healthy school environ­
ment accessible to all. To do so, some schools may have to provide
devices and facilities for those who are blind or deaf or are confined to
wheelchairs.
• Nutrition services can encourage students to recognize the importance of
healthy foods and menus for all students, promoting the importance of a
schoolwide approach to nutrition that involves everyone. School nutrition
policies can focus on a commitment to good health by calling for healthy
food choices throughout the school—in the classroom and cafeteria and
at sports events and extracurricular activities.
191
• Parent and community involvement can play a key role in fostering respect
for and promotion of the health of others. When parents and community
representatives are directly and frequently involved in the coordinated
school health system, they are acknowledging the value and importance of
school health efforts for all children. The school can and should reach out
to parents and community members, encouraging them to be presenters,
volunteers, helpers, planners, or participants in events and activities in and
outside of the classroom. Workshops for parents or visits to the home by
school-linked providers of services may help communicate the importance
and attributes of a supportive home environment in which students have
positive role models and nurturing families.
Chapter 4
Beyond Health
Education
Understanding Growth and Development
• A key aspect of physical education is an understanding of the process of
human growth and development, including ways in which a combination
of proper diet and activity can contribute to lifelong health and prevention
of disease. Also emphasized is the reality that people grow and develop at
different rates yet in many ways are similar.
• Psychological and counseling services can help students and their families
accept and understand numerous aspects of their own growth and develop­
ment, including disabilities. Individual and group counseling can enhance
students’ self-esteem and minimize the self-doubt that often affects students
in adolescence.
• A safe and healthy school environment acknowledges physical differences
among students. For example, toilets, sinks, and drinking fountains are
placed closer to the ground in areas used by younger students; all types of
facilities are made accessible to those in wheelchairs; and emergency
warning systems include a means of notifying deaf students and blind
students.
Using Health-Related Information, Products, and Services
• The school’s nutrition services program can help prepare students to become
well-informed consumers of healthy foods. The program can emphasize
healthy foods in the daily menu and healthy food choices in the school
cafeteria that extend to their ability to make well-informed decisions about
food at home, in grocery stores and supermarkets, and in a variety of
restaurants. It can also encourage students to be aware of the nutrient
values of the foods they eat and information found on the labels of packaged foods.
• An awareness of health-related products, information, and services can be
encouraged as part of the safe and healthy school environment component
through efforts to inform students about aspects of the school environment
Individual and group
counseling can enhance
students’ self-esteem and
minimize the self-doubt
that often affects students
in adolescence.
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Chapter 4
Beyond Health
Education
An important emphasis
in parent and community
involvement can be to make
students and their families
aware of community services
and resources available for
assistance in emergencies
and other health-care
and support needs.
that are health-promoting and those that need improvement. The
school should use only nonpolluting, nontoxic chemicals and paints, for
example, in cleaning and maintaining the physical plant. In many schools
asbestos removal programs and other efforts to rid the environment of
unhealthy chemicals or materials can be emphasized in health education.
Less obvious environmental factors, such as building design, lighting, and
sound deflection, can also be incorporated. Students can be involved in
cleaning, maintaining, and enhancing the school building and grounds
(for example, by planting trees and gardening) as one way of improving
the school’s physical plant and human climate.
• Parent and community involvement can play a critical role in making
students aware of health-related resources in the community and of
negative elements (for example, alcohol, tobacco, and other drugs or
safety hazards) that might be a threat to children’s health. An important
emphasis in parent and community involvement can be to make students
and their families aware of community services and resources available for
assistance in emergencies and other health-care and support needs. Both
formal resources (e.g., county agencies, community health-service
providers) and informal resources (e.g., neighborhood groups, recreation
clubs) should be featured.
• Health promotion for staff can and should encourage staff members
themselves to be informed consumers of goods and services that can affect
their health. Staff members can, in turn, share this knowledge with
students, thereby enhancing their position as healthy role models and
health-literate adults.
In addition to promoting the four unifying ideas of health literacy in
students, the components of a coordinated school health system should be
interrelated as much as possible. For example, specific organizing structures
designed to advance health literacy schoolwide can be used. They may include
frequent meetings of the school health committee and the coordinators of the
eight components, such as teachers, nutrition services staff, nurses, school
maintenance personnel, support staff, and parent and community volunteers.
Another approach might be regular communication about the coordinated
school health system within the school. Staff meetings can emphasize ways in
which the components of the comprehensive health system complement and
support each other. Bulletins, in-service events, and other communications can
emphasize health-related activities. Events such as health fairs and health career
days can further convey the priority of health at the school and the many
different ways in which the school develops and supports health literacy.
Also important in linking the components and developing a unified, coher­
ent approach to a coordinated school health system is continual emphasis on
the conceptual and content linkages among the components. For example, all
the components can support and relate to various aspects of health education.
193
Activities can be arranged and coordinated so that special events developed by
nutrition services support the study of foods and nutrients in the classroom. And
students’ testing of respiratory rates and physical fitness in physical education
can be coordinated with the study of human growth and development.
Chapter 4
Beyond Health
Education
Involvement of the School, the Family,
and the Community
A high degree of parent and community involvement is essential to unifying
and strengthening the components of a coordinated school health system.
Parent and community involvement should be encouraged from the earliest
stages of program planning and conceptualization and should be cultivated as
programs continue and expand.
Parents, other family members, and representatives of the community,
including representatives of community agencies and organizations that provide
health-related services, can be linked to the coordinated school health system in
a variety of ways:
• Through emphasis on early identification of health problems, such as
difficulties in seeing and hearing, recurrent infections, or chronic condi­
tions, such as asthma, health services can promote parent and community
involvement, underscoring the fact that everyone in the school and
community has a role to play in maintaining the health of each child, no
matter what the child’s needs might be.
• In some cases students needing psychological and counseling services may
have needs that cannot be met by the school’s staff. Parents can then be
referred to a variety of resources in the community.
• The physical education program can encourage students, their families,
and staff members to take part in physical activity outside the school.
Health clubs, sports leagues, programs sponsored by the local parks
department or community-based organizations, family fun nights,
organized hikes, and fund-raising walk-a-thons are all ways to show
support and enthusiasm for vigorous physical activity.
• The nutrition services program can help strengthen school-community
linkages by disseminating information broadly about the school’s nutri­
tion services and community food and nutrition programs. For example,
monthly lunch and breakfast menus can be printed with nutrition-related
news for parents and students, such as healthy, easy-to-prepare recipes;
and periodic updates can be provided to the school board, relevant
governmental agencies, and the local media. Working with local parentteacher groups, school nutrition personnel can introduce food-related
issues, such as the importance of a good breakfast in promoting academic
performance or information on how nutrition habits at home and after
Working with local
parent-teacher groups,
school nutrition
personnel can introduce
food-related issues, such
as the importance of a
good breakfast in
promoting academic
performance or
information on how
nutrition habits at home
and after school affect
choices at school.
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Beyond Health
Education
Students should be
encouraged to see the
connections between all
aspects of the environ­
ment, both in and out of
school, and their own and
others’ health. Students
should experience ways
to give back to the
community.
school affect choices at school. Good nutrition can also be promoted
through collaboration with community groups and agencies, including
professional associations interested in dietetics, medicine, child nutrition
programs, and home economics and local community-based organizations
that focus on youth and health issues. Connections with the food industry,
including food producers, retail stores, and restaurants, are another way to
promote the use of healthier food products throughout the community.
• The community can be involved in developing health-promotion programs
for school staff. For example, local fitness centers may be able to offer group
health-risk appraisals at reduced cost, and community health professionals
can be invited to deliver informal noontime presentations on health to
staff members.
• The community can also be involved in many different approaches to
promoting a safe and healthy school environment. Above all, students should
be encouraged to see the connections between all aspects of the environ­
ment, both in and out of school, and their own and others’ health. Stu­
dents should experience ways to give back to the community. For example,
they can experience the satisfaction of helping others by visiting nursing
homes, volunteering time at the local hospital, or collecting and distribut­
ing food for the homeless. Community service activities can be awarded
credit toward graduation. Students can also be involved in community
recycling programs. Students and teachers can organize ways to minimize
air pollution from automobiles by coming to school in carpools or buses,
on bicycles, or on foot. The school can communicate regularly about
safety-related concerns with local emergency services agencies, lawenforcement agencies, fire-protection districts, and community-based
organizations that can provide adults and students with training in such
techniques as first aid and cardiopulmonary resuscitation.
Numerous other examples could be provided of effective ways to link the
school, the family, and the community in health-related efforts. All can contrib­
ute to making the school and community an environment that promotes
children’s health. In addition, because in some cases the health of children can
be improved only through direct services and support to families, the schoolfamily-community linkages developed to support the coordinated school health
system can be used to provide school-linked services and support to families
when needed.
195
Local Advisory or Coordinating Councils
In recent years school health professionals have worked to create an infra­
structure to support coordinated school health systems. Particularly important
at a time of increasingly limited resources for school health is support at the
local level. An approach that has proven successful is that of establishing a local
school health council, sometimes called a school health advisory council.
Many different types of school health councils can be formed; there is no
single established or accepted model and no specific mandate or type of funds
for school health councils. Rather, the concept of school health councils has
been advocated by several leadership organizations, most notably the American
Cancer Society, and school districts are encouraged to develop school health
councils that address their specific needs.
Primarily advisory in nature, school health councils are groups of persons
who represent diverse segments of the community and who collectively advise
the local school system on health-related issues, activities, and programs.
Representatives might be community-based health professionals and volunteers,
school nurses, health educators, school administrators, physical education
teachers, parents, students, and others interested in and concerned about school
health. As suggested by the American Cancer Society, a school health council
may have several distinct but complementary functions, summarized as follows:
• Program planning—Organizing and participating in regular meetings to
assess local needs and to address problems and concerns
• Advocacy—Promoting school health issues by giving them a priority in
plans and the allocation of resources
• Fiscal planning—Assessing the financial needs of school health systems
and identifying and integrating funding sources
• Liaison with district and state agencies—Working with the school
district and local agencies to plan and develop curriculum and to allocate
resources
• Direct intervention—Initiating policies and organizing health-related
activities, such as school health fairs
• Evaluation, accountability, and quality control—Ensuring that funds
and resources are being used effectively and assessing local needs on a
continual basis4
To receive federal funds, such programs as Healthy Start and drug- and
alcohol- prevention programs are often required to work collaboratively with
similar agencies. When prevention programs collaborate, a broader base of
4
Improving School Health: A Guide to School Health Councils. Developed by Christin P. Bellian. Atlanta:
American Cancer Society, 1999.
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health issues can be addressed effectively, and such collaboratives can qualify as
local school health councils.
School health councils can be important to the Parent and Community
Involvement component of a coordinated school health system. They can be
useful in assessing community problems and identifying appropriate programs
and solutions. As the California Center for Health Improvement (CCHI)
noted in 2000, establishing a school health council not only allows communi­
ties to tailor health education programs to fit specific needs but also increases
opportunities for family involvement.5
A successful example cited by CCHI is the Long Beach Unified School
District’s School Health Advisory Council, which began in 1992 as a drug,
alcohol, and tobacco education advisory council as required by the Drug-Free
Schools and Communities Act. In 1995 the council, which meets quarterly,
expanded its focus to encompass all content areas of health education. Active
council members include representatives of law enforcement agencies, city
health departments, parent groups, student groups, the American Cancer
Society, the American Heart Association, and the American Lung Association.
Among the council’s many functions is that of providing a forum for sharing
information and connecting members from each of the eight components
of a coordinated school health system. The council has also helped to review
content standards for the district’s health, HIV/AIDS, and family life curricula.6 More information is available under “Health Policy Coach” at the
CCHI Web site at <http://www.cchi.org>.
Health Services in Schools
Why should health services be a priority for California schools? Schools
are ideal places in which to provide coordinated health and human services
because most children older than five years of age attend school. Therefore,
schools are logical places in which to provide such preventive health services
as screenings for vision, hearing, scoliosis, and dental problems. California law
requires not only that health screenings be provided (Education Code sections
49452 and 49452.5) but also that students be immunized against specific
vaccine-preventable communicable diseases (Health and Safety Code Section
120335).
Schools bring together large numbers of students and staff. Reasonable
caution requires that schools have an organized way of addressing all health
issues, including first aid, chronic disease management, medical emergencies,
5
“Involving the Family in School Health Advisory Councils.” Policy profile prepared by the California
Center for Health Improvement, Sacramento, 2000.
6
“Family and Community Involvement: School Health Advisory Councils.” Policy profile prepared
by the California Center for Health Improvement, Sacramento, 2000.
197
the identification of communicable diseases, and child abuse identification and
reporting. Schools must also provide for routine health care needs of students,
such as the administration of medications (Education Code Section 49423).
All these services require recordkeeping and management to ensure proper
documentation and follow-up care.
The need for school health services has expanded significantly as the circum­
stances of both the schools and the health care systems have changed. Federal
laws concerning special education students require that schools provide the
services necessary for these students to receive an appropriate education.
Examples of such services are the monitoring of vital signs, tracheostomy care
and suctioning, dressing changes, catheterization, gastric tube feeding, and the
administration of oxygen. Advances in medicine, reforms in federal law, and
school reform movements have allowed many students with chronic health
conditions, such as diabetes, cancer, arthritis, and severe asthma, to participate
in regular education settings. Schools must have a system in place that allows
for consultation with these students’ families and physicians, and the system
must be supervised by credentialed school nurses, who can also assist students
with medications, special treatments, and equipment use. Schools must also
provide health care services to students who develop acute health problems
while at school.
Legislative mandates and necessary precautions related to risks and liability
give schools little or no option in providing health services.7 Schools must be
prepared, for example, to deal with emergencies occurring on the school
campus that require special procedures and appropriately trained staff. Such
emergencies include severe allergic reactions; drug overdoses; choking; suicide
attempts; student or teacher death; trauma related to violence; and serious
unintentional injuries, such as playground and sports-related injuries.8
Many schools with adequate school nursing coverage, Healthy Start programs, or school-based or school-linked clinics offer health and social services
that help resolve issues of access to health care and fill or reduce gaps in the
community’s health care system. School health personnel can provide informa­
tion and counseling about safe and healthy lifestyle choices and risk reduction
that may empower students to assume responsibility for their health and safety.
Health counseling for students with health problems identified during treat­
ment might address the use of tobacco, alcohol, and other drugs; HIV/AIDS
and other bloodborne diseases; unintentional injuries; eating disorders or
obesity; and other health-related problems that may affect a student’s ability
to learn.9
7
Schools and Health: Our Nation’s Investment. Edited by Diane Allensworth and others. Washington,
D.C.: National Academy Press, 1997, p. 157.
8
Health Is Academic: A Guide to Coordinated School Health Programs. Edited by Eva Marx, Susan Frelick
Wooley, and Daphne Northrop. New York: Teachers College Press, 1998, p. 173.
9
Ibid, pp. 174-75.
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Options for Meeting Students’ Health Services Needs
According to the American Academy of Pediatrics, as cited in Schools
and Health, school health services should be viewed as a component of a
communitywide health care system.10 Using school health services for mandated screening and the identification of problems, follow-up, and referral
can improve the accessibility, effectiveness, and efficiency of primary care. For
students to benefit fully from health services, schools and communities need
to work together. Every school should have a core of health services provided
by credentialed school nurses and trained or licensed support personnel.
The school and community, working in tandem, need to assess which addi­
tional health services schools will provide, considering students’ health and
educational needs and the availability of appropriate health services in the
community.
Traditionally, credentialed school nurses are the backbone of school health
services and are often the only health care professionals on the school campus.
School nurses typically provide primary prevention and health care services
in a school health office, with or without the assistance of a health aide. The
National Association of School Nurses continues to recommend a ratio of one
school nurse to no more than 750 students in regular education.11
Students with special needs who require specialized services may be served by
school nurses as well as by licensed or nonlicensed assistive personnel; physical
therapists; occupational therapists; braillists; orientation and mobility special­
ists; speech, language, and hearing therapists; and audiologists. The National
Association of School Nurses recommends a ratio of one school nurse to no
more than 125 special education students.12
Potential Funding Sources for School Health Services
Historically, school districts or individual schools have paid the cost of
school health services out of district budgets. This practice has created an
inconsistent funding base that has been a barrier to the establishment of
universal school-based health services. In addition, student health and wellness
have tended to remain a low priority and have not been recognized as having
an impact on academic achievement. Consequently, no consensus exists within
the educational establishment on the need for school health services when hard
budget choices must be made. Therefore, it is important to look outside of
school budgets for reliable sources of financial support for school health
services.13
10
Schools and Health, p. 217.
National Association of School Nurses Position Statement: Caseload Assignments. National Association
of School Nurses Web site <http://208.5.177.157/positions/caseload.htm>. 1995.
12
Ibid.
13
Schools and Health, p. 206.
11
199
Some federal funds are available for school health services. These funds
include “entitlement” funds and reimbursement funds for services rendered.
Fund sources include federal Title XIX, which in California is known as the
Child Health and Disability Prevention program, and federal Titles I and V
of the No Child Left Behind Act of 2001, which can provide funds for health
care for educationally disadvantaged children. The Individuals with Disabilities
Education Act is another potential fund source; it partially supports mandated
specialized services for children with disabilities. Other federal resources include
funds for services to prevent HIV/AIDS and hepatitis B, funds for services to
prevent drug use through the Safe and Drug Free Schools and Communities
Act (Title IV), and the model coordinated school health programs of the
U.S. Department of Education (which may include health services).
Through the Mandated Cost Program, districts may file claims with the
State Controller’s Office to be reimbursed for mandated scoliosis screening and
related follow-up activities and for time spent auditing and following up on
immunization and first-grade physical examination requirements. In addition,
California has provided funds to support tobacco-use prevention and health
care for children and families living in poverty. Healthy Start grants fund a
variety of health and social services for eligible schools. In California the Local
Educational Agency Medi-Cal Billing Option, which allows school districts to
bill for health-related services provided to eligible students by appropriately
licensed employees, has generated millions of dollars statewide for participating
districts.
Local service clubs, volunteer health organizations (such as the American
Lung Association, the American Cancer Society, the American Heart Associa­
tion, and the American Red Cross), and private providers in the community
may provide funds or in-kind contributions for a school health services program. Managed care organizations are increasingly willing to work with schools
to provide health care services at school for students who are members of their
plan or to develop school-linked clinics for such care.
Although California’s Healthy Families and Medi-Cal for Children programs do not provide direct funds to schools, hundreds of children have the
opportunity to obtain low-cost or free health care coverage through participa­
tion in these programs. Schools are in a unique position to help ensure that
students and families have access to these and other affordable health coverage
programs. Healthy Families and Medi-Cal for Children offer comprehensive
medical, dental, and vision care coverage for children from low- to moderateincome families. Benefits are well-child care, immunizations, prescription
medicine, dental and vision care (including prescription eyeglasses), mental
health services, and physician and hospital services.
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The following examples illustrate some of the student health problems that
significantly affect schools:
• Nearly one in 13 school-age children has asthma. Asthma is a leading
cause of school absenteeism, accounting for more than ten million
absences per school year.14
• The number of children with diabetes has increased dramatically in recent
years, requiring school personnel to be educated in ways to recognize
emergency signs and symptoms and to intervene when necessary.15
• Oral disease is the most common childhood health problem. Children
in California have twice the rate of untreated tooth decay as do their
national counterparts.16
The volume and complexity of the need for health services for students are
indeed challenging for schools. It is imperative that schools establish policies
and protocols to manage those health-services needs. Qualified staff must be
in place and trained in protocols and procedures for the protection of students,
staff, and the school.
As noted in Schools and Health: Our Nation’s Investment, the American
Academy of Pediatrics has established the following seven guidelines for
establishing school health programs:
1.
2.
3.
4.
Ensure access to primary health care.
Provide a system for dealing with crisis medical situations.
Provide mandated screening and immunization monitoring.
Provide systems for identification and solution of students’ health
and education problems.
5. Provide comprehensive and appropriate health education.
6. Provide a healthful and safe school environment that facilitates learning.
7. Provide a system of evaluation of the effectiveness of the school health
program.17
Mental Health Issues in Schools
Mental health is one aspect of students’ health and well-being that many
educators tend to overlook. Yet mental health is an essential factor in students’
attitude toward themselves and in their ability to succeed in a variety of set­
tings, both in and out of school. Educators may be uncomfortable in dealing
14
Managing Asthma in the School Environment. Washington, D.C.: U.S. Environmental Protection
Agency, 2000.
15
“American Diabetes Association Position Statement: Care of Children with Diabetes in the School
and Day Care Setting,” Diabetes Care, Vol. 25 (2002), S122-26.
16
Mary Vaiana and Ian Coulter, The Oral Health of California’s Children: Halting the Neglected
Epidemic—California Children’s Dental Health Initiative. Oakland, Calif.: The Dental Health Foundation,
2000.
17
Schools and Health, p. 217.
201
with this aspect of young people’s development because of the challenge of
addressing mental health effectively and appropriately. Although teachers are
often the first adults to see that a student may be experiencing emotional
distress, teachers do not have the professional knowledge or expertise to
diagnose or treat mental health problems. Ignoring a student’s mental health
needs, however, is not an option. Schools and districts should develop referral
policies and procedures for dealing with mental health issues, and the proce­
dures need to be communicated clearly through sufficient staff training.
Psychological and counseling services are one of the eight components of
a coordinated school health system. This component holds an important place
in a well-designed school health program because a pressing need for it exists.
Howard Adelman notes that “between 12 percent and 22 percent of all chil­
dren suffer from a diagnosable mental, emotional, or behavioral disorder, and
relatively few receive mental health services.”18 According to Adelman, “Coun­
seling, psychological and social services are essential for youngsters experiencing
severe and pervasive problems.”19 He states that these problems include the
following:
• Inadequate basic resources, such as food, clothing, housing, and a sense of
security at home, school, and in the neighborhood
• Psychosocial problems, such as difficult relationships at home and at school;
emotional upsets; language problems; sexual, emotional, or physical
abuse; substance abuse; delinquent or gang-related behavior; psychopa­
thology
• Stressful situations, such as being unable to meet the demands made at
school or at home, inadequate support systems, and hostile conditions at
school or in the neighborhood
• Crises and emergencies, such as the death of a classmate or relative, a
shooting at school, or natural disasters (e.g., earthquakes, floods, torna­
does)
• Life transitions, such as the onset of puberty, a move to a new school,
and changes in life or family circumstances (e.g., change of residence,
immigration, loss of a parent through divorce or death)20
Seen in this light, the mental health needs and challenges of students take
on a more recognizable and everyday nature. A key question, then, is How can
schools work with families and community supports to address mental health
needs appropriately and effectively? Several statutes specify the referral proce­
dures for mental health concerns, and more detail on those statutes can be
18
Howard Adelman, “School Counseling, Psychological, and Social Services,” in Health Is Academic: A
Guide to Coordinated School Health Programs. Edited by E. Marx, S. F. Wooley, and D. Northrop. New York:
Teachers College Press, 1998, p. 142.
19
Ibid., p. 143.
20
Ibid.
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found in Chapter 2, “Developing Health Literacy in the Classroom and in the
School.” The protection of education rights for students with disabilities is
guaranteed by the following legislation:
1. The federal Individuals with Disabilities Education Act (IDEA)
(20 United States Code [USC] sections 1400 et seq.; and 34 Code of
Federal Regulations [CFR], parts 300 and 303)
2. The federal Rehabilitation Act, Section 504 (29 USC 705 [20] and 794;
and 34 CFR, Part 104)
3. The federal Americans with Disabilities Act (ADA) (42 USC 12101–
12213; 47 USC 225, 611; and 28 CFR, Part 35)
4. Education Code, Part 30 (sections 56000 et seq.)
5. California Code of Regulations, Title 5 (sections 3000 et seq.)
6. Government Code, Chapter 26.5 (sections 7570 et seq.) of Division 7
of Title 1
More information on the education rights of students with disabilities is
available at the Web site <http://www.cde.ca.gov/spbranch/sed/lawsreg2.htm>.
Although not specifically identified in Chapter 3, “Health Education,” as
being a part of a distinct mental health category, numerous themes that are
closely associated with mental health are woven throughout the description of
the health curriculum in that chapter. These themes cover the following topics:
•
•
•
•
•
•
•
•
Mental and emotional health
Growth and development
Alcohol, tobacco, and other drugs
Child abuse, including sexual exploitation
Roles of family members
Change within the family
Friendship and peer relationships
Sexuality
Adelman recommends using school-based strategies for prevention, inter­
vention, and treatment.21 After a professional assessment of students’ needs is
made, the services of school personnel—such as counselors, psychologists, social
workers, and nurses—should be implemented. Links between school and
community programs and services should be established to provide students
with the appropriate resources, opportunities, skills development, and formal
instruction supports they need.
All programs and services should be supported by policies and appropriate
training for staff to recognize the triggers for referring students for a profes­
sional assessment of their needs. The policies must be in compliance with
IDEA. A checklist of IDEA criteria is available at the CDE Web site at
<http://www.cde.ca.gov/spbranch/sed>.
21
Ibid.
203
The California Public Mental Health
System and Schools
California has a decentralized public mental health service delivery system,
and most services for adults and children are provided through the county
mental health departments. Many communities have multiple providers of
mental health services. Most insurers, health maintenance organizations, and
public insurance providers, such as Healthy Families, offer coverage for mental
health services. The public mental health system is intended to provide a safety
net for persons who have no other mental health care resources.
County mental health professionals can be contacted primarily by school
psychologists or nurses participating in the individualized education programs.
These health professionals can be valuable assets to school health councils and
multidisciplinary school health teams. They can help set up systems for student
referrals and provide mental health expertise.
In addition, the local mental health department is responsible for the
administration and delivery of several publicly funded services for children and
youths. Collaboration between schools and the public mental health system
provides an opportunity to maximize cost effectiveness and to meet students’
needs that can interfere with academic success if they go unmet.
Services available to children through California’s public mental health
system are as follows:
Medi-Cal
Medi-Cal (California’s name for the federal Medicaid program) is a health
insurance program that provides medical assistance for low-income persons. It
is funded through a state and federal partnership. Federal statutes require states
to provide diagnostic and treatment services to Medicaid recipients under the
age of twenty-one regardless of whether the state provides the same benefits
under its state Medicaid plan. In response, California has expanded its services
to include the Early Periodic Screening, Diagnosis, and Treatment program.
Funds can also be used to provide substance-abuse services to children with
simultaneous mental illness and substance-abuse diagnoses when necessary to
ameliorate the mental health problems of the child.
The Medi-Cal mental health care benefit is the most important part of
community-based services that are available to low-income students and
families. This benefit is a significant resource for school professionals to keep
in mind as they seek support for families of students who have been identi­
fied, formally or informally, as having behavioral or emotional difficulties.
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The public mental health system generally delivers the following
community-based and hospital-based Medi-Cal services through a network
of the state’s 58 counties:
•
•
•
•
•
•
•
•
•
Crisis services
Comprehensive evaluation and assessment
Individual, family, and group services
Medication education and management
Case management
Therapeutic behavioral services
Habilitative and intensive day treatment
Residential services (hospital)
Hospital in-patient services
These services are provided or arranged by the local mental health
departments.
Special Education Program
Legislation provides for the combining of educational and mental health
resources in an interagency delivery model to offer, in conjunction with the
educational system, specialty mental health services to students (Government
Code sections 7570–88). These federally mandated services are an important
entitlement for students who need the specific support of mental health services
to achieve academic success. This interagency program designates the county
mental health programs as the entities responsible for providing mental health
services to students who require special education, who have been determined to
be in need of mental health treatment in order to benefit from their education,
and who have exhausted all regular school counseling services and still need
additional counseling. The referral process and assessment process are very
stringent, and the policies must be clearly defined and communicated to staff.
Children’s System of Care
Another program of the state Department of Mental Health is the Children’s
System of Care (CSOC). In 1987 legislation was enacted that encouraged the
development of organized, community-based CSOCs for emotionally disturbed
(ED) children. The success of a planning model developed in Ventura County
led to the state requiring the following core values for a CSOC: (1) the target
population is composed of children and youths identified as ED; (2) the services
are culturally competent and child- and family-centered; (3) the families are
an integral part of the service planning and delivery; and (4) the children
are, whenever possible, served at home or in the most home-like setting pos­
sible. Because the system recognizes that many children receive services from
more than one agency (e.g., juvenile justice, education, social services, child
welfare, and mental health), services should involve formal collaboration and
205
coordination among the agencies. Typically, CSOC activities are coordinated
with special student study teams on campus or with school attendance review
boards working to meet the needs of students who have intense emotional or
behavioral needs.
Early Mental Health Initiative
The Early Mental Health Initiative (EMHI) is a part of the continuum of
mental health services administered by the state Department of Mental Health.
A preventive service for children, EMHI was established to fund three-year
demonstration programs serving school-aged children in kindergarten through
grade three who are identified as having moderate adjustment problems at
school. The purpose of EMHI is to ensure that these children start out well
in school and to increase the likelihood of their success in school.
Safe Schools and Violence Prevention
Ensuring a safe and healthy learning environment in which conflict is
effectively managed and minimized requires the collaborative efforts of all
school staff. Creating a safe school environment also requires the involvement
of parents and community partners, such as law enforcement and mental health
service providers. School psychologists, counselors, nurses, social workers, child
welfare and attendance supervisors, community partners, and others involved in
student support services must work as a team to assess students’ needs. This
team must also assist teachers and parents with programs and services that
support academic achievement and healthy development for all students.
The Safe and Healthy Kids Program Office (SHKPO) of the California
Department of Education provides assistance to county offices of education,
school districts, and schools through programs that address school safety. The
School/Law Enforcement Partnership (S/LEP), which is managed jointly by
SHKPO and the Attorney General’s Crime and Violence Prevention Center,
provides information, publications, conferences, and technical assistance on
school safety through the services of its members—a group of professionals
from law enforcement, education, and youth-serving agencies.
Education Code Section 35294 directs kindergarten-through-grade-twelve
public schools to develop a comprehensive school safety plan by coordinating
with school personnel, parents, students, and local law enforcement representa­
tives to develop site-based safe school plans. These plans must (1) identify
comprehensive approaches to school, student, and staff safety; (2) demonstrate
the ways in which the school’s vision incorporates school safety; (3) include an
assessment of recent incidents of school crime, areas of desired change, and
expected measurable outcomes; and (4) demonstrate a collaboratively designed
action plan for implementing site-appropriate safety programs and strategies,
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including the expected fiscal impact of executing them. Schools are to integrate
their safe school plan with other school improvement activities to prevent or
reduce violence and to provide or maintain a high level of safety conducive to
learning. Detailed information on the S/LEP program can be viewed at the
SHKPO Web site at <http://www.cde.ca.gov/healthykids> or at the Crime and
Violence Prevention Center Web site at <http://caag.state.ca.us/cvpc>.
The connection between problem solving and partnering is the focus of
the School Community Policing Partnership Program. This program offers
an opportunity for educational agencies and policing agencies to analyze
problems and develop solutions through innovative and collaborative thinking.
Education Code Section 32296.3 defines school community policing as an ap­
proach to safe schools in which schools, law enforcement, community agencies,
and the members of the surrounding school community collaboratively develop
long-term solutions to address the underlying conditions that affect the level of
school safety. Detailed information is available from the School-Community
Policy Partnership Program, telephone (916) 445-5629 or the Web site at
<http://www.cde.ca.gov/spbranch/ssp>, or the Crime and Violence Prevention
Center Web site at <http://caag.state.ca.us/cvpc>.
The Carl Washington School Safety and Violence Prevention Act provides
entitlements for school safety on the basis of student enrollments in grades
eight through twelve to school districts and county offices of education. Funds
can be used for such strategies as hiring personnel trained in conflict resolution,
providing on-campus communication devices, establishing staff training
programs, and establishing cooperative arrangements with law enforcement.
More information is available from SHKPO, telephone (916) 319-0920.
School Crime Information
Another responsibility of the SHKPO is the collection of data on the type
and frequency of crime in schools to provide the Legislature and the California
Department of Education with the necessary information to “permit develop­
ment of effective programs and techniques to combat crime on school cam­
puses” (Penal Code sections 628 et seq.). Historically, the collection of these
data has been accomplished through the California Safe Schools Assessment
(CSSA), a statewide uniform process for collecting school crime data at all
school sites. As additions to the Health Framework were being written, CSSA
was in abeyance while new data collection systems were being designed to meet
the requirements of the federal No Child Left Behind (NCLB) Act and the
California Budget Act of 2003.
According to Section 4112 of Title IV.A of NCLB, these new systems
must collect data from each kindergarten-through-grade-twelve public school
in California to provide information on truancy and suspensions and on
expulsions for violent or drug-related offenses. Each district must provide
information on the types of prevention programs and curricula being used in
207
the district and data on the prevalence of and attitudes toward drug use and
violence among youths.
In addition, Section 9532 of Title IX of NCLB requires the California
Department of Education, in consultation with local educational agencies,
to identify “persistently dangerous” schools. Such identification will require
the collection of data on the most serious offenses committed at schools, most
likely through the use of a subset of the data described above. A report to the
Legislature in March 2003 contained details of the proposed systems outlined
for meeting these federal requirements.
Threat Assessment
Threat assessment is a complex concept; the delineation of one threat from
another depends on the person involved in making the threat, the threat itself,
and the intended victim or victims of the threat. Because each situation is
unique, threat assessment should be viewed as a process in which each case is
handled very carefully and assessment is made in relation to the specific case,
not generalized with other cases. Profiling (the use of behavioral or demographic characteristics to identify types of persons likely to become violent) and
the use of checklists or other standardized assessment instruments have not
proven to be effective in assessing individual cases.22 Further, when used
inappropriately, these techniques may result in stereotyping and inappropriate
action.
Education Code sections 48900 et seq. address the issue of violence, including
threats, and outline the grounds for suspension and expulsion. Specifically,
Section 48900 authorizes suspension or a recommendation for expulsion of any
student who has “caused, attempted to cause, or threatened to cause physical
injury to another person. . . . ” Behavior that qualifies for sanction is defined as
“sufficiently severe or pervasive to have the actual and reasonably expected
effect of materially disrupting classwork, creating substantial disorder, and
invading the rights of either school personnel or pupils by creating an intimi­
dating or hostile educational environment” (Section 48900.4).
The Education Code further authorizes suspension or a recommendation
for expulsion when a student engages in sexual harassment; hate violence;
harassment, threats, or intimidation; or terrorist threats against school officials,
school property, or both (as defined in sections 48900.2–48900.4, 48900.7).
A “terroristic threat” is defined as “ . . . any statement, whether written or oral,
by a person who willfully threatens to commit a crime which will result in
death, great bodily injury to another person, or property damage in excess of
one thousand dollars ($1,000), with the specific intent that the statement is to
22
M. Reddy and others, “Evaluating Risk for Targeted Violence in Schools: Comparing Risk Assess­
ment, Threat Assessment, and Other Approaches,” Psychology in the Schools, Vol. 38, No. 2 (2001), 157–72.
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be taken as a threat, even if there is no intent of actually carrying it out, which,
on its face and under the circumstances in which it is made, is so unequivocal,
unconditional, immediate, and specific as to convey to the person threatened, a
gravity of purpose and an immediate prospect of execution of the threat, and
thereby causes that person reasonably to be in sustained fear for his or her own
safety or for his or her immediate family’s safety, or for the protection of school
district property, or the personal property of the person threatened or his or her
immediate family” (Section 48900.7).
Violence Prevention and Targeted Threat Assessment Process
A violence prevention and targeted threat assessment process consists of three
important elements:
1. A clearly understood system for safe and confidential reporting of threats
2. Ongoing staff development
3. A preventive assessment process
The first element is a safe and confidential reporting system that is known and
understood by all students and developed by the school to meet its unique
needs. Students should be educated on the importance of reporting threats of
violence to the proper school authorities and of understanding that remaining
silent can be dangerous to themselves as well as to others. Violence prevention
training for students may cover interpersonal communication, conflict resolu­
tion, anger management, recognition of signs of depression, ways of coping
with family tensions, and identification and reporting of threatening behavior.23
Means of encouraging students to report threats of violence include the installa­
tion of a telephone line for anonymous tips or a drop-box with forms for
reporting tips; the training and designation of selected adults as “safe contacts”;
and the establishment of a “safe room” monitored by a trained adult.
The second element is an ongoing staff development program that prepares all
staff to work together to develop a safe campus. Staff development programs
should be chosen carefully to meet the needs of the school-site staff and should
include training in targeted threat assessment and the social and emotional
development of students. Specialized training is needed for those persons
assigned to conduct or supervise the targeted threat assessment process. A needs
assessment of the school climate is conducted to determine at which point on
the learning continuum (awareness, knowledge, or skills) the staff development
should begin. The county office of education, the local department of mental
health, the California Department of Education, the Attorney General’s Office,
or the local law enforcement agency may be contacted for professional develop­
ment training. Topics for training may include safe-schools planning, classroom
23
Mary Ellen O’Toole, The School Shooter: A Threat Assessment Perspective. Quantico, Va.: Federal
Bureau of Investigation, 2000.
209
management, crisis prevention and response, and appropriate responses to hatemotivated behavior.
The third element is a preventive assessment process to identify students who
have the potential for violence. There is no common profile or set of characteris­
tics that applies to the perpetrator of targeted violence; therefore, “violence is
seen as the product of an interaction among the perpetrator, situation, target,
and the setting.”24 It is very difficult to distinguish between the making of a
threat and the posing of a threat. Relying solely on zero tolerance policies has
not always proved to be effective and can create legal entanglements for schools
and school districts. The following process is recommended for working with
students who may pose a threat:
1. Interview the individual student. Try to determine whether the student
is hostile or depressed, whether a desire to harm self or others exists, and
whether the student has made a specific plan and logistical preparations
to carry out the plan.
2. Corroborate the findings of the interview with cumulative behavioral,
emotional, and academic records. Check the records to determine
whether the student has any history of school problems, has family
problems, experiences isolation, or has a history of having been socially
excluded or bullied by peers.
3. Check with the adults, teachers, parents, and community members who
interact daily with the student. Interview these adults to determine
whether threats have been made, a plan has been revealed, the student’s
behavior has recently changed, or the student has had a recent loss or
traumatic experience. An intervention team of student support services
personnel should be available to assist in this process.
4. Elicit the help of skilled professionals to determine whether the findings
warrant further investigation or reporting. Consult with the school
counselor, school psychologist, or other mental health professional and
develop a plan of involvement and support for the student.
5. Report to school officials and law enforcement authorities if there is
suspicion of a threat or a threat has been made. A procedure for investi­
gating threats should be developed collaboratively by schools and law
enforcement agencies.
A targeted threat does not appear in isolation and usually involves more than
one member of the school community; therefore, effective threat assessment
and prevention must be a community or collaborative effort. School officials,
student support services and mental health personnel, faculty and staff, parents,
and law enforcement personnel must collaborate to develop and implement
strategies that prevent threats and violence. Multidisciplinary school site teams
24
M. Reddy and others, “Evaluating Risk,” p. 167.
Chapter 4
Beyond Health
Education
210
Chapter 4
Beyond Health
Education
should be used to identify strategies and resources to help individual students
and support schoolwide violence-prevention programs. In addition to the
threat assessment process, prevention programs may include the use of volun­
teer mentors, parent volunteers, peer counselors, school counselors, and school
resource officers. Other preventive strategies include arranging for public
service announcements encouraging students to report disturbing behavior or
threats, setting up peer assistance groups, educating parents on recognizing
possible early warning signs in their children and obtaining help for them,
organizing student assistance programs, and arranging “lunch buddy” programs
in which approved adults interact with students.
Suicide Prevention
A more subtle type of violence is harm to oneself, which takes various forms
that include eating disorders and suicide. The National Strategy for Suicide
Prevention (NSSP), a collaborative effort of the Substance Abuse and Mental
Health Services Administration, Centers for Disease Control and Prevention,
National Institutes of Health, and Health Resources and Services Administra­
tion, has noted that suicide is the third leading cause of death for people
between fifteen and twenty-four years of age. It is the fourth leading cause
of death in children between ten and fourteen years of age. Although suicide
attempts are more frequent among females, males are four times more likely
to die from suicide attempts.25
The percentage of young suicide victims who tell someone of their plans
beforehand is widely disputed among specialists in the field of adolescent
suicide. However, the general agreement is that many young people do alert
someone of their plan to take their own life. Research from the American
Association of Suicidology shows that students are more likely to to tell another
child closer to their own age than they are tell an adult.26 Therefore, teachers
and other educators need to watch for prolonged periods of moodiness or
depression in their students.
When teachers have a concern about a student or receive information that
may cause concern, they should consult with experienced student support
personnel (e.g., school counselors, school psychologists, school social workers,
or school nurses) or community mental health specialists, or both, to determine
students’ risk factors and the need for counseling. Students should be encour­
aged to tell their parents, teachers, administrators, counselors, and other
student support personnel if they are, or someone they know is, having
thoughts of suicide.
25
National Strategy for Suicide Prevention: Goals and Objectives for Action. Washington, D.C.:
U.S. Department of Health and Human Services, 2001.
26
Guidelines for School-Based Suicide Prevention Programs. Washington, D.C.: American Association
of Suicidology, 1999.
211
An analysis by the U.S. Department of Health and Human Services suggests
that strategies can be grouped into two areas: strategies for enhancing the
identification and referral of students at risk of suicide and strategies for
addressing risk factors directly. Education for school personnel in both of these
areas is essential because suicide-prevention programs included in the health
curriculum have met with mixed results.
The following goals and objectives have been proposed by NSSP to enhance
the identification and referral of students at risk of suicide and to address the
risk factors directly:
1. Promote awareness that suicide is a public health problem that is
preventable.
2. Adopt broad-based support for suicide prevention.
3. Adopt strategies to reduce the stigma associated with being a consumer
of services related to mental health, substance abuse, and suicide
prevention.
4. Adopt suicide prevention programs.
5. Promote efforts to reduce access to lethal means and methods of
self-harm.
6. Implement training for recognition of at-risk behavior and delivery
of effective treatment.
7. Adopt effective clinical and professional practices.
8. Improve access to and community linkages with mental health services
and substance-abuse services.
9. Improve reports and portrayals of suicidal behavior, mental illness,
and substance abuse in the entertainment and news media.
10. Promote and support research on suicide prevention.27
The implementation of these goals and objectives requires that school staff
be trained in the identification and referral of students at risk of suicide and in
strategies for addressing risk factors directly. Such training should be included
in district staff development training plans.
The School Health Ship
An appropriate metaphor for the entire process of planning and implement­
ing a coordinated school health system is the analogy of building a ship and
setting sail, as illustrated in figures 2 and 3.
Essential to the ship’s stability is health education. The ship’s keel and ribs,
which support the sheathing of the hull, are the nine different content areas.
The four unifying ideas of health literacy connect the content areas and, with
the content areas, form the hull.
27
National Strategy for Suicide Prevention.
Chapter 4
Beyond Health
Education
212
However, health education and health-related information are only one
element of a total approach to developing health literacy in children and youths.
The ship’s sails, which catch the energy of motivation, direction, and purpose
in the lives of individuals, institutions, and communities, are the seven other
components of a coordinated school health system.
Finally, the individual child, and ultimately every adult, is the captain of the
ship, steering it in the direction of a healthy, successful life.
C
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Fig. 2. Building the Hull of the Ship (Knowledge, Attitudes, Behaviors)
C
Chapter 4
Beyond Health
Education
Four Unifying Ideas of Health Literacy
•­ Acceptance of
personal responsibility
for lifelong health
•­ An understanding of
the process of growth
and development
•­ Respect for and
promotion of the
health of others
•­ Informed use of
health-related
information,
products,
and services
213
All those who plan and carry out components of the coordinated school
health system—in the school and in the community, as professionals, family
members, or volunteers—can help to build a sound and sturdy ship for today’s
children and youths. When the ship is well designed and well constructed, it
will be ready to weather the storms of life and take advantage of the gentle
breezes that make life fulfilling.
Fig. 3. Set Your Sails (Harnessing the Energy)
Health
Services
Physical
Education
Nutrition
Services
Psychological and
Counseling Services
Health Promotion
for Staff
Safe and Healthy
School Environment
Parent and Community
Involvement
Health Education
Chapter 4
Beyond Health
Education
C HAPTER 5
Assessment
of Health
Literacy
216
Chapter 5
Assessment of
Health Literacy
A
ssessment approaches aligned with the desired expectations described
in this framework are pivotal to the promotion of health literacy in
children and youths. Since it is true that what is tested strongly
influences what is taught, meaningful assessment focused on the knowledge,
skills, attitudes, and behaviors necessary for health literacy should be built into
curriculum design and the supporting structure from the outset.
Appropriate assessment will focus on the unifying ideas of health literacy.
That is, it will attempt to measure students’ progress toward:
•
•
•
•
The primary purpose of
assessment should be to
provide meaningful
feedback to the student
and teacher so that
individual growth can be
noted and future learning
can be tailored to the
student’s needs.
Assessments should
measure the extent to­
which the coordinated
school health system
enhances and reinforces
health literacy.
Accepting personal responsibility for lifelong health
Respecting and promoting the health of others
Understanding the process of growth and development
Becoming informed users of health-related information, products,
and services
The primary purpose of assessment should be to provide meaningful feedback to the student and teacher so that individual growth can be noted and
future learning can be tailored to the student’s needs. However, assessments in
health education should be constructed to serve other important purposes.
Because the health of students is influenced by the family, the community, the
school, and peers, assessments should be designed to provide feedback to these
groups. That is, assessment results should help parents, the community, and the
students themselves understand the progress made toward health literacy for all
students. These groups can use assessment results to help focus their efforts to
support the development of health literacy and track progress over time.
Assessments also can provide valuable information for focusing and planning
improvements in the coordinated school health system.1 Because student health
literacy is best achieved when health education is provided within the context
of a coordinated school health system, effective assessment of health literacy
must go beyond collecting only student-level data. Assessment should also
examine the extent to which staff and the coordinated school health system
promote and reinforce health literacy. Such assessment results, together with
data from student assessments, can provide the information necessary to plan
improvements in the coordinated school health system. When implemented,
these improvements can further promote the development of health literacy in
all students. Assessments should:
• Be consistent with the unifying ideas of this framework.
• Focus on knowledge, skills, attitudes, and behaviors rather than on
knowledge only.
• Provide useful feedback to individual students, teachers, and parents.
• Include the gathering of baseline health literacy data so that behavioral
change can be tracked over time.
1
See Chapter 1 for an explanation of the coordinated school health system.
217
• Measure the extent to which the coordinated school health system
enhances and reinforces health literacy.
• Promote ongoing refinement of both health education and the entire
coordinated school health system.
Student Assessment
In the planning of student assessment in health, the following principles
underlying effective assessment should be considered and integrated into the
assessment design:
• The assessment should examine the extent to which all students are
achieving the four unifying ideas of health literacy.
• Rather than measuring knowledge only, the assessment should focus on
health knowledge, healthy behaviors, attitudes about health, and skills to
increase the prevalence of positive health behaviors and reduce the preva­
lence of negative health behaviors.
• The assessment should revolve around exemplary tasks aligned with this
framework that provide information about student performance.
• The assessment tasks should be complex, open-ended, and meaningful.
They should allow students to demonstrate thinking, understanding,
and communication skills as well as mastery of health content. In contrast
to traditional assessments, they should provide sufficient flexibility in
approach so that students have opportunities to demonstrate health
literacy in a variety of ways. An understanding should prevail that a
variety of ways to solve a problem correctly may exist. Students should
have ample time to work on assessment tasks and opportunities to revise
and resubmit projects to raise performance to high-quality standards.
• Whenever possible, the assessment should be conducted in the course of
normal work. The class and the learning should not, in most cases, be
interrupted for a test.
• The primary purpose of the assessment should be to provide meaningful
feedback to the student, parents, and teacher so that future learning can be
tailored to the student’s needs and parents can understand and support
this learning.
Assessments based on these principles will include much more than the
traditional methods of assessment, such as multiple choice, true-false, or
machine-scored measures of acquired knowledge. A wide array of assessment
methods and instruments that measure behavior and skill development and
support critical thinking and a student-centered curriculum should be used to
assess student health literacy. Examples of student assessments include:
• Using self-assessments that include a risk assessment or personal inventory
to give students an understanding of their health status
Chapter 5
Assessment of
Health Literacy
218
Chapter 5
Assessment of
Health Literacy
A wide array of
assessment methods
and instruments which
measure behavior and
skill development and
support critical thinking
and a student-centered
curriculum should be
used to assess student
health literacy.
One of the most
effective ways to assess
student progress toward
health literacy is to
observe whether their
behavior supports or
improves their health.
• Using the results of a health-related physical fitness test to evaluate students’
fitness level and to develop a personal fitness plan based on their level of
fitness, knowledge acquired, and personal needs2
• Demonstrating an understanding of the connection between current
behaviors and lifelong health by developing realistic and long-term goals
related to health
• Role-playing ways to respond to physical, emotional, mental, and social
changes that occur in a lifetime, including identifying available resources
if needed
• Using positive social skills in small-group and large-group assignments
with other students to work effectively toward a common goal
• Demonstrating specific decision-making, refusal, and conflict-resolution
skills when given sample scenarios that allow students to grapple, in a safe
environment, with difficult situations likely to happen during their lifetimes
• Reflecting, in journal entries, on the skills learned in the classroom and the
use of those skills in the classroom, at school, with friends, or at home and
indicating how those skills influence attitudes and behavior
• Recording food consumption in food diaries and using the diaries to analyze
eating habits
• Developing a set of criteria for making decisions about health products
that allow students to demonstrate an understanding of how marketing
influences decision making
• Developing and using anonymous schoolwide surveys to obtain and analyze
group data regarding negative and positive health behaviors, giving an
important overall picture of the behavioral trends of students over time
• Developing and using student materials for schoolwide use that encourage
actions and behaviors promoting good health, such as videos offering tips
on skateboard, bicycle, and personal safety or a laminated poster illustrating
emergency escape routes for each classroom
• Developing student portfolios that demonstrate the student’s health literacy
by addressing each of the four unifying ideas
One of the most effective ways to assess student progress toward health literacy
is to observe whether their behavior supports or improves their health. However,
before assessments of behaviors are focused on, two cautionary notes are in order.
First, what a student learns in health education may not produce observable
behavioral changes until much later. To expect immediate change is unrealistic.
Second, assessment of behavior must be carefully constructed to respect students’
rights to privacy, community sensibilities, and existing laws and notification
requirements. Education Code Section 51513 requires parental permission to ask
questions about the students’ personal beliefs or practices and the parents’ or
guardians’ beliefs and practices in the area of family living. Before any data on
2
Education Code Section 60800 requires school districts to administer a health-related physical fitness
test to students in grades five, seven, and nine each year during March, April, or May.
219
student behavior are collected, schools should consider working with parents and
local community organizations or agencies to provide education and information
about the assessment, the rationale for the assessment design, and the intended
use of the assessment data. This communication with parents and the community
can help prevent misunderstandings and garner support for quality assessments.
In addition to using assessment results with individual students, teachers
should use student assessment data to evaluate the overall health curriculum.
The data can provide insights as to whether the curriculum is meeting the needs
of all students, is building on prior knowledge appropriately, and is consistent
with the developmental levels of the students.
Chapter 5
Assessment of
Health Literacy
Staff Assessment
Because health education involves staff not only as teachers but as adult models
of good health, the attitudes and habits of staff members regarding health play an
important role in promoting student health literacy. Voluntary assessments of
staff health behaviors and attitudes about health, as well as approaches used to
promote health literacy, will provide useful information about the staff’s commit­
ment to influencing students’ health and incorporating health literacy into their
own lives. The results will serve as a needs assessment for designing professional
development activities.
Whatever the grade level, staff assessment and follow-up staff development
workshops should be based on current information about health literacy and
effective teaching methods. Pedagogical skills that support critical thinking and
a student-centered curriculum are required to address the unifying ideas and
expectations of this framework. Assessment should focus on the extent to which
teaching strategies support students in developing the knowledge, skills, attitudes,
and behaviors necessary to achieve health literacy. For example, assessments might
ask teachers to reflect on how their teaching strategies help students (1) develop
decision-making and thinking skills; (2) solve problems individually and as part of
a group inquiry; and (3) gather, analyze, and present information. Teachers might
also reflect on how they support the development of student health literacy by
(1) connecting concepts in health education with learning in other curriculum
areas; (2) cooperating with other school staff members to make student health
literacy a priority at the school; and (3) considering the culture, ethnic values,
and customs of the community in curriculum design and delivery.
How instructional strategies used by teachers and the health literacy of teachers
are assessed will depend on the resources and staff available. Assessment can be
done through anonymous questionnaires, self-studies, or observations. One or
more designated staff members, preferably members of the school or school
district health committee, should take the lead and have the knowledge and skills
needed to carry out this responsibility. The information collected will help staff
reflect on their practices and determine changes they can make to promote
student health literacy.
Voluntary assessments­
of staff health behaviors­
and attitudes about­
health will provide useful­
information about the­
staff’s commitment­
to influencing­
students’ health.­
Assessment of the­
coordinated school­
health system can­
provide invaluable­
information for planning­
program improvements­
to promote student­
health literacy.­
220
Chapter 5
Assessment of
Health Literacy
System Assessment
Assessment of the coordinated school health system can provide invaluable
information for planning program improvements to promote student health
literacy. The assessment should involve both monitoring the implementation of
a coordinated school health system and evaluating the influence of this system
on student health literacy. It should involve collecting data on such factors as the
following:
• Number of students participating in different aspects of the coordinated
school health system, such as the number of students participating in
planned, sequential health education and physical education
• Extent to which all the components of a coordinated school health system
are being implemented3
• Levels of parent and community involvement
• Degree to which appropriate program planning has taken place
• Extent to which the school vision for the coordinated school health
system has been articulated and the manner in which policies have been
developed, reviewed, and implemented to support this vision
• Extent of linkages among the components of a coordinated school health
system
• Extent to which health education has been infused into the other
curriculum areas
The assessment should also examine the allocation of staff and resources to
support the coordinated school health system. If available, community health
data, such as the prevalence of iron-deficiency anemia among children, the
number of accidents involving bicycles in the past year, the prevalence of
sexually transmitted diseases among teenagers, or the incidence of teen preg­
nancy may be used together with school data. The assessment should be done in
the initial planning stages and in each year thereafter so that schools can monitor
their efforts to promote student health literacy and adjust those efforts as
necessary to improve their effectiveness.
Using data from student, staff, and system assessments, the school should
attempt to demonstrate, over a period of several years, the extent to which
students have achieved health literacy and incorporated the values of that literacy
into their daily living. Measuring the full continuum of outcomes, including
positive changes in knowledge, attitudes, skills, and behaviors, will demand a
variety of assessment methods and patience. Those planning assessments and
using the assessment results must be mindful that change in behavior requires
time. However, given the potential of assessment to influence long-term health
behaviors of students, quality assessments must be developed and used to
support progress toward health literacy for all students.
3
See Chapter 1 for an explanation of the coordinated school health system.
C HAPTER 6
Criteria for
Evaluating
Instructional
Materials for
Kindergarten
Through
Grade Eight
222
Chapter 6
Criteria for
Evaluating
Instructional
Materials for
Kindergarten
Through
Grade Eight
T
he criteria for evaluating the alignment of instructional materials with
the content of the Health Framework for California Public Schools,
Kindergarten Through Grade Twelve and evaluating the quality of
those materials in the areas of grade-level emphases, curriculum content,
program organization, assessment, universal access, and instructional planning
and support are discussed in this section. These criteria will guide the develop­
ment and govern the adoption in 2004 of instructional materials for kinder­
garten through grade eight. The criteria do not recommend nor require one
particular pedagogical approach, nor does the numerical order of the criteria
within each category imply relative importance. The criteria may also be used
by publishers and local educational agencies as a guide for the development
and selection of instructional materials for grades nine through twelve.
The criteria are organized into five categories:
1. Health Content/Alignment with Curriculum: The content as specified
in the Health Framework
2. Program Organization: The sequence and organization of the health
instructional materials
3. Assessment: The strategies presented in the instructional materials for
measuring what students know and are able to do
4. Universal Access: The information and ideas that address the needs of
special student populations, including students identified for special
education, English learners, and advanced students
5. Instructional Planning and Support: The instructional planning and
support information and materials, typically including a separate edition
specially designed for use by the teacher, that assist teachers in the
implementation of the health education program
Health materials must support teaching aligned with the Health Framework.
Materials that fail to meet the health content criteria will not be considered
satisfactory for adoption. Only programs that are determined to have met
Criterion 1 will be further evaluated under Criteria 2 through 5.
In order to create focused health instructional materials, publishers are asked
to concentrate on the content described in the Health Framework, especially in
Chapter 3, “Health Education,” and the Grade-Level Emphases Chart, as
adopted by the State Board of Education in March 2002. The instructional
materials must not contain extraneous content that is fundamentally contrary
to the Health Framework and detracts from the ability of teachers to teach
readily and students to learn thoroughly the content specified by the Health
Framework.
CRITERION 1: HEALTH CONTENT/ALIGNMENT WITH CURRICULUM
Instructional materials support the teaching and learning of the skills and
knowledge called for at the specific grade levels as outlined in the Health
223
Framework, including the emphases designated in the Grade-Level Emphases
Chart. Materials are fully aligned with the framework content. Materials must
be scientifically and medically accurate, must be based on current and confirmed research, and must enable students to develop goals of lifelong positive
health behaviors and attitudes. Materials must meet all criteria. Materials with
a glaring weakness or significant omission are not worthy of adoption. Programs with inaccuracies or errors that hinder the teaching of health content will
not be considered for adoption. To be considered suitable for adoption, health
instructional materials must provide:
1. Evidence and appropriate references, with page numbers, that demon­
strate alignment with the Grade-Level Emphases Chart and content
found in Chapter 3
2. Support of all content, as specified at each grade level, by topics, concepts,
lessons, activities, examples, and/or illustrations, as appropriate
3. Integration and coordination with the eight components of coordinated
school health1 and support of the four unifying ideas of coordinated
school health2
4. Accurate content to support health instruction as outlined in the Health
Framework and in pertinent Education Code sections
5. Interesting and engaging health content that provides students with
methods of evaluating the accuracy of health information claims through
the use of scientific criteria and, when appropriate to the grade level,
explains how to apply information to assess health-related behaviors
6. Medical and health vocabulary used appropriately and defined accurately
7. Scientifically and medically accurate content that reflects current practices
in use or recommended by health professionals
8. Direct instruction and activities that focus on students improving and
demonstrating proficiency in the topics noted in the Grade-Level
Emphases Chart
9. Instruction that is appropriate to the grade level and develops health
literacy (Health literacy is the capacity of an individual to obtain, inter­
pret, and understand basic health information and services and the
competence to use such information and services in ways that assist in
maintaining and enhancing health.)
10. When appropriate, opportunities for students to increase their knowledge
and understanding of health while reinforcing the skills and knowledge
1
Health Education; Physical Education; Health Services; Nutrition Services; Psychological and
Counseling Services; Health Promotion for Staff; Safe and Healthy School Environment; and Parent and
Community Involvement (see Chapter 4, “Beyond Health Education”).
2
Acceptance of personal responsibility for lifelong health; Respect for and promotion of the health of
others; An understanding of the process of growth and development; and Informed use of health-related
information, products, and services (see Chapter 3, “Health Education”). Also important is reinforcing
instruction on health behavior and health literacy through a collaborative effort by parents, the school, and
the community.
Chapter 6
Criteria for
Evaluating
Instructional
Materials for
Kindergarten
Through
Grade Eight
224
Chapter 6
Criteria for
Evaluating
Instructional
Materials for
Kindergarten
Through
Grade Eight
called for in the physical education, reading/language arts, mathematics,
science, history–social science, and visual and performing arts curriculum
frameworks
11. When appropriate, opportunities for students to evaluate the accuracy of
health-related information and to seek reputable resources and information
12. When called for by the Grade-Level Emphases Chart, introduction or
review of topics that are emphasized at another grade level
13. Compliance with all relevant Education Code sections, including sections
233.5, 51201.5, 51240, 51513, 51550, and 51553–55
Materials being considered for adoption must meet Criterion 1 before being
evaluated according to Criteria 2 through 5.
CRITERION 2: PROGRAM ORGANIZATION
The sequential organization of the health instructional materials provides
structure for what students should learn at each grade level and allows teachers to
convey the health content efficiently and effectively. The materials are well
organized and presented in a manner that provides all students opportunities to
acquire the essential knowledge and skills described in the Health Framework.
Materials must designate which grade levels are being addressed. To be consid­
ered suitable for adoption, health instructional materials must provide:
1. Alignment with the Health Framework, introducing new knowledge and
skills at a reasonable pace and depth of coverage and explicitly preparing
students for later grade levels
2. Organization that provides a logical and coherent structure to facilitate
efficient and effective teaching and learning within the lesson, unit, and
grade level as described in the Health Framework and the Grade-Level
Emphases Chart
3. Clearly stated student outcomes and goals that are measurable and are
based on the framework
4. An overview of the content in each chapter or unit that designates how the
lesson supports the Health Framework
5. A well-organized structure that provides students with the opportunity to
learn the grade-level topics and build on knowledge and skills acquired at
earlier grade levels
6. A variety of activities and texts that organize the grade-level content in a
logical way so that students develop prerequisite skills and knowledge
before they are introduced to the more complex concepts and understand­
ings of the topic
7. Tables of contents, indexes, glossaries, content summaries, references, and
assessment guides that are designed to help teachers, parents or guardians,
and students use the materials
225
CRITERION 3: ASSESSMENTN
Assessment should measure what students know and are able to do. Instruc­
tional materials should contain multiple measures to assess student progress.
Assessment measures should reveal students’ knowledge and understanding of
the health content. Assessment tools that publishers include as part of their
instructional material should provide evidence of students’ progress toward
meeting the skills and knowledge identified in the Grade-Level Emphases Chart.
Assessment tools should provide information that teachers can use in planning
and modifying instruction to help all students. To be considered suitable for
adoption, health instructional materials must provide:
1. Strategies or instruments that teachers can use to determine students’ prior
knowledge
2. Multiple measures of individual student progress at regular intervals to
evaluate attainment of grade-level knowledge, understanding, and ability
to independently apply health concepts, principles, theories, and skills and
to evaluate students’ abilities to evaluate the accuracy of health-related
information and to seek reputable resources and information
3. Guiding questions for monitoring student comprehension
4. Assessments that students can use to evaluate and improve the quality of
their own work
5. Formative, summative, and cumulative assessments to evaluate students’
work
CRITERION 4: UNIVERSAL ACCESSN
Instructional materials should provide access to the curriculum for all stu­
dents, including those with special needs: English learners, advanced learners,
students with learning difficulties, special education students, and other students
with special needs. Materials must conform to the policies of the State Board of
Education as well as to other applicable state and federal guidelines pertaining to
diverse populations and students with special needs. To be considered suitable
for adoption, health instructional materials must provide:
1. Suggestions based on current and confirmed research for adapting the
curriculum and the instruction to meet students’ assessed special needs
2. Strategies to help students who are below grade level in reading, writing,
speaking, and listening in English to understand the health content
3. Suggestions for advanced learners that are tied to the Health Framework
and that allow students to study content in greater depth
CRITERION 5: INSTRUCTIONAL PLAN
ING AND
SUPPORTN
Support materials for teachers should be built into the instructional materials
and should specify suggestions for and illustrate examples of how teachers can
implement the Health Framework in a way that ensures an opportunity for all
Chapter 6
Criteria for
Evaluating
Instructional
Materials for
Kindergarten
Through
Grade Eight
226
Chapter 6
Criteria for
Evaluating
Instructional
Materials for
Kindergarten
Through
Grade Eight
students to learn the essential skills and knowledge called for in the Health
Framework, including health literacy. These criteria do not recommend or
require a particular pedagogical approach. Publishers should make recommen­
dations to teachers regarding instructional approaches that fit the instructional
goals. Materials should provide teachers with a variety of instructional ap­
proaches. To be considered suitable for adoption, planning and support
resources must provide:
1. Clearly written and accurate explanations of health content, with sugges­
tions for connecting health concepts with other areas of the curriculum
2. Strategies for addressing and correcting common misconceptions about
health topics
3. A variety of pedagogical strategies
4. Lesson plans, suggestions for organizing resources in the classroom, and
ideas for pacing lessons
5. Support for or access to confirmed, research-based programs
6. A list of materials, educational resources, and tools that align with the
recommendations in the Health Framework
7. Suggestions and information for teachers to locate, interpret, convey, and
apply medically and scientifically accurate content and current, confirmed
research
8. Suggestions for how to use student assessment data within the program
for instructional planning purposes
9. Technical support and suggestions for appropriate use of audiovisual,
multimedia, and information technology resources associated with a unit
10. Suggestions for linking the classroom with reputable community resources in a manner consistent with state laws and school policies
11. Suggestions for activities and strategies for informing parents or guardians
about the health program and creating connections among students,
parents, guardians, and the community
12. References and resources to guide teachers’ further study of health topics
and suggestions
13. Demonstration of electronic resources (videos, DVDs, CDs) depicting
appropriate teaching techniques and offering suggestions for teachers
14. Homework assignments that support classroom learning, give clear
directions, and provide practice and reinforcement for the skills taught in
the classroom
15. Suggestions for encouraging students to study content in greater depth
16. In the teacher’s edition, ample and useful annotations and suggestions for
presenting the content of the student edition and ancillary materials
227
Appendix A
Selected Legislative Code Sections
This section contains information primarily related to the Education Code
and includes summaries of selected legislative code sections. The information
was current at the time of publication; however, those using this section should
keep in mind that the code sections might be amended by subsequent legisla­
tion. Educators and others interested in supporting coordinated school health
are encouraged to keep up to date on legislative changes that affect students’
health and health education.
Relevance of Legislation to Health Education
It is essential that California educators clearly understand the laws regarding
their responsibility to protect and promote the health and safety of schoolchildren. Many laws are in effect that apply to multiple aspects of the delivery
of health-related education, programs, and services. Selected legislative code
sections cover the following topics:
• Specific content and delivery of instruction in the health curriculum
• Requirements for parent notification and community involvement in
school health programs
• Specific training requirements for those who provide instruction in health
or health services at the school site
• Mandates on how to deal with potential student health problems, safety
risks, confidentiality, and crisis intervention
• Requirements for protecting students’ health and safety
This document provides an overview of school health laws in effect at the
time of publication. For up-to-date information about school health laws in
California, consult the following Web sites:
• California Healthy Kids
<http://www.californiahealthykids.org>
This Web site provides an online database of edited school health laws.
From this site users can obtain the text of a single law or a custom list of
selected laws.
• California Law
<http://www.leginfo.ca.gov/calaw.html>
This Web site provides the full legal text of each law. This site also offers
the option of subscribing to updates on bills as they pass through the
legislative process. Subscribers receive notification when legislative action
is taken on a bill.
228
Appendix A
Selected Legislative
Code Sections
Organization of Health-Related Code Sections
Many sections of the Education Code (and sections of other legislation) relate
to health instruction and the components of a coordinated school health system.
Such sections are dispersed throughout the Education Code. The relevant
legislative sections have been organized in tables as follows to facilitate user
reference:
• Table A.1, “Health Education Mandates.” Indicates the mandates for
health education. Summaries of code sections cited in this table may be
found after Table A.3.
• Table A.2, “Health Education Recommendations.” Indicates laws that
encourage or recommend topics and priorities for health education
instruction.
• Table A.3, “Coordinated School Health Legislation.” Briefly describes
many of the laws related to the other components of a coordinated school
health system.
Table A.1
Health Education Mandates
Instruction
Teacher
Preparation
Requirements
Parent
Notification/
Community
Involvement
Comprehensive
Health Education
EC 51202
EC 51210(f)
EC 51880–
81.5(b)
EC 51890
EC 51911
EC 51913–14
Alcohol, Tobacco,
and Other Drugs
EC 51202–03
EC 51260–66.5
EC 51268–69
EC 51260–66.5 HSC 11802
EC 51268–69
HIV/AIDS, STDs
EC 51201.5
(a),(b)
EC 51554(a)
EC 51229.8
Family Life/
Sex Education
EC 51553(a)
EC 51554(a)
Pregnancy/
Parenting Education
EC 51220.5(c)
Violence Prevention,
Safety
EC 233.5(a)
EC 35294
PC 11166(a)
EC 51513
Materials
EC 51891
EC 60040–42
EC 60044
EC 51201.5
(a),(b)
EC 51240
EC 51555
EC 51240
EC 51550
EC 51555
GC 3100
Key: Education Code (EC); Government Code (GC); Health and Safety Code (HSC); Penal Code (PC).
229
Table A.2
Appendix A
Selected Legislative
Code Sections
Health Education Recommendations
Instruction
Teacher
Preparation
Requirements
Parent
Notification/
Community
Involvement
Comprehensive
Health Education
Materials
EC 60042
Alcohol, Tobacco,
and Other Drugs
EC 51262
HIV/AIDS, STDs
EC 51820
Family Life/
Sex Education
EC 51553
Pregnancy/
Parenting Education
EC 8910–11
Violence Prevention,
Safety
EC 51860
Environmental
Protection
EC 8700–07
EC 8720–23
EC 44645
EC 51820
EC 51265
Note: Text from the Education Code regarding “recommendations” for health instruction and coordinated
school health is not included in this appendix because of space limitations. A summary of the text can be
viewed on the Web at <http://www.californiahealthykids.org>. The full text can be viewed at <http://
www.leginfo.ca.gov/calaw.html>.
Coordinated School Health Legislation
Beyond the Health Education component of a coordinated school health
system are seven additional components, described in Chapter 4, “Beyond
Health Education.” Several of those components—Physical Education, Health
Services, Nutrition Services, and Psychological and Counseling Services—are
supported by the Education Code sections cited in Table A.3.
230
Appendix A
Selected Legislative
Code Sections
Table A.3
Coordinated School Health Legislation
CSH Component
Physical Education
Health Services
Laws and Regulations
Topic
EC 51206
Requires the State Superintendent of Public
Instruction to employ a physical education specialist
to develop curriculum and staff development.
EC 51220–22
Require student participation in physical education.
EC 51225.3
Requires two physical education courses during
grades 9–12 for graduation. (Requires a minimum
of 400 minutes for every 10 school days.)
EC 51210, 51223
Require physical education for elementary students
for a minimum of 200 minutes for every 10 school
days.
EC 60800
Requires annual physical fitness testing for grades
5, 7, and 9.
EC 52715
Requires school districts to employ teachers with
physical education certification qualifications.
EC 49427
Directs local educational agency (LEA)
administrators to maintain fundamental school
health services at a specified minimum level.
CCR, Title 17, 6802;
HSC 124085
Require a Child Health Disability Prevention
physical examination in grade 1.
EC 48211–13,
48980, 49403,
49450–51;
CCR, Title 17, 2506;
CCR, Title 5, 202
Include requirements for communicable disease
control measures.
HSC 120335
Includes required immunizations for school entry.
EC 49451
Gives parents the right to refuse consent to health
screenings.
EC 49452.5
Requires scoliosis screening.
EC 49450
Requires confidentiality of health screening records.
EC 49456
Requires schools to report to parents on health
screening results.
USC, Title 20, 1400
Requires education for all disabled children.
Note: Text from the laws and regulations cited here is not included in this appendix because of space limitations. Summaries
of the text from California laws can be viewed on the Web at <http://www.californiahealthykids.org>. The full text can be
viewed at <http://www.leginfo.ca.gov/calaw.html>.
Key: California Code of Regulations (CCR); Education Code (EC); Health and Safety Code (HSC); United States Code (USC).
231
Table A.3
Coordinated School Health Legislation (Continued)
CSH Component
Health Services
(Continued)
Nutrition Services
Psychological and
Counseling Services
Laws and Regulations
Topic
CCR, Title 5, 3001,
3021.1
Require referral for chronic illness.
EC 49452; CCR,
Titles 5 and 17
Include requirements for vision and hearing
screenings and referrals.
EC 499530–36
Set proper nutrition as a high priority. LEAs may
apply to CDE for available state and local funds
for breakfast and lunch programs.
EC 49500–05
Set forth legislative intent that no child is to go
hungry.
EC 49590
Allows LEAs to authorize food sale on school
premises.
EC 49490–96
Establish nutrition services standards.
EC 49510–20
Set forth intent that students who receive public
assistance are ensured of a supplemental food
program while they attend school.
EC 49530
Establishes nutritional requirements for foods sold
at elementary and secondary schools (SB 19, Pupil
Nutrition, Health, and Achievement Act of 2001).
EC 49547–48
Discuss summer meal service.
EC 49424
Defines school psychologist services by a
credentialed school psychologist.
EC 49600
Defines “educational counseling” services and
programs to be provided by credentialed school
counselors.
EC 49602
Defines students’ rights to confidentiality and lists
provisions for reporting confidential information.
Appendix A
Selected Legislative
Code Sections
232
Appendix A
Selected Legislative
Code Sections
Summaries of Selected Education Code Sections
Education Code Section 233.5(a), principals of morality
Teachers shall endeavor to impress upon the minds of students the principles
of morality, truth, justice, citizenship, and so forth.
Education Code Section 35294, programs for school safety and violence
prevention
California public schools should develop for kindergarten through grade twelve
a comprehensive school safety plan that addresses safety concerns that are
identified through a systematic planning process.
Education Code sections 51201.5(a) and 51201.5(b), instruction on the
prevention of AIDS
School districts shall ensure that all students in grades seven through twelve
receive instruction on AIDS prevention. Each student shall receive the
instruction at least once in junior high or middle school and once in high
school. Parent notification of such instruction is required.
Education Code Section 51202, instruction on personal and public health
and safety
The adopted course of study shall provide, in the appropriate elementary and
secondary grades, instruction on first aid, fire prevention, conservation of
resources, and health, including the effects of alcohol, drugs, and so forth.
Education Code Section 51203, instruction on alcohol, narcotics, restricted
dangerous drugs, and so forth
Instruction on the nature of alcohol, narcotics, restricted dangerous drugs, and
so forth shall be provided in elementary and secondary schools. Governing
boards shall adopt regulations specifying the grade levels and the courses in
which such instruction is provided.
Education Code Section 51210(f), instruction in areas of study
The adopted course of study in grades one through six shall include health
instruction, including instruction on the principles and practices of individual,
family, and community health.
Education Code Section 51220.5(c), parenting skills
The adopted course of study for grade seven or eight shall include the equiva­
lent content of a one-semester course in parenting education and skills so that
students will acquire basic knowledge of parenting.
233
Education Code Section 51229.8, in-service training on AIDS-prevention
instruction
County offices of education and school districts, through regional training,
shall plan and conduct in-service training for all teachers and school employees
who provide AIDS-prevention instruction.
Education Code Section 51240, written request by parent to excuse student
from family life/sex education
A parent or guardian may request that a student be excused from family
life/sex education when such instruction conflicts with religious beliefs and
training.
Education Code Section 51260, trained instructors for drug education
Instructors in drug education, which includes the effects of the use of tobacco,
alcohol, narcotics, dangerous drugs, and so forth, must be appropriately
trained.
Education Code Section 51261, approval and reevaluation of teacher
certification programs for drug education
The State Board of Education shall approve only those teacher certification
programs for drug education that qualify under this section and shall continu­
ally reevaluate those programs.
Education Code Section 51262, instruction on the use of anabolic steroids
A lesson on the effects of the use of anabolic steroids should be included in
science, health, drug abuse, or physical education programs in grades seven
through twelve.
Education Code Section 51263, information on programs for the prevention
of drug and alcohol abuse
The California Department of Education shall make available information on
model drug- and alcohol-abuse prevention education programs developed and
funded by state and federal agencies.
Education Code sections 51264(a) and 51264(d), in-service training on the
prevention of gang violence and drug and alcohol abuse
The California Department of Education shall prepare and distribute to school
districts and county offices of education guidelines for incorporating into staff
development plans in-service training for teachers, counselors, athletic directors,
and so forth on the prevention of gang violence and drug and alcohol abuse.
Each school is encouraged to develop a single plan to strengthen its efforts to
prevent gang violence and drug and alcohol abuse and to include these topics
in its school improvement or school safety plan.
Appendix A
Selected Legislative
Code Sections
234
Appendix A
Selected Legislative
Code Sections
Education Code Section 51265, priority of in-service training on the
prevention of gang violence and drug and alcohol abuse
School districts and county offices of education should give a high priority to
in-service training programs for comprehensive gang-violence and drug- and
alcohol-abuse prevention education.
Education Code Section 51266(a), curriculum for the prevention of gang
violence and substance abuse
The Office of Criminal Justice Planning and the California Department of
Education shall collaborate to develop a model curriculum for the suppression
of gang violence and the prevention of substance abuse for grades two, four,
and six.
Education Code Section 51266.5, model curriculum for the prevention
of gang violence and substance abuse
State agencies shall review the model curriculum for gang-violence suppression
and substance-abuse prevention for grades two, four, and six and shall identify
the methods by which the curriculum can be most fully implemented in rural
school settings.
Education Code Section 51268, duplication of efforts in the prevention
of drug, alcohol, and tobacco abuse
The California Department of Education shall offer to school districts and
county offices of education guidance on avoiding duplication of efforts in
the administration of education programs for the prevention of drug, alcohol,
and tobacco abuse.
Education Code sections 51269(a) and 51269(b), improved delivery of
programs for the prevention of drug, alcohol, and tobacco abuse
The California Department of Education shall, to the extent possible, colla­
borate with other state agencies that administer education programs for the
prevention of drug, alcohol, and tobacco abuse to streamline and simplify
funding application processes. The Department shall develop an ongoing,
statewide monitoring, assessment, and data collection system to improve
program planning and delivery.
Education Code Section 51513, questions asked of students
Parents and guardians must be notified in writing of any test, questionnaire,
survey, or examination to be administered that contains questions regarding
beliefs and practices in sex, family life, morality, and religion.
235
Education Code Section 51550, parent notification of family life and
sex education courses
Governing boards of public schools may not require students to attend any
class in which reproductive organs and their functions and processes are
described, illustrated, or discussed. If such classes are offered, parents and
guardians of all students must be notified in writing.
Education Code Section 51553(a), sex education course criteria
All classes in grades one through twelve that teach sex education and discuss
sexual intercourse shall emphasize abstinence from sexual intercourse as the
only protection that is 100 percent effective against unintended pregnancy,
STDs, and AIDS.
Education Code Section 51554(a), parent notification of instruction on
family life, AIDS, STDs, and so forth
Parents and guardians shall be notified in writing at the beginning of the school
year (or at the time of enrollment when a student enrolls after the beginning of
the school year) of any instruction on family life, AIDS, STDs, and so forth
that will be delivered by an outside organization or guest speaker brought in
specifically to provide that instruction.
Education Code Section 51555, instruction on family life, AIDS, STDs,
and so forth in kindergarten through grade six
School districts, county boards of education, or county superintendents of
schools shall provide parents and guardians of all students written notice that
instruction on family life, AIDS, STDs, and so forth will be given. Information
stating parents’ and guardians’ right to request copies of sections 51201.5 and
51553 (relating to AIDS-prevention instruction) shall be included in the
written notice.
Education Code Section 51880, Comprehensive Health Education Act
of 1977
An adequate health education program in the public schools is essential
to continued progress and improvement in the quality of public health in
California. Maximum use shall be made of existing state and federal funds in
the implementation of comprehensive health education.
Education Code Section 51881.5(b), hazardous substances
Hazardous substances education programs in public schools are beneficial,
fostering in students an understanding of their role in protecting the environ­
ment and in safeguarding themselves from the dangers posed by hazardous
substances.
Appendix A
Selected Legislative
Code Sections
236
Appendix A
Selected Legislative
Code Sections
Education Code Section 51890, comprehensive health education programs
Comprehensive health education programs are defined as all educational
programs offered in kindergarten through grade twelve that are designed to
ensure that students will receive instruction that helps them in their decision
making regarding personal, family, and community health.
Education Code Section 51891, community participation in comprehensive
health education
The planning, implementation, and evaluation of comprehensive health
education must include active community participation.
Education Code Section 51911, evaluation of comprehensive health education
programs
Approval of district plans shall be made in accordance with rules and regula­
tions adopted by the State Board of Education.
Education Code Section 51913, evaluation standards and criteria
The State Board of Education shall establish standards and criteria to be used in
the evaluation of plans for comprehensive health education programs submitted
by school districts to the State Board for approval.
Education Code Section 51914, cooperation of parents, community, and
teachers in the development of health education programs
Comprehensive health education programs must be developed with the active
cooperation of parents, the community, and teachers in all stages of planning,
approval, and implementation.
Education Code Section 60040, adoption of instructional materials that
portray diversity
All instructional materials adopted by governing boards shall accurately portray
the cultural and racial diversity of our society.
Education Code Section 60041, adoption of instructional materials that
portray humanity’s place in ecological systems
Instructional materials adopted by governing boards shall accurately portray,
whenever appropriate, humanity’s place in ecological systems and the necessity
of protecting the environment.
Education Code Section 60042, adoption of instructional materials that
encourage responsible behaviors
Adopted instructional materials must encourage thrift, fire prevention, and the
humane treatment of animals and people.
237
Education Code Section 60044, prohibited instructional materials
No instructional materials shall be adopted that reflect adversely on people
because of their race, color, creed, national origin, ancestry, sex, disability,
or occupation.
Summaries of Other Selected Legislative Code Sections
Government Code Section 3100, public employees as disaster service workers
All public employees are declared to be disaster service workers for the protec­
tion of citizens’ health, safety, lives, and property in the event of disasters
bought about by natural, man-made, or war-caused emergencies.
Health and Safety Code Section 11802(a), funds for alcohol-abuse prevention
programs
Funds shall be allocated to programs for alcohol-abuse prevention in schools
and the community.
Penal Code Section 11166(a), reporting of child abuse
“Mandated reporters” (defined in Section 11165.7 to include teachers, instruc­
tional aides, classified school employees, and so forth) who know of or reasonably suspect child abuse shall report the known or suspected instance to a child
protection agency immediately or as soon as is practicably possible.
Appendix A
Selected Legislative
Code Sections
238
Appendix B
Project TEACH Recommendations
on Preservice Teacher Training
in Health Education
Project TEACH, funded by the California Department of Education and
College Health 2000, was designed to improve preservice teacher training in health
education. All colleges and universities providing teacher training in California
were invited to participate. The project examined current practices and collabora­
tively developed recommendations. These recommendations, issued in 1993, are
being used by participating institutions to help new teachers promote health literacy
among their students more effectively. The Project TEACH recommendations,
exemplary only, are presented as follows: 1
1. Universities/colleges should offer two separate courses—one for singlesubject credential candidates (secondary) and one for multiple-subject
credential candidates (elementary).
2. The courses should each be three units (semester or quarter) in length, and
there should be a minimum of 40 to 50 contact hours between the students
and the instructor.
3. Challenges to the course (credit by examination) should not be allowed.
Students should receive credit for the course only by completing the course
requirements.
4. CPR certification must cover infant-child and adult CPR as well as chok­
ing emergencies (American Red Cross Community CPR or American
Heart Association B-level).
5. Instructors are expected to utilize the Health Framework and familiarize the
students with mandated areas of instruction and Education Code sections
related to health education.
6. The courses should deal primarily with the health status and health instruc­
tion of children and adolescents. A personal health and wellness text (of the
type used in introductory college personal health courses) is not appropriate
for use in these teacher education courses.
7. The course for the multiple-subject (elementary) teachers should:
a. Make prospective teachers aware of health issues related to children.
b. Make prospective teachers aware of the structure of a comprehensive
school health system.
1
For more information contact Deborah Wood, Director, Healthy Kids Resource Center, Alameda
County Office of Education.
239
c. Help prospective teachers become familiar with the materials and
methods used in comprehensive school health education.
d. Utilize a variety of instructional strategies to model possible health
education strategies.
e. Include use of an appropriate text and/or instructional materials that will
enable students to become familiar with lesson plans, resources for health
education, instructional techniques, and the like.
f. Acquaint prospective teachers with the year 2000 objectives that affect
K–6 students and the health emphasis of It’s Elementary.
8. The course for single-subject (secondary) teachers should:
a. Acquaint prospective teachers with the year 2000 objectives for students
in grades seven through twelve and the health emphasis of Second to None.
b. Make prospective teachers aware of the structure of a comprehensive
school health system.
c. Teach prospective teachers how to integrate health instruction into their
single-subject curriculum.
d. Acquaint prospective teachers with the health problems and concerns of
adolescents. Included are such topics as teenage pregnancy, acne, sexually
transmitted diseases, steroids, substance abuse, abusive relationships,
mental health, injury prevention, and nutrition.
e. Emphasize the relationship between health and student performance.
9. Rename poorly named courses to reflect what should be taught in the course.
Suggested course names may include:
Health Education for Elementary Teachers
Health Education for Secondary Teachers
Some course titles that would not be appropriate are Personal Health,
Contemporary Health Issues, Health, Substance Abuse and Nutrition
Education, Health and Hygiene, Nutrition, Fitness, Biology, and Health
Studies.
10. Students who take a personal health course at a junior college or at another
school should not be allowed to have that course fill the obligation for the
health education for teachers requirement. Universities should instruct their
credential analyst to require students to take the specific course in health
education for teachers.
11. When universities offer only the combined course (for both multiple- and
single-subject teachers), care must be taken that multiple-subject teachers are
trained in content and teaching methods. Single-subject teachers must be
trained in how to infuse/integrate their curriculum with health topics. This
becomes a difficult task with the limited class time available. For this reason,
recommendation 1 should be given top priority.
Appendix B
Project TEACH
Recommendations
on Preservice
Teacher Training in
Health Education
240
Appendix C
Guidelines for Evaluating Web Sites
Growing numbers of Americans are turning to the Internet to obtain
health-related information. Those numbers increasingly include educators who
specialize in school health.
The availability of almost unlimited information is one of the great advan­
tages of the World Wide Web, but the Web also poses a potential problem,
especially regarding health-related information. “With a click of the mouse,”
observed the International Food Information Council in 1999, “a word-ofmouth phenomenon can be multiplied exponentially via the World Wide Web
or electronic mail and result in questionable nutrition, food, safety, and health
stories being sent directly to your computer.”1 Researchers Kotecki and
Chamness emphasize that “To ensure proper information use, consumers
must be able to separate credible WWW sites from noncredible sites.”2
One way to evaluate Web sites is through online reviews and discussions
with other school health professionals. Another is to bookmark Web sites that
have proven reliable in the past and to refer primarily to those sites and recom­
mended links found on those sites. Several other guidelines can be helpful
when reviewing Web sites:
• Be wary of Web sites that are designed primarily to promote or sell
products and programs.
• Look beyond personal anecdotes and isolated examples; solid empirical
research is preferable.
• Make sure to identify the source of the information. Established
organizations and governmental agencies are likely to be more reliable
than unknown or unrecognizable sources. Web sites ending in “.gov”
or “.edu,” for example, are developed by official governmental and
educational organizations.
• Note that the Healthy Kids Resource Center updates and evaluates the
Web sites included in its “Links” list on a regular basis (<http://
www.californiahealthykids.org>).
• Maintain a questioning attitude; do not take information at face value.
• Be sure to refer to the Getting Results criteria for evaluating research-based
practices when researching curriculum or programs (see Chapter 2,
“Developing Health Literacy in the Classroom and in the School,” in
this framework).
The form that follows is an evaluation tool designed to help users of Web
sites make well-informed decisions about a Web site’s accuracy and utility.
1
“The Mouse That Roared: Health Scares on the Internet,” Food Insight: Current Topics in Food Safety
and Nutrition (May/June 1999), 1–5.
2
J. E. Kotecki and B. E. Chamness, “A Valid Tool for Evaluating Health-Related WWW Sites,” Journal
of Health Education, Vol. 30, No. 1 (1999), 26-29.
241
Health-Related WWW Site Evaluation Tool
Title: _______________________________________________________________
URL: http:// __________________________________________________________
Date: _______________________________________________________________
Evaluator: ___________________________________________________________
INFORMATION
Criterion 1: Scope
A. Many different aspects of the topic are presented.
B. Each aspect is presented in depth.
Criterion 2: Accuracy
A. The information is consistent with other resources
on the topic.
B. The information presented is properly referenced.
C. The information is based on scientific data published in
peer-reviewed journals
D. The site includes a disclaimer.
Criterion 3: Authority
A. The authors or organizations supplying the information
are identified.
B. The authors or organizations are recognized in the field.
C. The credentials of the authors are identified.
D. The authors are writing about their discipline.
Criterion 4: Currency
A. The information presented is up-to-date.
B. The information builds on previous knowledge.
Criterion 5: Purpose
A. The purpose of the site is identified.
B. The information is appropriate for the intended purpose.
C. The intended audience is specified.
D. The source of funding for the site is identified.
Y
N
Appendix C
Guidelines
for Evaluating
Web Sites
242
Appendix C
Guidelines
for Evaluating
Web Sites
DESIGN
Y
N
Criterion 6: Organization, Structure, and Design
A. The information presented in the site is well-organized.
B. The terminology used is meaningful to the subject area.
C. The site contains a table of contents or provides an
organizational structure that makes the content easy to access.
D. The site contains specific links to data references.
E. The site contains internal search engines.
F. The document has a distinguishable header and footer.
G. The major headings and subheadings are identifiable.
H. The loading time for the site is reasonable.
I.
The site’s creation date is clearly displayed.
J.
The date of the last revision is clearly displayed.
K. The reading level and material presented is appropriate
for the intended audience.
Adapted from J. E. Kotecki, and B. E. Chamness, “A Valid Tool for Evaluating Health-Related WWW
Sites,” Journal of Health Education, Vol. 30, No. 1 (1999), 56–59.
Suggestions for rating: Tally the number of Y’s for both major categories
and rate the site by using the following scale:
Information
13–16: Credible site: convincing evidence exists
7–12: Ambivalent site: inconclusive evidence exists
0–6: Red flag site: insufficient evidence exists
Design
6–11: Accommodating site: easy to navigate
0–5: Hindering site: difficult to navigate
243
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Additional References and Resources
New resources in the field of school health have become available since the
1994 Health Framework was published. These resources provide a wealth of
information, offering guidance on curriculum development and assessment and
planning tools for developing the components of a coordinated school health
system. The references and resources that follow are organized by category.
California Healthy Kids Resource Center
The California Healthy Kids Resource Center (HKRC) is a well-established
resource for school health programs and related issues, providing up-to-date
information on assessment, research, programs, training, and laws related to
school health. Teachers, health professionals, and others who work with
students may borrow HKRC materials at no charge.
California Healthy Kids Resource Center
313 W. Winton Avenue, Room 180
Hayward, CA 94544
(510) 670-4581; FAX (510) 670-4582
<http://www.hkresources.org>
Other Agencies
The following agencies offer guidance and resources relevant to school health
programs:
Healthy Start and After-School Partnerships Program Office
California Department of Education
1430 N Street, Suite 6408
Sacramento, CA 95814
(916) 319-0923; FAX (916) 319-0221
National Association of State Boards of Education
277 South Washington Street, Suite 100
Alexandria, VA 22314
(704) 684-4000
National Institutes of Health
6601 Executive Boulevard, Room 8184
Bethesda, MD 20892
(301) 496-4000
Safe and Healthy Kids Program Office
California Department of Education
1430 N Street, Suite 6408
Sacramento, CA 95814
(916) 319-0920; FAX (916) 319-0218
250
Additional
References and
Resources
School Health Connections Office
California Department of Education
1430 N Street, Suite 6408
Sacramento, CA 95814
(916) 319-0914; FAX (916) 445-7367
Youth Education and Partnerships Office
California Department of Education
1430 N Street, Suite 6408
Sacramento, CA 95814
(916) 319-0917; FAX (916) 319-0219
Planning Tools
The Centers for Disease Control and Prevention (CDC), the National
Association of State Boards of Education, and the Council of Chief State School
Officers offer planning tools for developing coordinated school health systems.
The following documents are examples of those resources:
Bogden, J. F., and C. A. Vega-Matos. Fit, Healthy, and Ready to Learn: A School
Health Policy Guide. Alexandria, Va.: National Association of State Boards of
Education, 2000.
Guidelines for School and Community Programs to Promote Lifelong Physical Activity
Among Young People. Atlanta: Centers for Disease Control and Prevention, 1997.
Guidelines for School Health Programs to Prevent Tobacco Use and Addiction. Atlanta:
Centers for Disease Control and Prevention, 1994.
Guidelines for School Health Programs to Promote Lifelong Healthy Eating. Atlanta:
Centers for Disease Control and Prevention, 1996.
School Health Index for Physical Activity, Healthy Eating, and a Tobacco-Free Lifestyle:
A Self-Assessment and Planning Guide—Elementary School. Atlanta: Centers for
Disease Control and Prevention, 2002. Copies of this document are available at
no charge from CDC, telephone (888) 231-6405. The document can be downloaded from the CDC Web site at <http://www.cdc.gov/nccdphp/dash/SHI/
elementary.htm>.
School Health Index for Physical Activity, Healthy Eating, and a Tobacco-Free Lifestyle:
A Self-Assessment and Planning Guide—Middle School/High School. Atlanta:
Centers for Disease Control and Prevention, 2002. Copies of this document are
available at no charge from CDC, telephone (888) 231-6405. The document can
be downloaded from the CDC Web site at <http://www.cdc.gov/nccdphp/dash/SHI/
middle_high.htm>.
251
Publications
The following publications offer detailed information on coordinated school
health programs:
Getting Results, Part 1: California Action Guide to Creating Safe and Drug-Free
Schools and Communities. Sacramento: California Department of Education,
1998.
Getting Results, Part II: California Action Guide to Tobacco-Use Prevention Education.
Sacramento: California Department of Education, 2000.
Getting Results, Update 1: Positive Youth Development: Research, Commentary, and
Action. Sacramento: California Department of Education, 1999.
Getting Results, Update 2: Assessing the Effectiveness of Classroom-Based Prevention
Programs. Sacramento: California Department of Education, 2001.
Getting Results, Update 3: Alcohol, Tobacco, Other Drug Use, and Violence Prevention:
Research Update. Sacramento: California Department of Education, 2002.
Health Is Academic: A Guide to Coordinated School Health Programs. Edited by Eva
Marx, Susan Frelick Wooley, and Daphne Northrop. New York: Teachers
College Press, 1998.
This collection of essays by nationally known experts in their respective fields
helps to define the theoretical and practical aspects of coordinated school health
programs through a detailed examination of each of the eight components.
Schools and Health: Our Nation’s Investment. Edited by Diane Allensworth and
others. Washington, D.C.: National Academy Press, 1997.
This landmark report presents the findings and recommendations of the Na­
tional Academy of Science, Institute of Medicine, regarding coordinated school
health programs and systems.
Web Sites
Because many Web sites soon become outdated, only a few selected sites are
listed in this section. Each of the following Web sites is updated regularly and
contains links to other relevant Web sites:
California Center for Health Improvement’s Health Policy Coach
<http://www.healthpolicycoach.org>
California Department of Education, School Health Connections Office
<http://www.cde.ca.gov/cyfsbranch/lsp/health>
California Department of Education, Safe and Healthy Kids Program Office
<http://www.cde.ca.gov/healthykids>
California Department of Health Services
<http://www.dhs.cahwnet.gov>
California Department of Health Services, School Health Connections Office
<http://www.mch.dhs.ca.gov/programs/shc/shc.htm>
Additional
References and
Resources
252
Additional
References and
Resources
California Department of Mental Health
<http://www.dmh.cahwnet.gov>
California Healthy Kids Resource Center
<http://www.hkresources.org>
California Healthy Kids Survey
<http://www.wested.org/hks>
California School Boards Association
<http://www.csba.org>
California Student Survey
<http://www.safestate.org/index.cfm?navID=254>
California Tobacco Survey Results
<http://www.dhs.ca.gov/tobacco/documents/CTS99FinalReport.pdf>
California Youth Tobacco Survey Instrument
<http://www.dhs.ca.gov/tobacco/documents/LPEdhscyts99.pdf>
Centers for Disease Control and Prevention, Division of Adolescent
and School Health
<http://www.cdc.gov/nccdphp/dash>
Education Training Research Associates
<http://www.etr.org>
Monitoring the Future
<http://www.monitoringthefuture.org>
National Association of State Boards of Education
<http://www.nasbe.org>
National Institutes of Health
<http://www.nih.gov>
National Strategy for Suicide Prevention
<http://www.mentalhealth.org/suicideprevention>
Official California Legislative Information
<http://www.leginfo.ca.gov>
School Health Policies and Programs Study
<http://www.cdc.gov/nccdphp/dash/shpps/index.htm>
Search Institute
<http://www.search-institute.org>
Tufts University, Nutrition Navigator
<http://www.navigator.tufts.edu>
U.S. Department of Health and Human Services, Healthy
People 2010 Initiative
<http://www.healthypeople.gov>
Women, Infants, and Children Suppemental Nutrition Program
<http://www.wicworks.ca.gov>
Youth Risk Behavior Surveillance System
<http://www.cdc.gov/nccdphp/dash/yrbs>
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