“There are more skills and content than I can cover. How do I decide what to teach?”
The question above is one I am often asked as the person responsible for health and adapted/physical education in Oregon’s Portland Public Schools (PPS). And it is a fair question. PPS provides more health education than many school districts in the United States.
Students in our district receive health education every year in grades K-8 along with two required semesters in high school, with daily lessons/classes ranging from 9-18 weeks each year depending on the grade level. Yet it is still not enough to get to everything.
So how DO you decide what to teach?
Below I share four strategies our district uses to make the best use of our time with students and ensure that our health education curriculum is comprehensive and optimally relevant to their ever-changing health needs.
1. Follow State Laws, Mandates and Policies
Knowing your state’s laws and mandates and your district’s policies around health education is the best place to start. These are your non-negotiables. In Oregon, there are over 20 laws and mandates that govern and/or influence K-12 health education. Some of these are flexible, such as “all students must receive training in hands-only CPR one time between 7th and 12th grade.” Others are far more specific, covering several pages, and outlining grade-level expectations for content, knowledge, skills, time, etc.
However, your state laws and mandates, and district policies, help identify what is “tight” and what is “loose.” If you are trying to fit as much health education into a class as possible, you may have to make some tough choices. Laws and mandates tell you which choices you can/cannot make.
That said, it is important to remember that just because you are not teaching a specific drug and alcohol prevention curriculum, for example, does not mean you are not doing drug and alcohol prevention. If you are teaching lessons on mental and emotional health, then you are getting at some of the root causes for drug and alcohol use and abuse.
This is primary prevention. Too often we get hung up on the content, treating health as if it were made up of discrete categories that act independently of one another.
2. Use the National Health Education Standards
Another important tool in determining what to teach is looking to the National Health Education Standards and the National Sex Education Standards, Second Edition. These two documents provide excellent guidance.
As stated by the Centers for Disease Control and Prevention (CDC):
“Standards-based health education helps ensure curricula and instruction are designed to establish, promote, and support health-enhancing behaviors for students in all grade levels — emphasizing planned, sequential learning from pre-kindergarten through grade 12. Health education standards outline what students should know and be able to do by the end of specified grades, serving as a valuable tool for schools in selecting, designing, or revising curricula.”
As someone who has served on several state and national health education standards committees, I can say with confidence that these national standards documents are extremely valuable in guiding our work.
When considering standards, it is important to look at them horizontally (across skills) as well as vertically (across grade levels). The standards are meant to repeat and scaffold for one another across one year AND across the entire grade span.
One way our district uses the standards is to guide our decisions around prioritization of certain skills within each unit, rather than trying to cover all seven skills in every unit. For example, our fourth-grade mental and emotional health unit prioritizes Interpersonal Communication (IC) and Advocacy (ADV) — two skills that are well-aligned to the essential knowledge and developmental level of that age student. That does not mean the other skills are not also covered in the unit, but the assessments will be focused on IC and ADV.
Then in fifth grade, the mental and emotional health unit prioritizes two different skills. Our hope in doing this is that we are filtering all of the health content outlined in the standards through each of the different skills multiple times across a K-12 health education experience. The goal is to get more depth out of each unit. This allows us to focus more thoughtfully on the health education standards and ensure students are learning the skills and content.
3. Consider Best Practices in Health Education
The third strategy we use to prioritize our work is to consider research and/or theory-driven best practices in the field of health education. Best practices are identified through accessing a variety of sources. The National Health Education Standards provide a strong foundation and help set the stage for what we want students to know and be able to do.
Next we look at the SHAPE America guidance document Appropriate Practices in Health Education. Created by SHAPE America and a task force of exemplary health educators, this document lists best practices for:
- Creating a positive and inclusive learning environment that engages students in learning the skills they need to live healthy lives;
- Implementing a sequential, comprehensive curriculum — aligned with the National Health Education Standards and other relevant frameworks — that is skills-based, with an emphasis on developing health literacy;
- Employing instructional practices that engage students in learning and in developing their health-related skills;
- Using assessments that measure student growth, knowledge, and health-related skill development;
- Advocating for a positive school culture toward health and health education; and
- Maintaining high standards of practice.
We also use the Health Education Curriculum Analysis Tool (HECAT) published by the CDC. We collaborate with other districts to share problems of practice and ideas for improvement.
Finally, we draw from the field of public health, which has an important emphasis on health equity and social justice. Documents such as What Works in Schools, the Whole School, Whole Community, Whole Child (WSCC) Model, as well as publications from our state, county, and city health departments are invaluable.
4. Let the Data Guide Your Health Ed Instruction
The fourth and final piece of the puzzle is data. Data allows you to hone in on the specific needs of your community. Of all the content areas, health education has the most data available for guidance.
From formal and informal district surveys to state and federal ones such as the Youth Risk Behavior Survey (YRBS), you can identify the most important health trends facing your students. Compiling data allows you to streamline your health units by eliminating elements that are no longer relevant to your students (e.g., huffing paint) and adding in new concepts and skills (e.g., fentanyl, fake pills, Narcan).
For many of us, the amount of data we can access is overwhelming. For example, I can pull a report from our county health department which provides the number of births by age (e.g., ages 12-13, 14-15, 16-17, 18-19) each year by zip code.
It is important to identify your most valid and reliable data sources and use them to review your scope and sequence every 2-3 years. Large, standardized surveys like the YRBS can provide data on a range of health-related behaviors, while smaller, more formal/informal sources such as getting a district report on the number of suicide screenings conducted over the year, can help you focus your efforts on specific populations, regions, schools, etc. Both have value.
A word of caution about using data to drive decisions. Remember that data is not value free. Researchers decide what to ask and what not to ask and sometimes who to ask or not. They frame the questions, the structure, and how the data is collected. Thus, it is important to ensure your data cache comes from valid and reliable sources.
In addition, take the time to gather multiple data points and compare them. It is also essential to look at the systems and structures that lead to certain health behaviors and outcomes. It is not enough to identify that suicidal ideation is highest at one particular high school or within one particular population. You need to take it a step further and find out why it is higher so the prevention education you introduce has the best chance of having a positive impact.
You can do this by working with your schools and talking to teachers, counselors, social workers, students, and families.
Call to Action
While it may seem overwhelming to incorporate each of the above four steps into your scope and sequence and/or plan for the school year, it is okay to start small. Start by focusing on implementing the National Health Education Standards. The experts who come together to create the standards have engaged in all four steps already — just on a national level.
Once you feel more confident, use the other elements to individualize your state, district, school, and/or class scope and sequence. Select one unit and focus on adapting it to meet the specific needs of your students (at the district, school or classroom level). Include students in the process. Tell them what the data says about the health challenges they are facing and the health behaviors they are engaging in. Let them be your guide.
Finally, remember that health education is a complex and dynamic field. Your scope and sequence is your plan for the school year. It must be a living, breathing thing/document. The health-related issues facing students are changing constantly, and they need and deserve a curriculum that changes with them.
Jenny Withycombe, Ph.D., is the assistant director for Health and Adapted/Physical Education in Portland Public Schools in Portland, OR. She began working in education in 2003 as an elementary school teacher. Over the last 20 years she developed a passion for bringing inclusive health, wellness, physical education, and sport to young people.