Health Education Focus Group Report - California Department Of Education

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Health Education FocusGroup Report A Summary of Oral Comments Received at the November 2016 Health EducationFocus Group Meetings and a Compilation of Written Comments Received in Novemberand December 2016 Regarding the 2019 Revision of the Health Education Frameworkfor California Public Schools, Kindergarten Through Grade Twelve California Department of Education January 2017 Page 1 of 85

Table of ContentsIntroduction . 4Health Focus Group Discussion Questions . 5Summary Report of Oral Comments . 6A report of the oral comments reorganized to emphasize comments that were offered bymultiple focus group members at more than one focus group meeting.Oral Comments (By Focus Group Meeting) . 8This section provides a summary of the oral comments made by focus groupmembers and members of the public at the four focus group meetings. The oralcomments made by members of the public are briefly summarized in table formatfollowing the notes from each focus group meeting. Focus Group 1: November 1, 2016: Tulare County Office of Education, Visalia Focus Group 2: November 7, 2016, Sacramento County Office of Education,Sacramento, and via videoconference at Siskiyou and Butte County Offices ofEducation Focus Group 3: November 15, 2016, Alameda County Office of Education,Hayward Focus Group 4: November 29, 2016, Long Beach Unified School District, LongBeachWritten Comments Submitted by Focus Group Members and Members of thePublic . 43This section of the report is a compilation of written comments received in Novemberand December 2016. Focus group members, educators, members of the public, andstakeholder organizations were invited to submit written comments on the discussionquestions or the framework revision in general. Written comments submitted inconjunction with a focus group meeting are presented in the order of the meeting atwhich they were received. There were no written comments submitted in conjunctionwith the Alameda County Office of Education focus group meeting. Other writtencomments are presented by date received. The written comments are unedited,though the formatting has been altered for consistency and Web accessibility andpersonal contact information has been removed. Any errors are those of the authors. Focus Group 1: November 1, 2016: Tulare County Office of Education, VisaliaCalifornia Department of EducationJanuary 2017Page 2 of 85

Focus Group 2: November 7, 2016, Sacramento County Office of Education,Sacramento, and via videoconference at Siskiyou and Butte County Offices ofEducation Focus Group 4: November 29, 2016, Long Beach Unified School District, LongBeach Additional Written Comments ReceivedCalifornia Department of EducationJanuary 2017Page 3 of 85

IntroductionAs part of the process for revising curriculum frameworks, the California Code ofRegulations, Title 5, Section 9511(c) requires the California Department of Education(CDE) to convene four public focus groups of educators in different regions of Californiato provide comment to the Instructional Quality Commission, Curriculum Frameworkand Criteria Evaluation Committee, and State Board of Education. The HealthEducation Focus Group Report encapsulates the comments from the focus groupmeetings and serves as a starting point for the 2019 revision of the Health EducationFramework for California Public Schools, Kindergarten Through Grade Twelve (HealthEducation Framework).The report begins with this introduction followed by the list of discussion questions thatserved as the basis for the focus group discussion and the oral and written comments.Beginning on page 6, the report is divided into three sections. The first section is asummary of the oral comments reorganized to emphasize comments that were offered bymultiple focus group members at more than one focus group meeting. The second sectioncontains a summary of all oral comments made at the each of the focus group meetingsby both focus group members and members of the public. The third section of the report isa compilation of written comments received from focus group members and members ofthe public in November and December 2016.The focus group meetings were held on the following dates in the following locations: Focus Group 1: November 1, 2016: Tulare County Office of Education, Visalia Focus Group 2: November 7, 2016, Sacramento County Office of Education,Sacramento, and via videoconference at Siskiyou and Butte County Offices ofEducation Focus Group 3: November 15, 2016, Alameda County Office of Education,Hayward Focus Group 4: November 29, 2016, Long Beach Unified School District, LongBeachAll of the meetings were video recorded, and copies of those recordings are availablefrom the CDE upon request.California Department of EducationJanuary 2017Page 4 of 85

Health Education Focus Group Discussion QuestionsThe discussion questions were sent to all focus group members prior to the meetingsand were posted on the CDE Web page for public review. With a minimum amount oftime available for discussion at each of the meetings (about two hours), the questionswere crafted around major instructional and content shifts that will need to beincorporated into the new Health Education Framework. For example, the questionsguided the members of the focus groups and the public to provide insights andexamples regarding how to incorporate the health-enhancing behavior skills that areemphasized in the state-adopted content standards for health education and supportimplementation of recent state statutes related to health education and inclusivecurriculum and instruction.Preface: Two of the primary goals for health education are to improve health literacy forall students and to help every student develop and maintain a healthy lifestyle.Discussion on the following questions will ensure that the Health Education Frameworkfor California Public Schools: Kindergarten Through Grade Twelve supports thosegoals.1. How can the framework support instruction that provides students opportunities tolearn health education content and practice health-enhancing skills? Whatinformation should be included in an introductory chapter focusing on effectiveinstruction of health-enhancing skills?2. What guidance do teachers need to provide inclusive health education for allstudents, regardless of disability, gender, gender identity, gender expression,sexual orientation, nationality, race, ethnicity, language proficiency level, religion,socio-economic status, or living situation?3. How can the framework support effective student assessment using a variety ofassessment types, including assessment of health-enhancing behavioral skills?4. What guidance do school and district administrators need to fully support healtheducation and eliminate some of the barriers to health education instruction?5. One chapter of the Health Education Framework will consist of the evaluationcriteria for the next adoption of health education instructional materials for studentsin kindergarten through grade eight. What should the criteria require to ensure thatinstructional materials meet the needs of all California’s students and theirteachers?6. Finally, what other recommendations do you have to ensure that the HealthEducation Framework is a useful tool for California’s educators?California Department of EducationJanuary 2017Page 5 of 85

Summary Report of Oral CommentsThis summary is a condensed report of the oral comments that were offered by multiplefocus group members at more than one focus group meeting. Several themes andtopics emerged from the focus group discussions regarding what information should beincluded in the revised framework for health education.Health Education OverviewAt the beginning of the framework, there should be an explanation of how the standardsare organized, including the numbering system for identifying standards, and theessential connection between content knowledge and skills. The explanation shouldclarify the eight overarching standards and note their connections to skills in standardsin other content areas. The framework should provide a definition of health literacy,explain what health education is and what it should look like in the classroom, and makea case for the importance of health education. The goals of health education, asenvisioned in the health education standards, are for students to become health literate,make health-enhancing choices, and avoid risky behaviors. The framework should pointout that the skills in the health education standards are transferable to other schoolsubjects and apply to real-life situations.A Practical ToolThe framework should be a practical tool for teachers. It should be easy to read, notoverwhelming in length, free of jargon, and accessible for teachers who are not healtheducators. There should be many real-life examples for instruction in which the contentand the skills are woven together. The examples should focus on students’ behavior tohelp students develop health-enhancing skills and provide opportunities to practice skillsso that students can make healthy choices. The examples should be useful and teacherfriendly.Instructional SupportThe framework should provide guidance to teachers on developing lessons that areskills-focused, not just content. It should help teachers link health education to othersubject areas for an interdisciplinary approach. Teachers also want strategies fordifferentiating instruction to meet the needs of all students, including students withdisabilities and English learners. The framework should help teachers recognize andaddress personal biases, their own and those of their students, and create an inclusiveclassroom that is safe and supportive for all students, including lesbian, gay, bisexual,transgender, and questioning (LGBTQ) students. It should address the use of languageto help teachers model using inclusive language.The framework should provide considerable support for instruction in comprehensivesexual health that meets the requirements of the California Healthy Youth Act(Education Code sections 51930 to 51939), which mandates instruction at least once inmiddle school and once in high school. Because this instruction may not be provided bya credentialed health educator, the framework should help teachers identify resourcesCalifornia Department of EducationJanuary 2017Page 6 of 85

for medically accurate and age-appropriate information that is inclusive. The frameworkshould include examples that are gender and culturally inclusive and emphasize healthyrelationships.AssessmentThe framework should provide examples of many types of assessments. Assessment ofhealth education should focus on the skills in the standards, not just the content. Theframework should help teachers develop assessments that allow for multiple ways forstudents to demonstrate what they have learned. There should be ideas for student selfassessment and projects, skits, presentations, and other non-paper-and-pencilassessments.Administrative and Community SupportThe lack of administrative support is a barrier to health education that the frameworkshould address. The framework should stress the importance of professionaldevelopment for both teachers and administrators. It should help teachers andadministrators advocate for health education and the resources (e.g., instructional timein the classroom, funding for supplies, current instructional materials) to providecomprehensive and effective health education. The framework should offer guidance forteachers and administrators on how to talk with parents/community members regardingpotentially controversial topics in health education. The framework should also expressthe importance of having local policies and procedures related to health education andensuring that all school personnel are aware of services and resources to whichstudents can be referred.California Department of EducationJanuary 2017Page 7 of 85

Oral CommentsFocus Group 1: Tulare County Office of EducationFocus Group Members Present:NameAffiliationDavid RodgersEmily KuizengaHarriet HugginsNicole JohnsonRobert DanielSusan Killmer GabinTeri KahnTerri LindseyVisalia Unified School DistrictCentral Unified School DistrictClovis Unified School DistrictLucia Mar Unified School DistrictAntelope Valley Union High SchoolKern High School DistrictTehachapi Unified School DistrictLemoore Union Elementary School DistrictFocus Group Discussion Notes:Question 1How can the framework support instruction that provides students opportunities to learnhealth education content and practice health-enhancing skills? What information shouldbe included in an introductory chapter focusing on effective instruction of healthenhancing skills? The framework should be general enough to allow teachers to use their ownexpertise and knowledge of the local demographics and needs. Health educationshould change behaviors that are leading to shortened lives. Revise the list ofdiseases to include new diseases, such as Zika and West Nile.The framework should support continual self-assessments for students and givethem the confidence to be health literate.The framework should address how to decrease risk behavior and include howhealth education impacts student achievement.The framework should include a little reminder section for teachers on what tothink about, such as checking your own personal bias.Teachers want more specifics, less generalities. The framework should set thetone early on challenging topics, pretests, difficult or embarrassing topics; letthem know what’s coming. Also, it should have a guide to local resources andwhere to go for more assistance beyond the framework. It should mentionpersonal assessments for students, such as food logs and activity logs.The cognitive ability of students should be kept in mind.California Department of EducationJanuary 2017Page 8 of 85

It should help teachers focus on current health issues in their community. Theframework should express the difficulty of assessment of life skills versus mathskills and provide guidance to teachers.The framework should talk about how topics, such as decision making, areaddressed differently across grade and age levels. There needs to be scientificevidence for the information in the framework.Question 2What guidance do teachers need to provide inclusive health education for all students,regardless of disability, gender, gender identity, gender expression, sexual orientation,nationality, race, ethnicity, language proficiency level, religion, socioeconomic status, orliving situation? The framework needs to include information on what is legal—what you can andcannot say in the classroom. The framework should recommend thatprofessional teaching be done by professionals, in both certification andattitude/behavior.Teachers may need some specific topic education, especially on sexualorientation, gender identity, and even religion. They need to know how to workwith students in the various groups. The framework should include suggestionson how to introduce certain difficult topics.The framework should provide guidance on how to handle difficult questions,legal mandates, and help for how to work with parents.Teachers need guidance on how to handle their communities (conservativeversus liberal). (This comment was echoed by three other focus groupmembers.) They also need information on how to introduce difficult subjects.The framework should offer guidance that districts need to coordinate healthinstruction. A certificated person with the appropriate background and trainingshould provide training. This is usually only a semester course, so it needs to begood.Teachers need ongoing professional development on such topics as non-biasedlanguage and open communication with students and parents.The framework should include guidance for elementary teachers who do notreceive training on health education and ways that teachers can integrate healtheducation into other content areas because there is too little time to teach healtheducation well.The framework should impress upon folks that teachers need to collaborate.Question 3How can the framework support effective student assessment using a variety ofassessment types, including assessment of health-enhancing behavioral skills? The framework should include information on informal assessments, such asobservation and demonstration of skills; clarify what skill is expected at whatCalifornia Department of EducationJanuary 2017Page 9 of 85

grade level; and include ideas for writing prompts and some summativeassessments as well.Teachers need guidance on developing their own lessons and assessments thatare dependent upon the lessons.The framework should discuss pre- and post-assessments and interactive lifeskills with technology or lifestyle projects. Health education should be added tothe state testing system.Teachers want to create their own curriculum but need to start from somewhere,so give them ideas about how a student could show knowledge of a standard inmultiple ways.Tests do not always need to be multiple choice. Projects, writing, labs, anddrawings are all good. We need more than the old way of assessing students.Extended responses are a good way to assess learning styles of students.Health teachers really need to know the topic they are assessing.Some examples of assessing life skills are: Do’s and Don’ts skits, activities atchoosemyplate.gov, and having students design recipes and menus from theirown family history/culture with the appropriate identification of nutrition and foodgroups.Observe student behavior to assess their learning.Question 4What guidance do school and district administrators need to fully support healtheducation and eliminate some of the barriers to health education instruction? There should be as much professional development for administrators as wesuggest for teachers. Administrators lag behind teachers in terms of contentknowledge and how to work with parents to support the teachers.The framework should make the state and federal law clear to administrators,including what they must provide to students and schools (comprehensive sexualhealth, HIV/AIDS education, etc.) and what is and is not appropriate curriculum.The administrators need to be able to speak with parents.They should know what kinds of questions would be coming from parents andwhen parents can “opt out” their children.Administrators need to know about the new sexual health laws. Administratorschange schools/districts more than teachers, and they often do not know whatlocal board policies are in place. The framework should note that the local boardshould hold professional development on policies for administrators.There should be a discussion of the local control accountability plan’s impact onhealth education.The framework should promote the importance of health education.Administrators cut health instructional time, such as telling teachers to teach afour-lesson topic in two lessons to allow time for other things.California Department of EducationJanuary 2017Page 10 of 85

Question 5One chapter of the Health Education Framework will consist of the evaluation criteria forthe next adoption of health education instructional materials for students in kindergartenthrough grade eight. What should the criteria require to ensure that instructionalmaterials meet the needs of all California’s students and their teachers? The instructional materials should have age-appropriate text and images.The scope and sequence should be logical (e.g., start with body parts beforedifferent types of families).The instructional materials should include cross-curricular activities such as:math (body mass index) with health education (food map), the history ofdiseases, nutrition and fitness connected to physical education, and writing abouthealthy living (English language arts).The Positive Prevention curriculum is good but lacks engagement activities.Instructional materials should include writing, inquiry, and collaboration in theactivities.Address special populations and special education in the materials.Have materials updated often (not every six years) because topics changequickly.The materials should include multiple media (print, audio, tactile) and includelinks to technology-based information.Question 6Finally, what other recommendations do you have to ensure that the Health EducationFramework is a useful tool for California’s educators? Include current issues in student health, such as vaccinations, sex trafficking,texting and driving, sexting.Public health issues should be discussed to establish a link between the healtheducation topics and how public health issues impact lives.Mental health and social/emotional health do not have enough professionaldevelopment, so the framework should call that out. Use wording teachers arefamiliar with.The framework should offer ideas about who at the school/district can help you(by position, e.g., school nurse, school phycologist, nutrition staff).Describe different types of abuses: bullying, emotional, physical, psychological.There should be a central point of information from the framework on one Website so folks are on the same page.California Department of EducationJanuary 2017Page 11 of 85

Public comment:NamePhoebeCoppAffiliationDairy Council ofCaliforniaKatia ClarkConcerned mom, ACTJenniferChouAttorney, Fresno office ofthe American CivilLiberties UnionSalvadorCazarezVisalia Unified SchoolDistrictCalifornia Department of EducationSummary of CommentsThe framework should support student selfefficacy to change behavior. Students needto practice skills and their instruction shouldinclude performance tasks. Nutritioneducation should be an integral part of acomprehensive health education program.Social determinants of health should beaddressed.The difference between here and SanFrancisco is that the kids in San Franciscohave access to information, condoms, etc.We need to understand our kids will leavethis conservative area and go out into theworld, and they should be prepared. Localstatistics on teen pregnancy and sexuallytransmitted diseases are extremely high.Regarding the California Healthy Kids Act,some districts need help implementing thelaw, specifically with understanding the lawaround sexual health education programs.Sexual health information helps studentsmake healthy decisions. Instruction must bemedically accurate. The framework shouldbe a vehicle for disseminating thisinformation and promoting professionaldevelopment on this topic. Communitiesneed quality sexual health educationprograms. The CDE and SBE should be theleaders of this effort.Flexibility can also be a detriment. Flexibilitycan lead to inequality as some communitiesare more willing to discuss and teach sometopics that others. This is about socialjustice, not just health education. Allprofessional development is not createdequal either. Professional developmentneeds to be high-quality and provided by anexpert or do not do it. Poor professionaldevelopment can make teaching worse. Theinformation and material need to becomfortable for the students, not theJanuary 2017Page 12 of 85

NameAffiliationDavidFresno Barrios UnidosBouttavongCatyWagnerSequoia CommunityAdvocatesAmeliaWartherMom of a ten-year-old girland a sonMerrilynBradyRetired public healthprofessional and schoolhealth nurse, Alliance forTeen HealthCalifornia Department of EducationSummary of Commentsparents. The curriculum needs to be in thebest interest of students.In his area, sexual health is taught throughbiology classes. The local school district andthe non-profit each provide about half of theinstruction using Positive Prevention Plus.Being inclusive of all students is important.The information needs to be unbiased andscience-based. Lesbian, gay, bisexual, andtransgender students need to seethemselves the textbooks and images.There are accurate resources available. TheAmerican Civil Liberties Union (ACLU)toolkit is a great resource. Tulare is differentfrom other counties. Tulare county has morelesbian, gay, bisexual and transgenderfamilies than any other county in California.Assessments are out there, we need to findthe good ones that tell us if instruction isworking. Sexually transmitted infections andsexually transmitted diseases (STDs) arespiking here. Super-STDs are a growingproblem.Sexual health education is important toyouth. The comparison [between Tulare andSan Francisco counties] is not fair. Tularehas the highest rate of teen pregnanciesand STDs. It’s because we are tooconservative. Do not allow flexibility – makethem teach what the law demands under theHealthy Youth Act.I was born and raised here and never left.We hide behind the label of conservativecounty. If we conduct a survey we wouldlearn that we are not that conservative. Toooften we hear the cry of the right-to-lifegroups and not their opposition. Sexualhealth is the most important health topic toteach. These are the formative years to getthis information to people. Visalia UnifiedSchool District has a Health AdvisoryCommittee. We must use the health-riskassessment survey [Healthy Kids Survey] toinfluence our teaching. The informationJanuary 2017Page 13 of 85

NameAffiliationDavidRogersFocus Group Member,Visalia Unified SchoolDistrictCalifornia Department of EducationSummary of Commentsprovided is inconsistent even within thecounty.We want to teach more [comprehensivesexual health], not less. The flexibility is todo more, not less instruction. I urge themembers of the public to please go to theboard meetings and say what you saidtoday in support of comprehensive sexualhealth instruction.January 2017Page 14 of 85

Focus Group 2: Sacramento County Office of Education and viavideoconference at Siskiyou and Butte County Offices of EducationFocus Group Members Present:NameAffiliationSandra AzevedoMartie HagartyDiane LampeKimberly WaldenLora JonesNancy MidlinRoberto GantzButte County Office of EducationSiskiyou County Office of EducationSacramento County Office of EducationTwin Rivers Unified School DistrictSacramento County Unified School DistrictOakland Unified School DistrictStockton Unified School DistrictFocus Group Discussion Notes:Question 1How can the framework support instruction that provides students opportunities to learnhealth education content and practice health-enhancing skills? What information shouldbe included in an introductory chapter focusing on effective instruction of healthenhancing skills? I would like to see the integration of the other standards (e.g., math, science,physical education).I would like to see in the introduction chapter more public and community healtheducation in our school system. There is an impending disaster of antibioticresistance. We need the kind of coursework that will develop a greaterknowledge base for our students.I would like to also encourage the integration of health into other subjects, as isage appropriate. The framework should stress the awareness of personalresponsibility of all aspects of one’s health, including self-care. We need to helpreduce the stigma of mental health issues.The framework should have connections to common core standards. Healtheducation must be more than just the content but have application to students’lives. There should be a focus on decision-making skills and how to applycontent to decision making.The framework should introduce ideas for developing skills to make healthychoices. It would be nice to have a self-assessment and have students evaluatethemselves to see where they are in the range of skills and behaviors and revisitit often.California Department of EducationJanuary 2017Page 15 of 85

Health education should address the problem that while the CA Heathy Kidssurvey indicates youth understand risky behaviors, they do not know how toavoid the risks of unhealthy behaviors.Start with an emphasis on active learning. Kids need to have the opportunity topractice skills to maintain healthy lifestyles.The framework could potentially have something about brain plasticity and theimportant connections between mental and physical health.Question 2What guidance do teachers need to provide inclusive health education for all students,regardless of disability, gender, gender identity, gender expression, sexual orientation,nationality, race, ethnicity, language proficiency level, religion, socio-economic status, orliving situation? It is important to get up-to-date information and training for teachers who areteaching the curriculum. A lack of understanding could impact teaching.Teachers need to be well-formed.Teachers need ongoing professional development. There needs to be a hardlook at our own bias and the need to address the needs of all students.School culture needs to embrace all diversity. Students need to feel valued by alladults and that they are an essential part of their school. Students should beseen as global citizens.The framework should support ongoing professional development and providelinks to up-to-date resources and training in a central location.It would be helpful to understand the current laws and current court decisions toupdate school/district policies.Personal biases and cultural differences need a focus. Teachers need to knowthe local resources available. They need to know when to refer students foradditional support and services.The framework should include topics such as cultural sensitivity for educators,information on universal design for learning to make sure tha

explain what health education is and what it should look like in the classroom, and make a case for the importance of health education. The goals of health education, as envisioned in the health education standards, are for students to become health literate, make health-enhancing choices, and avoid risky behaviors. The framework should point

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