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State of Maine Guidelines for Coordinating School Health Programs To View the Guidelines Preface Click Here Health Education The health of the people is really the foundation Definition Comprehensive School Health Education (CSHE) includes curriculum, instruction and assessment that is sequential from kindergarten through high school and that meets the health education standards outlined in the Maine Learning Results. CSHE addresses physical, mental, emotional, and social aspects of health, and provides knowledge and skills that promote and enhance lifelong healthy behaviors. CSHE includes ten mandated content areas:
The framework for the CSHE Guidelines is as follows:
Rationale: CSHE motivates and enables students to maintain and improve their health, prevent disease, and reduce health-related risk behaviors. As indicated in the State of Maine Learning Results (1997): Health education gives students the knowledge and skills to thrive physically, mentally, emotionally, and socially. This knowledge helps students meet the challenges of growing up. It helps students to recognize the causes of ill health and to understand the benefits of prevention, good hygiene, and appropriate medical care. Through health education, students become aware of the dimensions of good health: physical soundness and vigor; mental alertness and ability to concentrate; expressing emotions in a healthy way; resiliency; and positive relations with family and peers. Health education also includes a set of skills to help students be better consumers of information, to manage stress and conflict, and to make better decisions in the face of conflicting messages, thus assisting them to live healthier lives (p. 23). Health education is a core academic subject requiring appropriate resources and support. GUIDELINES
GUIDELINE 1: Require health education as a core academic subject. Rationale: Maine's health education standards (Maine Department of Education, 2002, Chapter 127, "Instructional Requirements and Graduation Standards" require that health education be taught every year from kindergarten through eighth grade. Chapter 127 also requires students to complete a half-credit health education course for high school graduation. Several national surveys have found that:
In addition, national studies have shown that many school constituencies strongly view health education as essential to the preparation of well-educated persons. Health status and educational achievement are linked: Healthy students learn better than unhealthy ones, and well-educated individuals are healthier on average than those with less education. Indicators:
GUIDELINE 2: Ensure that health education instruction delivered to students transmits essential health knowledge and skills as specified in the health education curriculum, and that assessment of student performance is designed to determine whether students are mastering those essential skills and knowledge. Rationale: In order for students to acquire essential health knowledge and skills as identified in the health education written curriculum, actual classroom instruction must be consistent with the curriculum. Additionally, student assessment must be directly linked to curriculum and instruction. Student assessment strategies must be carefully designed to measure whether or not students have attained the objectives specified in the curriculum. Alignment of curriculum, instruction, and assessment is sound educational practice, regardless of the subject in question. Indicator:
GUIDELINE 3: Adopt appropriate policies and provide essential resources and supports to effectively implement a high-quality health education curriculum for all students. Rationale: Health education is an essential part of a well-balanced pre-K-12 curriculum. Adequate fiscal allocations should be provided, on the same level as other core curriculum subjects, for appropriate time, space, instructional materials and appropriate teaching and support staff. An effective support system for delivering the planned health education curriculum allows for students with varying needs and abilities to achieve instructional objectives that lead to attainment of health education standards. Indicators:
GUIDELINE 4: Deliver comprehensive health education within the context of a coordinated school health program. Rationale: Health instruction received by students enhances and is enhanced by all other coordinated school health program components. A dynamic interaction between health education and the other components of the coordinated school health program contributes to and reinforces students' health and academic goals, and is critical for maximum effectiveness. Many schools offer and coordinate at least some of the components of a coordinated school health program. As the number and coordination of these components increase, so does the potential for impact on instruction and on the health status of students. Schools are encouraged to have a health coordinator and to develop school health teams of administrators, staff, family and community members. These teams contribute to the successful implementation of each program component, and to the dynamic interaction of health education with all the other components. Examples of coordination include:
Indicators:
GUIDELINE 5: Adopt a sequential, comprehensive pre-K through high school health education curriculum. Rationale: CSHE includes ten mandated content areas:
Research has shown that the comprehensiveness of a health education program is one factor in determining its effectiveness. A 1989 Harris survey of students in grades 3 through 12 found that health knowledge, attitudes, and behaviors improved with increasing numbers of years of health education instruction. The School Health Education Evaluation (Connell, et al., 1985) found that students receiving multi-year, multi-topic health instruction had higher knowledge than students with no health education instruction. Indicator:
GUIDELINE 6: Align local health education curriculum with Maine health education standards. Rationale: The Maine health education standards, outlined in the Maine Learning Results, provide school districts with the framework to develop local health education curriculum. Indicator:
GUIDELINE 7: Design health education curriculum based on recognized research-based and theory-driven criteria for effectiveness, and on identified needs of students. Rationale: The elements of effective health education include:
When developing health education curriculum, the curriculum committee should seriously consider programs that have undergone evaluation using an appropriate control or comparison group and that have evidence that they effectively address the intended behaviors. The committee may adapt such programs to the needs of the students while maintaining fidelity to the program. Before reviewing specific programs, the committee should establish criteria for making their recommendations - for example, the relative weight of scientific evidence and values. Indicator:
GUIDELINE 8: Ensure that the health education curriculum includes essential health concepts and skills. Rationale: Strong, broad-based consensus exists among school health educators as to the essential concepts and skills students should learn to be healthy for a lifetime. These essential concepts and skills are defined by the Maine Health Education Requirements, Chapter 127; by National Health Education Standards; and by federal health guidance documents such as the CDC/DASH School Health Guidelines. Indicator:
GUIDELINE 9: Follow a sequential process for curriculum development, review, and adoption. Rationale: Following a sequential curriculum development process that involves multiple stakeholders will result in approval of a health education curriculum that meets student needs and is consistent with community norms. Employing this process also generates widespread buy-in and ownership of the curriculum. Although students of a given age share many characteristics, unique aspects of a community or of individual students should be documented and taken into account when planning a health education curriculum. A group of people who know the community and are familiar with the students should gather and examine relevant information about students at the school to determine priorities for health instruction. This group can include teachers, administrators, other school health staff, community and public health professionals, medical professionals, clergy, parents, and students themselves. Needs assessment can include student surveys, information from focus groups of students and/or parents, and data from health care providers or professionals about health concerns that are seen on a regular basis. The information should not point out health problems of specific students, but rather identify trends and students' risks relative to others their age. Indicators:
GUIDELINE 10: Provide adequate instructional time, opportunity, and resources to ensure student achievement of the health education standards outlined in the Maine Learning Results. Rationale: Studies show that adequate instructional time, resources and opportunities to learn are important for mastery of essential health knowledge and skills. Gains in students' health knowledge, attitudes and skills are most apparent when students receive at least 50 hours of health education instruction in grades K-8 and a full year of health education instruction at the high school level. Adequate instructional time is necessary for students to meet the health education standards outlined in the Maine Learning Results. Indicators:
GUIDELINE 11: Provide health education instruction and classroom materials that are culturally and developmentally appropriate. Rationale: Effective health education instruction and classroom materials must be geared to the developmental needs and characteristics of students. Learning is enhanced when the physical, mental, emotional and social status of students is considered. Indicator:
GUIDELINE 12: Utilize varied and effective instructional strategies that allow students to learn essential health concepts, as well as to observe, practice, and apply health skills. Rationale: Students have a variety of learning styles; thus teachers should employ a variety of instructional methods. Students who have the opportunity to practice health-enhancing skills are more likely to utilize these skills in real-life situations than are those who receive only academic instruction. Students must learn health skills related to decision-making, communication, problem-solving, and risk reduction in order to be able to choose healthy behaviors and to sustain those choices outside of the classroom. Indicator:
GUIDELINE 13: Teach health education as a separate, unique subject, with additional reinforcement across the other academic areas. Rationale: Studies indicate that it is optimal to teach health education as a separate course of study at every grade. Health education covers greater depth and is given more instructional time in the school curriculum when it is taught as a separate course of study. Offering comprehensive health education as a separate course of study increases the likelihood of it becoming a regular part of the instructional program at each grade level. Advances in knowledge about how children and adolescents learn support the idea of providing additional connections through thematic integrations of health education within and across other content areas. Indicators:
GUIDELINE 14: Provide instruction on individual health topics within comprehensive school health education. Rationale: Comprehensive health education for pre-K-high school students has been found to be more effective in changing health behaviors than occasional programs on single health topics. Indicator:
GUIDELINE 15: Assess student achievement in health education by utilizing a variety of strategies. Rationale: Health education helps students to acquire knowledge, and to develop and apply higher-order cognitive skills. Authentic assessment in any content area, including health education, takes the form of student products, performances and portfolios, and requires a clear link to predetermined standards/indicators. Use of multiple assessment strategies allows all students to demonstrate mastery of essential health knowledge and skills in ways that are meaningful to both teacher and student. Indicator:
GUIDELINE 16: Include health education in the local assessment system. Rationale: Health education is important to the well-rounded education of the whole child. The Maine Learning Results designates health education as one of the academic areas that must be taught and assessed in all public schools, regardless of resources. In 2001, the Maine Legislature enacted Title 20-A (MRSA Chapter 222), which requires that by the end of the 2003-2004 school year the locally established assessment system must be fully implemented as the measure of progress for health and physical education and other areas. By 2006-2007, students must achieve the standards described in the Learning Results in the areas of English language arts, health and physical education, mathematics, science and technology, and social studies in order to graduate from high school. Indicators:
GUIDELINE 17: Evaluate health education programs by systematically conducting a process evaluation to determine the extent to which teachers are delivering health education, and utilize state and local assessment scores to determine program effectiveness. Rationale: Process evaluation of health education should be routinely conducted to determine that the instruction delivered to students is consistent with the planned curriculum, and that the curriculum is aligned to the Maine health education standards. If inconsistencies are found, actions should be taken to identify and rectify barriers to curriculum implementation (e.g., unavailability of resources, lack of time, inadequate teacher preparation, etc.). Student assessment may demonstrate that students have not achieved specified learning objectives or attained health education standards. One reason for this lack of achievement may be that the health education instruction the students received was not consistent with the learning outcomes specified in the written curriculum. The only way to determine if curriculum implementation is a factor in low student achievement is to conduct routine process evaluation. The state and local assessment systems provide valuable data on student achievement of the health education standards, and is useful in determining program strengths and weaknesses. Indicator:
GUIDELINE 18: Participate in statewide assessments of student health knowledge and skills. Rationale: In addition to established standards in health education, state-level assessment establishes benchmarks and indicators to monitor progress on program effectiveness and student achievement. This assessment can assist policy makers in making decisions about use of resources, the effectiveness and efficiency of schools, and support of local actions. State, district and school-level data can be used by local education agencies in their local planning efforts. Indicators:
GUIDELINE 19: Employ elementary-level teachers who have completed one or more academic courses addressing the content and methods unique to health education at the elementary level as a part of their pre-service training. Rationale: Through national surveys, lack of teacher training has been identified as one of the most significant barriers to effective implementation of school health education at the elementary level. In order to be knowledgeable and comfortable with the health education curriculum, elementary teachers should be adequately prepared through appropriate course work. In order to be endorsed in Maine, elementary teachers are required to have a minimum of 12 semester hours to include all of the following: mathematics, reading, science/health, and social studies. Principals and school districts should seek to hire elementary educators who are prepared to teach health education. Elementary classroom teachers help lay the foundation for good health behaviors and practices in children. Elementary teachers that have a minor or major emphasis in health education in their pre-service education can provide expertise to other teachers in their grade and/or school. Indicator:
GUIDELINE 20: Employ middle-school teachers with primary responsibility for health education who have academic preparation addressing the content and methods unique to health education at the middle-school level, and who meet state certification requirements for health education. Rationale: Due to the complex and dynamic nature of health education and the unique developmental issues of the middle-level child, it is preferable for middle-school health teachers to have a major in health education. Individuals providing health education instruction at the middle-school or junior high-school level should have completed a formal major in health education from an accredited program, and hold the appropriate state certification to teach health education. Indicator:
GUIDELINE 21: Employ high-school teachers who have completed a formal major in health education from an accredited program and hold the appropriate state certification to teach health education. Rationale: Highly sophisticated knowledge and skills are required to educate today's high-school students about health. The current health problems and emerging health trends require schools to employ teachers who can adequately prepare high-school graduates to make complex health-related decisions. The expectation of teachers at the high-school level is that they will be content specialists in their subject area. State certification, which is required to teach high-school health education, ensures that these teachers have met requirements that validate their knowledge and skills. Indicator:
GUIDELINE 22: Offer opportunities for continuing professional development activities that address content, methods, and contemporary issues unique to health instruction. Rationale: Teachers who regularly participate in professional development activities are more likely to be effective health educators than those who do not. Continuing education is essential for teachers who provide health education instruction. It is important to assess and address teacher needs, especially for elementary teachers who may have had little pre-service training in the area of health education. Health education teachers should participate in a variety of health-related professional development activities; join relevant local, state, and national professional organizations; and engage in activities such as study groups, action research, and in-service and mentoring programs. Health education specialists are required to participate in relevant continuing education to maintain their teaching certificates. Indicators:
Maine Resources and Contacts Asthma Management and Control
Family Life Education
HIV Prevention Education
Health Education
Oral Health
Life Skills Training/Tobacco Use Prevention Education K-12
STD Prevention Education/STD Treatment & Follow-up
Safety Works Program/Workplace Safety and Health
Resources and References Allensworth, D. (1994) The research base for innovative practices in school health education at the secondary level. Journal of School Health, 64 (5). Allensworth, D. (1993) Health education: State of the art. Journal of School Health, 63 (1). American Academy of Family Physicians. (1999-2000) Policy statement on health education in schools. In AAFP Reference Manual. Leawood, KA: American Academy of Family Physicians. American Academy of Pediatrics. (2001) Health, Mental Health and Safety in School: National Guidelines. Chicago: AAP. American Association for Health Education. (1999) Responsibilities and competencies for teachers of young adolescents. American Association for Health Education, Board of Directors. (2000) AAHE position statement on comprehensive school health education. American Cancer Society. (1992) National action plan for comprehensive school health education. American School Health Association. (1994) Guidelines for comprehensive school health programs. Ames, Trucan, Wan and Harris (1992). Planning for School Health. New York: William C. Brown, Publishers. Birch, D.A. (1996) Step by Step to Involving Parents in Health Education. Santa Cruz, CA: ETR Associates. Bogden, J.F. and Vega-Matos, C.A. (2000) Fit, Healthy and Ready to Learn. Alexandria, VA: National Association of State Boards of Education. Caine, R.N. and Caine, G. (1991) Making Connections: Teaching and the Human Brain. Arlington, VA: Association for Supervision and Curriculum Development. Carlyon, P.; Carlyon, W.; and McCarthy, A.R. (1998) Family and community involvement in school health. In E. Marx & S.F. Wooley, eds., Health is Academic: A Guide to Coordinated School Health Programs. New York: Teachers' College Press. Centers for Disease Control and Prevention. (2000) School Health Index—Middle School/High School. Atlanta, GA: Department of Health and Human Services, Public Health Service. Centers for Disease Control and Prevention. (1997) Guidelines for school and community programs to promote lifelong physical activity among young people. Morbidity and Mortality Weekly Report, 46 (RR-6). Centers for Disease Control and Prevention. (1996) Guidelines for school health programs to promote lifelong healthy eating. Morbidity and Mortality Weekly Report, 45 (RR-9). Centers for Disease Control and Prevention. (1994) Guidelines for school health programs to prevent tobacco use and addiction. Morbidity and Mortality Weekly Report, 43 (RR-2). Collins, J.L.; Small, M.L.; Kann, L.; Pateman, B.C.; Gold, R.S.; and Kolbe, L.K. (1995) School health education. Journal of School Health, 65(8). Connell, D.B.; Turner, R.R.; and Mason, E.F. (1985) Summary of findings of the school health education evaluation: Health promotion effectiveness, implementation and cost. Journal of School Health, 55 (8). Council of Chief State School Officers. (1998) Incorporating health-related indicators in education accountability systems. Drolet, J.C., and Fetro, J.V. (1991) State conference for school worksite wellness: A synthesis of research and evaluation. Journal of Health Education, 61. Dryfoos, J. (1994) Full Service Schools. San Francisco, CA: Jossey-Bass. Dusenbury, L., and Falco., M. (1995) Eleven components of effective drug abuse prevention curricula. Journal of School Health, 65(10). Dusenbury, L.; Falco, M.; Lake, A.; Brannigan, R.; and Bosworth, K. (1997) Nine critical elements of promising violence prevention programs. Journal of School Health 67(10). Ferrara, S., and McTighe, J. (1992) Assessment: A thoughtful process. In A. Costa, J. Bellanca, and R. Fogarty, eds., If Minds Matter: A Foreword to the Future. Palatine, IL: Skylight. Fetro, J. (2000) Personal and Social Skills. Santa Cruz, CA: ETR Associates. Gallup Organization. (1994) Values and Opinions of Comprehensive School Health Education in U.S. Public Schools: Adolescents, Parents, and School District Administrators. Atlanta, GA: American Cancer Society. Gilbert, G., and Sawyer, R. (2000) Health Education: Creating Strategies for School and Community Health. Boston, MA: Jones and Bartlett. Harris, L. (1988) An Evaluation of Comprehensive Health Education in American Public Schools. New York: Metropolitan Life Foundation. Hendeson, A., and Rowe, D. G. (1998) A healthy school environment. In E. Marx and S. F. Wooley, eds., Health is Academic: A Guide to Coordinated School Health Programs. New York: Teachers' College Press. Joint Committee on National Health Education Standards. (1995) National Health Education Standards: Achieving health literacy. Atlanta, GA: American Cancer Society. Joyce, B. R., and Calhoun, E. F. (1996) Creating Learning Experiences. The Role of Instructional Theory and Research. Alexandria, VA: Association for Supervision and Curriculum Development. Kirby, D.; Short, L.; Collins, J.; Rugg, D; Kolbe, L.; Howard, M.; Miller, B.; Sonenstein, F.; and Zabin, L. (1994) School-based programs to reduce sexual risk behaviors: Review of the effectiveness. Public Health Reports, 109(3). Kolbe, L. J. (1994) An essential strategy to improve the health and education of Americans. In P. Cortese and K. Middleton, eds., The Comprehensive School Health Challenge: Promoting Health through Education, Vol. 2. Santa Cruz, CA: ETR Associates. Lohrmann, D. (1993) Overview of curriculum design and implementation. In B. S. Mahoney and L. K. Olsen, eds., Health Education Teacher Resource Handbook. Millwood, NY: Krause International Publications. Lohrmann, D., and Wooley, S. (1998) Comprehensive school health education. In E. Marx and S. Wooley, eds., Health is Academic: A Guide to Coordinated School Health Programs. New York: Teachers' College Press. Maine Department of Education. (2001) Instructional program, assessment and secondary school diploma requirements. Maine Department of Education. (1997) State of Maine Learning Results. Augusta, ME: Maine Department of Education. Maine Department of Education. (2000) Steps for designing, coordinating and managing health education curriculum, instruction and assessment. Marx, E., and Northrop, D. (1995) Educating for Health: A Guide to Implementing a Comprehensive Approach to School Health Education. Newton, MA: Education Development Center, Inc. Marzano, R.; Kendall, J.; and Cicchinelli, L. (1999) What Americans Believe Students Should Know: A Survey of U.S. Adults. Aurora, CO: Mid-Continent Regional Educational Laboratory. National Association of School Nurses. (1993) School Nursing Practices, Roles and Standards. Scarborough, ME: NASN. National Education Association. (1995) The National Education Goals Report. National Parent Teacher Association. (1997) National Standards for Parent/Family Involvement Programs. Chicago, IL: PTA. National Parent Teacher Association. (1987) National PTA Position Statement on Comprehensive School Health Education. Chicago, IL: PTA. Roeber, E. (1992) Developing the comprehensive assessment system: A. top down, B. bottom up, C. both, D. none of the above. Paper presented at the 1992 Education Commission of the States Conference on Large-Scale Assessment. Seffrin, J. R. (1990) The comprehensive school health curriculum: Closing the gap between state-of-the-art and state-of-the-practice. Journal of School Health 60 (4). Spinelli, C. G. (1998) Teacher education reform: Promoting interactive teaching strategies and authentic assessment for instructing an increasingly diverse population of students. Position paper. ERIC ED418076. Taylor, L., and Adelman, H. (2000) Toward ending the marginalization and fragmentation of mental health in schools. Journal of School Health, 70(5). Wiggins, G. (1998) Educative Assessment: Designing Assessments to Inform and Improve Performance. San Francisco, CA: Jossey-Bass. Wiggins, G., and McTighe, J. (1998) Understanding by Design. Alexandria, VA: Association for Supervision and Curriculum Development. Wilbur, K.M. (1994) Categorical funding in a comprehensive world. In P. Cortese and K. Middleton, eds., The Comprehensive School Health Challenge: Promoting Health through Education, Vol. 2.Santa Cruz, CA: ETR Associates. Windsor, R.; Baranowski, T.; Clark, N.; and Cutter, G. (1994) Evaluation of Health Promotion, Health Education, and Disease Prevention Programs (2nd ed). Mountain View, CA: Mayfield Publishing Company. To download a print copy of the Health Education section of the Guidelines, you must have Adobe Acrobat Reader software on your computer. Click the yellow icon to go to the Adobe web site for a free copy.
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