ERIC EJ887090: The Impact of Professional Development to Infuse Health and Reading in Elementary Schools

2010·0.32 MB·English

by  ERIC

Research Article
the impact of professional Development
to infuse Health and reading in elementary schools
Tami Benham Deal, Jayne M. Jenkins, Laurence O. Deal, and Adelle Byra
ABSTRACT
Background: Elementary classroom teachers must overcome a number of instructional barriers, including time
constraints and professional preparation, if they are to deliver effective health education and enhance health literacy
among youth. Purpose: This study examined the direct impact of a long-term professional development program on
integrating health education and literacy instruction on third-grade teachers’ confidence and practice and its indirect
effect on student learning. Methods: Data on confidence and implementation of instructional and assessment practices
were collected from 16 teachers. Students (n=99) from their classrooms and from four comparison classrooms (n=101)
completed pre- and post-program constructed response assessment. Results: Significant increases were seen in teachers’
confidence in describing health education standards, determining if students achieved the standards and using rubrics
to guide scoring practices. Children’s books were used to integrate instruction and most teachers increased the time
spent on integration activities. Students in their classrooms scored significantly higher than students in comparison
classrooms on health knowledge and skills. Discussion: These results confirm our belief that by increasing awareness
and understanding of standards-based health education and assessment, and by showing teachers how they can use
children’s books as the context for teaching and reinforcing health concepts and skills outlined in the standards, their
confidence about teaching health can increase. Translation to Health Education Practice: Integrating health and
language arts instruction may be the key to overcoming some of the factors teachers report as barriers to teaching
health education.
Deal TB, Jenkins JM, Deal LO, Byra A. The impact of professional development to infuse health and reading in elementary schools. Am
J Health Educ. 2010;41(3):155-166. This paper was submitted to the Journal on July 15, 2009, revised and accepted for publication on
September 29, 2009.
BACKGrounD were revised in 2007 and whereas the title states either require or encourage schools
One of the desired outcomes of health of the document was changed to Achiev- and districts to follow health education
education is to increase students’ health ing Excellence,7 the essence of the standards standards or guidelines based on the NHES.
literacy so they have the capacity to navigate has remained the same.) Results from the At the elementary level, most states (70.6%)
the numerous health challenges they will 2006 School Health Policies and Programs reported they have adopted goals, objectives
face in the 21st century. Experts across the Study (SHHPS)8 showed that 36 (72.0%) or expected outcomes for school health edu-
globe have espoused the critical role schools
can play in helping students achieve health
literacy.1-5 In 1995, the Joint Committee Tami Benham Deal is an associate professor in ming, Laramie, WY 82071. Laurence O. Deal is
on National Health Education Standards the Division of Kinesiology and Health, Uni- a health education teacher at Laramie Jr. High
(NHES) published, Achieving Health Lit- versity of Wyoming, Dept 3196, Laramie, WY School, Laramie, WY 82072. Adelle Byra is a
eracy, a document that outlined the essential 82071; E-mail: [email protected]. Jayne M. reading specialist at Linford Elementary School,
knowledge and skills children need to mas- Jenkins is an associate professor in the Division Laramie, WY 82070.
ter to become health literate.6 (The NHES of Kinesiology and Health, University of Wyo-
American Journal of Health Education — May/June 2010, Volume 41, No. 3 155
Tami Benham Deal, Jayne M. Jenkins, Laurence O. Deal, and Adelle Byra
cation, but only 19.6% had enacted specific reality given the increased demand to focus with reading, but teachers reported they
time requirements for health instruction. on high stakes testing areas like language were not exactly certain how it should be
Without such a mandate, the elementary arts and mathematics. An alternative to this integrated. Further research is needed to
curriculum may be narrowed to align with approach is to teach across the curriculum determine if teachers can use content and
subjects that are included in high stakes so that students are not denied the oppor- methods they have been prepared to use
testing. Other subjects like health, physical tunity to develop the knowledge and skills (e.g., language arts) as a vehicle for providing
education, music, art and the social sciences necessary to make healthy choices about literacy instruction and health education. If
may be limited or even eliminated.9,10 The behaviors that can affect their health and this approach is effective, achieving health
Center on Education Policy11 published academic success. literacy may become easier.
a report on the impact federal legislation In its publication, Health Literacy: A
(i.e., No Child Left behind Act of 2001) Prescription to End Confusion, the Institute purpose
requirements have had on instructional of Medicine reports that there is sound The purpose of this study was to examine
time in elementary schools in all 50 states, justification for taking this approach, specifi- the direct impact a nine-month profes-
including 349 school districts. They found cally as it relates to the integration of literacy sional development program on integrat-
that the shift in instructional time away instruction and health education.2 Research ing standards-based health education and
from non-tested subjects was relatively shows that learning occurs best through language arts in the elementary classroom
large. Districts that reported a reduction in authentic context26,27 and when classroom had on teachers and the indirect effect it had
instructional time did so by an average of discussions and activities are meaningful on learners. Changes in elementary teachers’
145 minutes per week. It has been estimated and functional.28 In addition, learning is en- confidence to teach health education when
that teachers need approximately 1-1/2 times hanced when teachers provide opportunities infused with literacy instruction and their
the instructional time they currently have to for children to apply their cognitive skills to practice of integrating reading and health
teach language arts, mathematics, science a personal issue or problem.29 Children are instruction and assessment were assessed.
and civics.12 It is not surprising that available faced with making decisions about their Differences in their students’ health knowl-
instruction time has become a major issue health and well-being on a daily basis. Health edge and skill also were investigated.
facing teachers today. Lack of time is one of concepts and situations found in many chil-
metHoDs
the primary barriers reported for not teach- dren’s books contain context and messages
ing health education.13,14 Even though most that are authentic and meaningful. Participants
elementary teachers believe health education The infusion of literacy instruction All third-grade teachers (n=29) in two
is important,13,14 they often feel unprepared with other content areas has been effective Wyoming school districts (one rural, one
to teach it.15-18 Inadequate pre-service in improving skills and knowledge in sci- urban) were invited to participate in the
coursework13,18,19 and in-service training ence,30 social studies31 and mathematics.31,32 nine-month professional development
opportunities in health education15,18 are It stands to reason that the integration of program, Read Wyoming: For the Health of
additional barriers that contribute to the literacy instruction and health education It. The rural school district consisted of five
lack of implementation of health instruction would be equally effective. Using children’s elementary schools. Of the 743 rural K-12
in the elementary classroom. When teachers books to improve health knowledge and students, 51 were third-grade students.
do receive training, either in specific health skills is one integration strategy that has Enrollment in the urban district was 13,301
content or in a comprehensive curriculum, been promoted;33-38 however, this instruc- K-12 students; 987 of whom were third-
significant changes can be seen in their tional strategy rarely has been subjected to grade students in the district’s 24 elementary
health knowledge,20 self-efficacy to teach empirical examination. Meckler and Vogler33 schools (that housed third grade). Addi-
health,21-23 feelings of preparedness15 and examined the effects of health instruction on tional elementary teachers (e.g., classroom,
amount of content taught.15,24 children’s reading and found that reading physical education, reading) and school
If schools are to be successful at im- and language skills improved more in chil- personnel (e.g., counselors, school nurses,
proving health literacy, then strategies for dren who received health instruction than curriculum coordinators) who expressed
overcoming these instructional barriers in children who did not receive the instruc- interest in the workshops were allowed to
must be identified and employed. One tion. Improvement was particularly noted participate. Overall, 26 elementary educators
way of dealing with the mismatch between in low level readers. The effect of integrated participated. because we were interested in
amount of content to be taught and available instruction on health knowledge and skills the effects of the program on third-grade
instruction time is to prioritize standards was not examined. Thackeray et al.14 found teachers who had direct responsibility for
and only teach to those that are deemed elementary teachers rarely teach health as teaching reading and health, only data
most important.25 This approach may be an independent content area. Instead, they from those participants (n=16; 5 males, 11
the elementary classroom teacher’s current integrate it. Integration most often occurred females; 6 rural, 11 urban) are reported here.
156 American Journal of Health Education — May/June 2010, Volume 41, No. 3
Tami Benham Deal, Jayne M. Jenkins, Laurence O. Deal, and Adelle Byra
Students in participants’ classrooms (n=99) ence, participants also completed monthly use to integrate health and literacy instruc-
completed a pre-test and post-test written tasks that required them to apply what they tion. School districts were reimbursed for
assessment on their health knowledge and learned in the workshops. The effectiveness costs associated with workshop-related
skills. Students (n=101) from four additional of the program was evaluated on the basis substitute teacher pay. Workshop facilitators
elementary classrooms in the urban school of change in teacher confidence to teach included a health educator who serves as the
district served as the comparison group by standards-based health education, teacher lead member of the state health education
completing the same pre-test and post-test. use of children’s books to infuse the in- assessment training cadre and a reading re-
No comparison group was used in the rural struction and student learning. covery teacher working toward her doctorate
district because all third-grade teachers in literacy education.
Workshop Design
participated in the program. The initial two-day workshop was
The face-to-face workshops were held
designed to meet three objectives. First,
Professional Development Program Design at central administration sites for both
participants would become aware of the re-
The U.S. Department of Education’s school districts. Participants received a
lationship between integrating and aligning
publication, Building Bridges: Missions and resource packet that contained workshop
Principles of Professional Development,39 and handouts, PowerPoint® presentations, and health and language arts standards, assess-
ments, and instructional strategies. Second,
principles of best practice in literacy instruc- supplemental readings, and a three-ring
tion40 were used to design and guide imple- binder to organize monthly work that each they would recognize reading materials con-
mentation of the professional development participant would submit. In addition, they taining health themes that can be integrated
program. The program design can be seen in received several resources from the Council into the literacy program. Finally, they would
Figure 1. Participants attended two face-to- of Chief State School Officers (CCSSO) State become familiar with scoring and using
face workshops, a two-day workshop in late Collaborative on Assessment of Student health assessments for content knowledge
summer/early fall and a one-day workshop Standards (SCASS) Health Education As- and health skills. The workshop began
in the middle of the academic year. sessment Project (HEAP), including a set of with an introduction to the Wyoming state
Prior to and following the first and assessment items, rubric scoring cards and health education standards and a review of
mid-year workshops, participants com- posters that provide student-friendly tips for the language arts standards. Participants
pleted questionnaires so that interventions meeting national and state health education were then introduced to the HEAP scoring
could be designed to meet their changing standards. Participants also received a copy system, which includes two four-point ru-
needs. This effort enabled the workshop of each of the children’s books that were brics - one for health concepts and one for
facilitators to work collaboratively with modeled in the initial workshop. At the end health skills. They practiced scoring student
the participants to plan the training. As an of the program participants were provided a work and discussed reasons for awarding
ongoing professional development experi- $150 stipend to purchase books they would specific score points. After the first scoring
figure 1. professional Development program Design
American Journal of Health Education — May/June 2010, Volume 41, No. 3 157
Tami Benham Deal, Jayne M. Jenkins, Laurence O. Deal, and Adelle Byra
round, workshop facilitators modeled how 100 children’s books. same set of questions used in the pre-project
a non-fiction book could be used to teach At approximately mid-academic year, a questionnaire. A five-point Likert-type scale
health within the context of the literacy les- one-day face-to-face workshop was held. The was used to indicate how likely participants
son. As the facilitators discussed different workshop included a time for sharing inte- were to use formal health education assess-
literacy strategies for using the book, they gration ideas and experiences. Participants ment in their classrooms. Responses ranged
completed a blueprint for integrating health completed another practice scoring round from not at all likely to extremely likely. Five
and language arts instruction. The blueprint on HEAP assessments to reinforce their open-ended questions were used to ob-
included health concepts and skills found in understanding of the health concepts and tain feedback from participants about the
the book and corresponding page numbers, skills outlined in the state standards and to strengths and weaknesses of the training and
health and language arts standards and determine consistency in evaluating student what additional support they would like to
benchmark indicators, HEAP assessment work. Additional books were blueprinted, have in the upcoming months.
item reference, brief introduction of book, and participants discussed how they might Prior to the mid-year workshop, partici-
follow-up questions to determine if students use the books in their classes. At the end of pants were surveyed to ascertain if changes
understand the health concepts and/or can the workshop they perused book lists and had occurred in the participants confidence
show the health skills, and ideas for how the catalogs to develop a list for purchase with levels and if they had implemented instruc-
book discussion could be extended into ad- the stipend. Project staff placed the orders tional and assessment strategies modeled in
ditional health and language arts activities. so participants received their books within the pre-program workshop. Confidence was
Participants then replicated the lesson six weeks of the mid-year workshop. assessed from the same set of questions used
blueprint using a fiction book. They perused Instruments in the pre-program questionnaire, and open-
the book for health messages that might be Participants were surveyed five times ended questions were used to determine if
meaningful and personal to their students during the course of the nine-month proj- and how participants had incorporated
and the HEAP database for assessments ect, prior to and immediately following the the use of children’s books to teach health
that aligned to related health concepts and initial and mid-year workshops, and again education and if they had formally assessed
skills. Throughout the remainder of the at the end of the school year. A 36-item pre- their students’ health knowledge and skills.
workshop participants examined different program questionnaire was developed to Participants were also asked about current
types of books that encompassed a variety obtain background information regarding professional development needs and types
of genres and completed blueprints that participants’ confidence about state health of support they would like to receive for the
outlined how they would implement them education and language arts standards and remainder of the school year. Participant
in integrated lessons. They discussed how assessment, use of literacy instructional confidence and future professional develop-
non-fiction books could be used to increase strategies, status of health education in their ment needs was again measured at the end
student comprehension before reading fic- classroom, use of integrated instruction and of the workshop.
tion books that contained the same health training needs. This information was used A final questionnaire was administered
themes and how fiction books could be used to assist the project staff in developing an at the conclusion of the academic year.
to springboard into discussions about health agenda for the initial two-day workshop. Questions from the pre-project survey
concepts and skills. Three additional practice A five-point Likert-type scale was used concerning confidence in standards and as-
scoring rounds on student assessments were with questions pertaining to confidence sessment and instructional strategies were
alternated between blueprint activities and about standards and assessment (responses replicated. Participants reported changes
discussions. Assessments were aligned so ranged from not very confident to extremely in their instructional and assessment prac-
health concepts and skills demonstrated confident) and to familiarity with different tices that were a result of the professional
in student work they scored were the same literacy instruction strategies (responses development they received in the project.
as those found in the books discussed after ranged from unfamiliar to very familiar). Open-ended questions were used to deter-
the practice scoring round was concluded. Open-ended questions were used to ex- mine how participation impacted teaching
At the end of the workshop, participants plore characteristics of literacy and health and assessment practices. Finally, a list of
were provided with the lesson template and instruction such as amount of instructional children’s books used in the two workshops
asked to complete monthly blueprints of time devoted to both subjects, strengths and was provided and participants indicated if
books they used in their classes. At the end weaknesses of current curriculum/programs, they had used them during the academic
of each month the researchers collected the integration practices, and desired outcomes year. A team of health education and read-
blueprints, made copies of all of them, and of the professional development project. ing researchers and practitioners reviewed
returned a completed set to each participant. Participants were surveyed again at the all iterations of the questionnaire to ensure
by the end of the program each participant end of the first workshop. Confidence in stan- content validity.
had a portfolio of blueprints for more than dards and assessment was assessed using the Student learning was evaluated using a
158 American Journal of Health Education — May/June 2010, Volume 41, No. 3
Tami Benham Deal, Jayne M. Jenkins, Laurence O. Deal, and Adelle Byra
HEAP constructed response assessment. The tests. Descriptive statistics (i.e., percent- and one rural school district in Wyoming.
assessment item was selected from the HEAP ages, means) were applied to questionnaire Program effectiveness was determined from
database, which contains approximately responses pertaining to teacher confidence participant responses and from changes
1900 elementary, middle school, and high concerning standards and assessment prac- in health knowledge and skill scores of 99
school items (see http://scassheap.org for tices, health curriculum and curriculum students from the 16 classrooms that were
sample items.) To ensure content validity integration. Paired sample t-tests were taught by program participants and 101
and scoring reliability, the HEAP subjected used to determine significant differences students from four comparison classrooms.
all items in the data base to multiple re- between their pre- and post-test measures. Quantitative and qualitative results pertain-
views by experts and field testing in more The Pearson product-moment coefficient ing to teacher confidence and practice, and
than 1500 classrooms.41 The constructed of correlation was used to examine the student learning, are presented and teachers’
response assessment was administered to relationship between teacher confidence in quotes are used to elucidate these findings.
students from participants’ classrooms describing health education standards and
Teacher Confidence
and to students in the comparison group assessment practices.
Prior to the start of the program only a
prior to the first professional development Expert reviewers used the HEAP rubrics
few of the teachers reported being confident
workshop and at the end of the school year. as the basis for scoring student assessments
to extremely confident in describing the state
The assessment was designed to measure on conceptual knowledge and health skill.
(6.3%) and district (18.8%) health education
the students’ knowledge about safety and Agreement must have been achieved by
standards (Figure 2). Similarly, less than 20%
the skill of accessing valid information and two of the three reviewers for the scores to
of the teachers indicated they were confident
products and services to enhance health. be included in the data analyses. A Group X to extremely confident in determining if
In this assessment, students were asked to Trial ANOVA with repeated measures on the students achieved health education standards
specify where they could go to get help when last factor was used to examine differences in and in using rubric/scoring systems to assess
someone in their family had a problem with students’ health knowledge and skill scores. core concepts and health skills (Figure 3). by
alcohol. The elementary level items in the Effect sizes (ES) were calculated for pair- the end of the project, nearly all of the teach-
HEAP database were initially created and wise comparisons by using Hedges’ g statis- ers reported being confident to extremely
intended for use by older children (e.g., 5th tic.42 The calculation of Hedges’ g involves confident in describing the state (90%) and
and 6th grade students). We modified the subtracting the means of two groups and district (81.5%) standards. All of the teachers
original HEAP item slightly to illustrate that dividing the mean difference by the pooled indicated they were confident to extremely
the situation described in the prompt made standard deviation across the intervention confident in using rubric-based scoring sys-
the youngster scared and uncomfortable. We and comparison groups. tems and in determining if students achieved
believed that younger children who had not Questionnaire responses were analyzed the standards. It is interesting to note that
observed or experienced a similar situation qualitatively to enhance understanding of confidence levels in each of these conditions
might not recognize the inherent fear and /or quantitative data. Peer review established dropped off considerably by the mid-point of
discomfort, and this lack of awareness could trustworthiness for the construction of com- the program, but rebounded by its end such
ultimately affect their response. Pre- and mon themes reflected in teachers’ responses that significant increases were seen in teacher
post-test administration occurred within to open-ended questions and reduced bias confidence in describing the state (t = -6.708,
a two-week window of the beginning and in the interpretation process.43 A researcher P<0.0001) and district health education
end of the academic year. Teachers were not experienced in qualitative methodology and standards (t = -5.516, P<0.0001), and deter-
aware of the pre-test and post-test assess- a graduate research assistant independently mining if students achieved those standards
ment content until they received the assess- analyzed the written records and grouped (t = -7.479, P<0.0001). Their confidence in
ments for administration. The University responses into categories. both investigators using rubrics to guide scoring practices on
of Wyoming Institutional Review board then met to discuss the classification systems. conceptual knowledge (t = -4.215, P<0.0001),
reviewed and approved the research protocol Consensus (100% agreement) between both and health skills (t = -6.248, P<0.0001), also
prior to its implementation. investigators had to be reached on all catego- significantly increased.
Data Analysis ries. When disagreements between investi- A significant correlation was found
The questionnaire was comprised of gators surfaced, the investigators restudied between teacher confidence in describing
items yielding both quantitative and quali- the original response, discussed points of health education standards and determin-
tative data. Quantitative data were analyzed contention, and established concurrence. ing if students met them (r=0.56, P<0.01).
using the Statistical Package for the Social As one teacher stated, “I know how to assess
Sciences (SPSS) Windows version 15.0 (SPSS results health standards now, so I do it. before I
Inc., Chicago, IL). A critical alpha level of The results are based on responses from took the Read Wyoming workshop I was
P<0.05 was adopted for all significance 16 elementary classrooms in one urban very unsure about health standards and
American Journal of Health Education — May/June 2010, Volume 41, No. 3 159
Tami Benham Deal, Jayne M. Jenkins, Laurence O. Deal, and Adelle Byra
the teachers used HEAP performance-based
figure 2. percentage of participants Who reported Being Confident, assessments during the school year. Short
very Confident orextremely Confident Describing state and District answer and extended response items were
Health education standards incorporated to assess writing, classroom
activities and health concepts. Performance
tasks were used to assess classroom activities.
This teacher reported that learning how to
assess was the most valuable aspect of the
project, “Learning to score assessments was
very valuable. I feel very comfortable in this
area now.”
Teacher Practice and Use of Books
Prior to beginning the professional de-
velopment program, teachers were asked
what they would like to accomplish as a
product of participating in the project.
One teacher wrote, “I would like ideas on
how to integrate health curriculum with
language arts so I don’t have to take time
to teach health in isolation.” Another wrote,
“[I would like] a way to integrate health so
it doesn’t take up too much time. It seems
like there isn’t enough time in the day to
figure 3. percentage of participants Who reported Being Confident,
adequately hit all subjects.” Teachers were
very Confident, or extremely in Assessment related tasks
asked to identify the most valuable activity
and/or information they received during
the two-day workshop and from the entire
professional development experience. Sev-
eral themes were common in their written
responses (Figure 4). Increased capacity
to integrate health and languages arts was
consistently reported. One teacher wrote, “I
realized how easy it is to bring health stan-
dards into language arts teaching.” Another
teacher stated, “I’m more aware of what I
need to bring out in health in my literature
series. I’m also much more aware of what
health topics I need to cover.”
The majority of teachers (79%) indicated
the time they spent integrating health and
language arts instruction increased. The
remaining teachers reported integration
time remained the same. The practice of
integrating health and language arts helped
how to assess them.” Confidence in describ- student learning. One teacher reported, teachers to negotiate the time barrier, as this
ing the standards and teachers’ subsequent “The SCASS assessments were really nice teacher indicated, “Teaching health through
use of HEAP assessment items to test stu- to have. I enjoyed using them and [my] literature…is more time efficient and [re-
dent knowledge and skills was also related scoring [ability] for Health and Language quires] less planning.”
(r=0.54, P<0.01). by the end of the year, Arts is improving.” Additionally, teachers Teachers frequently integrated reading
more than three-fourths of the participants reported using multiple types of SCASS and writing activities such as read and dis-
(77%) reported using HEAP items to assess assessment items in a variety of ways. All of cuss, literature circles, read aloud, shared
160 American Journal of Health Education — May/June 2010, Volume 41, No. 3
Tami Benham Deal, Jayne M. Jenkins, Laurence O. Deal, and Adelle Byra
figure 4. themes pertaining to the most valuable Activities/information
and Behavior outcomes of professional Development program
reading, Six-Traits writing and student made it easier to integrate materials with Improving Student Learning
journal responses. Science and art activi- the reading language arts standards and Students in participants’ classrooms
ties were also integrated as reported by this benchmarks.” Another teacher stated, “The scored significantly higher than students
teacher, “I have used several of the books most valuable piece is the blueprint. It gives from comparison classrooms on the post-
we received in class. I read the books aloud me information and quick access to books program assessment for both health con-
and we completed written study guides that will be useful in my classes.” At the end cepts (F=4.28, P<0.04, ES=0.30) and health
together. The students grew germ cultures of the program, all of the teachers reported skill (F=15.44, P<0.001, ES=.57). Effect
in Petri dishes and made posters about using at least one of the books that was blue- size measures show that while the interven-
washing hands.” Participation in the project printed in the workshops and most of them tion (i.e., participation in the professional
primarily provided teachers with increased (92.3%) used more than one book (Table 1). development program) had a small, but
awareness of how to integrate health and The primary reasons teachers chose a book significant effect on core concept knowledge,
language arts and how to find health con- was because it supported a health concept the intervention was more influential on
cepts and skills in literature books. The or skill they were teaching and the book students’ health skill.
teachers believed that integration saved was at the appropriate reading and devel-
time, and the project provided them the opmental level for their students. Lack of DisCussion
awareness and ability to integrate. time and inappropriate reading or develop- Elementary classroom teachers must
Creating a blueprint for identifying ment level were the primary reasons for not overcome a number of instructional bar-
health themes in children’s books and for using one or more of the books. Teachers riers if they are to deliver effective health
using the book to simultaneously teach also reported creating and implementing education and enhance the health literacy
health and language arts (reading & writing) blueprints for books they currently use in of youth. Lack of preparedness, confidence
was frequently reported by the participants their classrooms. One teacher stated, “I am and instructional time are just a few of these
as the most valuable experience in the work- trying to incorporate the Growing Healthy challenges. Read Wyoming for the Health of
shop. This teacher reflected, “The booklists curriculum into the classroom again to It was a professional development program
and blueprints were the most valuable as- back up the benchmarks; I am cataloguing designed to help elementary classroom
pect of the Read Wy[oming] Project. They & blueprinting the G.H. books.” teachers improve their confidence to teach
American Journal of Health Education — May/June 2010, Volume 41, No. 3 161
Tami Benham Deal, Jayne M. Jenkins, Laurence O. Deal, and Adelle Byra
table 1. Citations (isBn, lexile reading level [if Available]) that Were modeled and used
in Workshops by percent of teachers who implemented them in their language Arts lessons
% of Teachers Who
Title of Book
Implemented Book
Matott J. Drinking Fountain Joe. Littleton, Co: Clove Publications, Inc., 2000. (ISBN-13:
42.9
9781889191126, L not available)
Moore I. Six Dinner Sid. New York: Aladdin Paperbacks, 1991. (ISBN-13: 9780671796136;
35.7
690L)
McDonnell C. Toad Food and Measle Soup. New York: Puffin Books, 1984. (ISBN-13:
00.0
9780670035090, L not available)
Smith RK. Chocolate Fever. New York: Bantam Doubleday Dell, 1978. (ISBN-13:
21.5
9780142405956; 680L)
Cole J. The Magic School Bus Explores the Senses. New York: Scholastic, Inc., 1999.
50.0
(ISBN-13: 9780613593311, 490L)
Davidson M. Helen Keller. New York: Scholastic, Inc., 1969. (ISBN#0-590-42404-1, 520L) 42.9
Chier R. Danger: Alcohol. New York: Power Press Kids, 1996. (ISBN#0-8239-2339-8, 730L) 78.6
Vigna J. I Wish Daddy Didn’t Drink So Much. Morton Grove, IL: Albert Whitman & Com-
71.4
pany, 1988. (ISBN-13: 9780807535264, L not available)
health education and to develop imple- Prior to participation, fewer than 10% of implementation was not as easy as they had
mentation strategies that build on their the teachers reported being confident to anticipated. by the end of the school year
instructional strengths. Previous research extremely confident in describing state their confidence levels had rebounded to
has shown that only a small percentage of standards; however, after the initial work- post-workshop levels – a significant increase
classroom teachers feel prepared to teach shop almost all of the teachers reported from pre-program levels. These findings
health education,15-18 but professional this level of confidence. A similar pattern suggest that confidence can be improved
development can improve teachers’ self- was seen in their confidence to determine if when teachers participate in professional de-
efficacy and confidence to teach health students were achieving standards and us- velopment, but ongoing support is needed to
education.15, 21-23 Results from this study are ing the HEAP rubric-based scoring system insure that confidence continues to remain
consistent with these findings and confirm to draw inferences about student learning. high. Research has shown that short, one-
our belief that by increasing awareness and In both cases there was a considerable drop shot professional development workshops
understanding of standards-based health in confidence levels after teachers returned are not as effective in producing changes in
education and assessment, and by showing to their classroom and began implement- teacher practice as those experiences that
teachers how they can use children’s books ing health instruction and assessment. The occur over a longer period of time.44,45 Lon-
as the context for teaching and reinforcing mid-project survey results did not indicate a gitudinal research is needed that examines
health concepts and skills outlined in the reason for this change, but we suspect it was professional development outcomes and
standards, their confidence and likelihood an artifact of returning to the reality of the the variability in those outcomes that are a
of teaching health can increase. school. Immediately after the first workshop product of time.
by the end of the program, confidence teachers were enthusiastic about returning In addition to increased confidence,
in describing health education standards to their classroom and implementing what participation in professional development
and in determining if students had met they learned. Their post-workshop report can have an impact on the time teachers
those standards significantly increased. This on confidence to carry out these difficult spend in health education instruction.
change was seen immediately after teach- tasks could have been an acute effect of the In this study, more than three-fourths of
ers completed the first two-day workshop. training; that is, they may have found that the teachers increased the time they spent
162 American Journal of Health Education — May/June 2010, Volume 41, No. 3
Tami Benham Deal, Jayne M. Jenkins, Laurence O. Deal, and Adelle Byra
teaching health education and none of the suggest that these teachers now make better prompts to differentiate between the parts
remaining teachers reduced the amount of use of limited instructional time. that would elicit functional and conceptual
time they spent teaching it. These findings The two books that were used by the knowledge about health topics and the parts
are consistent with those reported by Tell- greatest number of teachers were Danger: that would elicit the health skill. They dis-
johann, et al.21 In their study, the number of Alcohol and I Wish Daddy Didn’t Drink So cussed criteria or skill cues that needed to be
hours devoted to health education instruc- Much. These books were modeled in the first present and what the different score points
tion by elementary teachers who completed workshop to show how non-fiction books from the HEAP scoring system meant. As
a 30-hour summer workshop was not only can be used to teach content knowledge and they practiced scoring student work, they
greater than a comparison group of teachers, to springboard into fiction books that can would look for evidence that the written re-
but significantly increased. be used to develop the context for applying sponse met the specific skill and core concept
by the end of this program, most of health knowledge and practicing health criteria. According to Easton,49 professional
the teachers increased the amount of time skills. Comments like, “[I] used books to give development should involve active learning
they spent integrating health and language facts and concepts [and] then had students practices that resemble the work that teach-
arts instruction. We believed that teaching write using and applying the knowledge ers do. The experience teachers received in
and assessing across the curriculum would to their lifestyles,” suggest that teachers scoring student work, an authentic teacher
increase if we built on teachers’ instruc- adopted practices that were modeled in practice, may have lead to their increased
tional strengths; that is, their confidence the workshops. It is possible more teachers confidence in using assessments and rubrics
and competence in teaching language arts. used these alcohol related books because of to score student work.
Teachers in this study frequently confirmed the history and prevalence of alcohol use The teachers seemed to favor perfor-
that they used language arts strategies like in Wyoming46 and the association between mance assessments (e.g., short answers, ex-
literature circles, reading aloud and shared binge drinking and violence.47,48 This reason tended responses, performance tasks that are
reading to teach health content and skills. did not emerge in the post-program survey. completed over multiple days) over selected
In previous research, teachers reported However, as these books were being modeled response items (e.g., multiple-choice). This
that they rarely taught health education in the workshop participants discussed the may be due to the written nature of student
independent of other content, and if it was sensitive nature of, and challenges in teach- responses on performance assessments.
taught it was usually in conjunction with ing about, alcohol abuse when students in These written responses could be used to
reading.14 We wanted to see if by exposing their classrooms came from families where simultaneously assess health knowledge and
teachers to children’s books that contain substance abuse and/or domestic violence health skills, along with traits of writing, and
meaningful health messages and helping was an issue. One participant even indicated teachers reported using them for multiple
them to recognize the content and health that he planned to implement the book, I purposes. Teachers valued the HEAP assess-
skills that were embedded in the books, Wish Daddy Didn’t Drink So Much, in the ments because they allowed for rubric based
they would be more likely to use the books days leading up to the winter break – a time scoring and dual assessment, particularly as
to teach health education. Eight books were he had observed to be fraught with alcohol it related to the six traits of writing. They
modeled in the workshops. by the end of the use and violent behaviors. also saw the HEAP assessments as a tool for
program, all of the teachers had used at least The professional development program making cross-curriculum assessment easier.
one of the books and half of them used at also influenced teacher practice in assess- One teacher related this ease of use to the
least four of the eight books. Lack of time ment. Initially, teachers did not express a axiom, “two birds with one stone…”
was the most consistent reason given for high level of confidence in assessing the Improved teacher confidence and com-
not implementing the books. This was not content knowledge and skills outlined in the petence in assessing health education stan-
surprising, considering that time constraints state and district health education standards. dards is an important outcome of this study.
are frequently reported in the literature as but after completing the program their Popham50 argues there is a gap in the assess-
a primary barrier to teaching health13,14,18,19 confidence significantly increased and more ment literacy of our nation’s teaching force
Teachers in this study commented on using than three-fourths of them reported using and this gap needs to be filled by colleges and
books and integrated learning as a way to HEAP assessment items to evaluate student universities through pre-service education
overcome the time barrier. Comments like, learning throughout the academic year. A and via professional development experi-
“My students were doing more reading and significant correlation was found between ences teachers receive. Results from this study
writing while learning various health issues, using these items to assess student achieve- show that through on-going experiences that
through literature,” “[I learned] how to teach ment and teachers’ confidence in describing provide practice in scoring student work and
more than one standard at a time,” and “I the standards. Scoring student work was an learning more about performance-based
realized how it [health content and skills] essential component of the professional de- assessment, barriers like confidence and
would fit into books I am already using” velopment program. Teachers dissected the competence can be overcome.
American Journal of Health Education — May/June 2010, Volume 41, No. 3 163
Tami Benham Deal, Jayne M. Jenkins, Laurence O. Deal, and Adelle Byra
One of the most promising findings control trial (RCT) design would provide limitations, important implications for pro-
of this study was the impact professional stronger evidence of the effect. While the fessional development in health education
development can have on student learning. quasi-experimental design provides accept- can be drawn from this study.
by the end of the study, students in class- able control in a setting where it is difficult
rooms taught by teachers who attended the to randomly assign students to classroom trAnslAtion into HeAltH
professional development program scored teachers who will or will not participate in eDuCAtion prACtiCe
significantly higher on the HEAP assessment the intervention,51 studies using RCTs would The purpose of this study was to examine
than students from comparison classrooms. have stronger internal validity for inferring the impact a long-term professional devel-
Effect size measures ranged from 0.30 for the causal relationship. opment program could have on elementary
conceptual knowledge about injury preven- There were several additional limitations classroom teachers practice and on student
tion and safety to 0.57 for the health skill of to this study. Teachers were volunteers so learning. The findings have several implica-
accessing valid sources of health information they may have been predisposed to the use tions for health education practice.
and services. According to the U.S. Depart- of integration practices, which could lead to Due to increased demands for school ac-
ment of Education’s What Works Clearing- selection bias. Results could also be biased countability and high stakes testing, finding
house,51 these effect sizes meet the criteria for because changes in teachers’ confidence and time for professional development outside of
being “substantively important.” Our find- practice were based on self-report and not the core curriculum may be difficult, if not
ings are consistent with other studies where direct observation. Risks to internal and impossible. As such, it is vital that we find
professional development for teachers had a external validity could be reduced if a RCT ways to embed health education in profes-
moderate effect on student achievement in or quasi-experimental approach was used sional development for core curriculum
math, science, and language arts. Yoon et al.45 to study the effects of professional develop- subjects like reading and writing.
provide a comprehensive review of research ment on elementary classroom teachers’ Integration may be a key to overcoming
on the effects of professional development confidence to teach standards-based health some of the factors teachers report as bar-
on student achievement. education and their use of integration riers to teaching health education. Profes-
Strengths and Limitations strategies for instruction and assessment. sional development in health education
One of the strengths of this study is that Direct observation of teacher practice could for elementary classroom teachers should
the intervention was sustained, intensive strengthen the findings. build on their pedagogical strengths and
and content-focused – three of the criteria Performance-based assessment was used provide instruction and assessment strate-
for high quality professional development to ascertain student achievement. This as- gies that will compliment their delivery of
stipulated in the No Child Left behind Act sessment required students to construct the core curriculum.
of 2001. In addition, teachers engaged in a written response that illustrated criteria During professional development teach-
active learning that was connected to peda- specific to the health skill and core concept ers should engage in active learning prac-
gogical skills and assessment practices that addressed in the prompt. Findings were tices that resemble the work they do in their
were relevant and meaningful, and that led limited by the students’ ability to commu- classrooms. In this program, teachers read
to direct changes in their confidence and nicate in written form. Alternative forms of books they could use in their classroom,
practice. They scored student work, devel- assessment, including oral communication, they reflected on health themes they could
oped lesson blueprints, discussed literacy could be used to provide evidence of student address and the different roles children
and integration strategies, and modeled achievement. Only one health concept, in- could play when they read the books in their
how they would use children’s books in their jury prevention and safety, and one health literature circles, and they practiced scoring
classrooms. by using children’s books to in- skill, accessing valid sources of information, student work.
fuse health instruction into the language arts products and services, were assessed in this Professional development should not
program, teachers were effective in helping study. To draw inferences about the effec- be limited to one-shot, short-term work-
their students develop a sample of the skills tiveness of cross-curriculum instruction shops or conferences. Instead, it should be
and knowledge they need to become more on student health literacy, a broader array long-term and continuous so that teachers’
health literate. of concepts and skills should be examined. confidence and competence to teach and
A quasi-experimental approach was used Constructed responses can reflect a deeper assess health education content and skill
to determine the effect of the intervention level of understanding than do selected re- is sustained.
on student achievement. by having a com- sponses, but scoring these responses is very Elementary classroom teachers can use
parison group of students we were able to time and labor intensive. Future research children’s books to infuse health instruction
detect differences in their health knowl- may need to assess student achievement into the language arts program. A variety of
edge and skill that was an indirect effect of through a balanced system of constructed non-fiction and fiction books can be used in-
the intervention. However, a randomized and selected response items. Despite these dependently or as springboards to compre-
164 American Journal of Health Education — May/June 2010, Volume 41, No. 3