Effective Pratices

In this set of slides, we're going
to take a look at how we evaluate

health education programs,
or interventions,

so that we know what actually works,
and what works best.

We're also gonna look at this idea
of fidelity in delivering

programs for educational purposes,

and the last thing we'll take a look at

are proven characteristics of
health education practices that work.

We're going to begin by exploring
some of the terminology

around program evaluation.

Some of you may have heard
people talk about

evidence-based interventions,
or evidence-based practices,

or evidence-based programs,

or maybe even someone say
they're using best practice.

And, it is often confusing what this lac--
what this language actually means.

So, we're gonna begin
by taking a look at some definitions,

and going forward with that knowledge.

When we use the terms
evidence-based interventions,

or evidence-based programs,
we're really talking about

interventions, or programs
that have been studied

very scientifically and very systematically
by independent reviewers.

And so, maybe you've heard
about different kinds of research,

like case-control studies.

Where you have two groups
that are similar on all characteristics

as much as possible, except for
the one thing that we're trying to study,

which is the intervention,
or the program that they're exposed to.

And so, we will give one group
a treatment, and that treatment

might be the intervention,
or the program of interest,

and the other group
will not have the treatment.

And, after a period of time,
we will evaluate the impact

of the intervention, or the program,

on the study group and compare it

to the control group, which did not
get exposed to that intervention, or program.

Sometimes we even add
the element of a study

being a blind or double-blind study.

And, if you have a blind study,
the people that are in the actual study,

the control group
and the experimental group,

they don't know which group they are in.

If you have a double-blind study,
the researcher doesn't know

which group is the experimental group

and which group is the control group,

and the people that are participants

also don't know which group they're in.
So, it's double-blinded.

Evidenced based interventions
and evidence based programs

have the highest quality
of research and evaluation

to determine effectiveness.

The third term I want to talk about today,
is this idea of best practice,

and in the setting that we're using,

we're gonna equate evidence informed programs
with the term best practice.

I would guess that many of wh--
you have heard people say

that they're using best practice,
and we don't always know

what they mean when they use that term.

Technically, best practice are programs,

or interventions,
that are informed, or guided,

by previous research
and what we know is effective.

But, they haven't necessarily undergone
the rigorous evaluation studies

that our other kinds
of evaluation practices have.

And so, it's not that if somebody says

they're using best practice,
that it's not worthy,

or that we shouldn't incorporate it
into our teaching strategies,

it's just that it may be informed

by some anecdotal evidence,
as well as some previous principles

that we know have worked,
but it hasn't been directly tested.

Having good research on programs,
or curriculums, or interventions

is super good,
and we wanna make sure we have that,

but the delivery of
those evidenced based programs,

or evidence based interventions,
is only as good

as the fidelity with which
those programs are implemented.

So, this idea of fidelity
in evidence based programs,

or in evidence based curricula,

is tied to the faithfulness

with which a curriculum
or a program is implemented.

And so, what we need to be able
to articulate, if we're going to try

to figure out how well
we're delivering an evaluated program,

one that we know is evidence based,

is how much do we know
about the program's core components,

and to what degree
are we faithfully executing

that program as it was
intended to be delivered?

So, when we look
at evidence based programs,

they have many core components,
and we'll talk about each of those.

But the idea of fidelity,
is that we must deliver

- with faithfulness -
the characteristics of a program

that were present when it was tested
in the original evaluation project.

So, the first core component
that we want to pay attention to is content.

Or, what is actually being taught?

So, content as you can see, involves:

the knowledge, attitudes,
values, norms, and skills

that are addressed in
the learning activity that you're using.

And, sometimes you'll hear people
talk about this core component

as adherence.

And, basically what they're saying
or asking is:

Was the program delivered as it was designed,
or written in it's original form?

The second core component
of fidelity in evidence-based programming

is pedagogy, or how the content is taught.

So, this is often talked about
as a quality of the program delivery.

So, was the teacher
or the facilitator able to deliver

the program as it was originally intended?

And, part of the thing
that might contribute to that are:

the teacher credentials,
the skills they have in the methods

that were prescribed to be used
in the program, their level of enthusiasm,

preparedness, and even positive attitudes

towards the program outcomes.

The third core component
involved in fidelity has to do

with implementation
and the logistics around implementation.

A lot of times you'll hear people
talk about exposure, or dose,

and looking at the actual number
of sessions, or class periods,

that were included
in the original curriculum,

or the length of each
of the sessions,

or the kinds of techniques and methodologies
that are used to deliver the material,

or the amount of material received.

These are all,
have to do with exposure and dosage.

So, for instance, if I was
delivering a program with fidelity,

I would not be able to say,

"Boy, I only have enough time
to do four out of the eight

originally prescribed lessons, and so,
I am just going to leave out those other four

and not worry about it.

And our class sessions
are only forty-minutes long,

the original research study, the class sessions
were sixty-minutes long,

and I would just kinda
not worry about that".

And those kinds of insults
to exposure, or dosage,

detract from fidelity of delivery.

Evidence-based practices and
evidence-based, interventions are only

as useful as our ability
to deliver those programs, or curricula,

or interventions with fidelity.

And, think about what happens
typically in a teaching situation.

If you give a teacher a canned curriculum,
and by canned curriculum

I'm going to use that term to represent
an evidenced based practice.

So, someone's developed a curriculum,
it has these core components

that were tested
and found to be effective,

and then that curriculum was adopted,
or adapted, by a particular school district

and now you're - at the instructor level -
you've been assigned

to deliver this curriculum.

If you are not able to deliver
that curriculum with fidelity,

meaning adhering to those core components
from the original research,

then you can't expect the program outcomes
to be similar to what

was demonstrated in the original research.

Educators love to monkey around

with established curriculum, they may say,

"Oh, I don't have enough time
to do this many sessions",

or maybe the district doesn't have
enough money to provide all the

support materials, or maybe they don't
even do any professional development

specific to that curriculum delivery
with the instructor

before they ask them to implement it.

All those things degrade
the ability of the program,

or the curriculum to be delivered with fidelity,
and potentially will impact

the program outcomes
that we are actually looking for.

So, in summary, being able to deliver an evidence-based

program is very important. Because we know it has

some established effectiveness, principles behind it, but if we can't

deliver an evidence based program with fidelity,

meaning faithfulness to the curriculum, or the program,

as it was implemented and tested,

then we lose the beauty of having evidence based programs.

This next group of slides talks about programs that work.

Or, characteristics of health education programs
that work.

And the way that the different characteristics were arrived at,

is a group of researchers did what is called a meta-analysis.

And so, they looked at literally hundreds of research studies

that were evaluation studies of health education programs

and the different characteristics of those programs.

And they collectively looked at, what were the common characteristics

across all of those different programs that were deemed to be effective?

And so, they got kind of a list, or a set, of characteristics

of effective health education programs.

The first one, and the first characteristic of a health education

program that works, is-it seems kinda like a no-brainer,

and it's basically programs that work focus on clear health goals

and related behavioral outcomes.

And you might go,

"Hmm, seems like that'd be the only way to go about it".

But, you'd be surprised sometimes

how people just start down a program, or a lesson,

and they haven't really thought through,

what the end-point is, what the goal is.

And, they haven't clearly defined how they're going to get there,

and what the learning or behavioral outcomes are.

So, we know that when you take the time and

effort to identify, very clearly, what you want to acheive,

and how you are going to get there,

that you have a more effective program.

Health education programs that work are research based

and theory driven.

So, this can tie directly back to this idea that we do have the ability

to find out what evidence based programs, or evidence based

interventions are available and follow those.

So, that's research based.

But also we need to have theory driven programs as well.

In chapter 2, on pages 44 and 45 in your readings,

you'll see there is a description of the theory of planned behavior

and how it's applied to behavior change and driving a program

or a lesson so that it has a better chance of being effective.

The other thing that is important for us when we say

research-based and theory driven,

is that we also look at this idea of social determinants

and health determinants that go beyond just knowledge.

And so, again, when you look at chapter 1 in your readings,

and look at pages 5-7,

you'll have that conversation about some of the determinants of health

that go beyond just information
that are important for us to keep in mind.

Health education programs that work directly address our

individual values and attitudes and beliefs,
and that's very important,

that we drill down into beliefs, attitudes, and values.

But, they also address, or look at, group norms, and

whether those norms are accurate or not,

and how group and individual attitudes, values, and beliefs

can absolutely support health enhancing behaviors.

Programs that work focus on helping individuals assess

their risk or harmfulness of engaging in some risk behaviors,

but it also includes reinforcing protective factors.

So, one of the things that's a challenge to us as educators,

and especially elementary educators is younger people.

And especially if we look at early elementary,

are developmentally not in a great place

to be able to look at their risk and assess the harm

that might come from engaging in risk behaviors.

And so, we really need to, with those younger kids,

help reinforce protective factors,

because those they can understand.

Supportive behaviors and protective factors

that will protect them from harm and other risk behaviors.

Effective health education practices

address social pressures and influences.

Think about this, and how much it's related to

our health education standards.

Can you think of one of our national health education standards

that pinpoints this very aspect

of delivery of health education programs?

Effective health education programs build personal competence,

social competence, and self-efficacy by addressing skills.

It is not happenstance that our national health education standards

are primarily focused on skill building.

We know from research that effective curriculum builds skills

such as communications skills, refusal skills,

assessing accuracy of information,

decision making skills, goal-setting skills,

and confidence in dealing with social pressures

to avoid, or reduce risks.

So, we know that health education programs

that work are intimately connected to skill building,

and that there are developmental steps to skill building

that are important for us to keep in mind.

So when we are doing skill building, we want to make sure

we discuss the importance of the skill and why it's relevant,

and how it's related to other things

that we may already know how to do.

And we want to present that step-by-step modeling of the skill.

And we want to make sure we give students the opportunity

to practice and rehearse the skill in different kinds of scenarios.

And that we are constantly providing feedback and more practice,

and reinforcement of positive engagement in the skill.

Health education programs that work provide functional knowledge.

And, if you remember, when we were talking about lesson design

and lesson planning, we identify that functional knowledge was

accurate, it was honest,

it was age and developmentally appropriate,

and it answered the, "So, what?" question.

So, what will students know or be able to do

that will positively contribute to maintaining or improving their health?

So, functional knowledge is basic, it's accurate, and

it directly contributes to health promoting decisions and behaviors.

It's essential in effective health education programs.

Effective health education programs use strategies that

help personalize information and engage students.

So, you'll see that the learning experiences are often

very student-centered, they are very interactive,

and they're very experiential.

Whether that be through group discussions, or cooperative learning,

or problem solving, or role-playing, or peer-led activities,

all these kinds of strategies are designed to

personalize and engage students.

And you will note that a lot of these strategies that we are trying to

get students to develop are very much about building

executive functions, and social-emotional learning characteristics.

And we will talk more about those later in this term.

Age and developmentally appropriate information as well as

learning strategies and methods and materials are essential

if we really want to have effective health education programming.

So, understanding concepts and skills are covered

in a logical sequence and understanding the relationship

between sequencing and age,

and developmental appropriateness is key.

Educational methods, materials, and strategies

have to be culturally inclusive.

And, we'll talk about this a lot, and we already have, to some extent.

But, we really need to be very much aware of everything that we say,

do, show, ask, and how all those materials and conversations

are inclusive of diverse culture, and lifestyle, and that they build on

the cultural resources of families and communities,

and are constantly promoting values,

and attitudes, and behaviors that acknowledge

the value of diversity among all students and families.

Programs that work provide adequate time for instruction and learning.

This is a real challenging point for a lot of health education

curricular methods and practices.

As we talked about early on, because health is not a testable subject,

it sometimes gets minimized in the direct instruction

across our classrooms.

And so, when we are trying to constantly grab these

little bits and pieces of time to have instruction specific to health,

it's hard to have this connectedness

and to get this bulk of time for instruction

and learning that will best support what we are trying to do

around adoption and maintenance of health behaviors.

Effective health education curricula builds on previously learned concepts

and skills, and provides opportunities to reinforce those skills

across topics and grade level.

Things are scaffolded, or we have the opportunity to have

skill booster sessions as subsequent grade levels,

so that we can integrate skill application into other academic areas.

These are all important concepts for

having successful and effective practice.

Health education programs that work try to take every opportunity to

connect students with peers or parents or family members

or positive role-models out in the community that can reinforce health

promoting norms, and health promoting attitudes, values, beliefs, and behaviors.

The last characteristic of health education programs that we know

are effective, is that they include teacher information

and plans for professional development that enhances instruction,

and therefore student learning.

So, we need to make sure that the people who are teaching,

or that are implementing a program,

are knowledgeable about the curriculum and the content,

that they are comfortable and skilled in implementing

the expected instructional strategies,

and they're always getting professional development

to acquire new skills, or new assessment strategies

as curriculums grow and develop.

So, we've just looked at a big laundry list of characteristics

of effective health education curricular practices,

and now I want to spend just a few minutes

talking about a couple of

practices that we know are not quite so effective.

The first one are scare tactics, and think for a minute,

if you were going to define what a scare tactic is,
what would you tell me?

Scare tactics are not recognized as an effective health ed strategy.

And, there's some very good reasons for that.

Often they are overly simplistic and they may use inaccurate

or incomplete information.

You don't get the whole story.

And, the other thing that is essentially the most troubling

about a scare tactic is they don't provide skills

or information about how to avoid or reduce

or eliminate a risk.

And so, if your only strategy is to show people pictures,

or talk to them about danger and risks to scare them,

what often happens is you paralyze their thinking and their actions.

You get them stuck in a place and they can't move forward

or do anything different.

If you are presenting information that is anxiety producing,

which a lot of health information can be,

that has to do with risk behaviors,

you can talk about anxiety producing information

but then you follow that information with skills and

additional strategies on how you can avoid, reduce, eliminate,

change your risk behavior. That's education.

Scare tactics is: you show pictures,

or you give data that is intended only to scare and shock

people and there's no educational practice that moves forward.

I have to tell ya, I always laugh when I talk about scare tactics,

because I taught sexuality education at the college level for a number of years,

and I still have a old set of slides that are from the State Department of Health

that are pictures of sexually transmitted infections and disease states.

And I always say to people,

"Ya know, I know that I could take all those slides

and I can sit and show em to you in this room,

and I could talk to you about all the negative aspects

of these hideous diseases that I'm showing,

and I could scare you into - even if you're sexually active person -

I could probably scare you into not having sex for a night.

But, am I educating you about anything?

No. I'm just trying to shock you and scare you,

and I'm not really providing skills on how to avoid, reduce,

or eliminate risk from unprotected sex".

So, again, the scare tactics are not an effective educational strategy

and we need to keep that in mind

when we are delivering health education

because it's important that we move beyond just details

and really provide accurate, complete information

and skill building to eliminate or reduce risk.

The other educational strategy that I want to ask you to be somewhat

cautious about, is trying to assume that an assembly,

or other short-term, one-time event will provide

enough instruction and practice and information

to have positive behavioral outcomes.
(train horn in background)

I would venture to guess that you have all been a part of assemblies

at some point in time,

whether it was during your elementary, middle, or high school years,

where you were given health messages

and had various guest speakers try and convince you of some

health behavior, or some action, or how to avoid some kind of risk.

And, one of the things we need to be really mindful of

when we think about assemblies, kind of these short duration,

one-hit-wonders, is to be thoughtful about the perception

of the message that's being delivered,

and also the duration,

and if we have an opportunity to actually link that assembly

to other pieces of instruction and opportunities for

practice so that we can have some possibility of effectiveness

in a larger instructional plan.

Let me give you an example of message perception

that you want to be thoughtful about.

So, some of you may have had an assembly at some point in time

where, ya know, a recovering drug addict was brought in,

and the person talked about how they were just had to

hit rock bottom and they lost this, and they lost that,

and they had a really hard time.

And then they were able to access treatment or care,

and they came back, and now here they are and they're talking to you

and telling you the dangers of, ya know,

drug addiction and drug use.

And the people that have brought this speaker to you are hoping

this is gonna be impactful and that it's going to help you

evaluate the negative risk of drug addiction, or that you won't go there.

What we know is that when we bring in those kinds of speakers

that sometimes for some students,

that's not the perception and that's not the message that they get.

For some adolescents who tend to be a little bit of risk takers

in the first place they may hear that speaker and go,

"Ya know, you told me that if I use drugs they would kill me

or that it would destroy my life.

But, ya know, this person - it was rotten for a while, they-they lost some things

and they were down-in-the-dumps and they really had a bad time for a while,

but ya know, they got out of it and now they're okay.

And they're really in a pretty good place".

That's a very different message, a very different perception

than maybe we thought we were sending to our students.

So, be thoughtful about the lens through which students will engage

with your speaker, and the message that you think you're sending.