Leigh Szucs (00:10):
Welcome to our webinar titled CDCÕs health education curriculum analysis tool, or HECAT, mental and emotional health module updates. In 2021, CDC released an updated version of the HECAT to help translate research into practice and support schools in delivering quality health education. Today, we're excited to provide an overview of key updates from the mental and emotional health module. My name is Leigh Szucs and I'm a health scientist in CDCs division of adolescent and school health known as DASH. In this role, I work primarily on DASH's health and sexual health education portfolio, supporting research and programmatic activities with schools across the United States. I'm joined today by my colleague, Marcy Hertz, Marcy.
Marcy Hertz (00:57):
Thanks so much Leigh. Yes. My name is Marcy Hertz, as Leigh said, and I'm a senior health scientist also in DASH and I serve as the subject matter expert on our work related to mental health promotion and substance use prevention in schools. In today's presentation, we will be talking about youth mental health and practices and strategies for schools to promote mental health and emotional wellbeing. We are excited to share an overview and recent updates to CDCs health education, curriculum analysis tool or HECAT, and take a deeper dive into chapter six. The mental and emotional health module we'll be highlighting examples of student level knowledge expectations that are essential for universal mental health promotion and will end our session by sharing helpful tools and resources for schools.
Marcy Hertz (01:51):
CDC defines mental health prior to adulthood as reaching developmental and emotional milestones and learning healthy social skills and how to cope when there are problems. The inability to cope and problem solve often leads to symptoms of poor mental health, or even to mental health disorders, including anxiety and depression. Poor mental health and suicide related behaviors among young people is a severe and growing problem in the United States. Poor mental health is associated with a host of health risk behaviors, both during adolescents and into adulthood. It can lead to risky sexual behavior, elicit substance use, unintended pregnancy, school absence and dropout, and other potentially lifelong health problems. Let's begin by looking at recent data on the mental and emotional health of today's youth. CDCs youth risk behavior survey summary and data trends report from 2009 to 2019 provides the most recent surveillance and trend data on health behaviors and experiences among high school students in grades nine through 12 across the country. It reports on the behaviors that contribute to the leading causes of death morbidity and social problems among youth and young adults, including mental health and suicide. Our nation's youth, as you can see here on this side, continue to struggle with mental health. Of great concern is the increasing number of students reporting feeling sad and hopeless. But as you could also see on this slide of every indicator we track related to mental health and suicide, none are improving and four out of five have been deteriorating over time.
Marcy Hertz (03:33):
Continuing to look at YRBS data, as you can see on this graph in 2019 about 37% of high school students experience periods of persistent feelings of sadness or hopelessness during the past year. Persistent feelings of sadness or hopelessness are defined as feeling so sad or hopeless almost every day for two weeks or more in a row that the students stopped doing usual activities. More students, almost 20% seriously considered attempting suicide during the past year and more made a suicide plan or attempted suicide in 2019 than a decade ago, with the exception of being injured in a suicide attempt. All of these changes from 2009 to 2019 were statistically significant.
Marcy Hertz (04:23):
Some students report poor mental health and more suicide related behaviors than other students. For example, two thirds of lesbian, gay and bisexual students, and nearly half of female students report persistent feelings of sadness or hopelessness. Nearly half of female students and more Hispanic than white students or black students reported persistent feelings of sadness or hopelessness in 2019. Mental health problems and youth often go hand in hand with other health and behavioral risks like increased risks of drug use, experiencing violence, and higher risk sexual behaviors that can lead to HIV, sexually transmitted diseases, and unintended pregnancy. In addition, having positive mental health, that is the ability to cope and problem solve when faced with challenges and stressors, can reduce the likelihood of engaging in health risk behaviors and can promote overall health and wellbeing. Other data collected through CDCs 2021, adolescent behaviors and experiences survey or ABES, an online survey of a probability based nationally representative sample of US public and private school students in grades nine through 12, assess US high school students, mental health and suicide related behaviors during the COVID 19 pandemic.
Marcy Hertz (05:39):
These findings published in an April 2022 MMWR highlight the relationships between adolescent mental health outcomes and school connectedness. We know that youth are resilient and that feeling connected to school and to family can protect against poor mental health. We found that students who felt close to people at school were significantly less likely than students who did not agree or strongly agree that they felt close to people at school to report the indicators displayed in the middle of this chart. The same significant relationship held for those who felt virtually connected to people during the pandemic. Mental health issues among youth are an important public health concern during the ongoing COVID 19 pandemic. Comprehensive strategies that improve connections with others at home in the community and at school might foster improved mental health among youth during and after the pandemic. As we've learned nationally during the COVID 19 pandemic, schools are critical in supporting children and families. While the expectation is that schools provide education, they also provide opportunities for youth to connect with each other, to engage in meaningful activities, and to receive social, emotional and mental health supports and services all of which can reduce or prevent poor mental health and help protect against negative health outcomes. Now, I'll turn it over to Leigh to talk more about educational strategies for schools. Leigh.
Leigh Szucs (07:11):
Thanks, Marcy. To best address adolescent mental health critical supports, education, and services need to be comprehensive and everyone has a role to play. Schools are uniquely positioned to build safe and supportive environments, integrate social emotional learning and skill competency, provide staff training, support staff mental health, links students to mental health services and review disciplinary policies to ensure equity. Comprehensive and skills focused education provided by schools can be done in the form of quality health education and is critical. Health education is the formal structured combination of planned learning experiences that provide the opportunity for students to acquire information and skills needed to make health promoting decisions, achieve health literacy, adopt health enhancing behaviors, and promote the health of others. Curriculum is the primary organizing framework for delivering health information and skills through schools. So what is a health education curriculum? CDC defines health education curriculum as any planned structured learning experiences that provides students with the opportunities to acquire the attitudes, knowledge and skills that impact health. Health education curriculum include five core elements; a set of intended learning outcomes or objectives that directly relate to students, acquisition of health related knowledge, attitudes, and skills, a planned progression of developmentally appropriate lessons or learning experiences that lead to achieving health behaviors or outcomes, continuity between lessons or learning that clearly reinforce the adoption in maintenance of specific health enhancing behaviors, content, and materials that correspond with the sequence of learning and help teachers and students meet learning objectives, and lastly, curricula include assessment strategies to determine if and to what extent students have achieved the desired learning.
Leigh Szucs (08:39):
In order to strengthen school health education, CDC created the health education curriculum analysis tool or HECAT. As we've said, it is CDCs primary evidence informed tool for advancing health education through schools. The HECAT contains process guidance, appraisal tools, and resources for carrying out a clear, complete, and consistent analysis of commercially packaged or locally developed health education curricula. Analysis results can help school and community leaders select or develop appropriate and effective health education curricula, revise, and improve locally developed curricula strengthen the delivery of health education in the classroom and improve the ability of school health educators to support healthy behaviors and outcomes among youth.
Leigh Szucs (10:09):
The HECAT is aligned with the national health education standards and CDCs 15 characteristics of effective health education curriculum resource. The tool addresses a comprehensive array of health topics, including mental and emotional health. HECAT is designed to be used by state, local, or tribal health and education agency staff, curriculum committees, teams or educators at schools, and school districts, community organizations serving or working with youth institutions of higher education and other pre-service teacher training programs and commercial curriculum developers. As was mentioned in the beginning, CDC recently updated the contents of HECAT based on emerging research in adolescent and school health. As part of that 2021 update HECAT is now offered in two formats. As you can see here, users can access the tool using and downloading the PDF manual found on CDCs healthy youth webpage, as well as, through the interactive online application called HECAT online together. These multiple user formats help improve the accessibility and reach of the HECATÕs chapter six includes 10 modules to address specific health topic curricula and comprehensive health education curricula.
Leigh Szucs (11:31):
Each module contains a description of the health topic to be addressed, including the healthy behavior outcomes or HBOs relevant for the curricula in a specific topic area. All modules use the national health education standards core concepts standard one as the framework for analysis. The framework helps determine the extent to which the curriculum is likely to enable students mastery of essential knowledge and skills that promote health behavior in that topic area, because school curriculum must meet local community needs and conform to curriculum requirements at the state or local level users are encouraged to review the list of HBOs knowledge, expectations, and skill expectations in their chosen topic area. Before beginning analysis, HECAT users can add, delete or revise items in any of the modules to meet community needs and curriculum requirements based on the youth needs and data. Now we'll take a deep dive into the mental and emotional health module highlighting new and revised student level knowledge expectations.
Leigh Szucs (12:41):
Let's begin by talking about healthy behavior outcomes, a pre-K through grade 12, mental and emotional health curriculum should enable students to achieve nine healthy behavior outcomes. As you can see here on the screen, these range from expressing feelings and emotion in health enhancing ways, to establishing and maintaining healthy relationships. During the recent update to HECAT three new HBOS were added to this module; HBO three, manage interpersonal conflicts in healthy ways, HBO seven show acceptance of difference in others and HBO nine practice habits that promote mental and emotional wellbeing. Let's explore the connections between the healthy behavior outcomes in HECAT and how the knowledge and skill expectations found in the tool can help schools review or create mental and emotional health curricula. When using HECAT to analyze curriculum, the first step is to identify the desired health behavior outcomes starting on those left-hand side shown in orange.
Leigh Szucs (13:44):
So in this example, let's say that a mental health curricula is designed for elementary students in grades three through five and one of the desired behavioral outcomes at the end for students is their ability to prevent and manage emotional stress and anxiety in healthy ways. The HECAT identifies specific knowledge expectations shown in the green boxes that are aligned and believed to help students achieve that behavioral outcome. So for example, students ability to identify appropriate ways to express and manage needs wants emotions and feelings, as well as, identify causes and effects of stress are knowledge, expectations aligned or mapped to the HBO of preventing and managing emotional stress and anxiety in healthy ways. The users will find in HECAT that all knowledge expectations are mapped to the healthy behavior outcome of interest and are shown highlighted in yellow with the exact HBOS that correspond. As a final piece HECAT users may also want to understand what skills could help students build knowledge in order to reach the desired, healthy behavior outcome. In the blue boxes, you can see skill examples, such as demonstrating effective verbal and nonverbal communication skills or identifying resources that can help achieve a goal to improve mental and emotional health or describing how media and technology influence mental health practices and behavior as being critical skills for influencing the knowledge needed to reach the health behavior outcome.
Leigh Szucs (15:25):
The process of identifying the HBO and selecting relevant knowledge and skill expectations based on local priorities and needs is how HECAT users can utilize the tool to inform systematic review revision or development of mental and emotional health curricula across all grades pre-K through 12. Now that we understand more about the connections between HBOS and knowledge and skill expectations, let's highlight important topics that users can expect to find within the mental and emotional health module. Since the development of HECAT, the mental and emotional health module has included content related to respect, empathy, expressing and managing feelings and emotions, recognizing and celebrating diversity, resolving conflict in healthy ways, helps seeking for mental health, recognizing and preventing bullying and or victimization, and healthy relationships in the context of family and peers. This set of topics provides a wide range of important information and skills to help youth achieve those desired healthy behavior outcomes, including the promotion of positive mental health and risk reduction. In HECAT's recent update in the fall of 2021, a number of key revisions were made to strengthen those existing topics and add new topics. 
Leigh Szucs (17:00):
In the 2021 revision HECAT users will find alignment of content about emotional regulation and recognition from leading social and emotional health learning competencies across grades pre-K through 12, a strengthening of the intersection of mental and emotional health with other health topic areas, content to help students recognize and value diversity and healthy relationships, updated terminology that reflects the evolution of language regarding stereotyping, bullying, harassment, bias, prejudice, and discrimination, and a stronger focus on the influence of communication technology, including social media on the relationships that peers and young people have with family others in their community and how those impact mental and emotional health. New and updated knowledge expectations are provided in all grades spans pre-K through 12, as well as additional specificity to the skill expectations aligned with the national health standards two through eight were included in the recent update. In the next set of slides weÕll talk about specific examples of revised or new knowledge expectations in this module. 
Leigh Szucs (18:06):
Related to promoting emotional recognition and regulation, knowledge expectations beginning in younger grades include items such as identifying internal and external signs that one is experiencing different feelings or emotions, as well as, for older students explain the body's physical and psychological responses to stressful situations in ways to reduce their impact. The recent updates strengthen language on the intersection or overlap as I mentioned between mental and emotional health and other health behaviors and domains. For example, new items in secondary grades include analyzing how differences in power and control in a relationship can contribute to aggression and violence. Notably HECAT sexual health and violence prevention modules include complimentary knowledge expectations for managing emotions and feelings and help seeking behaviors across grade levels that are also related to mental and emotional health. Users that have selected this mental and emotional health module are also encouraged to look at those complimentary modules when selecting, developing, or revising mental and emotional health curricula related to recognizing and valuing diversity and healthy relationships. New knowledge expectations include and reflect explain the importance of talking with parents and other trusted adults about feelings, as well as evaluate healthy and unhealthy strategies to manage difficult relationships with families, peers, or dating or sexual partners.
Leigh Szucs (19:41):
In the recent updates updated technology now includes and is reflected in knowledge expectations. For example, discuss how stereotyping, bullying, harassment, bias, prejudice, and discrimination are distinct and related to each other and explain their impact on self, others, and society is a knowledge expectation found in grades six through eight and nine through 12. Lastly, intentional focus on the role of communication technology and the impacts on youth mental and emotional health were included in the recent updates. For example, across secondary grades six through 12 new knowledge expectations, including include analyzing how sharing or posting personal information electronically about self or others on social media sites and other digital communications can negatively impact mental and emotional health. That concludes the deep dive into some of the new and revised knowledge expectations found within HECATÕs mental and emotional health module. All content shared in this webinar are accessible in the he cap's PDF version found on the healthy youth website or through the HECA online application.
Leigh Szucs (20:52):
We encourage users to review the full module before beginning systematic analysis of either commercial or locally developed and available mental and emotional health curricula. In the final section, we'll highlight some key resources and tools to help inform school's work in mental health promotion and prevention to accompany the HECAT. CDC created a series of new fact sheets, detailing the tools core features and forms for intended audiences and guidance on how to access and use HECAT online. Interested users can also reference the CDCs HECAT frequently asked questions page to learn more about common questions and answers that users have about updates and the online system. Other resources that might be helpful for schools working to promote mental and emotional health through universal primary curricula and prevention includes CDCs characteristics of effective health education curricula. This resource highlights 15 characteristics based on the growing body of research and evaluation in universal primary prevention across health topic areas. Developing a scope and sequence for health education is another resource that provides users with a step by step process for creating or revising a scope and sequence for across many topic areas, including mental and emotional wellbeing and health.
Leigh Szucs (22:16):
And lastly, the health education pacing guide and unit planner is a tool created by CDC to support classroom teachers or facilitators of mental and emotional health curricula and provides guidance, templates, and examples for pacing and ensuring curricula and instructional materials align with desired health behavior outcomes and curriculum requirements. All of these resources can be found on the CDC, health education tools and resources page. Everything presented in today's video can be found on CDCs healthy youth webpage. Additionally, CDCs tools for healthy schools shown on the right includes a free eLearning training series. All about HECAT the eTraining series, overviews key features of the tool, how it can be used and provides an example walking through one of the modules. Both webpages and training resources provide much more detail about HECAT so we encourage you to check them out today. Finally, I'll turn it back over to Marcy to talk more about resources for promoting mental health through school connectedness and classroom management. Marcy,
Marcy Hertz (23:23):
Thanks so much, Leigh. Increased connectedness and support are key to addressing mental health and suicide among our nation's youth. Connectedness refers to a sense of being cared for, supported and belonging, and can be centered on feeling connected to family like parents or caregivers or other important people in organizations in a person's life. Recent CDC research has found that youth connectedness also has long lasting effects. Youth who feel connected at school and at home were found to be as much as 66% less likely to experience health risk behaviors related to sexual health, substance use, violence, and mental health in adulthood. CDC has a series of school connectedness fact sheets that outline six key strategies that teachers, administrators, other school staff and parents can implement to increase the extent to which students feel connected to their school. Effective classroom management is also associated with higher levels of school connectedness.
Marcy Hertz (24:23):
Classroom management is the process that teachers and schools use to create and maintain appropriate student behavior in classroom settings and the benefits of effective classroom management extend to academic related outcomes, including decreasing disruptive behaviors, increasing student engagement, and improving teacher student relationships that support emotional learning. Research conducted by CDC identified evidence-based classroom management approaches that promote student connectedness and engagement across six strategy domains, including those who see on your screen: teacher caring and support, peer connection and support, student autonomy and empowerment, management of classroom, social dynamics, teacher expectations, and behavior management. Learn more about each domain on CDCs healthy use webpage, including classroom strategies school staff can try today. This concludes our video, HECAT's mental and emotional health module and supporting resources. If you have questions or additional assistance, please reach out to CDC. Thanks.