1 Kevin Lorson [email protected]Health & Opioid-Abuse Prevention Education (HOPE) Curriculum Health Education Teacher Session OAHPERD Summer Institute – June 14, Please register on Pilot Kevin Lorson

2 Today’s Goals: Examine the opioid epidemic and the federal, state and local response. Describe prevention efforts. Examine the role of the teacher, health educators, school personnel and the school in drug abuse prevention. Review the HOPE Curriculum Project. Practice the HOPE Curriculum Lessons. Develop a HOPE Curriculum Action Plan.

3 Effects on children E.g. – Butler County – 43% are drug-related and 63% of those are because of opioids. 13,700 in >12,400 in 2015 in protection services (11%).

4 Opioid Background Info:

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7 Addressing the Opioid CrisisSocietal Causes Prevention Treatment / Response Unemployment Skills Based Health Education: -Functional Knowledge -Peer Refusal -Decision Making -Peer Norms -Advocacy First responder training -Naloxone access & use Poverty Lack of neighborhood or family cohesion Increased beds in treatment centers Perceptions that pain must be managed with drugs Prescriber Education -Effective pain management -Reduce overprescribing Community based treatment programs Reduce barriers to treatment -Cost (insurance) -Stigma Federal - President Obama signed, health legislation (CARA act) that includes funding to fight the opioid epidemic. Government cracked down on pill mills and prescription regulation leading to a surge in overdoses from heroin and fentanyl found on streets State – (9/1/2016) Ohio receives nearly $2 million from the DHHS under three health-related programs to address the statewide epidemic of opioid misuse and overdoses. Kasich administration invested nearly $1 billion in 2015; 2/3 of it for drug-addiction and mental-health care through the expansion of Medicaid; Other spending includes drug courts, highway drug seizures, a state drug-prescriber registry, medication-assistance services, treatment in adult and youth prisons. Earmarked $20 million of Third Frontier Start Talking education and prevention program. Local - Addressed piecemeal by churches, police, judges, nonprofit groups and volunteers usually at county level task forces. White lettered items: Health education teachers have a role to play with these. It's affecting every sector of our community: > Cultural and social self-destruction > Women can’t function as mothers > Babies born addicted to opioids/heroin > Prostitution; violence; and despair (suicide) > Children/students raised with family members addicted to heroin > Generational poverty Important issues to consider: > Stigma – afraid to ask for help > Secrets – students hide problems > Prevalence - not only rural issue but now a suburban issue > Students in fear of going home after school because parent/family member overdoses Proper use & disposal of Rx medicine Physician overprescribing “pill mills” Law Enforcement -reduce access to drugs Recovery Programs -Peer support Recognize Signs & Getting Help -Parents -Teachers -Peers International & domestic drug trafficking

8 Ohio’s Response: HB 367 OverviewHB 367 requires Ohio schools to select a health curriculum that includes instruction on the dangers of prescription opioid abuse and the connection between prescription opioid abuse and addiction to other drugs, such as heroin. Governor’s Cabinet Opiate Action Team (GCOAT) makes recommendations that are published by ODE. ODE provided recommendations for instruction at each grade band (K-2, 3-5, 6-8, 9-12)

9 Ohio Joint Study Committee on Drug Use Prevention Education RecommendationsK-12 Substance Abuse Prevention Education – consistent, age-appropriate, evidence-based. Required Reporting for Schools – how are schools fulfilling the requirements to provide substance abuse education. Social and Emotional Learning Standards – Standards exist for K-3, extend to K-12. School & Community Surveys – Complete YRBS or OHYES! Survey annually. Expand Substance Abuse Curriculum across Subjects. Convened by AG Mike DeWine 22-members of lawmakers, state agencies, prevention specialists, organizations and educators Develop recommendations for policies, legislation and practices to enhance drug abuse education in schools.

10 Ohio Joint Study Committee on Drug Use Prevention Education RecommendationsResources for schools about substance abuse prevention Substance Abuse and Mental Health Intervention Training Dedicated Prevention Personnel at the Department of Education. Strengthen and Involve Law Enforcement Support Before- and After-school Programs Convened by AG Mike DeWine 22-members of lawmakers, state agencies, prevention specialists, organizations and educators Develop recommendations for policies, legislation and practices to enhance drug abuse education in schools.

11 Ohio Joint Study Committee on Drug Use Prevention Education RecommendationsCommunity-based Prevention Engaging Families and Caregivers Youth-led prevention Incorporate Prevention in Higher Education Study Committee keeps working. Full Report Convened by AG Mike DeWine 22-members of lawmakers, state agencies, prevention specialists, organizations and educators Develop recommendations for policies, legislation and practices to enhance drug abuse education in schools.

12 Current Opioid & Drug Abuse Prevention Education Ohio InitiativesStart Talking Governor Kasich’s initiatives to give families, educators, and community leaders the tools to start the conversation with Ohio’s youth about the importance of living health, drug-free lives Information, teachable moments in the classroom, athletics and law enforcement. Parents360Rx Know! 5 minutes for Life Other resources: Generation Rx Drug-Free Action Alliance

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14 Risk Factors & Protective FactorsRisk Factors – those factors associated with a greater potential for drug abuse. Protective Factors – Those factors that are associated with reduced risk. *Most at risk do not start using *Risk factor for one may not be for another. “Risk Trajectory or Path” (National Institute on Drug Abuse (2003). Preventing Drug Use among Children and Adolescents: A research-based guide for parents, educators and community leaders) Trajectory – how risks become evident at different stages of a child’s life.

15 PAX & Social-emotional learning is the foundation that develops protective factors and reduces risk factors Generation RX – opiate information and descriptions of pharmacology (for pharmacists) Start Talking – classroom, family and community support resources HOPE – scope and sequenced curriculum for health education (and classroom teachers)

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17 Health Education in OhioOhio is the ONLY state without health education standards. Health Education is the ONLY academic content area without academic content standards. General Assembly has oversight of health education, not the Ohio Department of Education (ODE). Only content area. Ohio is a local control state NO ODE health education consultant. ODE cannot develop or publish curriculum, but they can provide links and resources.

18 Ohio’s Health Education RequirementsGraduation Requirement: One-half unit (60 hours) K-8: NO Time Requirement but, Must have a health education curriculum for all schools that must include: Nutrition (including natural and organically produced foods, the relation to health and the use and effects of food additives. Harmful effect and legal restrictions against the use of drugs of abuse, alcoholic beverages, and tobacco. Venereal disease* Personal safety and assault prevention, child abuse prevention (K-6), 9-12 Dating violence and sexual assault prevention. Prescription opioid abuse prevention. Organ Donation

19 Effective Health Education CurriculumFocusing on Health-related Skills, Attitudes, and Functional Knowledge Skills v. Information Approach to Health Education: An Example Planned and Sequential Comprehensive Active Student Involvement Engaged, excited and enthused through discussions, simulations, games, experiential learning. Planned and Sequential Based on age-appropriate, developmentally appropriate knowledge, learning strategies, teaching methods, materials Aligned with specific behavioral outcomes (HBOs, Health Behavior Outcomes) Informed by educational research and theories (Skills-based approach to health education is supported by health behavior theories and models such as the Health Belief Model, the Theory of Planned Behavior, the Social Cognitive Theory.) Comprehensive Designed to increase students’ understanding of risks and the possible consequences of engaging in those risks Reinforces protective factors such as taking responsible for their health, knowing what situations may be within their control as well as which may not be in their control, examining how positive and negative influences are related to their choice to participate in risk behaviors or healthy behaviors. Active Student Involvement in Lessons (Role-plays, group discussions, simulations, games, experiential learning) Basing lessons on accurate, up-to-date functional knowledge Personalizing health-related information and skills Being culturally inclusive Reinforcing health-related skills in other subject areas as well as health class Helping student make positive connection with responsible adults

20 Health Education StandardsKEY CONCEPTS – comprehend concepts related to health promotion and disease prevention. ANALYZING INFLUENCES – analyze the influence of others, culture, media, technology on health. ACCESSING VALID HEALTH RESOURCES - access valid information, products and services. INTERPERSONAL COMMUNICATION SKILLS - use interpersonal communication skills to enhance health and avoid or reduce health risks.

21 Health Education StandardsDECISION-MAKING SKILLS - use decision-making skills to enhance health. GOAL-SETTING SKILLS - use goal-setting skills to enhance health. SELF-MANAGEMENT SKILLS – demonstrate health-enhancing behaviors to avoid or reduce health risks. ADVOCACY SKILLS - advocate for personal, family, and community health.

22 HOPE Curriculum Project:Three year project funded by the Ohio Department of Higher Education: Design a K-12 opioid abuse prevention curriculum for existing health education curriculum. Provide professional development for teachers, administrators, and other school health partners throughout Ohio. Evaluate the implementation and impact of the HOPE curriculum and opioid abuse crisis on students, teachers, schools and communities.

23 Characteristics of the HOPE CurriculumDesigned for K-12 with lessons for each grade band K-5 - designed for classroom teachers, aligned with English Language Arts. Middle and High School - designed for licensed health education teacher. Enhance health education, not a new program. Designed to supplement, not replace, a comprehensive approach to alcohol and other drugs prevention education. Connected with Start Talking!; Generation Rx; youth-led prevention programs.

24 HOPE Curriculum Lesson Plans - Draft ✓ Teacher Guide - Draft Aug. 2017Three lesson plans for each grade K-8, 10 lessons for HS. Includes with an lesson enhancements and extensions. Teacher Guide - Draft Aug. 2017 Tips to implement the lessons and additional content knowledge packets with instructor notes School Administrator Guides – Draft Aug. 2017 Additional resources; FAQs; letter to parents overviewing the topic and resources. Staying Connected – Draft Winter 2018 Ideas for additional follow-up, community and parent engagement, and social marketing based on the foundation established by Start Talking!

25 HOPE Curriculum OutcomesDevelop health literate students by: Enhancing functional health knowledge Focus on essential information that leads appropriate health behaviors. Developing personal beliefs that support healthy behaviors. Identifying group norms that value a healthy lifestyle. Demonstrating the essential skills necessary to adopt, practice and maintain health enhancing behaviors. Communication and decision-making skills Standards-based, tailored to meet students’ developmental needs, flexible to match school, and teacher resources. Add in the importance on developing skills consistently over time. Address that lots of knowledge – pick and choose content that is functional and will lead to being drug-free. A

26 Key Outcomes: Grades K-2Lesson 1 - Identify rules about medicines at home and school Identify trusted adults who can help with taking medicines. Recognize the healthy decision when encountering medicine, unknown or unsafe substances. Don’t know = Don’t touch, don’t taste, don’t take & tell a trusted adult. Lesson 2 – Decision Making. Choose a healthy option when making a decision. Lesson 3 – Communication Skills. Use effective communication skills to make healthy choices.

27 K 1st 2nd Lesson 1 2 3 4* Trusted Adults & Using Medicines SafelyStudents will identify trusted adults at home and at school or in the community who can help with taking medicines. Students will also differentiate between an adult, friends and a trusted adult. The lesson will emphasize why we take medicine and the rule that we only take medicines with the help of a trusted adult. “We Make Healthy Choices” The lesson focuses on making healthy or safe choices with medicine, people who can help them make healthy choices, and how to make healthy choices about medicines. Students will sort a set of fish (decisions) into healthy and unhealthy categories, and keep the healthy fish for their fishbowl. Making Healthy Choices: Don’t Let Your Eyes Fool You. Students play a Jeopardy-type game to review making healthy choices, family and school rules about medicines, identify unsafe household products and trusted adults.  2 Medicine & Harmful Substance Safety The lesson focus is to make healthy decisions and following the rules for medicines, household products and unknown substances. Students will look at pictures of medicines, household or unknown substances and decide if they are safe, unsure or unsafe decisions. Who Wants to Make Healthy Choices? Students will practice making healthy choice by playing the “Who Wants to Make Healthy Choices?” game. During the game students analyze the situation to determine if it was a healthy and safe, or unhealthy and unsafe choice. Decision-Making Basics: Stop, Think, Choose Students will review key concepts from Lesson 1 to unlock the “Code of Choices. Students will use the steps of making a healthy decision (“Stop, Think, Choose”) in three situations. 3 Keep Sammy Safe with Healthy Decisions Students make healthy decisions about medicines to be sure the puppet named “Sammy Safe” is safe and healthy. Communicating Healthy Choices Lesson 3 combines decision-making and communication. The focus is on identifying healthy choices and when to ask for help from a trusted adult. Being Assertive To Be Healthy Lesson 3 will introduce assertive communication skills to make a healthy decision to avoid unhealthy and unsafe situations. 4* I Will Make Healthy Choices In this lesson students will advocate for making healthy choices with medicines. Students will develop and sign the pledge to be safe with medicines and harmful substances. I Will Make Healthy Choices about Medicine Students will brainstorm three possible reasons for making healthy choices. The student writes a sentence with their favorite reason and identifies who can help them with medicine. Advocating for Healthy Choices about Medicines Students will develop a paragraph that describe how to make healthy choices, who can help with making healthy choices, and the reasons to make healthy choices.

28 Kindergarten, Lesson 1

29 Kindergarten - Lesson 2

30 2nd Grade – Lesson 3 Situation: You are playing over at your friend Joey’s house. You hurt your leg while playing soccer, and say, “Oh wow, that really hurts.” Joey goes inside and then returns with one of his parent’s pill bottles. He opens it and offers you 2 of the pain pills. What do you say? You say: “I do not want to take those pills. Taking someone else’s medicine is unsafe and unhealthy.” Look at other person’s eyes while speaking. Stand up straight. Speak loudly enough for person to hear you. Calmly say, “I do not want to do that.” (What they are asking you to do?). Calmly say, “That is unsafe and unhealthy.” (Why it is unsafe/ unhealthy?).

31 Key Outcomes: Grades 3-5 Lesson 1 – Rules, consequences and healthy choices Explain how to use medicines correctly Identify family and school rules about medicines and drug use. Identify trusted adults who can help with taking medicines or how to get help for others. Explain the harmful effects of unhealthy decisions or misuse of medicines, drugs and harmful products. Lesson 2 - Identify options and their potential outcomes when making a healthy decision. Lesson 3 - Demonstrate effective verbal and nonverbal communication skills to avoid drug use. Lesson 4 – Advocating to be Drug-Free!

32  Lesson 3rd 4th 5th 1 Healthy Choices Make You Healthy Students will use a graphic organizer to compare and contrast the positive and negative consequences of making healthy choices about medicines. The lesson will reinforce following school and family rules for medicine use and always asking for help from a trusted adult to take medicine. Your Health is not a Game of Chance The purpose of the lesson is to reinforce making healthy choices and the consequences of unhealthy choices. We will use a “Game of Chance or Roll of the Dice” activity to show the risks and consequences of making healthy or unhealthy decisions. The lesson wraps up with reinforcing who can help you make healthy decisions about medicines. Making healthy decisions with over-the-counter and prescription medicines. Students will compare and contrast OTC and prescription medicines. The lesson will reinforce home and school rules for taking, storing and disposing medicines (including always taking under the direction of an adult) in the context of learning about prescription medicines. 2 Healthy Decision Detective Students will apply the steps to making a healthy decision in the role of Detective H.S. (Healthy, Safe) Decision. As Detective H.S. Decision students will use the steps of making a healthy decision, identify consequences of the decision, and determine if the decision healthy, safe and respectful. Your Mission? Making Healthy Decisions The lesson will develop assertive communication skills and strategies to be confident and stand up for yourself and your healthy decisions. Students will think about what they will say in a situation, and then practice being assertive in delivering the message with a peer. Stop, Think, & Choose to Make Healthy Decisions The Stop, Think, Choose model will be used to help student think about the alternatives and possible consequences before making a choice. The lesson will also use a stoplight to determine if a choice is safe (Green), needs additional thinking or help (Yellow), or is unsafe (Red). Students will play a board game where they will review key concepts, identify positive/negative consequences to decisions and apply the “Stop, Think, Choose model. 3 Refuse to Use The lesson focus is on standing up for yourself and the healthy decisions you make. Students will learn practice the four aspects of looking at the person, stating the decision firmly but politely, walking away if pressured continuously, and telling a trusted adult about an unhealthy/unsafe situation. Being Confident & Assertive to Make Healthy Choices The lesson will develop assertive communication skills and strategies to be confident and stand up for yourself and your healthy decisions. Students will plan and write what they will say in a situation, and then practice being assertive in delivering the message with a peer. Don’t Give in to Peer Pressure: Make Healthy Choices The third lesson will practice the “Three No’s and a Walk” refusal technique. Students will apply the refusal techniques in two different scenarios. The teacher will debrief the scenarios to reinforce positive influences on healthy choices, and being assertive to make healthy choices. 4*  Advocating to be Drug-Free - Lesson 4 is a lesson enhancement. This lesson could be added as an extension to another lesson or it can be a separate stand-alone lesson if time allows. Students are asked to share what they have learned about healthy choices and express that in a creative manner using a RAFT (Role, Audience, Format, Topic). Underline key aspects – e.g. decision-making

33 5th Grade: Lesson 2 and 3

34 Lesson 4: Advocacy

35 Key Outcomes: Middle SchoolLesson 1 - Explore the reasons and influences on drug use Proper use v. misuse of OTC, prescription and illegal drugs. Examine school, family and norms. Lesson 2 - Demonstrate assertive communication strategies and refusal skills. Lesson 3 - Apply decision-making principles to make a healthy decision. Lesson 4 - Advocate to others the reasons to be drug free.

36 6th 7th 8th 1 Proper Use v. Misuse Reasons for Drug Abuse Lesson 6th 7th 8th 1 Proper Use v. Misuse Understand the dangers associated with taking OTC and prescription drugs inappropriately by identifying proper use/misuse in scenarios. Reasons for Drug Abuse Why students use drugs, the influences on using or not using and how drug use impact their lives. Influences on Drug Use Influences on drug use including peers, media and information about prescription drugs. 2 Communication Strategies for Refusing Drugs Students will write assertive refusal statements and identify assertive verbal and nonverbal cues to promote drug free messages. Refusal Skills Apply communication skills, peer resistance skills and strategies in role plays and scenarios. Refusal & Communication Skills Demonstrate peer refusal skills and apply strategies in different peer pressure scenarios. 3 Proper Use of Prescription and OTC Medicines Apply the stop, think, choose model to analyze a scenario and make a healthy choice. Decision-Making Apply the Stop, Think, Choose Model and while examining the influences on that decision, consequences of the decision and reflecting on the effectiveness of the decision. Effective Communication to Facilitate Healthy Choices Apply the decision-making model to be drug free and to avoid riding in a motor vehicle with an impaired driver. 4*  Advocating to be Drug-Free *Lesson 4 – Advocating to be Drug-Free by writing a letter that encourages a 5th grader to make drug-free choices when they get to middle school. (*Lesson 4 is an additional that can be used as a culminating assessment in middle school).

37 High School Key Outcomes:Proper Use & Misuse of opioid, prescription drugs and OTC medicines. Reasons & Consequences Influences on drug use. Communication strategies & refusal skills. Communicating my own decision. Encouraging others to make a healthy choice. Responding to peer pressure and influence. Decision-making skills. Community Connections and Getting Help. Advocating to be Drug-Free.

38 High School Lesson Outline1 2 3 Impact of Drug Use Analyzing the impact of drug use on relationships, society, the user’s health, education, and future. Levels & Consequences of Addiction Stages of addiction using scenarios to see the physical, psychological, social and societal consequences of addiction. Proper Use of Prescriptions & OTC Characteristics of OTC and prescription drugs, identify consequences of abuse, and apply their knowledge in scenarios to determine proper use. 4 5 6 Opioid Abuse Prevention Impact of opioid abuse on individuals, families and communities. Writing a letter to a friend who is hanging out with kids that are using heroin that outlines the dangers, consequences, and impact of opioids on self and others. Influence on Drug Use. Examine the various social, psychological, environmental, biological and social influences on drug use. Avoid riding in a car with someone under the influence Analyzes the dangers associated with driving and riding in a car with a person who is under the influence. 7 8 9 Decision-Making Use the decision-making process (Stop, Think, Choose) including identifying barriers, influences, consequences, and alternatives. Refusal Skills Practice and apply peer resistance skills, negotiation, collaboration and effective communication to avoid drug use. Getting Help Identify how to get help from community and school resources for themselves and/or others who have a drug addiction.  Lesson 10 - Advocating to be Drug-Free Develop drug free messaging that will promote and persuade other teens to be drug free this might be in shared in the form of news headlines, tweets, letters, posers, poems, raps, commercials or media campaigns. Underline key aspects – e.g. decision-making

39 High School - Lesson 6 Kendra enjoyed her evening with friends attending a concert at the Huntington Center. She was completely sober and driving home, as a misty rain began to fall. Unbeknownst to her, a drugged driver was heading her way as he crossed the centerline of the highway. The drugged driver hit Kendra head-on. Her injuries were numerous and life-threatening. Most people would have died within minutes, but she had not. During emergency surgery, surgeons worked hard to save her life. She spent 2 weeks in a coma and 3 1/2 weeks on life support before waking to learn all she had been through. She had all kinds of emotions knowing that her life would never be the same. She is going to have to learn how to walk again, talk again, and some injuries will be permanent, such as the paralysis on the left side of her body. She inquired about the other driver and learned that he tested positive for prescription drugs in his system at the time of the accident. The driver's name was John. Earlier on the night of the crash John was hanging out with some friends and sharing a variety pack of pills. He is not sure of what he took, but he started get a headache and feel nauseous; he wanted to go home. John’s friend Paula told him he was too high to drive, but John insisted that he drives better when he is a little buzzed. Paula tried one more time, but dropped it and watched John pull away. John’s symptoms now turned to dizziness, but he kept driving so he could get home. About 10 minutes into his drive, he started seeing double. He unrolled his window to get some fresh air, but that wasn’t enough. He crossed the centerline and crashed into an oncoming car.

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41 HS Lesson Practice What is the skill or behavior targeted in this lesson? What is the functional health knowledge? What are the challenges you see? Students? Teacher? What will your students learn in this lesson? Students - Common misconceptions, difficulty in learning skills, managements Teacher?

42 Tips for Skill BuildingDiscuss the importance of the skill, its relevance, and relationship to other learned skills. Presenting steps for developing the skill. Model the skill. Practicing and rehearsing the skill using real-life scenarios. Providing feedback and reinforcement.

43 High School - Lesson 9

44 High School - Lesson 9

45 What can I do right now? Health Education Curriculum RecommendationsRevise Middle School & High School Curriculum to align with health education standards. Consistent messaging across units (e.g. nutrition, safety, etc) Refine the focus to functional health knowledge, skills, and behaviors to be drug-free. Develop effective Alcohol, Other Drug and Tobacco Unit. Review course offerings to meet students’ needs. Examine opportunities in K-5 to integrate consistent messages.

46 Alcohol & Other Drug Education RecommendationsElementary Curriculum Examine opportunities to integrate and reinforce drug abuse prevention education in ELA. Provide professional development or resources for teachers. Examine presence & potential of health education in K-5. Utilize existing community and prevention resources Identify community and school resources. Make connections to families & integrate consistent drug-free messages in your school and community using the Whole School, Whole Child, Whole Community Model. Judy – ODE website.

47 Alcohol & Other Drug Education RecommendationsThey need to know you care! Give students a reason to care. Youth led prevention is effective Classroom teacher is more effective than one- time presenter (consistent messaging). Do NOT show methods of drug use or specific products or paraphernalia. Address short & long-term consequences Girls are more likely to take risk info seriously, and boys are less likely.

48 Alcohol & Other Drug Education RecommendationsScare Tactics DON’T work! Recovering addicts have NOT been shown to be effective May normalize the behavior Be more than facts, (because they probably already know more than you). Engage your students in learning (NO teacher preaching).

49 Alcohol & Other Drug Education RecommendationsAssemblies don’t work unless they are followed up by reinforcing messages or work to address what was learned. Reflection and commitment are great ways to put a drug-free plan into action. Share the NORM – e.g. 80% of students have not misused prescription drugs. Consistent, coordinated, and purposeful approach that engages your students, school, parents and community. JOE – Add references to each of these to support these statements.

50 HOPE Curriculum Professional DevelopmentProfessional Development Sessions Health Education Teacher (2.5 hrs.) Overview curriculum, lessons, and skill-based approach to health education. School Administrator (2-2.5 hrs.) Overview drug abuse prevention in schools, K-5 lessons, overview K-12. Utilizing ESCs, County Task Forces or multiple school districts. Goal is participants in each session Request a copy of the lessons

51 Your Turn