Child-to-Child Newsletter.2

A Steady Climb on the Six Steps to Health’: A Response
Clare Hanbury, Health Education & Children’s Rights Consultant and Child-to-Child Trust Adviser

A description of Child-to-Child's six-step approach to health education is often met with great excitement. It neatly suggests a framework into which we can put our enthusiasm for donor-friendly issues such as children's participation, relevant curriculum development, community participation, children's rights and, above all, health education that is linked to improved health for children and their families.

But does it work in practice?
Through the excellent Health Action Schools project in Pakistan, the Child-to-Child Trust has the opportunity to develop its understanding of the complexities and tensions inherent in making the six-step approach work in a formal school setting.

From the article, A Steady Climb on the Six steps to Health, we learn that teachers’ confidence in the manageability of the approach is developed when they examine and then produce a series of activities around a particular topic, such as Home Safety. Some of these activities take place within lesson time and others within homework time. The activities at the core of these lessons and homework time are designed to follow the six-step pattern of: (1) Understanding, (2) Finding Out More, (3) Discussing and Planning, (4) Taking Action, (5) Evaluation, and (6) Doing It Better.  The activities are linked to three types of objectives: KNOW, DO and FEEL.

The examples given in the topic planners reveal the inherent tension between planning activities to develop a topic and using the six-step approach. The approach is designed to be flexible and responsive with activities at Step 3 flowing from the results of activities in Step 2.

In the example on the topic Home Safety, assumptions are made in the topic planner that the most dangerous area in the home will be the kitchen, that children will suffer burns and that an important activity is to learn how to deal with these burns. This theme is developed further at Step 4 (Taking Action) where it is suggested children actually treat burns and call for help. But what if kitchens are not the key dangerous areas in the majority of children's homes? Rather than assuming this, a more responsive approach may be to get children to discuss potential dangers at home, to teach children how to do a survey to see if any of these dangers exist, and if they do, consider what can be done to make the home safer. Also, it may be important to discover what measures are already being taken by parents (and neighbours) to minimize dangers to children at home. In this way the project could take off and develop in a way that is more deeply connected to the lives of the children, their parents and friends. By deciding to focus at the outset on kitchens and burns, teachers run the risk of losing the potential to involve the children in relevant learning that leads to actual health benefits.

Another point for careful consideration during development of the topic planner is the temptation to expand the topic rather than deepen understanding of it and connect it with children's lives. For example, in the topic on Coughs and Colds, activities suggested focus also on:

Coughs and Colds would seem to be a broad enough topic for a series of lessons without these extra topics.

A helpful feature of the HAS topic planning is the devising of specific learning objectives under the three headings, KNOW, DO and FEEL. Developing teachers' competence in devising objectives is important and useful, as the objectives guide the teacher in how to design and develop a topic. It is particularly exciting to see how the HAS project emphasizes attitudinal changes by asking teachers to consider ways in which they want children to feel as a result of working on a particular topic.

However, by setting many objectives at the beginning of the planning process, it may be tempting for teachers later to ensure that their objectives are achieved, rather than responding to the issues that emerge from the Finding Out activities at Step 2. This point links back to the tensions between planning and developing a topic and using the six-step approach. It may be useful to limit the number of planned objectives to, for example, two objectives per category and for this list to be revisited by the teacher (and the children?) as the topic develops through the six steps. There will always be unexpected issues arising and these can be recorded to develop the relevant topic planner and/or develop a new topic.

It may also be helpful for the teachers to have guidance on constructing objectives that are more specific. For example, in the topic area, Children with Disabilities, it is suggested that children develop ‘skills to encourage children with disabilities to participate’. But what skills? Participate in what? How? A useful acronym that has often been used to help construct learning objectives is SMART, i.e. Specific, Measurable, Achievable, Relevant and Time-bound.

In summary, this project's use of the six-step framework may be strengthened by supporting teachers to:

The title A Steady Climb…and the sub-heading, Beginning with Small Steps, suggest that those involved are aware of how much further the project can develop. Nevertheless, by involving children in active learning and building on their capabilities for health action, the project has made a valuable start on a path towards improved health for children and their families.

The Six-step Methodology in Perspective
Hugh Hawes, Child-to-Child Trust Education Adviser

The health action methodology is certainly one of the most important products to have come out of the Child-to-Child movement. Yet it is one of the most difficult to adopt since it gives a concrete framework through which children can be involved in their learning and be given a measure of responsibility and control that adults over centuries have also found so difficult to devolve.

Because it is so important it needs to be examined carefully. Educational history is littered with new theories that were espoused too enthusiastically and perished when it was found they did not provide all the answers. So there is need to emphasize first that the stepwise approach developed though the Child-to-Child approach is not synonymous with the concept of ‘active learning’. It is an approach that links learning in class with action outside it and is therefore best used in areas such as health, environmental, moral and civic education. These areas in their turn are often not discrete and separate school subjects, so it becomes important to identify when the stepwise approach can be usefully used and when it can’t. It can, for instance, be used in a science unit on water; it cannot be profitably used in a unit on levers in the same syllabus which will require a different kind of active learning based on experiments with simple everyday things. Both methods are equally important in developing learning and living skills in children.

This distinction is worth making because though the HAS programme in Pakistan works within a modest number of relatively discrete periods, many other schools in different countries are following current syllabuses most of which have ample room for using this very valuable approach. The key is to identify those areas, convince any sceptical authorities such as heads and inspectors that the children will benefit from working with blocks of four to eight lessons rather than single discrete periods and use the enthusiasm of the children, as the HAS programme has done, to convince people that more of the same will be both popular and productive. In this way it will be possible to present the methodology for what it is, one weapon (albeit a very important one) in the armoury of teachers who seek to transform rote learning into a real educational process that teaches children to think and links learning with living.

We should also guard against interpreting the approach too rigidly. For the six steps need not always be six and need not always be linked with rigid classroom periods. What is vital in the approach is the realization that learning happens in different places at home and in school, that ideas can be tested and developed against reality and that children can be encouraged to make a difference to others while they are learning and not afterwards. A class that discusses how mosquito larvae develop, and introduces fish into ponds where they breed, an activity I saw taking place in Maharashtra State in India, may only be covering three of the steps (it is mightily difficult to evaluate the effect of this action) but they are learning actively. Indeed it is often just as productive to think of our stepwise approach in terms of a term's or year’s activity as in a unit of six lessons. The topic on home safety is a case in point, for it is the long-term effect of this that is vitally important.

 Following my concerns about rigidity, I see the concept of SMART objectives, a ‘must’ for training activities, less generally applicable when dealing with attitude change. Although it is absolutely vital for first aid objectives to be specific, measurable, achievable, relevant and time-bound the same may not equally apply to an objective in a unit on disability such as 'be a friend and behave well with children with disabilities'. This objective though it is relevant is not specific, only partially achievable, certainly not time-bound and very difficult to measure.

Yet nonetheless, nothing that I have said negates the great value of planning units in a series of lessons. When this is possible it not only makes for effective learning but gives the teachers support for their planning.

Nor should anything in this brief response dampen our enthusiasm for the Pakistan Health Action Schools project, which in a very real sense shows how sound theory can really deliver concrete action.

The Six-step Approach: Starting with and Trusting in Teachers
Dr. Tashmin Kassam-Khamis, Assistant Professor, The Aga Khan University, Institute for Educational Development

As has been elaborated, the Child-to-Child six-step methodology is one approach that links learning (school) with living (home).  Whilst it provides a useful framework in which to plan a health education unit (topic), it is not meant to be rigidly confined to six steps but rather promotes a series of lessons that encourage children’s participation in their learning. In a context such as Pakistan, where the majority of teachers are untrained and teaching is limited to chalk and talk, this transition from a teacher to child-centred way of teaching is not an easy or straightforward one.

The tensions between planning and executing children-directed, children-initiated activities are real and have been felt in our Health Action Schools in an effort to move from a 'Desirable' to a 'Most Desirable' level of participation. (For example, Children deciding the topic of need and finding out more, Children taking and evaluating action.) The notion of using open ended content with planning only anticipated methods is unrealistic when teachers are used to the textbook being their teacher’s guide, or even curriculum, and when confidence in using active methods still needs to be built. Our experience in Pakistan shows we need to start with where teachers are at and trust in teachers. The activity sheets, based on sound health knowledge, are one of our greatest resources that help teachers deal with the neophobia of trying something new, as it gives them the confidence of clear health content for setting objectives with a “bag of ideas” for activities with children. And as our teachers usually come from the same environments as their students, they adopt the objectives and activities that they feel are contextually relevant. The topic planner, further, is filled by teachers who have never before set objectives (SMART or otherwise) or planned a unit of lessons and thus provides a format and structure to help the teacher to do both. As health topics (like other subjects) do not fit into neat, discrete boxes, the overlap between themes is evident in the planners. This indeed helps to reinforce topics previously covered and to make links between prevention and disease, for example, clean water and diarrhoea; immunization and pneumonia.

The subject area of health education is new to our teachers in Pakistan. However, those that have begun to teach health (which is not ‘examined’ and directly relates to daily living) demonstrate that this subject provides a vehicle for teachers to improve the way they teach. The six-step approach has been a pathway to school improvement in our Health Action Schools.