2 How to Use This Health Literacy/ESL Curriculum Overview The curriculum is organized into12 units that include step-by-step instructions on how to teach the educational sessions to community members. Each unit consists of two sessions; therefore, the curriculum covers 24 sessions in total. A curriculum overview is included in Appendix 1. The curriculum includes interactive learning activities and situations confronted by participants in everyday life. It integrates language learning and health literacy within a cardiovascular disease health context. Low/intermediate ESL curricula generally include the goals of expanding students essential English communication skills and cultural knowledge. Students develop oral skills and reading strategies, expand their vocabulary, begin to use more complex sentence patterns, and learn how to use some community resources. This curriculum was developed for Hispanic adults who can read and write in Spanish and have a low to intermediate level of English proficiency. In order to develop English language proficiency skills, a popular ESL program, Excellent English published by McGraw Hill serves as a foundation. This curriculum includes the Excellent English Level 2 student book and the Teacher Edition. The student book is designed for a beginner-intermediate level and 1
3 it is divided into 12 units. The selected ESL curriculum provides the framework for structuring and integrating the health literacy component. This curriculum is designed to be implemented in a community-based or educational setting. Content ESL objectives include how to: participate in conversations on familiar topics in social situations; recognize and respond appropriately to intonation patterns in English speech; understand and use some key subject-specific vocabulary items with visual aids; communicate orally using accepted features of English grammar; and appropriate use of some language features that indicate different levels of formality in English. Students also demonstrate comprehension of key information from written and/or audiovisual materials. In order to ensure that ESL, health literacy, and the health context are properly included in the curriculum, each of the 12 units include a lesson plan that combines goals and objectives related to these three components. Additionally, the lesson plan includes a section with specific instructions on how to facilitate the session, the time needed to complete each section, a detailed description of the classroom activities, and the materials and resources needed. The following examples illustrate how ESL, health literacy and the health contexts are combined: 1) To achieve the ESL-related goal of understanding and using some key subject-specific English vocabulary, students will have to respond appropriately to written questions based on health; 2) To achieve the ESL-related goal of demonstrating comprehension of key information from media works, students will have to describe in English the information presented in a website on a health issue; 3) To achieve the ESL-related goal of appropriately using some features of language that indicate different levels of formality in English, students will have to demonstrate how to initiate a telephone conversation to make an appointment at a doctor s office; 4) To achieve the ESL-related goal of extracting 2
4 information from specific features of text, students will use brochures, charts, and diagrams. Format Each session is presented in motivational ways to engage learners and maintain their attention throughout the activities to maximize the learning experience. The curriculum includes instructional materials (e.g., information, handouts, etc.) for participants to take home to read and share with their family and friends. All 12 units include ESL educational activities which integrate the listening, speaking, reading and writing components. Resources are listed at the end of each unit. 12 Units 1. Citizens and Community: Document and Numeracy (eligibility for financial aid/programs, access to health care, Medicaid form, health insurance form) 2. In the Community: Prose (Searching and locating reliable health information/service/resources on the internet and physically) 3. Daily Activities: Document, Numeracy, and Prose (appointments, medical history, medical instructions, rights & responsibilities) 4. People and Learning: Document and Numeracy (informed consent, questions about treatment and surgery) 5. Medication Management: Prose and Numeracy (read Over-the-Counter and prescription medication labels: dosage, frequency, expiration date, refill, warnings) 6. Living Well: Prose and Numeracy (heart disease risk factors and heart s structure) 7. Planning Ahead: Prose and Numeracy (Diabetes prevention, blood sugar levels) 8. Shopping, Cooking, and Eating: Prose and Numeracy (High blood pressure, cholesterol) 9. Food and Nutrition: Prose and Numeracy (Healthy eating, Food pyramid, food groups, creating menus) 10. Consumer Smarts: Prose and Numeracy (Read and interpret nutrition labels) 11. Get Moving! Prose and Numeracy (Healthy weight, physical activity, Body Mass Index) 3
5 Timeline 12. Personal Goals: Prose and Numeracy: (Smoking: negative side effects/cessation) The curriculum is to be implemented over six or twelve weeks, one unit may be covered weekly or if implemented as an intensive class, two units may be covered per week. Potential changes in English proficiency, health literacy, and cardiovascular health may not be detected within a shorter implementation period. The curriculum brings together 12 units; each unit is designed to last approximately 3.5 hours. There is a total of 42 hours of instruction. About the Sessions Dialogues, role play and other interactive skill-development activities will be conducted in English. This format facilitates learning, and the integration of the health literacy component into ESL instruction, which generally incorporates cooperative learning and role play activities in order to practice language, grammar and vocabulary in everyday situations. The curriculum includes lesson plans with learning and skill-related objectives, classroom activities, supporting materials, and resources for each session. Each session builds English language proficiency and covers a different health related topic to help community members adopt heart healthy habits. All sessions last about 3.5 hours. Extracurricular activities are encouraged. For instance, the facilitator may want to take your group on a grocery store tour between session 8 and 10 with the goal of shopping for a healthy diet. 4
6 Session Outline Each session begins with a section that explains: -What you want group members to do or learn (Language & Health literacy objectives) -Texas adult education ESL Standards (these may be substituted by another state s standards) -ESL Level -Duration of the unit -Materials and supplies that you will need -Worksheets and materials that you will hand out -Key health vocabulary to be covered The Procedures section for each unit is divided as follows: Introducing the Session Homework review Introduce the language and health literacy objectives Conducting the Session ESL activities using Excellent English Level 2 (ESL program by McGraw Hill) Practice and Application Introduction to the lesson by reading a vignette (story) to provide context. Key health vocabulary development Health literacy specific learning activities Homework assignment Teaching Tips ESL Tips Technology Tips Resources 5
7 Getting started At least 6 weeks in advance 1. Find a location. Find a place to teach the sessions in your area that people can get to easily. Call local clinics, schools, churches, and community centers. Reserve a room for a tie when community members can attend. 2. Tell people about the project. Let community leaders and others know that you are offering the course. Ask clinic personnel, clergy, and caseworkers to recommend it. The course can help participants and their families learn how to live healthier lives and improve English language skills. 3. Advertise the sessions. Post flyers at health fairs and in community sites such as clinics, grocery stores, churches, and other places in the community. Place announcements in local media outlets. 4. Class size. A small group of 10 to 12 people is best. Try to get about 20 people to sign up, because some may not show u for the class and others may drop out. At least 1 week before each session 1. Read through the sessions and handouts. 2. Carefully read the information that you will present to the group 3. Review the instructions for each activity. 4. Ask a health educator, dietitian, nurse, or doctor to explain any information you do not understand. 5. Review the list of handouts and make copies and gather materials you will need for each session. The day of the session 1. Review the list of materials and handouts. 2. Arrive 30 minutes ahead of time to set up the room. 6
8 Working with your group Leading the group -Get to know the members of you group. -Use words and terms that are familiar to the people in your group. -Encourage group members to ask questions. -Keep the sessions flowing smoothly so everyone is interested and involved. -Be observant. Motivating group members -Praise or reward group members efforts in order to keep them motivated. -Encourage group members to share opinions. -Encourage participants to take small steps toward change. - When closing the session tell the group members that you enjoyed the session and thank them for their attendance. Encourage students to provide feedback by asking what they thought about the session. Getting people to come -Remind the group members that it is important to come to all sessions. -Ask people to team up and call one another as a reminder to attend the sessions. -Remind them about the meeting tome and the length of classes. 7
13 CITIZENS AND COMMUNITY Session 1 Health Literacy/ESL UNIT 1 Language Objectives Simple present of be: statements and contractions Contrast be and have Simple present of be: Yes/No and information questions Read and interpret information Use capital letters and correct punctuation to write a paragraph Health Literacy Objectives Document: become familiar with the content of medical forms and practice filling out some sections of medical forms. Numeracy: read and interpret health information from a bar graph. Texas Adult Education ESL Standards Listening1.4 Understand and respond to communication in face-to-face conversations and short narratives related to familiar topics. Speaking 1.4 Use expanded vocabulary in familiar situations. Reading 2.3 Decode and recognize most words in short-to-medium length, continuous text with some assistance. Writing 2.4 Organize ideas around a single familiar topic to produce a short, legible, and comprehensible paragraph. ESL Level Low beginning-low intermediate Duration 3.5 hours Materials Excellent Eng. Teacher Edition Excellent Eng. Student book English dictionary English-Spanish dictionary Writing paper Pens/pencils/markers Blackboard/whiteboard Chalk/dry erase markers Index cards Vignette 1 (Act. 1.6) YHYL Handout: A Day With The Ramirez Family (Act. 1.7)
14 Medical assistance forms (Medicaid, etc.) (Act. 1.10) Private Health Insurance Request Form (Act. 1.11) Bar graph: Medicaid s Impact on Access to Health Care. (Act. 1.12) Bar graph: Leading Causes of Death Texas Hispanics, 2005 (Act. 1.12) Bar graph: Prevalence of Heart Disease by Demographic, Texas, 2007 (Act. 1.12) Bar graph: Prevalence of Stroke by Demographic, Texas, 2007 (Act. 1.12) Key Health Vocabulary Health insurance Eligibility Payment Health services Preventive care Lifestyle Changes Risk Heart disease Healthy Unhealthy Habits Insurance company Policy holder Beginning the Session (30 min.) Procedures 1. INTRODUCTION (30 min.) The teacher will introduce him/herself and welcome the students by explaining the objectives and dynamics of the class. An icebreaker activity will follow to develop good rapport within the group, for example, the students will be asked to briefly introduce themselves by saying their names and sharing something about their family members. Example: My name is. I am. I have. What is your name?. The students will write their names on index cards and display them on their desk. Binders containing the students worksheets for each unit will be distributed as well as Excellent English student books and notebooks for note taking. The teacher will write the unit language and health literacy objectives on the board and volunteer students will read them out loud.
15 Conducting the Session (60 min.) 2. Students will be engaged to begin grammar on EE Student book, pg. 7 (15 min.) GRAMMAR CHART: Present Tense of Be The students will study there are two kinds of negative contractions with be. Example: He s not= He isn t. 3 WRITE: Students will use the correct affirmative or negative form of the verb be to complete sentences. ANSWER KEY: EE Teacher edition pg Students will continue with grammar pg. 8 (15 min.) 1 WRITE the numbers next to the words to match the names of facial features. ANSWER KEY: EE Teacher edition pg. 8 2 WRITE. Use the Describing people chart for students to fill out the blanks on the paragraph template using the correct forms of have and be. ANSWER KEY: EE Teacher edition pg. 9 3 WRITE. Students will describe a classmate by writing four sentences. 4. Students will continue with grammar pg. 13 (15 min.) GRAMMAR CHART: Questions with Be. Students recognize there are two different types of questions and that they are asking for different types of information (yes/no or information). 3 MATCH. Students will match information questions with the correct answers. ANSWER KEY: EE Teacher edition pg WHAT ABOUT YOU? Students will answer information questions by writing complete sentences. 5. Students will continue with grammar pg. 15 (15 min.) 3 MATCH. Students will match information questions with the correct answers. ANSWER KEY: EE Teacher edition pg WRITE. Students will write information questions using the following words: What, Where, and When. ANSWER KEY: EE Teacher edition pg. 19
16 Practice and Application (120 min.) 6. VIGNETTE (10 min.) The teacher will make an introduction to the lesson by reading a vignette (in Spanish) to provide context using a story that is unfolding. There will be a brief group discussion about the content of the vignette which can take place in Spanish or English. 7. MEET A LATINO FAMILY IN THE UNITED STATES (15 min.) The teacher will distribute to each student A Day With The Ramirez Family YHYL pg. 17 In small groups, students will read the description of the five family members. Students will share what character they identify with and why. 8. VOCABULARY DEVELOPMENT (15 min.) The teacher will write new vocabulary words (health insurance, eligibility, payment, health services, preventive care, lifestyle, changes, risk, heart disease, healthy, unhealthy, habits) on the board. Students repeat vocabulary words after the teacher reads them. As a whole group, the students will brainstorm the meaning of the above mentioned concepts. 9. PUBLIC HEALTH INSURANCE (15 min.) The teacher will form small groups (3-5 students). The teacher shows an example of a Texas health insurance form (e.g., Medicaid form) and asks: What is a health form? When do you need it? Why is it appropriate? Students work in their groups to make a list of what kind of information and/or questions would be found on a medical form. The teacher captures group work by writing notes on the board. The teacher presents basic rules for filling out medical forms (REEP curriculum) while students take notes: -Read everything before you start. -Print all using ink. -Use N/A instead of blanks. -Bring personal information documents you may need to fill out the form (e.g., immunization records, official ID, social security number, and insurance card). 10. MEDICAL FORM (e.g., Medicaid) (20 min.) The teacher will distribute a Medicaid form to each student. The teacher will guide a discussion about the students previous experiences filling out this form; the students will identify some specific sections of the form. With the guidance of the teacher, the students will individually read and fill out
17 the following sections of the Medicaid form: -Personal information, pg. 1 -Household Information, Section A, pg. 2 -Medical information, Section F on pg PRIVATE HEALTH INSURANCE (15 min.) The teacher shows an example of a general private health insurance form. The teacher will distribute a photocopy of this form. Students will work individually to fill out the form using their personal information (pg 1). Students will express their opinions about the content of the two forms presented. 12. NUMERACY (20 min.) The teacher will form four small groups. The teacher will distribute a different bar graph to each group. The teacher will guide the students to identify different sections of the graph mentioned above. Students will read and interpret the bar graph assigned to their group. Each group will participate in discussions about the information presented on the graph, for example, the percentages used for comparison purposes. Homework Assignment (10 min.) Students will use capital letters and correct punctuation to write a five sentence paragraph about their overall health. This paragraph assignment will be reviewed by the teacher. Example: What is your lifestyle? My lifestyle is. I am/am not at risk of heart disease. The habits I need to change are. On the next session, volunteer students will share with the class. The students will use capital letters and correct punctuation to write a paragraph describing the content/questions of the Medicaid form. ESL Tips Optional Expansion Activity: Flip Card, instructions described on EE Teacher Edition pg Students take turns making a sentence using the correct form of the verb be (e.g., he/negative/divorced= He isn t divorced.). Technology Tips Students will be encouraged to fill out health insurance forms online, (for public or private services) using a computer at home or at their local public library, they may visit or
18 Resources Forstrom, J., Pitt, M., Vargo, M. & Velasco, S. (2008). Excellent English: Language Skills for Success. New York: McGraw Hill. Forstrom, J., Pitt, M., Vargo, M. & Velasco, S. (2008). Excellent English: Language Skills for Success, Teacher s Edition. New York: McGraw Hill. Texas Center for the Advancement of Literacy and Learning (2008). Texas Adult Education Standards and Benchmarks for ABE ASE and ESL Learners. Accessed at on January 28, Texas Department of State Health Services. Leading Causes of Death Texas Hispanics, Accessed at on April 14, Texas Department of State Health Services. Prevalence of Heart Disease by Demographic, Texas, Accessed at on April 14, Texas Department of State Health Services. Prevalence of Stroke by Demographic, Texas, Accessed at on April 14, Texas Health and Human Services Commission. Application for Assistance, Accessed at https://www.yourtexasbenefits.com/wps/themes/html/ssportal/downloads/appi ntegratedapplication.pdf on April 14, 2010.
19 Texas Health Insurance Plans. Texas Health Insurance Request Form, Accessed at on April 29, The Henry Kaiser Family Foundation. Medicaid: The basics. Accessed at on April 14, U. S. Department of Health and Human Services and National Heart Lung and Blood Institute (2008). Your Heart, Your Life: A Community Health Worker s Manual for the Hispanic Community.
20 VIGNETTE UNIDAD 1 Hace unos meses, la familia Ramírez llegó a la ciudad de El Paso, Texas, en Estados Unidos, donde instalaron su residencia. Como muchas de las familias inmigrantes en este país, están viviendo situaciones diferentes a las de su país de origen, como por ejemplo el idioma, la cultura, los alimentos y los servicios de salud. Este último punto se ha convertido en una necesidad básica, pues Mariano, Virginia y Doña Fela ven que su peso ha aumentado y que podrían estar en riesgo de alguna enfermedad. Sus hijos Carmen y Néstor, también han encontrado la necesidad de acudir al médico para recibir sus exámenes anuales requeridos en las escuelas de este país. Conforme empiezan a buscar opciones, encuentran que los servicios de salud son costosos y que ellos no podrían pagarlos. A través de los medios de comunicación y de algunas instituciones de la ciudad se enteran de la posibilidad de recibir servicios de salud gratuitos por parte del gobierno, pero necesitan llenar y enviar una aplicación (Medicaid) para solicitar los servicios. También buscarán la posibilidad de adquirir un seguro de salud privado, para acceder a otros servicios.
22 Application for Assistance Instructions: There are various ways to apply for assistance. You can: Call to apply over the phone or to get help in applying. Complete and mail this application to: HHSC Go online at: to apply. P.O. Box Complete and fax this application to: HHSC-TEX or Midland, Texas Applicant SSN: Applicant Initials: Last Name First Name MI Social Security Number : - - Date of Birth (MM/DD/YYYY): / / Home address: (street address, apt. #, city, county, state, zip) Home phone number: ( ) (area code, phone number) Mailing address: (if different from home address) You can apply for services by filling out, signing and returning only this page. However, we encourage you to fill out this entire application now because we may be able to determine your benefits sooner. Benefits for food stamps will be provided from the date it is received by Health and Human Services Commission (HHSC). If you submit just this page, you will need to provide more information before we can decide if you qualify for benefits. Answer the questions marked for the program(s) for which you want to apply. Please fill out this application in dark ink. If there is not enough room for all your information on this application, include that information on additional pages. Program Description Check To Apply Helps people buy food. If you qualify, we may be able to process your Food Stamps application in one day. Benefits will be provided from the date of Apply application. Children's Health Insurance Apply Medicaid for pregnant women Apply Medical Assistance Medicaid for low income adults who are caring for a child living in the Provides help in the payment of medical bills, home (TANF-level Medicaid) including doctors, hospitals, and medicines. Medicaid for the Elderly and People with Disabilities (including Apply payment for care in nursing facilities, other institutional settings, or for Apply people who have lost SSI benefits) Temporary Assistance for Needy Families Helps families with children meet their basic needs with monthly cash assistance or a one time annual payment. Apply Medicare Savings Programs Helps with Medicare premium(s), co-payments, and deductibles. Apply If you mark Yes for one or both of the programs below, Department of Aging and Disability Services staff will contact you. Long Term Services and Supports Provides assistance at home and access to community-based services allowing those who qualify to live in the community. This assistance can include meals, nursing care and help with tasks like dressing and bathing. Check if you are interested in receiving Long Term Services and Supports for people with mental retardation. Check if you are interested in receiving Long Term Services and Supports for people who are elderly or have disabilities other than mental retardation. Food Stamps: You may qualify for emergency Food Stamps if any of the following apply to you: 1. Yes No Is anyone in your home a migrant worker or a seasonal farm worker? 2. Yes No Does your household have $100 or less available and do you expect your income this month to be less than $150? 3. Yes No For this month, is the money you have and the money you expect to receive this month, less than the total of the following expenses that will be due for this month? If so, enter the bill amounts that are due: Rent / mortgage: Water: Gas: Electricity: Sewage: Phone: Medical Assistance for Pregnant Women: Yes No Is anyone in your household pregnant? If yes, who: Due Date: Number of Babies Expected: X Signature of Applicant or Authorized/Designated Representative Yes Yes Date 1 H1010-E-0407
23 Section A: Information about Members of Your Household All Programs Complete the following for all of the members of your household. If you reside in a nursing facility, facility for the mentally impaired, adult foster care, or continuing care retirement communities, also include information about your spouse who does not live with you. Section A: Persons 1-5 First Name Middle Name Last Name Head of Household Person 2 Person 3 Person 4 Person 5 That person's relationship to you Self Check (ü) to apply for the following programs Food Stamps Medical Assistance Temporary Aid to Needy Families (TANF) Medicare Savings Program (MSP) Social Security Number Date of Birth Gender Are you Hispanic or Latino? Yes No Yes No Yes No Yes No Yes No What is your race? (Select one or more) American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White Marital status* U.S. Citizen Yes No Yes No Yes No Yes No Yes No Texas resident Yes No Yes No Yes No Yes No Yes No Applicant SSN: Applicant Initials: Last Name of Child's Father First Name of Child's Father Child's Father is Child's Father's Social Security Number Child's Father's Date of Birth Last Name of Child's Mother First Name of Child's Mother Maiden Name of Child's Mother Child's Mother is In Home Out of Home Deceased In Home Out of Home Deceased In Home Out of Home Deceased In Home Out of Home Deceased Child's Mother's Social Security Number Child's Mother's Date of Birth * Marital status = Married, Single, Divorced, Separated, Widowed In Home Out of Home Deceased In Home Out of Home Deceased In Home Out of Home Deceased In Home Out of Home Deceased In Home Out of Home Deceased In Home Out of Home Deceased 2 H1010-E-0407
24 Section B: Food Stamps To get Food Stamps most initial applicants MUST report to a HHSC Benefit Office for a Food Stamp interview. If any of the reasons below apply to you, you may request a telephone or a face-to-face interview in your home. Check any of the following that apply and, list the phone number where you can be reached: ( ). I live more than 30 miles away from the local HHSC Benefit Office. I am ill. I cannot come to the local HHSC Benefit Office because of bad weather. I do not have transportation. My work or training schedule conflicts with the local HHSC Benefit Office hours. I am a victim of family violence. I (and my household) is (are) elderly or disabled with no earned income. I must take care of a household member. Section C: General Information All Programs 1. What is the primary language spoken in your household? 2. We can provide an interpreter at no cost to you. If you need an interpreter indicate the type below: Spanish Vietnamese American Sign Language (ASL) Other 3. Yes No Is anyone in your household disabled? If yes, who: 4. Yes No Does anyone in your household receive TANF, Food Stamps, or Medicaid from another state? If yes, Who: State: Month last received: Who: State: Month last received: 5. Yes No Do you have a physical or mental condition that requires special accommodations? If so, what: 6. Yes No Is anyone in your household a member of a federally recognized tribe? If yes, who: What tribe: 7. List the people in your household who fit the following descriptions: Veteran Name VA Claim Number Active Military, National Guard or Reserves Has a parent, spouse or deceased child who was a veteran 8. Yes No Has anyone in your household ever received Supplemental Security Income (SSI)? If yes, who: 9. Yes No If you are in a nursing facility, do you intend to return to your own home or stay in the facility for less than six months? 10. Yes No If you are not living in your own home, do you intend to return to your own home? If yes, what is the date you expect to return to that home? Yes No If yes, is anyone living in that home while you are not living there? Applicant SSN: Applicant Initials: 11. Yes No Is anyone in your household a victim of family violence? If yes, who? Food Stamps and TANF Only 12. Yes No Is anyone in your household fleeing from any law enforcement agency on any felony charges, or in violation of probation or parole according to a court? If yes, who: 13. Yes No Has anyone in your household had a felony conviction for conduct occuring on or after August 22, 1996, involving the possession, use, or distribution of a controlled substance? If yes, who: 14. Yes No Is there anyone in your household who is living in a group home, homeless shelter, drug treatment center, shelter for battered women, or other institution? If yes, who: Type Institution: Institution Name: 15. Yes No Are you or anyone in your household disqualified from participating in the TANF or Food Stamp Program in Texas or anywhere else in the United States? If yes, Who? Where? For how long? When? 3 H1010-E-0407