Preparation Manual

Section 3: Overview and Exam Framework
Health EC–12 (257)

Exam Overview

Table outlining the test format, number of questions, and time.

Exam Name	Health EC–12
Exam Code	257
Time	5 hours
Number of Questions	90 selected-response questions and 1 constructed-response question
Format	Computer-administered test (CAT)

The TExES Health EC–12 (257) exam is designed to assess whether an examinee has the requisite knowledge and skills that an entry-level educator in this field in Texas public schools must possess. The 90 selected-response questions and the 1 constructed-response question are based on the Health EC–12 exam framework. Questions on this exam range from grades EC–12. Your final scaled score will be based only on scored questions.

The Standards

§235.1. General Requirements.

1. The knowledge and skills identified in this section must be used by an educator preparation program in the development of the curricula and coursework as prescribed in §228.30 of this title (relating to Educator Preparation Curriculum) and serve as the basis for developing the examinations as prescribed in §230.35 of this title (relating to Development, Approval, Implementation, and Evaluation of Teacher Certification Standards).
2. Unless provided otherwise in this title, the content area and grade level of a certificate category as well as the standards underlying the certification examination for each shall include the following:
1. the relevant Texas Essential Knowledge and Skills (TEKS) curriculum adopted by the State Board of Education, as prescribed in §74.1 of Part II of this title (relating to Essential Knowledge and Skills);
2. the English Language Proficiency Standards (ELPS) adopted by the State Board of Education, as prescribed in §74.4 of Part II of this title (relating to English Language Proficiency Standards);
3. the relevant knowledge and application of developmentally appropriate, research- and evidence-based assessment and instructional practices to promote students' development of grade-level skills; and
4. the relevant grade-banded Pedagogy and Professional Responsibilities Standards, specifically including how to effectively address the needs of all student populations.
3. A person must satisfy all applicable requirements and conditions under this title and other law to be issued a certificate in a category. A person seeking an initial standard certification must pass the appropriate examination(s) as prescribed in §230.21 of this title (relating to Educator Assessment).

Statutory Authority: The provisions of this §235.1 issued under Texas Education Code, §§21.003(a); 21.031; 21.041(a) and (b)(1), (2), and (4).
Source: The provisions of this §235.1 adopted to be effective March 8, 2018, 43 TexReg 1267; amended to be effective March 6, 2019, 44 TexReg 1125.

Domains and Competencies

Note: Percentages in the pie chart do not add up to 100 due to rounding.

The content covered by this exam is organized into broad areas of content called domains. Each domain covers one or more of the educator standards for this field. Within each domain, the content is further defined by a set of competencies. Each competency is composed of two major parts:

• The competency statement, which broadly defines what an entry-level educator in this field in Texas public schools should know and be able to do.
• The descriptive statements, which describe in greater detail the knowledge and skills eligible for testing.

Domain I—Health and Wellness

Competency 001—(Body Systems and Health-Related Factors): Demonstrate understanding of health promotion and disease prevention practices; structures and functions of human body systems; and factors that influence health, growth, and development.

For example:

1. Demonstrate knowledge of the stages and expected patterns of physical, cognitive, social, and emotional development during childhood and adolescence.
2. Demonstrate knowledge of social determinants of health and their effects on growth and development, including the relationship between adverse childhood experiences (ACEs) and health.
3. Recognize the structures, functions, and interactions of all body systems and factors (e.g., heredity, environment, substance use) that affect the functioning of body systems.
4. Demonstrate knowledge of personal care and hygiene practices that have positive effects on lifelong health and wellness.
5. Apply knowledge of types, causes, modes of transmission, and signs and symptoms of common illnesses and diseases, including vector-borne illnesses and diseases.
6. Apply knowledge of practices for preventing communicable, noncommunicable, and chronic diseases and methods of screening for, managing, controlling, and treating illness and disease.
7. Demonstrate knowledge of scientifically proven principles of nutrition, sources and functions of nutrients, factors that influence nutritional and caloric requirements, and factors that influence food choices.
8. Apply skills and strategies for interpreting, analyzing, evaluating, and comparing nutritional information (e.g., food labels, promotional claims, allergen lists) to promote health-enhancing dietary decisions.
9. Demonstrate knowledge of the physiological and psychological effects of physical activity, the components of health-related fitness, and principles and strategies for maintaining and improving fitness.

Competency 002—(Mental, Emotional, and Social Health and Well-Being): Demonstrate understanding of mental, emotional, and social health and strategies and skills for building, maintaining, and improving mental, emotional, and social health and well-being.

For example:

1. Analyze connections between mental, emotional, and social health and the role of the health education teacher in supporting students' health and success in cross-curricular learning.
2. Recognize the role of positive self-esteem and a healthy self-concept in avoiding negative behaviors that can occur in conjunction with mental health concerns.
3. Analyze ways in which internal and external factors, including protective and risk factors (e.g., positive adult relationship, routine, healthy diet, trauma, grief and loss, adverse childhood experiences [ACEs], environmental factors), may influence mental, emotional, and social health and well-being.
4. Identify strategies that promote students' awareness and use of self-regulation techniques and strategies to promote positive mental, emotional, and social health and well-being.
5. Apply knowledge of causes of stress and effects of stress on mental, emotional, and social health and well-being.
6. Identify strategies for promoting students' ability to cope with and manage stress in healthy ways (e.g., rest, proper nutrition, physical activity, positive relationships, counseling).
7. Demonstrate knowledge of signs and symptoms of mental health disorders and conditions (e.g., anxiety, depression, trauma) and strategies and resources for supporting students with mental health disorders (e.g., services in the school setting).
8. Demonstrate knowledge of signs, symptoms, and potential origins of the diagnosable eating disorders (i.e., anorexia nervosa, bulimia nervosa, binge eating disorder, pica, rumination disorder, avoidant/restrictive food intake disorder); effects of eating disorders on health; and strategies and resources for supporting students with eating disorders in seeking services.
9. Apply knowledge of how to promote students' ability to seek support in processing and overcoming anxiety, grief, and adverse life events in order to maintain overall mental health and wellness.
10. Identify skills and strategies for developing students' emotional resilience and for promoting students' ability to positively influence peers in stressful situations.

Competency 003—(Reproductive and Sexual Health): Demonstrate understanding of reproductive development, sexual health concepts, and approaches and skills for protecting overall health and well-being.

For example:

1. Demonstrate knowledge of anatomical, physiological, and emotional changes associated with puberty and how these changes may affect personal health.
2. Demonstrate knowledge of reproductive and sexual health concepts, the risks of early sexual activity, and strategies and resources for promoting students' ability to protect their reproductive and sexual health (e.g., setting and respecting personal boundaries).
3. Recognize the responsibilities of individuals involved in dating relationships, the foundations and characteristics of healthy and unhealthy dating relationships, and resources for helping individuals involved in abusive dating relationships.
4. Recognize factors that influence decisions about reproductive and sexual health (e.g., values, media messages, peer pressure) and strategies and skills (e.g., using and accepting refusal techniques) for making responsible decisions about reproductive and sexual health.
5. Demonstrate knowledge of laws related to sexual consent and sexual offenses and of strategies, skills, and resources for preventing, avoiding, resisting, and deterring sexual harassment, exploitation, abuse, and assault.
6. Demonstrate knowledge of types, characteristics, and modes of transmission of sexually transmitted infections (STIs), including HIV; and recognize the importance of screening, testing, and early treatment for STIs and HIV.
7. Apply knowledge of medically accurate and evidence-based methods and resources for preventing, avoiding, and treating sexually transmitted infections (STIs), including HIV.
8. Recognize the benefits of practicing abstinence from sexual activity and the importance of support from others in maintaining abstinence.
9. Recognize stages in the pregnancy and birth cycle, factors that affect prenatal development, and physiological and psychological changes that may occur during and after pregnancy.
10. Demonstrate knowledge of legal, financial, societal, and educational responsibilities and consequences related to teen pregnancy and parenting, as well as options and resources available to teen parents.

Domain II—Health Skills for Reducing Risks

Competency 004—(Prevention of Alcohol, Tobacco, and Other Drug Use): Demonstrate understanding of concepts related to alcohol, tobacco, and other drug use (e.g., any type of substance abuse) and skills and strategies for preventing and reducing health risks related to alcohol, tobacco, and other drug use.

For example:

1. Identify short-term and long-term effects (e.g., physical, psychological, social) of using alcohol, tobacco, and other drugs, including nonprescribed and over-the counter (OTC) medications.
2. Demonstrate knowledge of ways in which internal factors (e.g., depression, self-esteem, personal values) and external factors (e.g., media, family, peers) may influence decisions related to alcohol, tobacco, and other drug use.
3. Recognize the role of assertiveness, negotiation, resistance, and refusal skills in avoiding and minimizing risks related to the use of alcohol, tobacco, and other drugs.
4. Apply knowledge of skill-based strategies and activities that promote students' ability to avoid or reduce health risks related to the use of alcohol, tobacco, and other drugs.
5. Recognize how health-risk behaviors involving the use of alcohol, tobacco, and other drugs may lead to participation in other unhealthy behaviors (e.g., reckless driving, fighting).
6. Apply knowledge of school-based and community-based efforts to address and prevent student involvement in health-risk behaviors related to alcohol, tobacco, and other drugs.
7. Analyze economic, social, legal, educational, and personal consequences related to the use of alcohol, tobacco, and other drugs (e.g., loss of license, effects on public safety and the health-care industry).
8. Demonstrate knowledge of interventions and treatments for alcohol, tobacco, and other drug abuse, as well as age-appropriate strategies for coping with another person's substance abuse.

Competency 005—(Interpersonal, Social, and Family Relationships and Communication): Demonstrate understanding of skills and strategies for promoting healthy communication and for maintaining healthy interpersonal, social, and family relationships.

For example:

1. Apply knowledge of communication skills that enhance students' ability to express thoughts and emotions appropriately and communicate clearly in a variety of social settings.
2. Demonstrate the ability to promote healthy interpersonal, social, and family interactions and relationships, including the ability to recognize and respond effectively to verbal and nonverbal communication.
3. Analyze the influence of positive communication behaviors versus negative communication behaviors on interpersonal, social, and family relationships.
4. Recognize characteristics of healthy social support networks, types of groups and group dynamics, and positive and negative consequences of various types of group interactions (e.g., in-person situations, digital spaces and platforms).
5. Apply knowledge of strategies and skills for developing and maintaining friendships and of the importance of healthy, caring relationships for developing self-esteem and well-being.
6. Demonstrate knowledge of the influence of peers and the effects of peer pressure on students' physical, mental, emotional, and social health and well-being.
7. Apply knowledge of healthy relational techniques and skills for resisting and responding to peer pressure.
8. Apply knowledge of appropriate strategies, skills, responses, and policies for preventing and addressing bullying, harassment, intimidation, and exclusion, including electronic and digital forms (e.g., school policies, social and emotional learning activities to promote relationship and coping skills).
9. Demonstrate knowledge of characteristics (e.g., trust, support, neglect, substance use) that may influence family relationships and the physical, mental, and emotional health and well-being of family members; and identify resources for addressing family concerns.
10. Demonstrate knowledge of ways in which healthy families, homes, and communities can provide supportive and nurturing environments for children's development.

Competency 006—(Injury Prevention and Safety): Demonstrate understanding of skills and strategies for promoting safety, preventing accidents and injuries, addressing bullying, and responding to emergencies.

For example:

1. Demonstrate knowledge of safe and unsafe conditions in the school, home, community, and environment; activities for promoting students' ability to identify and evaluate potential hazards; and strategies for promoting students' use of safe behaviors.
2. Apply knowledge of principles, rules, resources, and precautions related to personal safety, including traffic and pedestrian safety, fire prevention, poisoning and overdose prevention, water safety, and safety during recreation and play.
3. Demonstrate knowledge of home and school safety and emergency response plans, including their components and benefits.
4. Apply knowledge of how to promote students' ability to be safe and responsible citizens in digital and online environments and to obtain help from trusted adults when feeling bullied, uncomfortable, exploited, or unsafe as a result of digital or online interactions.
5. Demonstrate knowledge of strategies for responding to reports of bullying and providing appropriate physical, mental, emotional, and social support for all individuals involved.
6. Analyze conditions, perceptions, and behaviors that contribute to unintentional injuries (e.g., proximity of weapons, impaired judgment, alcohol use) and identify strategies for helping students assume personal responsibility in preventing injury.
7. Apply knowledge of strategies for recognizing and avoiding potentially dangerous situations; methods for preventing, responding to, and reporting different types of violence (e.g., intentional injury, dating violence, gang violence, hate crimes); and appropriate ways to seek assistance.
8. Apply knowledge of first-aid procedures for responding to injuries and respiratory and cardiac emergencies (e.g., treating for shock, administering CPR or AED, clearing an airway obstruction).
9. Identify sources of help and procedures for obtaining assistance in an emergency or crisis, including incidents caused by natural or human-made disasters.
10. Demonstrate knowledge of recognizing and responding as a mandatory reporter to potential signs and symptoms of child abuse, neglect, exploitation, and suspected human trafficking.
11. Apply knowledge of local crisis policies and protocols related to concerns of self-harming behaviors or suicidal ideation and identify resources and supports to help ensure students' safety.

Competency 007—(Personal Health Efficacy Skills): Apply knowledge of strategies and activities for promoting students' use of self-assessment, goal-setting, decision-making, conflict-resolution, and self-advocacy skills to enhance health.

For example:

1. Demonstrate knowledge of principles, criteria, and methods for evaluating personal health strengths and risks, health behaviors and patterns, and consequences of health choices.
2. Apply knowledge of steps and procedures for using decision-making and problem-solving skills and processes in various health-related contexts.
3. Apply knowledge of techniques and skills for establishing, prioritizing, analyzing, and monitoring personal health-related goals.
4. Recognize the importance of seeking advice, guidance, and support from others (e.g., health-care professionals, family members, peers) in making decisions about personal health.
5. Demonstrate knowledge of ways in which individuals can contribute to improving community and environmental health (e.g., advocacy, conservation, volunteerism).
6. Apply knowledge of strategies and activities that encourage and support students in advocating for personal, family, and community health.
7. Demonstrate knowledge of age-appropriate techniques, processes, activities, and resources for promoting students' conflict-management and conflict-resolution skills.
8. Apply knowledge of strategies and approaches for promoting students' ability to use self-management techniques and critical-thinking skills to enhance personal health.
9. Apply knowledge of principles, criteria, and strategies for encouraging students to create, evaluate, assess, and adjust personal health plans that emphasize positive health behaviors.

Domain III—Health Literacy and Health Education

Competency 008—(Health Literacy): Understand health literacy; influences on health behaviors; and strategies and skills for accessing, evaluating, and using health-related information, products, and services.

For example:

1. Demonstrate knowledge of concepts and principles related to health literacy (i.e., the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions).
2. Analyze ways in which attitudes, values, and behaviors related to health and wellness are influenced by peers, family, culture, technology, perceptions of social norms, and other factors.
3. Demonstrate knowledge of sources of valid health-related information and knowledge of principles and skills for locating, researching, analyzing, and evaluating health-related information, products, and services.
4. Analyze the impact of various forms of media messages on students' perceptions regarding nutrition, attractiveness, sexuality, body image, substance use, violence, and other health-related topics.
5. Analyze social media and marketing techniques related to health information, products, and services and apply criteria and skills for identifying and analyzing media messages.
6. Apply knowledge of appropriate and relevant resources, strategies, and activities for promoting students' effective use of health knowledge and skills in making decisions about health behaviors, products, and services.
7. Apply knowledge of the roles of community, government, nonprofit, and private organizations in providing health-related information and services to individuals and families and in advocating for public health.
8. Demonstrate knowledge of state and federal laws and guidelines governing the health, safety, and consumer rights of individuals and families.

Competency 009—(Health Education Program): Understand the organization, goals, and purposes of the school health education program and principles and practices for effective, data-driven, culturally responsive, and developmentally appropriate instruction and assessment.

For example:

1. Demonstrate knowledge of the organization, goals, and purposes of school health education programs and important state and national initiatives (e.g., Whole School, Whole Community, Whole Child [WSCC] model).
2. Analyze the use and synthesis of national-, state-, and district-level data on behavioral health risks among students to determine health education goals and priorities and to plan inclusive school health education programs.
3. Demonstrate knowledge of the roles of school policies and local health advisory councils in the implementation of health education, including the responsibilities of a School Health Advisory Council (SHAC).
4. Apply knowledge of principles and techniques for evaluating the effectiveness of a school health education program and for adapting and modifying the program based on observation of students, assessment data, program evaluation results, and reflection.
5. Demonstrate the ability to design and implement instruction that is based on the Texas Essential Knowledge and Skills (TEKS) for Health Education and that achieves learning goals and ensures student progress.
6. Apply knowledge of strategies for planning instruction that facilitates students' functional health knowledge and skill development and that addresses students' abilities, interests, developmental levels, and cultural backgrounds.
7. Demonstrate knowledge of principles, criteria, and methods for creating, selecting, and implementing health education assessments to evaluate students' functional health knowledge and skill proficiency.
8. Apply knowledge of how to interpret health education assessment data and use data-driven decision making to guide planning, adjust instruction, and provide constructive feedback to enhance learning.
9. Apply knowledge of legal, ethical, and professional issues and responsibilities relevant to health education.
10. Recognize the benefits of professional development activities and resources for enhancing health education knowledge and pedagogical skills.

Domain IV—Educating All Learners and Professional Practice

Competency 010—(Differentiation Strategies in Planning and Practice): Understand how to identify and implement developmentally and culturally appropriate strategies and data-driven practices to effectively teach and engage all learners.

For example:

1. Demonstrate knowledge of the principles of universal design for learning (UDL) and how to apply UDL guidelines to incorporate the flexibility necessary to maximize learning opportunities for all students.
2. Apply knowledge of effective methods for fostering students' active participation and individual academic success in one-to-one, small-group, and large-group settings and for facilitating all students' inclusion in various settings (e.g., academic, social).
3. Apply knowledge of activities, instructional delivery, and high-quality instructional materials that build on students' individual interests, primary language, experiences, and prior knowledge; respond to students' strengths and needs; and promote the development of prerequisite skills and positive dispositions toward learning in the content areas.
4. Demonstrate knowledge of how and when to adjust and scaffold instruction using vertically aligned content, instructional activities, and assessment in response to various types of feedback from students.
5. Demonstrate knowledge of how to identify, select, and implement appropriate and effective accommodations for students with 504 plans or Individualized Education Programs (IEPs), including collaborating with other professionals to meet the needs of all students.
6. Demonstrate knowledge of the various categories of disabilities as outlined in the Individuals with Disabilities Education Act (IDEA) and of Child Find obligations and educational implications specific to children with unique learning differences (e.g., developmental delays, autism spectrum disorder, dyslexia, intellectual disabilities, behavioral/emotional challenges, specific learning disabilities).
7. Demonstrate knowledge of the Code of Ethics and Standard Practices for Texas Educators, as well as school-specific policies and procedures.
8. Demonstrate knowledge of best practices for communicating consistently, clearly, and respectfully with all members of the campus community, administrators, and staff.
9. Demonstrate knowledge of best practices for communicating regularly, clearly, and appropriately with parents/guardians and families about student progress by providing detailed, positive, and constructive feedback and for partnering with students' families in furthering students' achievement.

Competency 011—(Culturally Responsive Practices): Understand how to identify and implement culturally responsive, developmentally appropriate practices to effectively teach and engage all learners.

For example:

1. Demonstrate knowledge of strategies and practices that acknowledge and respect diversity and identity (e.g., cultural, economic, linguistic, racial, ethnic, gender, ability, sexual orientation) and provide a supportive inclusive learning environment in order to promote students' overall development and learning, including understanding of the benefits of primary languages and multilingualism to learning.
2. Recognize the role personal bias plays in potential learning expectations for all students in order to promote safe, positive, and supportive interactions and learning environments for all students.
3. Demonstrate knowledge of activities, approaches, and resources that encourage and support exploration and engagement and promote a positive disposition toward learning for all students.
4. Demonstrate understanding of the role of language and culture in learning, as well as how to modify instruction to support language acquisition to ensure that both language and instruction are accessible across the content areas.
5. Demonstrate knowledge of ways to work collaboratively with parents/guardians, teachers, school and community service providers, and students to support all students, including but not limited to English learners (ELs), and programs such as ESL, bilingual, and dual language.
6. Demonstrate knowledge of ways to work collaboratively with teachers, related service providers, parents/guardians, and students to effectively support the implementation of an Individualized Education Program (IEP) and instructional accommodations, modifications, and strategies.
7. Demonstrate knowledge of best practices for maintaining and facilitating respectful, supportive, positive, and productive interactions with and among students.
8. Demonstrate knowledge of best practices for implementing behavior management systems to maintain an environment in which all students can learn effectively.
9. Demonstrate knowledge of best practices for maintaining a classroom culture that is based on high expectations for student performance and encourages all students to be self-motivated and take responsibility for their own learning.
10. Demonstrate knowledge of best practices for maximizing instructional time, including managing transitions.

Competency 012—(Data-Driven Practice and Formal/Informal Assessment): Understand the types, selection, and uses of data-driven, developmentally appropriate assessments and assessment practices to effectively support program improvement and all students' learning.

For example:

1. Demonstrate knowledge of the various purposes of the use of developmentally appropriate assessments for evaluating students across domains.
2. Apply knowledge of basic assessment terminology and of types, characteristics, uses, and limitations of formal, informal, and alternative assessments (e.g., developmental screenings, formative and summative assessments, observations, portfolios, state-mandated assessments, types of assessment accommodations and modifications, curriculum-based measures).
3. Apply knowledge of ways to develop and select developmentally appropriate assessments and assessment strategies (e.g., use of TEA resources such as formative assessment banks), ensure that assessments are aligned to instructional objectives and outcomes, and use assessment results to inform instruction and measure student progress throughout the content areas.
4. Apply knowledge of considerations and strategies for effectively administering assessments and documenting assessment outcomes.
5. Recognize legal and ethical issues related to assessment, responsible assessment practices, and confidentiality.
6. Demonstrate knowledge of the foundational elements of Response to Intervention (RtI) and apply this knowledge through differentiation in planning, delivery, and assessment of tiered instruction for all students that is anchored in data literacy and progress monitoring.
7. Interpret and use information from formal and informal assessments, including the use of multiple measures of assessment, to inform decisions and plan and evaluate student learning.
8. Interpret assessment results to enhance students' learning through acquisition of knowledge of students, evaluation, and development monitoring; inform ongoing instructional planning; and continuously adjust learning activities and environments for individuals and groups.
9. Demonstrate knowledge of a variety of types of systematic observation and documentation (e.g., anecdotal notes, checklists, data collection) and the ability to use these processes and procedures to gain insight into all students' development, strengths, needs, and learning.

Domain V—Constructed Response

Competency 013—(Constructed Response): In a written response, apply pedagogical content knowledge of health education to design and implement appropriate instruction to achieve specific learning objectives.

For example:

1. Given a specific learning objective as outlined in the TEKS for Health Education, identify the conceptual understanding and skills necessary for students to achieve the objective.
2. Design instructional activities to support students' achievement of the learning objective and explain how those activities will be effective in achieving the goal.
3. Describe appropriate assessment approaches for evaluating student learning and performance.
4. Describe potential modifications, accommodations, and differentiation to the instructional activities, along with a rationale, to meet the needs of all students.

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