Appendix - Grade 7

Appendix A

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In your life, do you have control over decisions about:	Yes	No
what school you attend?
whether or not you attend school?
what time you get up in the morning?
whether or not you will join a school or community team or group?
whether you will feel happy or sad today?
how tall you will grow?
what diseases you will acquire?
whether you fasten your seat belt?
whether you live to be 100 years old?
whether you use tobacco?

Appendix B

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Sample Checklist for Evaluating Health-related Sources of Information (Grade 7)

Author: _______________________ Publisher: ___________________________________

Title: _________________________ Copyright Date: ______________________________

Criteria
The author	Yes	No	Not sure/ Don't know	Comments
The author's credentials are visible for the consumer to see.
The author's educational background is in the discipline in which the author is writing. (Note: Be cautious of titles which sound impressive but might not really indicate professional qualifications.)
The author is a recognized expert in the discipline in which the author is writing.
The source
The source (publisher, producer) is recognized in the health field.
The source is interested in sharing information, not in presenting a bias or making a profit.

'Yes' answers are positive indicators.

Appendix C

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Sample Checklist for Evaluating Health-related Information (Grade 7)

Author: _______________________ Publisher: ___________________________________

Title: _________________________ Copyright Date: ______________________________

Criteria
The information	Yes	No	Not sure/ Don't know	Comments
The information is based on personal observations or experiences and not sound scientific data.
The author uses broad or vague generalities.
The author uses testimonials of what others have said or done with little or no supporting evidence.
Sensationalism and/or scare tactics are used to emphasize points.
The information includes ambiguous statements or unsubstantiated claims.
The information includes loaded words.
The information is inconsistent with other reliable information on the same topic.
Significant information has been omitted.

'No' answers are positive indicators.

Appendix D

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Sample Rubric for Evaluating the Elements of a Commit Self Action Plan

Element of Action Plan	Less Effective Rating of 1	Somewhat Effective Rating of 2	More Effective Rating of 3
Who	Plan includes name of one support person.	Plan includes name of an adult or a teacher as well as name of a peer support person.	Plan includes name of an adult or teacher as well as name of a peer support person and name(s) of others who will be involved in the action plan.
What	Plan includes a statement of what is to be done.	Plan includes a goal statement that is clear, specific, measurable, and attainable.	Plan includes a goal statement that is clear, specific, measurable, and attainable. Also included is a statement of purpose related to personal commitment.
How	Plan includes a vague outline of what is to be done.	Plan includes some details about what is to be done.	Plan includes a step-by-step outline of what is to be done to work toward the goal and achieve it.
Why	Plan includes a vague explanation about why particular steps are in place.	Plan includes some details about why some steps are in place.	Plan includes justification of why specific steps are planned to meet the goal. Possible barriers or obstacles are listed, along with ways they might be overcome.
When	Plan includes start date and end date.	Plan includes start date, end date, and at least the first check-in date.	Plan includes start and end dates as well as check-in dates and celebration dates. Details are included about dates and times for each step of the action plan.
Where	Plan includes no indication of where the action plan is to be carried out.	Plan includes scant details about where the action plan is being carried out.	Plan includes specific indication of exactly where each step of the action plan is to be carried out.

Appendix E

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Sample Rubric for Evaluating the Implementation of an Action Plan

	0	1	2	3
Who What evidence is there that a support person was involved throughout the implementation of this action plan?	Support person is not mentioned in the log. No signatures. Support persons were not used.	Support person is mentioned occasionally in the log. No signatures to provide supporting evidence. Support persons may have been used.	Support person is mentioned in the log but there is no signature to provide evidence. Or, the signature is included but there is little or no evidence of involvement.	Support person(s) is included throughout the log. Student log or journal includes signature of support person(s) at start date, check-in dates, celebration date(s), and end date. Support persons were used.
What What evidence is there that the goal was attained?	Goal statement is not mentioned in the log. The goal was not met.	Student log includes goal statement but does not evaluate her or his implementation to determine the degree to which the goal was attained.	Student log includes goal statement and partial evaluation of the student's implementation. The goal was partially met.	Student log includes goal statement accompanied by student's evaluation of implementation. The goal was achieved.
How What evidence is there that the step-by-step plan was followed?	Student log includes no evidence of implementation. The action plan was not carried out.	Student log includes scant details of actions taken. The action plan may have been partially implemented.	Log includes details of step-by-step action but does not include student's thoughts throughout the implementation. The action plan was carried out.	Student log includes: details of step-by-step progress both action and thoughts. The action plan was carried out.
Why What evidence is there that the steps within the plan progressed toward the goal?	There is no mention of obstacles or how they were overcome.	Student log identifies obstacles but does not say how they were overcome.	Student log identifies obstacles that were partially overcome.	Student log identifies possible barriers or obstacles and how they were overcome.
When What evidence indicates that the proposed timelines were followed?	Student log includes start and end dates.	Log includes start and end dates as well as at least one check-in date.	Log identifies start, end, check-in, and celebration dates. Also includes signatures.	Student log includes: dates and times of each step within the action plan check-in dates celebration dates signature of support person at dates and times of check-ins and celebrations.
Where (if applicable) What evidence is there that the action plan was implemented in the arranged location(s)?	Log does not indicate location of implementation.	Log includes some details about where the action plan was implemented.	Log includes complete details about where each step of the action plan was carried out.	Student log or journal includes: complete details about where each step of the action plan occurred signature of support person from the facility/agency/ community/ family.

Appendix F

Identifying Passive, Assertive, and Aggressive Responses

Babysitting Scenario
Imagine that a neighbour calls you at the last minute asking you to babysit that evening. You do not have any other plans but you really do not feel like babysitting. Your response could be:
'No, I will not babysit. You always call at the last minute.'
'No, I cannot babysit tonight, but I would like to come another time. Please call again and give me a few days notice.'
'Well, uh ... well ... no, I am not busy ... but, I kinda wanted to stay at home tonight, but, ... O.K. if you need me, I will come.'

Questions

1. Which response is a passive response?

2. Which response is an assertive response?

3. Which response is an aggressive response?

4. Which response is disrespectful of your needs and wishes?

5. Which response is disrespectful of the neighbour's feelings?

6. What are your thoughts and feelings about the second response?

Appendix G

My Problem-solving Style

Number from 1 to 15 in your notebook. Answer T (true) or F (false) to each of the following statements.

When I have a problem to face I usually:

blame someone else for it
pretend it does not exist
feel that I can try to work it out
take advantage of others involved in the situation
make sure I get my own way
decide there is not much I can do about it
listen to the opinions of others and evaluate their help
complain bitterly about it
express both positive and negative feelings about it
let things work out themselves
ask for help if needed
force my ideas for a solution on other people involved in the situation
follow someone else's ideas
consider the resources I have
believe it is all a matter of circumstances.

Scoring Instructions

Make three columns in your notebook, titled Passive, Aggressive, and Assertive. Statements 2, 6, 10, 13, 15 belong under Passive. Statements 1, 4, 5, 8, 12 belong under Aggressive, and 3, 7, 9, 11, 14 belong under Assertive.

Score your problem-solving style in the chart below by giving yourself one point (1) for every T response. F responses rate a zero (0). Note your score beside the appropriate statement number in each of the three columns. Then total your score for each column.

Passive Statement	Aggressive Statement	Assertive Statement
2	1	3
6	4	7
10	5	9
13	8	11
15	12	14
Total =	Total =	Total =

What is your preferred problem-solving style?

Source: Reproduced from Health Education: A Curriculum Guide for Grades 7-9, 1985. Used with permission of GLC Silver Burdett.

Appendix H

One-liners

First one-liner

Student 1
"No, thanks"
(Passive)
Student 2
"No, thanks"
(Passive)
Student 3
"No, thanks"
(Passive)

Second one-liner

Student 1
"I guess it's O.K."
(Passive)
Student 2
"I guess it's O.K."
(Passive)
Student 3
"I guess it's O.K."
(Passive)

Third one-liner

Student 1
"You'd better do it."
(Passive)
Student 2
"You'd better do it."
(Passive)
Student 3
"You'd better do it."
(Passive)

Appendix I

Action Scenarios

You and two friends are at a local convenience store. One of the friends proposes shop-lifting. You decide to tell the friends that you are not willing to steal.

A girl in your class is having a party. You and two of your best friends are invited. You have your parents' permission to attend. When you arrive, it is clear that the girl's parents are not home. It is an expectation in your family that you attend parent-chaperoned parties. You do not feel comfortable about the situation and do not want to stay. You decide to tell your best friends how you feel.

You have just finished an essay for your Social Studies class. An acquaintance (friend of a friend) offers you $20.00 so he or she can change the essay a bit and use it in another class. You decide to tell the acquaintance that you do not cheat and you do not want any part of his or her cheating either.

You have a crush on someone in your class. Your friends make fun of the person and tell you that he or she is not good enough for you. You decide to tell your friends how you feel about their comments.

A guy or girl, the same age and grade as you, lives on your street. You do not go to the same school. Only in the summer do the two of you spend much time together. One summer afternoon, the two of you are at the park and meet some of her or his friends. They offer you a cigarette and want you to smoke with them. You do not want to smoke, but they are pressuring you to try it just this once. You decide to tell them that you do not want to smoke with them.

Response Alternatives and the Consequences of Communicating Assertively

Your parents want you to attend the high school where they went. You would rather go somewhere else.
Passive

Aggressive

Assertive

Positive Consequences of Communicating Assertively:

Negative Consequences of Communicating Assertively:

Use the format above for the following situations:

Someone you do not want to go out with asks you to a movie.

You and a group of friends are deciding on which movie to see. One member of the group suggests a movie you do not want to see.

You are sitting in math class. The girl behind you throws a piece of chalk across the room. The teacher turns around in time to see the chalk fly through the air and hit another student. The teacher yells out your name and says, 'I will see you after school'.

You and your younger sister are watching T.V. Your little sister is a real pest and she starts changing channels, standing in front of the T.V., punching you, and generally bugging you. This happens every time the two of you are alone.

There is a person of the opposite sex in your class that is always punching and hitting you. You know the person kind of likes you, but you are really tired of being punched and poked all the time.

Several friends at a party ask you to try drugs, but you do not want to.

Appendix K

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Assertiveness Action Plan Outline (Grade 7: Commit Self)

Element of Action Plan	Action	My Action Plan
What	Set a specific assertiveness goal	A goal that will help me be more assertive in my day-to-day life is ______________________________________________________. ______________________________________________________.
When	Set a start date, an end date, and check-in dates	I plan to start my action plan on (start date) _______________ and to finish my action plan on (end date)____________________________. I will check-in with my support person on _______, _____________, and _____________________.
Why	List benefits of achieving assertive goal Identify obstacles	My assertive goal will benefit me by __________________________ ______________________________________________________. Possible obstacles I will need to overcome are ______________________________________________________.
Who	Identify a support person	A person who will support my personal commitment to achieving my assertiveness goal is _________________. Signature: ________________________________________
How	List step-by-step plan of how to achieve goal	To achieve my goal I will use the 4 steps of delivering an assertive message: along with such body language as ___________________________ ______________________________________________________. and voice qualities as _____________________________________ ______________________________________________________.
Where	Identify location(s)	Based upon what I want to achieve (my goal) and how I am going to achieve it (step-by-step plan) I will carry out my action plan at _________________________ and possibly at ___________________________________.

Appendix L

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Sample Rubric for Evaluating the Elements of an Assertiveness Action Plan

Element of Action Plan	Less Effective Rating of 1	Somewhat Effective Rating of 2	More Effective Rating of 3
Who	Plan includes name of one support person.	Plan includes name of an adult or a teacher as well as the name of a peer support person.	Plan includes name of an adult or teacher as well as the name of a peer support person and the name(s) of others to be involved in the action plan.
What	Plan includes a statement of what is to be done.	Plan includes a goal statement that is clear, specific, measurable, and attainable.	Plan includes a goal statement that is clear, specific, measurable, and attainable. Also included is a statement of purpose that this is about assertiveness and personal commitment.
How	Plan includes a vague outline of what is to be done.	Plan includes some detail of what is to be done.	Plan includes a step-by-step outline of what is to be done. Steps to delivering an assertive message are specified. One or two body language details and one or two voice quality enhancements to delivering an assertive message are included.
Why	Plan includes a vague explanation about why particular steps are in place.	Plan includes some detail about why some steps are in place.	Plan lists possible barriers or obstacles and how they might be overcome. Justification is provided for why specific steps are planned to meet the goal.
When	Plan includes start date and end date.	Plan includes start date, end date, first check-in date, and some details about when assertive messages will be used.	Plan includes start and end dates as well as check-in dates and celebration dates. Details are included about dates and times for each step of the action plan.
Where	Plan includes no indication of where the action plan is to be carried out.	Plan includes scant details about where the action is being carried out.	Plan includes specific indication of exactly where each step of the action plan is to be carried out (e.g., at home, in the lunchroom at school, on the bus, at band practice).

Note: Voice qualities and body language vary with individuals and among cultures. Each individual will determine what is appropriate for him or her, when practising assertiveness skills and behaviour.

Appendix M

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Sample Journal Format for Assertiveness Action Plan

Situation	Assertive Message I Tried	How Others Responded to my Message	Support I Requested or Received	Comments
When Where	Steps to delivering an assertive message Body language and voice quality enhancements			What I should try to do differently the next time What worked well

My thoughts about today:

What I learned about myself today:

Date: __________________

Appendix N

Sample Decision Making in the HIV/AIDS Education Unit (Grade 7)

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Sample Decision Making in the HIV/AIDS Education Unit
(Grade 7)

Challenge

To live an AIDS-free lifestyle, the information in the HIV/AIDS Education Unit tells me that my challenge is to access and evaluate HIV/AIDS resoruces.

Alternatives

I will list all the alternatives to me in meeting that challenge ...

Alternative #1
Access multiple resources and evaluate them for sound scientific data Alternative #2
Access multiple resources and screen them for biased reporting techniques Alternative #3
Access multiple resources and identify use of unsubstantiated claims Alternative #4
Access multiple sources of information and check for sensationalism and/or scare tactics Alternative #5

Consequences

I will consider various consequences of those alternatives ...

Alternative #1
Pros Cons Alternative #2
Pros Cons Alternative #3
Pros Cons Alternative #4
Pros Cons Alternative #5
Pros Cons

Decision

The information indicates that the best choice for me is ...

Goal

In order to meet my challenge, my personal goal is to commit to maintaining an accurate, up-to-date information base of at lease three reliable sources.

Appendix O

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Sample HIV/AIDS Education Action Plan (Grade 7: Commit Self)

Name: __________________________ Date: ____________________________

What
In order to meet my challenge, my personal goal is to commit to maintaining an accurate, up to date information base of at least three reliable sources.

How
To meet my goal, I am going to ______________________________________________
(e.g., access and evaluate a resource from our school library in week one, a resource from a public or regional library in week two, a web-site in week three).

When
I will begin this action on _____________________________________________ (i.e., date).
I will practise this action _____________________________________ (i.e., times per week).
I will evaluate this action on ___________________________________________ (i.e., date).
Between the start date and the evaluation date I will check in with my support person(s) on (check-in dates)

Where
I will carry out my action plan in such locations as ____________________________
(e.g., home, school, community agency).

Who
I have asked for the support of _________________________________________
(i.e., name of one or two people who are willing to fulfil the role of support person).

Signatures
Student signature ________________________________________
Teacher signature ________________________________________
Support person(s) signature _______________________________

Check-in Dates and Comments

______________________________________________________________________

Evaluation Date and Comments

______________________________________________________________________